With President-elect Donald Trump about to take office, many people in the health community are wondering what his administration will mean not just for the future of the Affordable Care Act, Medicare and Medicaid (which Trump and his Republican allies in Congress have vowed to either repeal or dramatically revise), but for other health-related policies and programs. Concerns are high that progress made in recent years will be reversed, particularly if evidence-based science is rejected or downplayed.
To find out what some of those worries might be, Second Opinion asked several health and medical experts in Minnesota to answer this question:
With a new administration taking over the White House, what is your greatest concern for your particular corner of the health/medical field in the coming year? What is your greatest hope?
Their answers follow.
1. A decrease in insured Americans, an increase in predatory drug pricing, and more eco-health disasters. “My biggest fear is that the federal government will turn from health programs that reach out to every citizen to block grants to states that will allow states to enact programs that reverse the tremendous decline in the number of persons without health insurance. I fear that the monopolistic and sometimes predatory pricing for drugs will continue under the false flag of protecting the research capability of the hugely profitable pharmaceutical industry. I am concerned that the student loan programs that ensure opportunities for all will be slashed and that the health care industry will thereby lose practitioners of great talent and broad life experiences. I am worried that eco-health disasters like the water crisis in Flint will become much more common as regulatory standards and monitoring of industry and local government are dismantled. It is especially disheartening that each of these federal “reforms” will be justified as economic stimulants as they harm the public health on which national productivity is based.” — Dr. Steven Miles, professor of medicine and bioethics, University of Minnesota
2. A failure to protect the public from toxic chemical exposures. “President-elect Donald Trump’s choice of Oklahoma [Attorney General] Scott Pruitt to lead the [Environmental Protection Agency] is concerning. As AG, Pruitt sued the very agency he is slated to head numerous times. Trump says he wants to reduce regulations, so he may try to undermine EPA’s work under the Toxic Substances Control Act [TSCA], a law updated by Congress in 2016 through a bipartisan effort. TSCA now gives the EPA new authorities and timelines for addressing thousands of hazardous chemicals. Trump’s desire to shrink federal agencies could leave the EPA underfunded and understaffed to carry out this work. States like Minnesota will need to keep taking action to protect public health from toxic chemical exposures, so it’s encouraging that Pruitt is a states’ rights advocate. My hope is that EPA will continue to make steady progress in addressing hazardous chemicals and will respect the right of states to enact their own chemical safety laws.” — Kathleen Schuler, program director of Healthy Kids and Families and co-director of Conservation Minnesota’s Healthy Legacy program
3. The undermining of women’s access to affordable reproductive health care. “The outcome of the election is sure to bring unprecedented attempts to undermine the care we provide for our patients at Planned Parenthood. We expect a dangerous and divisive agenda that could hurt our patients and deny tens of thousands of people in Minnesota access to cancer screenings, birth control, STD and HIV testing and treatment and other care they rely on. We expect efforts to restrict access to abortion, repeal the Affordable Care Act, and make it harder for people most in need to access reproductive health care. As we look to 2017, the collective leadership of the health care community is ever more important. Standing up to this divisive and despairing agenda will require that all of us come together. We need to inspire one another. We need to be generous with our time, our talents, our voices and our resources as never before.” — Sarah Stoesz, president and CEO of Planned Parenthood of Minnesota, North Dakota, South Dakota
4. The weakening of anti-smoking and anti-air-pollution efforts. “The American Lung Association remains hopeful that in 2017 our nation will continue improving the air we breathe, reducing the use of all tobacco products and eliminating exposure to secondhand smoke. We are also hopeful that we will defeat lung cancer and help people better manage their COPD, asthma and other lung diseases so as to lessen the burden on families. However, the American Lung Association is very concerned about efforts under way in Washington that are aimed at dramatically weakening the bipartisan and popular policies that will protect youth from tobacco products, continue to clean up our air and provide funding for federal research funding. We know that these protections are both necessary and popular among a broad majority of Americans. The American Lung Association will continue our efforts to protect and strengthen these laws for all Americans, and we invite you to join us.” — Robert Moffitt, spokesperson for the American Lung Association in Minnesota
5. Uncertainty about global as well as domestic public health policies and practices. “2017 not only brings a new president to the White House, but also a new director-general to the World Health Organization and a new United Nations secretary general. Together, these leadership positions represent the “air traffic control” of public health worldwide. As a result, there is tremendous uncertainty about the future practice and policies of global and domestic public health. To date, the Trump administration has sent mixed signals as to how they will govern and allocate resources for public health. The president-elect has made numerous comments over the past year challenging science-based policy, including on climate change and immunizations. Dr. Tom Price, named as Secretary of Health and Human Services, is an active member of the Association of American Physicians and Surgeons, which advocates a range of scientifically discredited hypotheses, including that vaccines cause autism, climate change denial and that HIV doesn’t cause AIDS. However, Mike Pence, the incoming vice president, has been a major supporter for the President’s Emergency Plan for AIDS Relief. And secretary of state designee Rex Tillerson has been a champion for global public health programs. Uncertainty reigns.” — Michael T. Osterholm, director of the Center for Infectious Disease Research and Policy, University of Minnesota
5. People waiting to see what happens in Washington. “2017 will be a time of great opportunity to improve our health system. We can adopt a more efficient enrollment and purchasing system for people with high risks and those who need subsidies. We can expand payment methods that focus on patient outcomes and encourage less waste on treatments with marginal benefits. We can agree on better performance metrics across payers so we reduce the administrative burden on doctors while expanding transparency about their results. We can do more to reduce health disparities by race and income by providing more information that helps address both the social and care difference that cause these disparities. The greatest risk is people waiting to see what happens in Washington and not taking the actions we know have worked to give Minnesotans better care: focusing on patient and community needs, testing new processes and partnerships to improve outcomes, and sharing information on results.” — Jim Chase, president of Minnesota Community Measurement
6. Being ready for future health challenges. “Protecting and improving the health of the public is not a partisan issue. While there will certainly be debates over which health policies to pursue, the ultimate public health goals are shared by most policy makers. For example, I believe we all want to protect Americans from serious public health threats. That list of threats includes not only infectious diseases like Zika, avian flu and Ebola but also extreme weather events and environmental risks such as water contamination. Over the years, America has built up a strong public health partnership among federal, state and local partners. I am proud of the partnerships Minnesota has built with [the Centers for Disease Control and Prevention] and other federal partners. We must protect what has been built, and strengthen it so we’re ready for the future health challenges. I am optimistic that President-elect Trump and his team will recognize the importance of this public health partnership and work with us to protect the health of all Americans.” — Dr. Edward Ehlinger, commissioner of the Minnesota Department of Health