In the last three weeks alone, since President Trump took office, there have been significant changes in the healthcare landscape across America and the world. Trump’s agenda in putting “America First” aims to save billions of dollars, but this could be at the expense of some of the most vulnerable populations in the world. Here is how some of his policies may exacerbate health disparities.
Potential Medicaid Cuts
Medicaid, the U.S.’s largest health insurance program, covers more than 70 million people. Although Trump has promised to “love and cherish” Medicaid, he has also stated that “it will only be more effective and better.”
The future of Medicaid remains uncertain as congressional Republicans are exploring changes to the program in order to enact Trump’s domestic agenda of costs savings. In fact, trillions of dollars could be cut for Medicaid by capping the amount of spending per enrollee as well as implementing Medicaid work requirements. This policy would add administrative hurdles which would make it difficult for individuals to stay enrolled in Medicaid.
The end result could be millions of Americans being dropped from Medicaid, as well as the loss of important non-required health benefits such as vision and dental benefits.
Medicaid provides insurance for poor Americans. This means children, those with disabilities, pregnant females and low-income individuals would receive less access to primary care, cancer care, mental health care and even access to important medications. Medicaid cuts will hurt America’s most vulnerable population, predominantly those that can’t afford healthcare to begin with. This, of course, will have devastating consequences for public health and may cause many Americans to get sick and even die.
Robert F. Kennedy’s Nomination As Secretary Of Health And Human Services
Trump’s pick for Secretary of Health and Human Services, the top public health position in the federal government, could also impact health disparities.
Kennedy is a known vaccine skeptic, and has repeatedly made claims that vaccines cause autism. As I have explained previously in Forbes, this type of rhetoric will undoubtedly lead to increased vaccine hesitancy, decreasing vaccination rates of important diseases and thereby threatening herd immunity. When diseases previously eradicated reappear such as what is already occurring with Measles, vulnerable and marginalized populations are affected most.
This is because those that live in rural parts of the country may end up getting these serious diseases because they lack access to medical care and vaccines that would otherwise protect them. Those that live below the poverty line may get hospitalized and even die because they cannot afford vaccines or have the means to get to a medical clinic. Furthermore, minorities such as Black Americans and Hispanic Americans will also suffer, as they disproportionately have lower vaccination rates compared to White Americans. Words matter, and underserved populations are at risk of getting sick and hospitalized the more vaccine hesitancy there is in America.
Foreign Aid Cuts
President Trump has proposed withdrawing from the World Health Organization through an executive order and has called for shutting down the United States Agency for International Development. These changes alone would prevent billions of dollars from reaching low-income countries in the effort of preventing infectious diseases like HIV, TB and malaria.
Although Marco Rubio, the U.S. Secretary of State, has allowed for core life-saving medicine and medical services to be delivered throughout the world, it remains unclear what type of services are included and what this actually means. As examples, HIV clinics in South Africa have been closed, and Malaria aid to several countries in Africa remains threatened.
Vaccination programs in several African countries has now halted due to the aid shutdown. Although the U.S. State Department for Emergency Humanitarian Assistance issued a waiver that would get malaria medicines to millions of people that urgently need them, for every day that aid is not given, over 1,000 people will die of malaria. Importantly, these are all preventable deaths, largely in poor children that lack health resources to treat their medical conditions.
PEPFAR Impact On Global Health
President Trump’s initial 90-day freeze on foreign aid also included the President’s Emergency Plan For AIDS Relief, a program that has provided life-saving HIV/AIDS care to low-income countries throughout the world. However, on February 1st, the Trump administration provided a limited waiver for PEPFAR, allowing anti-retroviral therapy, HIV testing and counseling; among other services.
The program’s future and legacy may still remain in jeopardy because of what the waiver does not include. The limited waiver does not include cervical cancer screening, pre-exposure prophylaxis of HIV for those that are not pregnant women as well as services for orphans and vulnerable children. This will undoubtedly result in poor health outcomes for many poor and underserved children, exacerbating HIV diagnoses in many poor countries throughout Africa and the world. Remember, PEPFAR has saved more than 26 million lives since its inception back in 2003.
Trump has staunchly advocated for his “America First” policy and hopes to save trillions of dollars in the process. It may be at the cost of millions of lives in both America and the world, resulting in the perpetuation of health disparities and inequities that already exist.
