ANN ARBOR—Speculation abounds on what a Donald Trump presidency will mean to the future of public health, particularly health care coverage.
To measure the potential impact of commitments and statements made by the president-elect and his appointees, researchers at the University of Michigan, Oxford University and the London School of Hygiene & Tropical Medicine have drafted a scorecard that shows in graphic form the dire consequences that are likely if the new administration follows through with what they have said in areas ranging from Obamacare and climate control to reproductive health and gun violence.
Their findings are reported in the Lancet.
"The Trump presidency is likely to take the U.S. backwards on almost every form of public health policy, from health care access to global health to climate change," said Scott Greer, associate professor of health management and policy at the U-M School of Public Health. "Not only will such a shift undo decades of bipartisan consensus on many issues, it is also unlikely to happen without serious domestic political consequences.
"There's no way to sugarcoat it. We know a lot about what we need to do to improve public health, including by expanding health care access, for example. And there are explicit Trump and Republican commitments to do the opposite."
Using the United Nations' "Sustainable Development Goals," objectives agreed upon by most countries in the world, Greer and colleagues zeroed in on the key health goals and matched them with relevant statements by Trump and other Republican Party leaders.
They then created a traffic light system of scoring, with red designating the actions of the administration that most assuredly would reverse progress on health policy, amber suggesting the outcome is unclear and might not lead to a negative outcome, and green indicating a position that supports further progress.
The scorecard for the incoming administration was mostly red with some amber and no green. Those in the red include universal health coverage, evidenced-based health policy (the science behind health care), reproductive health, vulnerable populations (prisoners and detainees), social determinants of health and health inequalities, and gun violence.
Greer emphasizes that the researchers don't know what the new administration will actually do, but that their analysis is based on what Trump and his team have said about these issues, and the current state of politics.
"The politics risk putting public health on one side of a partisan divide, which is not where a field committed to evidence and health ought to be," he said. "That makes it imperative to not just voice objections to harmful policies, but also to work across parties and every level of government to identify areas where there can be progress and agreement found. Being patronizing and partisan is not the right strategy."
Greer says what remains uncertain is where the Trump will land compared with his party. On some issues, like environmental and occupational health regulations, he is aligned with party leaders. But one of the biggest questions is what he'll do to follow up on his statements to repeal and replace the Affordable Care Act. Party leaders want to repeal the ACA and convert Medicare into a voucher system and Medicaid into a block grant.
"Substantial numbers of Trump voters as well as large parts of the health care system, rural and urban, depend on these programs, and Trump explicitly defended Medicare during the campaign," Greer said. "Pursuing the full Republican health care agenda could present insoluble policy and optics problems for the party, and potentially even drive a wedge between movement conservatives, whose objective is to shrink the state, and Trump voters who want to defend the programs they need.
"The real question is how much Trump picks out his own agenda and pushes it, and how much he just chooses to sign the budgets and legislation that the Republicans in Congress serve up."