The MAHA Attack on Public Health Continues

A health care mirage appeared on Jan. 8. The House passed a three-year extension of the Affordable Care Act tax credits which had been cut in the GOP’s so-called “Big Beautiful Bill,” with 17 endangered Republicans joining all the Democrats to vote for it. But it was dead on arrival at the Senate, as Trump threatened a veto should it ever pass, and instead offered a vague promise of a plan, including drug prices “slashed by 300, 400 even 500%,” meaning that drug companies would pay YOU up to four times the cost of your drugs.

In short, nothing serious can be expected from Republicans as the vast majority of the 24 million Americans covered by the ACA will see their premiums skyrocket, even though states like California are doing their best to soften the blow. It will take a few months before it’s clear what the impacts will be, Covered California told Random Lengths in December.

But as outlined in our last issue, that’s hardly the only front on which America’s health is being harmed by Trump and the Republicans. A major front we wrote about was the attack on vaccines, culminating in the drastic cut of the slate of recommended vaccines from 17 to 11, including meningococcal disease, which can be fatal within 24 hours.

One offshoot of this attack we didn’t cover was the mid-December cancellation of $12 million in grants from the Department of Health and Human Services to the American Academy of Pediatrics for programs aimed at reducing sudden infant deaths, improving teen and young adult health, preventing birth defects, such as fetal alcohol syndrome, and identifying autism early, according to an academy spokesperson.

A DHHS spokesman told NBC via email the grants were canceled “because they no longer align with the Department’s mission or priorities,” which says everything you need to know about the Trump administration’s hostility to public health and wellbeing.

One bit of good news in the new year was a federal judge’s ruling restoring the funding in a preliminary injunction on Jan. 11. Judge Beryl Howell wrote that the DHHS had likely had a “retaliatory motive” in terminating grants.

The Attack On Nursing

There’s also a two-pronged attack on nursing, once again courtesy of the so-called “Big Beautiful Bill”: On the one hand, it’s cutting funding for nurses’ higher education, thereby reducing the supply of new nurses in a field plagued with shortages. On the other hand, it removes staffing level requirements, justified by — guess what? The shortage of nurses!

The education funding cut is part of much larger cut of roughly $284 billion, by eliminating the Graduate PLUS program, which allowed students to borrow up to the full cost of attendance for graduate degrees. The new limits are based on the type of program: $50,000 per year and $200,000 total for “professional” degrees, $20,500 per year and $100,000 total for all others. But what qualifies wasn’t written into the law.

In November, a Department of Education committee released definitions and surprise! Nursing and other female and minority-dominated professions like teaching, social work, physical therapy and physician assistant programs, were excluded from professional classification.

This produced a strong backlash from unions and professional associations in these fields, and the rule has not yet been finalized, but even if nursing is reclassified, funding and the supply of nurses will be reduced from what it otherwise would have been. It’s a cut that makes no sense, Paul Glastris argued in Washington Monthly in December: “[Nursing] has strong debt-to-earnings ratios, strict licensing requirements, sustained labor-market demand, and a clear social return. If taxpayers are going to subsidize any graduate profession, nursing is among the safest investments.”

This brings us to the other attack on nursing: Beginning on Feb. 2, the federal requirement that nursing homes maintain a registered nurse on-site around the clock will be eliminated — a change that recalls Arnold Schwarzenegger’s first act as governor in 2003, when he illegally tried to roll back nursing level requirements that had taken years to develop.

The regulation assured families of quality care, explained Sean Domnick, president of the American Association of Justice, in a December op-ed for The Hill. “It meant quicker intervention for strokes, sepsis, respiratory failure and the countless complications that define elder care. It meant accountability in facilities where staffing has been a chronic problem for decades.” It’s not just his opinion. “Decades of peer-reviewed research have shown what happens when RN staffing decreases. Higher rates of infections. More falls. More pressure ulcers. More emergency transfers. Higher mortality. These aren’t political talking points — these are real people,” he wrote.

So, in short, on the one hand, Republicans are reducing the supply of nurse by cutting support for their education, and on the other they’re justifying cutbacks in round-the-clock care because of a nursing shortage they’re helping to produce.