WASHINGTON—Donald Trump has promised to change Washington, and he surely will. Yet while he may play some wild cards in the realms of medicine, science, and public health, you can also look for some surprising continuity with President Obama’s administration.
Here’s our preview of what to expect.
The H1N1 flu pandemic broke out within Obama’s first few months in office, and nearly 61 million Americans eventually contracted it. He later had to contend with the worst outbreak of Ebola in history, which left thousands dead in Africa and led to some hysteria stateside, and the unexpected rise of Zika.
The White House and Congress were stalled for months trying to reach agreement to fund the Zika response, a precedent that worries many outside groups. Ambitious efforts to shore up the international infrastructure to stop epidemics before they come to the United States are at risk as a result.
Still, the general verdict is that the president handled these crises calmly and with scientific rigor. Most recently, the administration spearheaded an effort that could lead to a Zika vaccine being produced in record time.
Trump could not be more different. Where Obama was calm, perhaps a little aloof in his critics’ eyes, the president-elect was often sensationalist.
“A single Ebola carrier infects 2 others at a minimum,” Trump tweeted in November 2014. “STOP THE FLIGHTS! NO VISAS FROM EBOLA STRICKEN COUNTRIES!”
He even became conspiratorial at times, casting doubt on the scientific consensus.
“Ebola is much easier to transmit than the CDC and government representatives are admitting,” he said that October. “Spreading all over Africa-and fast. Stop flights[.]”
As for the Zika outbreak, which unfolded during the presidential campaign, Trump never expressed much interest in the issue. In one notable interview, he largely deferred to Florida Governor Rick Scott on what should be done to stop the global health crisis.
Our verdict: Things are going to change.
Perhaps no issue has attracted as much bipartisan consensus as the heroin and painkiller epidemic, which is now killing more than 30,000 Americans a year.
In his last months in office, Obama signed the first major legislation to address the crisis and another bill that provided $1 billion in funding for those programs. His surgeon general produced a landmark report explaining the origins of the crisis and outlining a comprehensive vision to stop it.
Trump, too, takes the crisis seriously. He said repeatedly on the campaign trail how much he had heard about it from supporters in states like Ohio and Pennsylvania.
“The incoming administration has acknowledged the issue,” Dave Zook, who lobbies on behalf of the Collaborative for Effective Prescription Opioid Policies, told STAT after the election. “Obviously a lot of the impact is in the red areas of the map.”
In the final weeks of the campaign, Trump laid out a detailed plan for addressing the crisis. He emphasized the need for better addiction treatment and reiterated policies supported by Obama, such as raising the cap on how many patients doctors can treat for opioid addiction.
Trump could focus more on law enforcement than Obama did—he liked to say on the trail that his proposed wall on the Mexican border would keep out heroin along with undocumented immigrants. But unless the president-elect departs dramatically from his campaign rhetoric, he will largely build on what Obama has started.
Our verdict: More of the same.
Obama’s tenure will be remembered for its big ideas: the cancer moonshot, the Precision Medicine Initiative, the BRAIN Initiative.
They weren’t always popular—critics of the National Institutes of Health under Obama would say it was too enamored with these headline-grabbing projects—but nobody doubted the president felt strongly that the federal government should be devoted to medical research.
Nobody can be sure if Trump feels the same way.
He and his family do have relationships with renowned medical institutions such as the Dana-Farber Cancer Institute and St. Jude Children’s Research Hospital. One of his advisers over the last year has been Newt Gingrich, the former House speaker who initiated the doubling of NIH’s budget in the 1990s and wants to see it doubled again. Gingrich told STAT that Trump is seriously considering keeping Obama’s NIH director, Dr. Francis Collins, which would allow those big projects to continue.
But the rest of Trump’s record worries many scientists and advocacy groups. He has flirted with anti-vaccination rhetoric, to the point that anti-vaccine groups think they will now have an ally in the White House. He told a conservative radio host that he had heard “terrible” things about NIH, though he wasn’t any more specific.
His vice president and health secretary nominee are opponents of embryonic stem cell research. His pick to head the Office of Management and Budget questioned whether there should be any government funding of research. One of his top White House health policy aides has linked some forms of birth control to abortion.
Then there is Peter Thiel. The Silicon Valley billionaire is said to be wielding tremendous influence over science-related personnel in the new administration. He has been in touch with former NIH director Elias Zerhouni about a top science post in the Trump White House.
“Thiel is the only silver lining I see in the administration,” one scientist who has been affiliated with Thiel told STAT. “He’s pro-science, anti-regulation.”
But others are wary. Thiel is known to have an interest in what many consider fringe science, such as anti-aging projects.
Trump’s personnel decisions should ultimately provide some clarity on how his administration will approach medical research. Until then, it’s hard to know.
Our verdict: Unclear.
Though skyrocketing drug prices became a major news story in the last years of Obama’s presidency, he was never really at the forefront of the efforts to crack down on the cost of medicine.
It may have been in part a tactical decision. Drug makers were big boosters of the president’s health care plan in 2009, and they struck a deal with the White House that allowed them to avoid more direct price controls.
When the administration did move to address drug costs, with an ambitious Medicare experiment under an office created by the health care law, pharma fought back and the administration eventually backed off.
Trump, meanwhile, is unorthodox (to say the least) for a Republican when it comes to drug pricing. During the campaign, he endorsed allowing Medicare to directly negotiate the prices it pays for medications.
After his win, biotech stocks initially jumped, amid industry relief that they’d been spared from Hillary Clinton—who had promised a much more aggressive pricing crackdown. That didn’t last long, though. Trump told TIME magazine he wanted to bring down drug prices, and stocks fell. The bully pulpit will loom large in the Trump era; a single tweet can erase millions of dollars on Wall Street.
But, in the end, many people in Washington are skeptical much will change for drug companies. While Trump has his idiosyncrasies, the underlying facts that make the industry so influential with lawmakers—its sizable coffers and strong support among lawmakers of both parties—have not changed.
“The Republicans in Congress have no stomach for doing a regulatory scheme on drug pricing. It’s not their bag,” Ira Loss, senior health care analyst at Washington Analysis, said. “They don’t want to bother the people in R&D. In all honesty, Obama doesn’t want to bother those people either.”
Our verdict: More of the same.
OBAMACARE AND MEDICARE
The Affordable Care Act is a major piece of Obama’s legacy. It has insured upward of 20 million people and brought the US uninsured rate to historic lows. It has been the catalyst for major changes in how health care is paid for and delivered, while providing many benefits (such as free preventive services) that many Americans may not have understood.
However, the law’s marketplaces have struggled to stabilize and insurers have dropped out of the market at an alarming rate. Many people have faced high deductibles and narrow networks in the plans they’ve purchased through these exchanges.
The law is still highly divisive and Republicans, including Trump, have campaigned for years on the promise to repeal it. Now they’ll have their chance. It won’t be an easy task and many details must be hashed out, but there seems to be general GOP unity about largely dismantling the ACA.
But on Medicare, Trump could find himself at odds with Republican leaders—and more in line with Obama.
House Speaker Paul Ryan and Congressman Tom Price, Trump’s nominee for health secretary, have supported a major overhaul of the program. Trump, on the other hand, has said repeatedly that he would not support cuts to Medicare and that he wants to save it.
As he often said on the campaign trail: “We’re going to protect our Medicare.”
Our verdict: Unclear.