During his four years in office, President Donald Trump has made numerous promises on crucial issues like health care, environmental regulations, cannabis legalization, and more. He’s stuck to some but not all of his vows. Here’s where Trump’s record stands on a few key health issues today—and how his actions could ultimately impact your health. (And, for comparison’s sake, here’s how Joe Biden winning would affect your health as well.)
On the coronavirus response:
The U.S. has been a worldwide leader in COVID-19 deaths: At press time, the U.S. has a rate of 65.99 COVID-19 deaths per 100,000 people, compared to 11.68 in Germany, 0.85 in South Korea, and 0.51 in New Zealand, according to Johns Hopkins. As Joe Biden pointed out in the first presidential debate, Americans account for 20% of global coronavirus deaths but just 4% of the world’s population. A few days before the United States passed 200,000 confirmed COVID-19 deaths in September, Trump said, “We have done a phenomenal job with respect to COVID-19.” The facts say otherwise—and some (controversial) projections estimate that the U.S. could reach 410,000 dead by the end of the year
Trump reportedly knew back in February that the SARS-CoV-2 virus was deadly and decided to “play it down.” He has since mocked, flaunted, or ignored scientific consensus on COVID-19, questioning scientists and health authorities and implicitly promoting coronavirus conspiracy theories. For instance, take his behavior surrounding masks. Health authorities agree that masks are critical to reducing the spread of the coronavirus; three in four Americans are in favor of a mask requirement, according to a nationally representative Associated Press-NORC Center for Public Affairs Research survey from July that polled 1,057 U.S. adults. Trump ridiculed Biden for wearing a mask during the first presidential debate, then announced that he’d tested positive for COVID-19 three days later. He has consistently refused to wear a mask in public, even while sick with COVID-19. Then there’s social distancing, which the Centers for Disease Control and Prevention (CDC) actually says “is the best way” to minimize the virus’s spread. Trump has continued to hold large outdoor and indoor rallies with many mask-less attendees. He went to the White House Rose Garden event in September to honor his nomination of Judge Amy Coney Barrett to the Supreme Court. The event, which featured many unmasked guests speaking closely and even hugging, unsurprisingly became a superspreader.
Convoluted and changing testing policies, delays in test results, and contaminated test kits under the Trump Administration all contributed to a lack of efficient and widespread coronavirus testing, as SELF previously reported. Trump has falsely claimed that “if we didn’t do testing, we would have no cases.” But, as SELF previously reported, experts say we need more coronavirus testing, not less, to tamp down on this virus. Trump’s administration has also reportedly challenged the CDC’s communication on coronavirus and children along with telling the CDC to change its testing guidance against the advice of scientists.
The desperate search for a COVID-19 vaccine may seem like a bright spot here, but the truth is a little murkier. Several American pharmaceutical companies, including Pfizer, Moderna, and Johnson & Johnson, are conducting Phase 3 trials, the final stage in the development process before vaccine approval. Considering vaccines usually take several years to develop and test, that’s record timing. It’s thanks in large part to Operation Warp Speed, a Department of Health and Human Services (HHS) program that gave billions of dollars to pharma companies and sped vaccine development by authorizing the manufacture of vaccines while they’re still undergoing testing. The HHS says this reduces financial risk without affecting product quality. The issue here is that Trump has suggested a vaccine will be available before election day. Public health experts are highly skeptical. The U.S. Food and Drug Administration (FDA) passed strict new guidelines on emergency use authorization that would likely push the vaccine’s timeline past election day. The White House promptly blocked these guidelines, so the FDA is looking into other avenues to guarantee that coronavirus vaccines are as safe and effective as possible, according to the New York Times. For what it’s worth, nine pharmaceutical companies have signed a pledge saying they will not cut safety corners in creating a COVID-19 vaccine.
On health care access:
During his 2016 presidential election campaign, Trump promised to “repeal and replace” the Affordable Care Act (ACA, also known as Obamacare). His administration went through many unsuccessful attempts to do so before Republican-led Congress passed the Tax Cuts and Jobs Act in December 2017, which eliminated Obamacare’s individual mandate, so people now don’t pay a penalty for opting out of health insurance. Expecting more healthy people to subsequently stop buying insurance, insurers have already hiked some insurance premiums. A 2019 analysis by the Kaiser Family Foundation found that health insurance premiums increased by 32 percent on ACA silver plans in 2018, although many but not all people got subsidies that have so far offset the price. In 2018, the uninsured rate for U.S. residents increased for the first time since before Obamacare passed, according to the U.S. Census Bureau. A May 2018 report by the nonpartisan Congressional Budget Office estimated there will be 6 million more uninsured people between 2018 and 2023 due to the elimination of the individual mandate.
During the first presidential debate, Biden said that Trump still “does not have a plan” for health care. Former Republican House speaker Newt Gingrich responded with an op-ed arguing that Trump has a “1,000 step progress on health reform” that includes “a series of small but significant reforms.” Notably, Gingrich points out Trump’s expansion of association health plans (AHPs, which allow small employers to band together to offer insurance to employees) and increased availability of short-term, limited-duration plans (STLDs, which have a duration of fewer than 12 months and are renewable up to 36 months). In October 2017, Trump signed an executive order that allowed insurers to sell health care plans that don’t meet ACA standards, paving the way for more loosely-regulated AHP and STLD plans that are meant to be more affordable and compete with Obamacare plans. STLD plans, however, aren’t available to people with preexisting conditions, according to the Kaiser Family Foundation. And AHPs can raise premiums based on a person’s age, gender, location, or job, according to the Center on Budget and Policy Priorities (CBPP). Both STLD and APS exclude essential health benefits like maternity care, substance use treatment, and mental health services that Obamacare plans guarantee. Meanwhile, a series of other measures by the Trump Administration has made Medicaid more expensive and less accessible, according to the CBPP.
In June, the Trump administration asked the Supreme Court to overturn Obamacare as “unconstitutional”. Obamacare makes it illegal for insurers to deny service or treatment to people with preexisting conditions (which used to happen often). If it’s fully overturned, Democrats insist that the more than 7 million Americans diagnosed with COVID-19 so far could find themselves without insurance, as insurers could deem it a “preexisting condition.” Days before the first presidential debate this September, the Trump Administration released an executive order outlining an intent to guarantee health coverage protections for people with preexisting conditions. Debate moderator Chris Wallace and other observers, however, called the order “largely symbolic,” since it has no technical language and leaves loopholes that would allow insurers to drop coverage.
Nearly two-thirds of Americans believe that abortion should be legal in all or most cases, according to a nationally representative 2019 Pew poll of 4,175 adults. Trump seems to have agreed at one point, having told the press “I am very pro-choice” in a 1999 interview. But he has consistently supported abortion restrictions as president. Trump’s Supreme Court nominee, Amy Coney Barrett, has a record of advocating limits on abortion rights. If confirmed, pundits believe Barrett will continue to impose abortion limitations and may overturn Roe vs. Wade, the 1973 Supreme Court ruling that legalized abortion nationwide. (Barrett herself has said she’d follow the Court’s precedent on abortion.) In 2016, Trump said that if abortion were outlawed, there should be “some sort of punishment” for people who seek it. His second-in-command, Vice President Mike Pence, has one of the most extensive anti-abortion records among Republicans and said he hopes to see Roe v. Wade “consigned to the ash heap of history where it belongs.” Before Roe, illegal abortions accounted for a reported 17 percent of all pregnancy-related deaths (though the real number was likely higher), according to the Guttmacher Institute.
Trump has imposed other significant limitations on abortion. He has appointed more than 200 federal judges to-date); in a campaign letter this September, Trump vowed that if re-elected he’ll continue “filling the Supreme court and lower courts” with judges who oppose abortion. His administration has tried to restrict the availability of medications that induce abortions without surgery in the first trimester. His administration supported a failed Congressional measure to make permanent the Hyde Amendment, a rule that prevents Medicaid from covering abortion in most cases. He reinstated the global gag rule, (also known as the Mexico City policy), which prevents U.S. aid from going to international organizations that counsel on abortions. And Trump instituted a “domestic gag rule”, which blocks federal funding for U.S. organizations that provide abortions. Planned Parenthood estimates this rule has kept 4 million Americans from accessing affordable preventive health care.
On climate change:
Our rapidly-warming planet could impact everything from tick-borne diseases to allergies, along with making natural disasters even more devastating, according to the CDC. The Environmental Protection Agency (EPA) has made it clear that climate change is real and is happening in large part because of humans. Nearly two-thirds of Americans agree with these statements, according to a nationally representative April 2020 poll by Yale and George Mason University researchers, who surveyed 1,029 adults. Yet Trump has repeatedly questioned climate change science, telling reporters as recently as September that “I don’t think science knows actually” whether the horrific 2020 California wildfires are linked to climate change.
For the past four years, Trump’s environmental agenda has mostly undone former President Barack Obama’s major regulations. Trump replaced Obama’s Clean Power Plan, which limited carbon pollution from U.S. power plants—one of the biggest sources of pollution in the U.S.—with the weaker Affordable Clean Energy (ACE) rule. A 2019 analysis in Environmental Research Letters estimated that compared to no policy at all, ACE only “modestly reduces” carbon dioxide emissions nationally and actually increases those emissions in 18 states and Washington, D.C. Trump also eliminated fuel economy standards for passenger vehicles and limitations on greenhouse gas (GHG) emissions from refrigerants and air conditioning. And he pulled the United States’ commitment to the Paris Climate Agreement, an accord signed by 189 countries to-date that aims to reduce GHGs to limit temperature rise to 2 degrees Celsius above pre-industrial levels. In all, the Trump Administration has enacted at least 100 climate rollbacks, according to a July 2020 tally by The New York Times. Two-thirds of Americans believe the federal government isn’t doing enough to address climate change or protect air and water quality, per a nationally representative November 2019 poll of 3,627 adults by the Pew Research Center. Inaction will take a toll: A September 2020 analysis from the nonpartisan research firm Rhodium Group concluded that Trump’s policy changes may add up to 1.8 gigatons of carbon dioxide (CO2) to the atmosphere by 2035 (about a third of our total CO2 emissions in 2019).
On opioids and cannabis legalization:
After more than 42,000 Americans died from opioid overdoses in 2016, the Trump administration declared the opioid crisis a public health emergency in 2017. The following year, Trump signed the Support for Patients and Communities Act, which provided grants to offset the costs of medications that treat opioid addiction, expanded access to medication that treats overdoses, adjusted Medicare and Medicaid and increased penalties to limit overprescription, and attempted to stop the importation of drugs like fentanyl. It also reauthorized funding for the Cures Act, which puts $500 million a year toward the opioid crisis. Some experts argued that the law wasn’t enough because it didn’t pay for a wide and sustained expansion of addiction treatment. Then, in 2019, Trump announced $2 billion in grants to state and local governments to fight the opioid crisis. Deaths from opioids decreased slightly for the first time in years, from 47,600 in 2017 to 46,802 in 2018, according to the CDC.
In 1990, Trump said he supported cannabis legalization; during the 2016 presidential campaign he repeatedly said he backed states’ rights to legalize cannabis and “100 percent” supported medical cannabis. But in January 2018 Attorney General Jeff Sessions rescinded the Cole memorandum, a rule that had allowed states to legalize cannabis without federal interference. Trump’s 2021 federal budget proposal also called to end protections that keep the federal government from interfering in states’ regulation of medical cannabis (so far 33 states have legalized medical cannabis and 11 allow for recreational cannabis use). These moves signaled the federal government could come down hard on cannabis. In April 2019, Trump said he supported the Strengthening the Tenth Amendment Through Entrusting States (STATES) Act, a bipartisan bill filed by Sens. Cory Gardner and Elizabeth Warren that would allow states to create their own cannabis policies. The bill doesn’t legalize cannabis or change the statute of cannabis, however, which would still be classified as a schedule 1 drug alongside heroin. Then, in February 2020, a top Trump spokesperson said that illegal drugs, including cannabis, “need to be kept illegal.” That same month, Trump repeatedly applauded countries that execute people who sell drugs. “I don’t know that our country is ready for that,” he said.