The Trump Presidency Is Going Great

The Trump administration looked at PEPFAR – the George W Bush-era HIV program credited with saving over 26 million lives – and apparently decided the real emergency was that too many poor, queer, pregnant, or otherwise inconvenient people were still alive. So in 2025 they yanked grants across the board, especially via the now-vaporized USAID, and a new report finds the impact has been "severe and devastating": more than 1,700 clinics and drop-in centers shuttered, over 16,000 full-time health workers fired, and prevention services gutted worldwide. But sure, tell us more about how this White House is "pro-life".

Even the parts of PEPFAR Trumpworld allegedly wanted to protect were wrecked, because – as the researchers gently put it – you can’t surgically cut funding without blowing up the whole system. Programs to prevent mothers passing HIV to their babies were disrupted at almost two-thirds of organizations, with a fifth just giving up entirely. Care and treatment services stopped at many sites, and clinics reported they couldn’t even get basic lab supplies, condoms, or drugs. Some organizations disappeared altogether – and that’s just the ones we can count, since when you kill an NGO, its email account dies too.

The cherry on this public health funeral cake is that groups lucky enough to keep any US money had to contort themselves to obey Trump’s anti-DEI crusade, an expanded "global gag rule," and bans on anything that might look like respect for LGBTQ people, sex workers, or victims of gender-based violence. Nearly 80% of surveyed organizations said they were told to restrict their work: no tailored services for sex workers, no real support for trans people, no gender-based violence programs – because the priority isn’t stopping HIV, it’s enforcing the culture war. The result? Fewer diagnoses, fewer prevention programs, and a very real risk of reversing two decades of progress against HIV so Trump can feel tough on pronouns from a golf cart.

Republicans have finally found a way to make the Affordable Care Act less popular: remove the “affordable” part. After President Trump and the GOP in Congress refused to extend enhanced ACA subsidies, premiums did what everyone except the administration’s pet think tanks predicted — they exploded. Double and even triple-digit increases from 2025 to 2026 have pushed 5 million people off marketplace coverage, because it turns out Americans can’t pay a second rent every month just to see a doctor.

The Trump administration is trying to spin this as a heroic crusade against "fraud," borrowing talking points from the Paragon Health Institute, a conservative outfit apparently convinced that millions of people spontaneously committed identity theft just to get a checkup. Actual health policy experts point out the obvious: when Congress spent billions on enhanced tax credits during the pandemic, enrollment doubled because people could finally afford coverage. Then Republicans let those credits expire, Democrats shut down the government trying to save them, and now 5 million fewer people have insurance — which the White House is treating as a victory, presumably for the freedom to go bankrupt from a broken arm.

The result: ACA enrollment is down 13% in a single year, from 24.2 million to 19.2 million, and the administration is patting itself on the back for "cleaning up" the rolls. It’s a neat trick — engineer a price spike, shove millions off coverage, and then blame imaginary fraudsters instead of your own policies. The marketplace isn’t collapsing, it’s being methodically sabotaged by people who think health care is a luxury and suffering is a moral teacher, as long as it happens to someone else.

The Trump administration has discovered a bold new frontier in "health care reform": telling people with cancer and HIV to go get a job or lose their chemotherapy and antiretrovirals. The Centers for Medicare and Medicaid Services, now helmed by daytime TV supplement salesman Dr. Mehmet Oz, just rolled out a nearly 400-page Medicaid work-requirement rule that says you’re only exempt if your disease is actively stopping you from working. Early-stage cancer? Daily radiation but you can technically stand upright? HIV that’s controlled with meds? Congrats, you’re “able-bodied.”

States are now ordered to jam this bureaucratic nightmare into their systems by January 1, on a timeline health policy experts say usually takes years. Advocates are already warning that people newly diagnosed with cancer or living with HIV will lose coverage over paperwork errors or confusing rules — precisely when they need continuous treatment to stay alive. But Oz assures us this is really just about a "path to prosperity," explaining that millions on Medicaid are supposedly just sitting at home watching 6.1 hours of TV a day, so naturally the solution is to dangle their chemotherapy over a shredder until they clock more hours at work.

Republicans jammed these rules into their July 4, 2025 budget bill that not a single Democrat supported, and their think tank friends at the Paragon Health Institute are already applauding the "appropriate balance" between program integrity and accommodating those who "genuinely" need help. Translation: if your illness doesn’t neatly fit their spreadsheet definition of incapacity, your lifeline is now a work-reporting form you can lose in the mail. Sixty-eight million low-income Americans rely on Medicaid, but sure, let’s see how many of them we can knock off the rolls by forcing cancer patients to prove they’re sick enough for Republicans to care.

Robert F. Kennedy Jr, Trump’s health secretary and resident anti-vax oracle, just fired the two doctors leading the US Preventive Services Task Force — the group that decides which preventive care (mammograms, colonoscopies, depression screenings, statins, etc) must be covered by insurance for free under the ACA. So naturally, the administration’s response to a panel that quietly saves lives is to kneecap it and change the locks.

HHS had already spent a year slow-walking the task force into a coma, indefinitely postponing public meetings and freezing long-awaited updates on things like cervical cancer screening and maternal depression. Now Kennedy has yanked the chairs mid-term, praising their “leadership” in the same letter where he fires them and telling them they’re welcome to reapply, like contestants on some dystopian reality show where the prize is getting micromanaged by political appointees who learned epidemiology from Facebook.

Kennedy claims he’s bringing “transparency” and fixing a “lackadaisical” panel that already holds public meetings, posts all its evidence, and takes public comment. Translation: he wants a task force that will say what the administration wants it to say, just like the vaccine advisory committee he already replaced with less qualified loyalists. Former chair Michael Silverstein calls this an unprecedented level of government intrusion into scientific work; the administration calls it Tuesday.

The task force was designed with staggered terms so no one health secretary could blow it up overnight. Trump and Kennedy looked at that safeguard and treated it like a challenge. The result: a supposedly pro-life government purging the people in charge of preventing cancer, heart disease, and postpartum depression, because nothing says “freedom” like making it harder and more expensive to catch deadly diseases before they kill you.

Donald Trump has withdrawn the nomination of wellness influencer–adjacent surgeon Casey Means for US surgeon general, after her confirmation hearing went so badly that even Susan Collins and Lisa Murkowski couldn’t bring themselves to mumble their usual, “deeply troubled, but voting yes.” Means, who bailed on her surgical residency and has been cagey on vaccines, will instead continue to serve the administration’s MAHA (Make America Healthy Again, because of course there’s a slogan) crusade under health secretary Robert F Kennedy Jr, the anti-vax whisperer-in-chief.

Having burned through yet another nominee, Trump quickly pivoted to his favorite hiring pipeline: Fox News. He’s now nominating Dr Nicole Saphier, a radiologist, CDC advisory committee member, and longtime Fox talking head whose key policy credential appears to be writing a book titled Make America Healthy Again, arguing you don’t need things like socialized medicine when you can just snack on personal responsibility. Trump praised her as a “STAR physician” and “an incredible communicator,” which is polite code for “she looks good on cable and agrees with me.” The nation’s top public health post continues its transformation from serious job to branded content slot.

The Trump administration has discovered a bold new frontier in cruelty: charging disabled people rent for existing in their parents’ homes. Under a draft rule quietly cooking at the Social Security Administration and the White House’s Department of Government Efficiency (yes, that’s a real thing, not a Veep joke), SSI benefits for disabled adults and indigent seniors would be cut by up to a third if they dare to sleep in a bedroom under the same roof as family members who are themselves poor enough to qualify for food stamps.

For people like 22-year-old Shy’tyra Burton, who survives on $994 a month and lives with her dad, that’s about a $330 monthly hit because the government has decided her tiny room is a luxury suite. Up to 400,000 disabled and elderly poor people could see their benefits slashed or vaporized, all because the Trump team wants to pretend that anyone not paying full market rent to their own family has a secret benefactor. The fact that SNAP has already verified these households are broke? Irrelevant. The new plan is to endlessly recalculate the "value" of your bed and your mom’s checking account and then dock your check accordingly.

Religious conservatives who actually read the parts of the Bible about caring for the vulnerable are, predictably, horrified. Galen Carey of the National Association of Evangelicals is out here quoting judgment-of-the-faithful theology while Trump’s budget guy Russell Vought and Social Security Commissioner Frank Bisignano try to turn SSI into a paywall for family affection. Dozens of Down syndrome organizations have begged the administration not to do this, which in Trump World mostly serves as proof they’re on the right track.

When ProPublica asked the White House about any of this, OMB communications director Rachel Cauley called the story “trash” and “false,” then heroically failed to identify a single incorrect fact. The SSA, meanwhile, insists Bisignano is "committed" to serving “America’s most vulnerable” while actively drafting rules to yank their lifeline if they’re not sufficiently alone and miserable. Family values, Trump edition: you can love your disabled kid, or you can help them eat — just don’t try both under the same roof.

Minnesota families with disabled kids are finding out what happens when you put Dr. Mehmet Oz in charge of Medicaid: he calls it a "crackdown on fraud," then reaches for the bone saw. Federal prosecutors uncovered real Medicaid fraud in Minnesota, so the Trump administration responded with its usual nuance — by freezing hundreds of millions, maybe billions in Medicaid funds that actual patients rely on to, you know, live. The message from Washington: if some crooks stole money, better punish the children with cerebral palsy.

Oz is out there declaring this is all the fault of "leadership" in Minnesota, while health policy experts are standing on the sidelines yelling that this level of funding threat is unprecedented and could destabilize care for people nationwide. Minnesota’s Attorney General Keith Ellison is now suing, accusing the administration of its trademark strategy: "cut first, no matter what the law says or who gets hurt, and ask questions later, if at all." The administration insists this is about protecting taxpayers; coincidentally, it also advances Trumpworld’s long-standing dream of shredding Medicaid without having to bother with Congress or pesky things like legislation. Fun fraud-fighting twist: the people actually getting punished are the ones in wheelchairs, not the ones in cufflinks.

The VA Secretary wandered up to Congress for only the second time during the Trump administration to explain a national plan to "streamline" VA bureaucracy, which is Washington code for "we're about to break this and maybe our friends will get rich." Democrats asked for details; the administration, in keeping with long-standing tradition, arrived with vibes, buzzwords, and a powerpoint probably titled OPERATION: TRUST US BRO.

Instead of consistent oversight on the agency that literally keeps veterans alive, Trump’s team has treated the VA like a side quest they occasionally remember between indictments and Truth Social posts. Now they want to "drastically" reorganize one of the largest health systems in the country, while barely bothering to show up to Congress to explain how many vets get kicked off the merry-go-round. Streamlining, in this context, sounds a lot like: fewer services, more outsourcing, and a fresh round of contracts for whichever donor last picked up dinner at Mar-a-Lago.