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As the dust settles on Donald Trump’s electoral victory, many experts are concerned about how a second Trump term will affect existing policy, and public health could encompass some of the most pressing issues. Trump has been vocal about his mistrust of health agencies. At a rally in Wisconsin, he said his administration would “take on the corruption at the FDA, the CDC, World Health Organization and other institutions of public health,” arguing they are dominated by “corporate power” and “China.” With controversial Cabinet picks like Robert F. Kennedy, Jr. as the head of the Department of Health and Human Services (HHS), and Dr. Mehmet Oz as head of the Centers for Medicare and Medicaid Services (CMS), a lot can change for the country’s public health systems.

The second Trump presidency is “poised to have big impacts on consumer health care,” said CNBC. Trump will likely face “few legislative roadblocks” as Republicans now have majorities in all branches of government. With this, Trump will “have the power to influence America’s healthcare landscape, including insurance coverage, drug price negotiations, government health and safety regulations and reproductive healthcare access,” said Insider.

Health-related agencies are most likely to see a loss in capabilities, namely the Centers for Disease Control and Prevention (CDC) which came under fire following Covid-19. Under Trump, the agency would “most likely lose the authority to enact the few actions it is empowered to use in public emergencies,” said The New York Times. This includes “pausing housing evictions, limiting the movements of cruise ships and requiring masks on public transportation.” However, a “complete restructuring of the CDC may not be realistic,” because it would require congressional support including from moderate Republicans.

With slashed funding to medical agencies, the “world’s largest public funder of biomedical research seems poised for a major overhaul in the next few years,” said Scientific American. The National Institute of Health (NIH) has been a “frequent target of Trump and his Republican and other allies.” While how restructuring would happen is unclear, “proposals have included everything from shrinking the number of institutes by half to replacing a subset of the agency’s staff members.” Stifling medical research can have long-term consequences for disease prevention.

Trump’s second term could change insurance coverage and abortion access. The president-elect has had a “mixed record” on these issues, said Insider. Despite this, the Trump administration and Project 2025, a conservative policy blueprint, have plans to “try to roll back the Medicaid expansion under the Affordable Care Act, which broadened the pool of people who qualify for coverage.” This could be done by capping funding or adding work requirements for Medicaid recipients. As for abortion access, many fear Trump “will seek to impose a federal ban on abortion,” but that would require congressional approval, said Time. Even if a measure like this does not pass, Trump may pursue “efforts to restrict access to abortion pills, especially when they are administered through telehealth or delivered by mail,” said NBC News.

What next?

Trump’s nomination of Dr. Oz to head the CMS has set off alarm bells. The TV doctor has drawn criticism for “espousing scientifically dubious theories and promoting treatments with no documented efficacy,” said Axios. Also, he has “no experience running a large government bureaucracy like CMS.” Oz has also publicly backed privatized Medicare, which would require a 20% payroll tax, and that has many “concerned that low- and middle-income Americans would be responsible for funding the private insurers,” said Newsweek. Complete privatization could also limit access to doctors and hospitals that don’t accept insurance.

RFK Jr. has been tapped to head the HHS, which oversees the CMS and other health agencies. He is a longtime vaccine skeptic. Removing all vaccine mandates “would put American children at risk of diseases like measles and polio, which have largely been held at bay by the requirements,” said The New York Times. His other ideas are also “wild,” said Olga Khazan for The Atlantic. “If his worst ideas come to pass, experts tell me, heart attacks might increase, dental infections might spike, and children might needlessly die of completely preventable diseases.”