Bracing to Teach Health Policy in the Age of Trump

I’m teaching Introduction to Health Policy and Management for the first time this semester, and as I’ve continued to process my grief from this week’s presidential election, I looked ahead to my last substantive lecture before we transition to group project presentations.

My heart sank.

Lecture title: “The Future of Health Reform in the U.S.”

I immediately joked on Facebook, “This will be a short lecture. One slide: There is none.”

A friend corrected me, “Actually, there is one. Just not the one we want.” And she’s right.

As any political science or policy professor can tell you, teaching these days is difficult. It’s a challenge to navigate the intense emotions that go with an election such as this, and looking ahead to the precarity of our future. And it’s a challenge to present health policy and public health facts when only one of our two major political parties engages with facts and evidence-based policy (whether on the importance of abortion access, the evidence behind needle exchange programs, the value of the increasingly and sadly politicized vaccines, or the health and economic benefits of Medicaid expansion through the Affordable Care Act).

We know that Donald Trump will try again to repeal the Affordable Care Act and return to high-risk pools. We know that the consequences of such a decision are dire, not only because 27% of Americans had declinable preexisting conditions as of 2017 when Republicans tried this last time, but because people have continued to take advantage of expanded health care access and thus developed more documented medical histories, and because many people experienced complications from COVID, which would complicate obtaining health coverage amid medical underwriting. It is important that our students, many of whom want to go into public health and medicine, understand these things.

We know that JD Vance has expressed a desire to have a national abortion ban, as have those involved in Project 2025, with which the Trump campaign was intimately connected. Will this actually happen? It’s hard to say. Donald Trump said that that was not his policy objective, but that was in the context of the election and concerns about a growing gender gap amid Kamala Harris’s ascension to the top of the Democratic ticket. But coming from the person who routinely boasts about having been the one to get Roe v. Wade overturned, we should not assume that Republicans will adhere to any semblance of support for “state’s rights” in this context.

We know that Donald Trump will push yet again in defense of Medicaid work requirements, which resulted in many people in Arkansas losing health coverage despite fulfilling the requisite number of hours worked, because of insurmountable paperwork burdens.

We know that Donald Trump has pledged to put RFK Jr. in a prominent position in public health, and the dangers that that poses for us. From hostility to vaccines due to pseudoscientific nonsense about connections to autism, to opposition to fluoridation of drinking water, to hostility to reproductive health care (which has far-reaching effects), empowering this quackery will cause needless and senseless death and suffering. We have made so many important public health accomplishments in the last few decades. We should be preventing the next pandemic, but instead we’re going to concentrate on making measles great again.

And we know that as per usual under Republican administrations, but especially one as anti-science as that of Donald Trump, public health funding is going to suffer grave cuts, which will make it more difficult to study and intervene in a broad array of public health problems.

It is important that our students know the stakes.

My mother likes to quip that truth has a liberal bias. In the case of public health, it’s true.

I don’t just support the Affordable Care Act because it saved my life. As a health policy professor, I support the Affordable Care Act because we know that patients have been able to obtain preventive as well as life-saving care that they would not otherwise have, they have better health outcomes and more financial security, and hospitals and other health care providers fare better when they are not delivering as much uncompensated care. These are good things!

I don’t just support abortion rights because I believe that women should have bodily autonomy (though I do). As a health policy professor, I also support abortion rights because we know that especially in a country with poor maternal health outcomes (especially for Black women), it’s vital that people be able to access a broad array of reproductive health care, including the ability to terminate a pregnancy, especially but extending beyond the setting of significant health complications.

Sometimes these discussions feel one-sided, so I bring data. Lots of data.

From the Kaiser Family Foundation. From the Center on Budget and Policy Priorities. From the Urban Institute. From the Economic Policy Institute. From the Centers for Disease Control and Prevention.

Since 2016, many of us have struggled with communicating in political and policy spaces. Some (to my consternation… New York Times, I’m looking in your direction) have relied on bothsidesism. Others have tried to stray away from ongoing political and policy events.

I’ll be honest, I do neither. I try not to be on a soapbox (my general stance is that I’ll be dogmatic about the act of voting and defense of democracy so that we can preserve the institutions within which we can debate substantive policies over which we can have reasonable disagreements), but I’ll take evidence over bothsidesing issues with life or death consequences. There aren’t two science-based sides to vaccines. Of course, there are different lenses through which we can look at contentious issues like abortion, but we know that the medical and public health communities – from ACOG to APHA to the AMA – have been unified on issues like the Court’s ruling in Dobbs, and the ways that will undermine health outcomes for women. And I’m skeptical that we can give our students a quality education in public health without engaging in ongoing efforts at health policy and public health reform, because it will implicate the system in which they hope to work.

So, as we look ahead to the next Trump Administration, I’m in this fight for science. For public health. For health care access and equity. And I’m following the data.

We’ll have a hard conversation in a couple of weeks about what the future of health reform looks like. And in the spring, I’ll be teaching Introduction to Health Policy, The Politics of Health Policy, and Administrative Burden & Inequality in U.S. Health Care.

Buckling in for a rocky ride. Stay tuned…