Comprehensive Impacts of Trump’s First Year: Health and Safety
It has been a surreal year. Just when we think things can’t get any worse, lo and behold, a new tweet comes out. Or a new policy is introduced. Or a new world leader is so offended that we get closer to doomsday. Trump’s election has normalized and publicized the proverbial anonymous yahoo comments, and it’s hard to imagine that he still has a small but loud base of support and that people chose this narcissistic, sexist, racist sociopath consciously. He has exemplified our slow, subtle transformation from intelligent citizens to mindless consumers to salivating spectators who have a constant need for entertainment and outrage.
I always said that when voting for president, what we’re really voting for was the Supreme Court. I am going on record to say that I was wrong. Dead wrong. Trump has proven beyond a shadow of a doubt that there are so many ways a president can be harmful other than by Supreme Court appointments. To be sure, judicial appointments are one major way that Trump is detrimental to the country, and it will take at least a generation to recover from those appointments alone. But this document shows that a president can do deep and lasting damage in many ways.
Although I vacillate between disgust and defeat and anger, I am trying very hard to channel all of those feelings into fighting against our spiral toward Idiocracy. The only way to do this is for everyone who is eligible to actually get out and vote in every single election. This November’s midterm elections will tell us if Americans are really ready for progress or if they’re apathetic enough to continue our moral, ethical, and constitutional decline.
There have been several year-end round-ups about Trump’s first year. Many of them are laughably revisionist. But there were some informative ones. Axios created a great chart of search trends for some of the biggest news events of the first year, showing how we’ve all jumped from one four-alarm news fire to another. Rolling Stone summarized the damage of Trump’s first year. And Roger Cohen with the New York Times editorialized our frightening reality in If This is America.
This piece is meant to be a comprehensive assessment of the impacts of Trump’s first year as President of the United States of America (let that sink in). There are many things that happened during the campaign that are not included. Included are impacts from January 20, 2017, to January 31, 2018 (in some cases, February 1). There are sure to be things missing, but I have done my best to record these impacts. The impacts are listed under 19 different categories:
3. Women & Families;
4. LBGT;
6. Ethics;
7. Targeting free press/free speech/Privacy;
8. Health & Safety;
9. Consumer Protections;
10. Education;
11. Transportation/Infrastructure/Housing;
12. Immigration;
13. Social Contract;
14. Business/Economy/Budget;
15. Military/Defense/Police;
16. World;
17. General Governance;
18. Character; and
19. Some good news. Because there is always some good news.
Of course, some of the impacts may fit under multiple categories. For example, does Trump’s encouragement of police to treat suspects violently fall under Health and Safety or Law Enforcement? Or maybe Ethics or Character? There are many such conundrums, and I have tried to categorize each example appropriately. Some may disagree on the categorization. And that’s OK. As a researcher, I’m still pondering good ways to visualize all of this data, but in the meantime, it’s listed here. Fair warning: This is long. The items may not necessarily be in chronological order.
Since this will take me months to write, I will publish each section as I complete it. This eight article is on Trump’s impacts on health and safety.
I want to acknowledge Amy Siskind’s weekly list of subtle changes that experts in authoritarianism say to watch out for. Amy’s in-depth listings were invaluable, and a must-read itself.
Buckle your seatbelts.
First on Trump’s agenda has always been repealing the Affordable Care Act (ACA), also known as Obamacare. Trump couldn’t care less about the 20 million Americans who have benefited from the ACA, not including those who now have the right to pump at work, as well as a free pump to do so. In fact, Trump has shown that he has very little knowledge about health care or health insurance, how much it costs, or how it works, claiming that “you pay $12 a year for insurance and then get a nice plan when you’re 70.”
Republicans in Congress have tried to kill the ACA more than 70 times. Rachel Roubein published a timeline of repeal efforts since Trump came to power. Thankfully, they have all been unsuccessful so far. Even without repeal, Trump has tried to scale back the ACA in other ways.
Trump is also fighting against gun safety at every turn. Margaret Hartmannhas detailed every gun policy that Trump has proposed.
· Right from the get-go, Trump has tried to gut Obamacare. He signed an executive order encouraging federal agencies to use as much leeway as possible to dismantle Obamacare and make cheaper plans with skimpier benefits more available, essentially reverting back to the status quo before the ACA. He also ended subsidies that help low-income Americans get health care. Because of his cuts to subsidies, premiums for insurance plans in Pennsylvania, as one example, will increase by 30.6 percent instead of the estimated 7.6 percent. Thanks to Trump, the uninsured rate in the US rose to 12 percent. During his first year, the number of uninsured people increased by more than 3 million people.
· Had the Obamacare repeal been successful, some of the impacts would have included a phase-out of the Medicaid expansion, smaller subsidies for less generous health insurance plans with higher deductibles, the repeal of the individual mandate and the addition of a 6-month waiting period for coverage, tax cuts for the wealthy, and the defunding of Planned Parenthood. In fact, retroactive tax cuts for the wealthy have been described as one of the biggest impacts of republican bills to repeal health care. Had the repeal been successful, 22 million people would have lost health care coverage.
· When it was clear that the ACA wasn’t going to be repealed, Trump decided to try to sabotage the process instead by shutting down healthcare.gov on days when people are likely to shop for health coverage. Trump also pulled the Department of Health and Human Services out of enrollment events. These efforts worked to reduce access to healthcare. In Michigan, a prior top performer of health care enrollment, Trump cut funds for assisting consumersduring open enrollment by 89 percent. Leaked internal documents detailed how the Trump regime and Republicans planned to sabotage the ACA through administrative actions.
· Trump also directed the head of the Centers for Medicare and Medicaid to deny a request from Iowa to fix its healthcare marketplace as part of a larger effort to undermine the ACA.
· As a final attempt to dismantle the ACA, the GOP tax bill removes the individual mandate, which incentivized people to have insurance, which kept insurance premiums low. This, combined with the massive deficit that the tax bill has caused, will result in “less health insurance for individuals; less coverage for elderly and poor Americans; less revenue for doctors, hospitals, and myriad health care businesses; and, quite possibly, a less-healthy, less-productive workforce.”
· Trump also slashed funding to the 340B program, which required drug companies to give discounts to healthcare companies and hospitals serving low-income and Medicare patients.
· Trump established a working group to discuss health care, particularly health care for women, that included exactly zero women.
· Speaking of women’s health, parts of the ACA that republicans have tried again and again to repeal are those that prohibit lifetime caps, which leave people financially ruined, especially when having a premature baby or baby with disabilities. Jessica Valenti wrote about the hypocrisy of being “pro-life” and supporting anti-health care bills that will quite literally kill people.
· Trump also rolled back the birth control mandate in the ACA, which required employers to include birth control coverage in their insurance plans. Employers can now claim any “religious” or moral objection. Hundreds of thousands of women are now left with no coverage for birth control.
· Women aren’t the only group that republicans hate. They let expire the CHIP(Children’s Health Insurance Program), which provided low-cost health insurance, leaving 9 million children without health care. In January 2018, 114 days after expiration, Republicans finally agreed to extend funding for 6 years. However, an overlooked part of that continuing resolution was that it didn’t include funding for community clinics and hospitals that care for low-income patients. As one constituent stated, “It’s self defeating to fund CHIP but not health centers since most kids with CHIP receive their care at community health centers. So they may have CHIP but they won’t be able to access services because their Health Center is closed.”
· Trump has also disregarded the LGBT community in threatening funding for HIV/AIDS efforts. ONE Global noted that Trump’s budget proposal will lead to the “first global increase in new HIV infections since 1995, with nearly 200,000 additional HIV infections in the first year.” If the cuts are maintained, the ONE Campaign estimated that nearly 600,000 people could be infected by 202.
· Wanting to legally discriminate against women and the LGBT community in one fell swoop, Trump introduced “The Conscience and Religious Freedom Division” in — wait for it — the HHS Office of Civil Rights! This new division will work to protect health workers who want to refuse to treat patients because of religious or moral beliefs. This new division is a punch back reversal of President Obama’s policy that barred health care workers from refusing to treat transgender individuals or people who have had or are seeking abortions.
· Apparently, people with disabilities are also at risk under the Trump regime. AG Sessions rescinded more than two dozen guidelines from President Obama that clarified the Americans with Disabilities Act (ADA). One especially worrying guideline rescinded discussed implications of the ADA’s integration mandate on employment.
· Trump established a commission to combat the opioid epidemic, which was led by the office run by Jared Kushner. The report from this commission was very similar to a report published by the Surgeon General’s office under President Obama. The commission’s findings led Trump to declare the opioid epidemic a public health crisis, but not a national emergency, which would have actually led to funding for anything to deal with it. Nor did Trump request any funding for dealing with it. In fact, to deal with the problem, Trump appointed Kellyanne Conway, who has zero experience in drug policy, to lead the White House response.
· As a first response to the opioid crisis, Trump wanted to try a modern-day version of “Just Say No,” a Reagan-era campaign that has been overwhelmingly shown to have zero impacts on drug use. If Trump was only proposing things that did nothing to help, it would be bad enough. But despite the commission recommending solid approaches, such as expanding drug courts, Trump’s AG Jeff Sessions rolled back American drug policy by a decade and doubled down on the “war on drugs,” including pushing for maximum penalties, strict sentencing, and tougher crackdowns on addicts. Sessions is dealing with drug addiction by focusing on law enforcement and federal prosecutors. Sessions went so far as to say that he’s open to the death penalty for drug offenses! Session’s suggestions for those suffering from pain is to “take some aspirin sometimes and tough it out a little.” Of course, there’s no American problem that Trump can’t blame on immigration; he wants to fix the epidemic by having more border security. In the meantime, commission members have called the commission itself “a charade,” saying, “This and the administration’s other efforts to address the epidemic are tantamount to reshuffling chairs on the Titanic.” Trump implemented only a couple of the commission’s recommendations and, as noted, has made no real policy proposals or funding plans to deal with the crisis.
· Trump named Alex Azar as head of the Health and Human Services. All prior heads were former elected officials, leaders in academia or medicine, or executive branch managers. Azar comes from Eli Lilly, a pharmaceutical giant regulated by the Department of Health and Human Services.
· Speaking of HHS, Trump ended the National Registry of Evidence-based Programs and Practices (NREPP), which was created in 1997 to help people, agencies, and organizations identify and implement evidence-based behavioral health programs and practices in their communities.
· Trump slashed the CDC budget for preventing health epidemics, causing the CDC to significantly downsize prevention activities to fight against potential worldwide outbreaks of things such as Ebola. [Coincidentally perhaps, as of April 2018, a new Ebola outbreak has been reported.]
· Disease prevention may be on hold on other ways, too. Drug companies that received massive tax cuts under Trump’s tax plan have decided to end investments in Alzheimer’s and Parkinson’s research.
· People are also not safe from natural disasters under Trump. Customs and Border Protection continued to operate roadside checkpoints during the evacuation from Hurricane Harvey. Immigrants were afraid to leave their homes and evacuate.
· Even those who don’t have to fear deportation are not safe from natural disasters under Trump. At the start of hurricane season, there were no agency heads — no one in charge — at FEMA or the National Oceanic and Atmospheric Administration, which oversees the National Hurricane Center and the National Weather Service.
· Even after hurricanes have passed, we’ve seen that people are still unsafe. Trump denied a request from several members of Congress to waive shipping restrictions to help get gasoline and other supplies to Puerto Rico after Hurricane Maria. [As of this writing in April 2018, most of Puerto Rico is still without power.]
· After initially denying a waiver for food stamp recipients in Puerto Rico to receive hot food, Trump eventually granted the waiver. The largest nurses organization said that the federal government was “delaying necessary humanitarian aid to its own citizens and leaving them to die” in Puerto Rico.
· After cancelling the unethical contract with Bronze Star LLC to deliver storm tarps to Puerto Rico (not to be confused with the unethical contract with Whitefish), Puerto Ricans were still without storm tarps at the beginning of 2018. Many are still without storm tarps or roofs.
· After FEMA workers worked overtime to try to help hurricane victims, FEMA asked some of these workers to return some of their compensation or not be compensated for future work.
· Refugees International, an international human rights group, suggested that FEMA “seriously undermined the effectiveness of the aid delivery process” in Puerto Rico, and even months after the hurricane, relief efforts were uncoordinated and poorly implemented, which was “prolonging the humanitarian emergency on the ground.”
· Trump also disbanded The Community Resilience Panel for Buildings and Infrastructure Systems, a cross-agency group created to help local officials protect residents against extreme weather and natural disasters. The group was created by President Obama and openly discussed the health and safety impacts of climate change, which apparently was enough of a reason to get rid of it.
· Under the GOP tax bill, wildfire and earthquake victims, including small businesses, can no longer deduct their losses related to that natural disaster.
· Not-so-natural disasters may also increase under Trump. In yet another effort to ease “unnecessary regulatory burdens,” Trump rolled back safety regulations on offshore drilling operations that were implemented after the Deepwater Horizon explosion and oil spill that killed 11 people and injured 36 more people.
· As part of his deregulation efforts, Trump rolled back regulations and the use of fines against nursing homes that have harmed residents or put them at risk of injury. Some examples or common citations no longer fined include failing to protect residents from avoidable accidents, neglect, mistreatment, and bedsores.
· Trump also has disregarded Americans’ safety by rolling back gun regulations. Trump ended the requirement of including those who are mentally ill in the gun background check system. He did this very quietly with only a brief mention at the end of a media advisory that had no other reference to firearms. Trump’s DOJ also removed thousands of wanted fugitives from the FBI criminal background check database by redefining which fugitives were barred from guns, giving any fugitive who hasn’t crossed state lines easy and legal access to guns. And Interior Secretary Ryan Zinke lifted President Obama’s ban on lead ammunition and fishing tackle used on federal lands and waters, which protected birds and fish from lead poisoning.
· The Army Corps of Engineers is using the courts to reconsider a ban on carrying firearms on its land, which includes 422 lake and river projects in 43 states spanning 12 million acres, encompassing 55,000 miles of shoreline and 4,500 miles of trails, and including 90,000 campsites and 3,400 boat launch ramps, as well as a third of all freshwater fishing waters.
· The Trump-controlled Congress passed the NRA-sponsored Concealed Carry Reciprocity Act, which will require all states to honor other states’ concealed carry permits, “even if the permit holder’s state of residence has much lower standards or no permit requirements at all.”
The next article will cover Trump’s impacts on consumer protections.
