Donald Trump policies at odds with ‘MAHA’ push

Stephanie Armour, Tribune News Service

In his March address to Congress, President Donald Trump honored a Texas boy diagnosed with brain cancer. Amid bipartisan applause, he vowed to drive down childhood cancer rates through his “Make America Healthy Again” (MAHA) initiative. A few days later, the administration quietly dropped a lawsuit to cut emissions from a Louisiana chemical plant linked to cancer. At first glance, Trump appears to have fully embraced the MAHA movement championed by Health and Human Services Secretary Robert F. Kennedy Jr. From proclaiming in his congressional speech a goal to “get toxins out of our environment” to launching a new commission to study cancer and other ailments, Trump has vowed to end what he calls an epidemic of chronic disease. But even as he extols MAHA, Trump has unleashed a slew of policies likely to make Americans less healthy. He’s slashing 20,000 full time positions from HHS and cutting more than $4 billion in indirect costs related to health research grants, including studies into treatment for Alzheimer’s and cancer. He also supported a GOP plan likely to kneecap Medicaid, a joint federal-state program that covers about 72 million Americans.

The contradictions raise doubts about the sincerity of Trump’s support for the MAHA agenda and his administration’s commitment to making a dent in chronic disease — conditions that afflict about 133 million Americans and account for roughly 90% of the $4.5 trillion spent annually in the US on health care. The administration’s attention to chronic disease is also notable for its lack of focus on expanding health insurance. Research shows people with coverage have lower death rates; insurance provides free or low-cost preventive care that can help manage chronic disease and reduce risks of serious complications. “The layoffs at HHS, cuts to Medicaid, and reduction in research could all end up resulting in less healthy Americans,” said Larry Levitt, executive vice president for health policy at KFF. “They’re talking about getting at the root causes of chronic disease. Less research and protections will undermine that goal.” KFF is a health information nonprofit that includes KFF Health News.

HHS leaders have said that they focused personnel cuts at agencies on redundant or unnecessary administrative positions. The administration has said the job cuts will save money and make HHS more responsive. “Streamlining bureaucracy and eliminating redundancies is how we deliver on the mission of Making America Healthy Again — not by preserving a bloated system that’s failed to improve outcomes despite record spending,” HHS spokesperson Vianca Rodriguez Feliciano said in an email. Public health advocates say the staffing cuts run counter to the promise of a MAHA agenda dedicated to reducing chronic disease. “HHS declared that their mission is to Make America Healthy Again,” said Sharon Gilmartin, executive director of Safe States Alliance, on a press call. The alliance is a nonprofit focused on preventing injury and violence. “How can we do that when the people who have spent decades of their life combating the health issues of our nation are being tossed out with no notice?” The HHS workforce reductions decimated divisions focused on chronic disease.

Gone is most of the Centers for Disease Control and Prevention’s population health division, which conducted research and developed public health programs on chronic disease. Gone, too, are staffers at the National Institutes of Health who focused on Alzheimer’s research. After HHS staffers working on Alzheimer’s projects were put on administrative leave, the Alzheimer’s Association sounded the alarm about the cuts, saying in an April 1 statement that the reductions “could cause irreversible damage.” And gone is the CDC’s Office on Smoking and Health, which worked to protect the public from the harmful effects of tobacco use. The administration also gutted the FDA’s Center for Tobacco Products, which enforces advertising restrictions. Tobacco use is the leading preventable cause of disease, disability, and death in the country. “Cuts to CDC and FDA tobacco control programs are devastating,” Tom Frieden, who served as director of the CDC from 2009 to 2017, said April 18 on the social media platform Bluesky.

According to administration fact sheets and press releases, the staffing cuts will save $1.8 billion a year and shrink HHS’ workforce from 82,000 to 62,000 full-time employees. HHS will be retooled to focus on “safe, wholesome food, clean water, and the elimination of environmental toxins,” according to a March 27 press statement. The restructuring will improve Americans’ experience with HHS by making the agency more responsive and efficient, the statement said. Roger Severino, a lawyer who led the HHS Office for Civil Rights during the previous Trump administration, said the job cuts are necessary because the HHS budget has grown while American health has declined. “If you want to Make America Healthy Again, you have to make HHS healthy again. You have to trim the bureaucratic fat,” said Severino, who is now vice president of domestic policy at the Heritage Foundation, a conservative policy group. “We haven’t seen chronic disease go down or obesity go down, while autism rates are up. If this were a private company, it would have gone bankrupt years ago.”

But many public health experts question how the federal government will be able to respond to existing problems, as well as new health issues, with fewer employees and resources. Infectious diseases are one area of concern. Trump, on the first day of his second term in office, withdrew the nation from the World Health Organization, which detects, monitors, and responds to emerging health threats. The US has been the largest financial contributor to the organization. Without membership, the US may remain in the dark if the WHO identifies an emerging threat that could ultimately spread and become global. Spillover can happen: In 2014, an Ebola outbreak in West Africa led to 11 reported cases in the US. The WHO played a central role in developing infection-prevention protocols and provided logistical support to affected countries. The evisceration of the US Agency for International Development could also leave the nation more vulnerable because the agency worked with countries such as Vietnam on early detection of diseases including bird flu. The agency typically would have aided in the response to a current Ebola outbreak in Uganda, providing support that doctors say helped prevent spread in past outbreaks.

The staffing reductions and frozen or canceled grants are having an immediate impact on the ability to respond to infectious outbreaks. Right now, for instance, Texas is in the throes of a measles outbreak, with more than 500 confirmed cases. But the administration’s funding cuts forced the Dallas County health department to lay off 11 full-time workers and 10 part-time staffers responsible for responding to such outbreaks, Philip Huang, director and health authority for the Dallas County Health and Human Services Department, said at a press event. The administration has also imperiled ongoing research, including studies and trials related to chronic disease. Trump ended hundreds of research projects at the National Institutes of Health totaling more than $2 billion, including projects on HIV prevention drugs and Alzheimer’s disease research. “Patients enrolled in NIH studies led by Plaintiffs face abrupt cancellations of treatment in which they have invested months of time with no explanation or plan for how to mitigate the harm,” according to a federal lawsuit filed in Massachusetts by scientists and researchers. The research being cut could potentially have supported Trump’s pledge, when he honored the boy with brain cancer, to drive down rates of the disease. In the weeks since, however, Trump’s administration announced plans to weaken automobile tailpipe emission standards. Trump slashed more than 400 grants to Columbia University, including millions earmarked for a cancer center.

“It’s making people sicker again. Now that would be a more honest bumper sticker,” said Leslie Dach, a former Obama administration official who is the executive chair of Protect Our Care, which advocates for the Affordable Care Act. “They’re stopping research on vaccines and gutting health care programs that keep 100 million Americans healthy. It’s all show. It’s a bunch of junk.”