Health care – not just abortion – was on the ballot, and they lost big

It was perhaps natural that campaign media coverage of presidential candidates’ health policies began and ended with abortion rights; since June 2022, when the Supreme Court overturned Roe v. Wade, 20 states have banned abortion or passed draconian restrictions on the procedure.

This situation could become even more dire with the re-election of Donald Trump. But many other health care issues were implicitly on Tuesday’s ballot. Republicans may well feel empowered to continue their long campaign against the nation’s public health infrastructure, intensify their attacks on science and spread Robert F. Kennedy Jr.’s anti-vaccine mantra, which has gained traction way into Trump’s inner circle. .

It is almost certain that the Biden administration’s progress in making health care more accessible and affordable for all Americans, especially seniors on Medicare, will be reversed. RFK Jr. and other health care charlatans, like Florida Surgeon General Joseph Ladapo, could participate in national policymaking. Religion-based policies could come to the fore, leaving science-based policies aside. The looting of health establishments by private investors could increase.

If any of these eventualities materialize, America’s health profile could deteriorate precipitously. The main victims would be women, the elderly and low-income households.

Let’s look at the details. Some of these stem from the Heritage Foundation’s famous Project 2025, a road map to a reactionary future that will certainly animate many of the Trump administration’s policies. But others reflect policy efforts already attempted in red states or promoted during Trump’s first term.

Abortion

Abortion rights protections were on the ballot in 10 states and passed in seven — not including Florida, where a measure overturning the state’s draconian abortion ban garnered 57 percent of the vote but did not reach the 60% required to be adopted. (This threshold was adopted in 2006 after being placed on the ballot by a Republican-controlled legislature; it turns out that the 60% rule was adopted even though it itself did not receive 60%. voices.)

The seven states in which voters protected the right to abortion by enshrining it in the state constitution were Arizona, Colorado, Maryland, Missouri, Montana, New York, and Nevada. The measures failed in South Dakota and Nebraska.

Republican and conservative hostility toward abortion rights persisted despite the horrific deaths of pregnant women, as doctors were unwilling to terminate their pregnancies because the treatment would violate their state law, even in an emergency, and would expose doctors to consequences, including criminal prosecution.

Trump specifically said he would “under no circumstances” support a national ban on abortion, but that leaves open a multitude of ways to achieve that goal under another name, whether by enforcing an old federal law to limit the shipment of abortion pills, install opponents of reproductive rights in federal health agencies as he did in his first term, or by other means. Clearly, the right to abortion is not safe under the Trump presidency.

Gender

Trump has made gender-specific medical treatments a target of his campaign, spinning a deranged fantasy that schools would subject children to sex-reassignment surgeries behind their parents’ backs; The 2025 Project scorns what it calls “the new woke gender ideology, which has ‘gender-affirming care’ and ‘sex reassignment’ surgeries on minors as its main tenet.” »

This is similar to laws passed in several red states banning any gender-affirming care for minors. In fact, surgery is not part of the standard of care in gender affirmation cases involving children and adolescents. The authors of Project 2025 advocate banning transgender people from serving in the military.

Affordable Care Act

Repealing Obamacare, as it is colloquially called, has been a primary Republican goal since the law was signed into law in 2010. The law was saved from repeal in 2017, under the last Trump administration, by a single “no” vote from the late senator. . John McCain, R-Ariz.

It’s still a target. House Speaker Mike Johnson promised last month that there would be “no Obamacare” under another Trump term. The law is popular, however, favored by 62% of Americans, according to a KFF opinion poll conducted in May. Trump repeatedly promised to offer an alternative program, but never did so.

Draft 2025 calls for giving more leeway to basic health plans such as association health plans and short-term health plans. These do not meet ACA standards because they often exclude essential health services and can mislead consumers into believing that a condition or treatment is covered – only learning the truth when they are trying to get cover.

The road map also calls for narrowing the ACA’s contraceptive mandate, which it says “has been the source of years of blatant attacks on the religious and moral beliefs of many Americans.” (Of course, the ACA does not require that anyone actually use birth control, only that it be covered without cost sharing.)

He calls for removing the Ella “morning after pill” from the contraceptive mandate. It also calls for rolling back the Food and Drug Administration’s safety approval for the abortion pill mifepristone, which is currently the subject of a lawsuit by anti-abortion activists.

Medicaid and Medicare

These crucial federal health care programs – the first for low-income Americans and the second for the elderly – are in the crosshairs of the Republican Party. Project 2025 says they are “the primary drivers of our $31 trillion national debt.” …Essentially, our deficit problem is a Medicare and Medicaid problem.

Never mind that the biggest driver of the federal deficit is the tax cut for corporations and the wealthy signed by Trump in 2017, which could add $5.2 trillion to deficits over the next 10 years.

According to Project 2025 estimates, Medicare and Medicaid together cost $17.8 trillion from 1967 to 2020, a period of 53 years. This year, the two programs serve more than 140 million Americans, or more than 41% of the population. (Medicare members also pay premiums for some of its parts.)

Even though Trump has pledged not to cut Medicare benefits, conservative antagonism toward Medicaid, the state-federal health care program for low-income Americans, has never diminished. In 2014, under the leadership of former Speaker Paul Ryan, R-Wisc., House Republicans proposed converting the program that covered a percentage of state health care costs for enrollees into a block grant structure , which lacked the flexibility needed to deal with epidemics. as they occur. Ryan’s plan would have cut Medicaid funding by 26 percent over a decade.

It failed, but the idea was taken up by Trump in his first term, although it was not implemented. Expect it to be reviewed again. The 2025 Project calls for adding work requirements to Medicaid, an idea that has proven to be unsuccessful in the past in terms of reducing unemployment or improving enrollees’ health, but which ended up being excluded from the program thousands of people.

The last Trump administration’s authorization for some states to impose work requirements for Medicaid was overturned by a federal judge in 2019; the Biden White House sent the idea to the dumpster.

The 2025 Project asserts that the ACA “requires states to expand their Medicaid eligibility standards” to include anyone at or below 138 percent of the federal poverty level. It’s a lie. Following a Supreme Court ruling, the ACA leaves it up to each state to cover low-income people without children; Ten states, all under the control of Republican governors or legislatures, still have not done so. The draft also calls for eliminating the 90% government contribution to the cost of this coverage and reducing it to a “fairer and more rational level”, probably lower.

Vaccines

The rapid development of COVID-19 vaccines, which prevented approximately 1.1 million deaths in the United States and more than 10.3 million hospitalizations in the year following their introduction in December 2020, has been one of the few real achievements of Trump’s first term. We therefore do not know why he turned against them, and against vaccines in general.

During his campaign, he promised: “I will not give a cent to a school that has a vaccination or mask mandate. »

It’s possible this reflects the influence Robert F. Kennedy Jr. had on Trump, who promised to give RFK Jr. a decision-making role on health care. This prospect should make all Americans uncomfortable, as Kennedy is a one-stop shop for conspiracy theories ranging from anti-vaccine claims to outright anti-Semitism.

The truth is that vaccines are undoubtedly a triumph of medical science. They eradicated smallpox from the face of the Earth and reduced diseases such as measles, polio, and whooping cough to occasional outbreaks (among the unvaccinated). If Trump and RFK Jr. intend to make the world safe again from these diseases, they should say so bluntly.

For the authors of Project 2025, COVID vaccines and other anti-pandemic policies were nothing more than infringements on individual rights (don’t think of the children and families whose rights to a healthy life would be compromised by the elimination of vaccination obligations at school).