proposal

Healthcare Policy in the Second Term of the Trump Administration: Policy Implications of the Kennedy Nomination

Takakazu Yamagishi

Introduction

When President-elect Donald Trump nominated Robert F. Kennedy Jr. for the incoming Secretary of Health and Human Services, he posted, "For too long, Americans have been crushed by the industrial food complex and drug companies who have engaged in deception, misinformation, and disinformation when it comes to Public Health... Mr. Kennedy will restore these Agencies to the traditions of Gold Standard Scientific Research, and beacons of Transparency, to end the Chronic Disease epidemic, and to Make America Great and Healthy Again!"1 The Department of Health and Human Services (HHS) is an immense agency that includes 13 organizations, such as the NHI and CDC, and accounts for 28% of total federal spending in the 2023 budget year.2

Kennedy is a son of Robert F. Kennedy, who served as a senator and attorney general in 1954, and a nephew of US President John F. Kennedy. In addition to being a member of the Kennedy family, he attracted attention as an environmental lawyer for his involvement in lawsuits regarding the pollution of the Hudson River. Kennedy also founded an anti-vaccination advocacy group Children's Health Defense, and became famous as an anti-vaccine activist. He claimed that measles, mumps, and rubella vaccines cause autism, which experts criticized as scientifically groundless. During the COVID-19 pandemic, he caused another controversy by calling the COVID-19 vaccine "the worst vaccine ever" and claiming that it was designed to save Chinese and Jewish people.3

Kennedy initially ran as a Democratic candidate for the 2024 presidential election but switched to an independent midway. He withdrew toward the end of the campaign, declaring his support for Trump. At that time, it was alleged that Trump promised Kennedy a crucial government position, such as Secretary of Health and Human Services. Reportedly, Kennedy's support ultimately contributed to Trump's victory. I believe otherwise and nominating Kennedy as Secretary of HSS means something more than a reward.

Kennedy began using the watchword "Make America Healthy Again" at the rallies where he declared his support for Trump. Needless to say, the phrase took after Trump's "Make America Great Again"―Kennedy's MAHA and Trump's MAGA. Against the Democratic Party, which asserts that the government should expand the scope of health insurance coverage and improve health standards, the Republican Party has been forced into, so to speak, a defensive battle, countering that it would be better to use private sector resources.4 It seems that Trump found it worthwhile to use Kennedy for the Republican Party to launch an offensive in the healthcare field. Although Kennedy's discourses have been subject to various criticism, some of them gained support from scientists.

This paper will discuss American healthcare policy under the second-term Trump administration, focusing on how the new administration will deal with Obamacare, abortion, and transgender medical services, taken up as crucial issues during the election campaign. Next, it will detail the MAHA agenda that Kennedy emphasizes and discuss how the policy will develop following the inauguration of the new administration.

Key Issue in the Presidential Election

Healthcare policy refers to decisions, plans, and actions taken to achieve the medical goals of society. Specifically, it encompasses access to medical services, costs and equity, medical technology and medicines included in the services, and other preventive measures. Healthcare policy is a key issue in every presidential election because rising healthcare costs, for example, directly affect the household economy. However, we must not forget that America is a country of "Give me liberty, or give me death!"5 It is a nation shaped through rebellion against the deprivation by the state's power of bodily freedom and the right to make choices about one's body. With such founding ideals as background, American healthcare policy constitutes a key issue over which fierce political battles are underway.

(1) Obamacare

Expanding the coverage of health insurance has been a crucial issue in American healthcare policy since the early 20th century. Reformists argued for the extension of public health insurance following the examples of major European countries, whereas conservatives countered that the extension of private health insurance during World War II made it possible to institute a semblance of a universal health insurance system without government's involvement. However, as time passed, it dawned on many that the conservative claim was hard to achieve.

In March 2010, a groundbreaking bill was passed to institute a universal health insurance system. That was the Patient Protection and Affordable Care Act, commonly known as Obamacare. Until then, many company workers had joined a collective insurance provided by their employers. Meanwhile, other individuals had to buy private insurance; however, they became uninsured if they could not pay high premiums charged due to a history of past diseases. Obamacare was a system that made it easier for the latter group of people to enroll in insurance.

After the enactment of the bill, the Republican Party tenaciously campaigned against it with the watchword "Repeal Obamacare." Among leaders in the first Trump administration, Vice President Mike Pence and Secretary of HHS Alex Azar also clarified their anti-Obamacare stance. Trump also supported repealing Obamacare, but the anti-Obamacare bill did not pass either house of the US Congress, where Republicans were dominant, though. The fight over Obamacare ended in July 2017. Behind this was the fact that the number of Obamacare beneficiaries had steadily increased since it took full effect in 2014.

In the 2024 presidential election campaign, Trump moderated his stance toward Obamacare compared to his position during his first term. He refrained from articulating the view that Obamacare should be abolished; instead, he maintained that Obamacare should be improved, and its costs reduced. In the televised presidential debate, Trump said he was considering abolishing it, but when asked about an alternative system, he just said he also had an "concept."

In the second term of the Trump administration, Obamacare will likely be accorded a low priority. As Obamacare beneficiaries increased, public approval of it also spread.6 Another reason is people's concern about losing health insurance due to their experiencing the COVID-19 pandemic. Trump will use Obamacare to criticize the "big federal government" and will likely go so far as to halt the increase of subsidies initiated by the Biden administration. Yet, it is hard to imagine that he will mobilize his political resources to implement the total abolition of Obamacare.

(2) Abortion

Abortion is an essential component of pregnant women's healthcare. The appropriateness of abortion-related policies is now questioned. The Dobbs v. Jackson ruling, a June 2022 Supreme Court decision, has significantly altered the environment surrounding abortion in the United States. Until then, the act of having an abortion was a matter of a woman's privacy and should be left to the discretion of each individual. However, the Dobbs v. Jackson ruling stated that it should be decided by each state. As a result, as of November 6, 2024, there are 13 states that, in principle, prohibit abortion under any conditions.7

During the election campaign, Harris stirred up concern that abortion could be banned nationwide if Trump were elected. In response, Trump maintained his basic stance that the question of abortion should be determined by each state. Vice-presidential candidate Vance stated that if Congress passed an abortion ban bill, Trump would veto it. Trump denied the statement, a denial which, however, revealed the difficulties he faces regarding abortion.

If a bill to prohibit abortion across the country were to pass, the Republican Party would no doubt face a hard time in subsequent elections, for according to opinion polls, about 60% of people endorse the legalization of abortion.8 Trump will likely oppose abortion in general while prolonging the debate on relevant specific issues and observing the situation.

(3) Transgender

Transgender refers to a state in which one's self-identified gender is different from one's physical gender. Vice-presidential candidate Vance was vehemently opposed to transgenderism during the election campaign. He referred to Minnesota, where Tim Walz, a Democratic vice-presidential candidate, serves as governor, as a "trans refuge" due to its inclusive policies toward transgender individuals. Vance was particularly vocal in his opposition to providing to minors medical services related to gender reassignment.9

There is a political calculation behind focusing on the issue of transgender people, whose population ratio is estimated to be around 0.5 to 1.6%. It is pointed out that emphasizing this issue is effective in winning the votes of suburban mothers and of socially conservative Hispanics and blacks.10 It is a cunning strategy to create a split within the LGBTQ community by focusing on transgender folks ("T") rather than on LGBTQ as a whole.11 Focusing on this issue may help ease evangelicals' dissatisfaction with Trump's negative stance on abortion. In its second term, the Trump administration will likely address transgender issues while balancing the issue of abortion. It will be a tough four years for transgender people.

Kennedy's MAHA Agenda

Because he believed that his second-term administration would face a difficult battle over the above issues, Trump felt the need to launch an offensive against the Democrats by creating an additional frontline in the healthcare field. Kennedy has consistently been interested in children's health. He lists children's health issues, including autism, anxiety disorders, depression, developmental disorders, respiratory diseases, obesity, and diabetes. The Democratic Party has also implemented policies on children's health but has focused on financial aspects such as expanding medical insurance coverage. In contrast, Kennedy attributes the child health crisis to environmental factors affecting children, including food and chemicals, the mushrooming of government agencies assigned to regulate these issues, and the accompanying "corruption." I believe that Trump saw the policies advocated by Kennedy as an effective weapon to launch a new battle against the Democrats in the field of healthcare.

(1) Vaccines, Fluoride, Processed Foods, and Pesticides

Although Kennedy has been an anti-vaccine activist, after his nomination, he said, "I'm not going to take away anybody's vaccines." He appeared to be considerate because he must pass the Senate nomination process. Yet, he said at the same, "I'm going to make sure scientific safety studies and efficacy are out there, and people can make individual assessments about whether that product is going to be good for them," and stressed his wariness of vaccines, suggesting that the vaccine inspection process has been compromised.12

Fluoride attracted a lot of attention when Kennedy declared just before the polling day that "Donald Trump would push to remove fluoride from drinking water on his first day in office if elected."13 Fluoride is rated effective in improving oral hygiene and preventing cavities; it spread after World War II. Fluoride is commonly used in dental care services, but its inclusion in drinking water was considered by the economically disadvantaged to be a worthy preventive measure. However, Kennedy asserts that fluoride is associated with developmental disorders and lower IQ in children.14

Kennedy calls for regulating ultra-processed foods, which he says are harmful to children. Ultra-processed foods are industrial products such as preservatives, sweeteners, and colorings. The primary purpose of ultra-processed foods is to improve taste and conservation, but they are generally high in calories, salt, sugar, and unhealthy fats, while low in nutrients. Many of frozen foods, processed meats, dressings, other seasonings, and mass-produced bread fall into ultra-processed foods. Kennedy advocates the regulation of these products, claiming that they lead to childhood obesity and diabetes. He also advocates the regulation of pesticides to prevent food poisoning in children.15

(2) Reforming the Department of HHS

Trump has been employing the phrase "Drain the swamp" since 2016, which means to root out crooked career politicians and bureaucrats rampant in Washington D.C. He encouraged Kennedy with the phrase "Go wild," suggesting his expectation of thorough reform of the Department of HHS. This is identical to what Kennedy has been asserting.16

Kennedy argues that the worsening environment surrounding children is due to the distorted approval processes for food and drugs caused by compromises between the federal government and related industries. He describes federal health regulators as "sock puppets"17 and critiques the controversial practice of the "revolving door" between industry and government, which involves hiring former regulators by regulated companies. Kennedy has already mentioned ousting high-ranking bureaucrats hostile to himself. He also claims a reduction in the budget appropriated to the Department of HSS.18

Conclusion

By nominating Kennedy as Secretary of HHS, Trump appears to attempt to "change the game" in healthcare. During the recent election campaign, Harris denounced that "Republicans want to return America to a dark past." I think that Trump recognized the utility of Kennedy for delivering the message that the Republicans are a future-oriented party that can protect children.

However, Kennedy's MAHA agenda does not coincide in every respect with Trumpian policies. The regulation of ultra-processed foods and pesticides contradicts Trump's deregulation policy in his first presidency; Kennedy may confront the opposition of powerful industry lobby groups.

Still, I think that Trump may allow Kennedy to do as much as he wants. Kennedy, who will fight within the huge bureaucratic organization of the Department of HHS, is seen as a beacon of hope for Trump supporters who want to support fighting vested interests. Trump appears to think that having a member of the prestigious Kennedy family fight for him is vital to winning the next midterm elections and for a person whom Trump will nominate as his successor to win the 2028 presidential election, for which Trump himself cannot run. Once nominated by the Senate, Kennedy would no doubt become a "clamorous" Secretary of HHS.

(Professor, Nanzan University)

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