“Ultimately I shifted my selection pretty drastically,” she said. “I was struggling to find a residency program in the South where I could still get the training I consider fundamental to the skill set needed to be an OB/GYN.” Instead of going home to Georgia, she’s headed to Pittsburgh to start her medical residency this summer. Panakam has plenty of company.

For the second year running, fewer graduating U.S. medical students applied for residency training in states with abortion bans or restrictions than in the previous year, according to . (Overall applications were down slightly, because students are being urged to apply to fewer programs, but the decrease was markedly larger in states where abortion is illegal or significantly restricted.)

It’s not just obstetrician-gynecologists; the decline crosses specialties, including those that don’t serve primarily pregnant patients. That could threaten the future of the overall medical workforce in states with bans, because doctors tend to locate permanently where they do residencies.

“The geographic misalignment between where the needs are and where people are choosing to go is really problematic,” said Debra Stulberg, who chairs the Department of Family Medicine at the University of Chicago. “We don’t need people further concentrating in urban areas where there’s already good access.”

The concerns of graduating medical students extend beyond their ability to practice medicine; they’re also worried about their own health, or that of their partners. “People don’t feel safe potentially having their own pregnancies living in those states,” Stulberg said.

Some students say it’s a hard decision.

“I feel some guilt and sadness leaving a situation where I feel like I could be of some help,” said new medical school graduate Hannah Light-Olson, who will leave Nashville for OB/GYN training at the University of California at San Francisco this summer. “I feel deeply indebted to the program that trained me, and to the patients of Tennessee.”

It’s not that residency programs are going unfilled. There are still more graduating students from medical schools both in the United States and abroad than there are residency slots. But Beverly Gray, an associate professor of obstetrics and gynecology at Duke University School of Medicine, worries that abortion restrictions impact “whether we have the best and brightest coming to North Carolina.”

Residents in states where abortion is banned will still get training in abortion techniques, which are also used for miscarriages and other conditions. But to train on the procedures they’ll have to leave the state. And some students worry the training won’t be sufficient.

“I would rather have not become an OB/GYN than not be trained as a good one,” said Laura Potter, who is moving from medical school at the University of California at Davis to residency at Mass General Brigham in Boston.

But there are students choosing to train in states with abortion restrictions to make sure patients there get the care they need. And others hope to relocate to those parts of the country after their training 鈥� including Panakam.

“Long term, I still hope to practice in the South,” she said. “But at this point in my professional journey, it’s a little too early for me to restrict my training in any meaningful way.”

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Blum turned to programs mostly in states where abortion access 鈥� and, by extension, abortion training 鈥� is likely to remain protected, like California, Colorado, and New Mexico. Arizona has enacted a law banning most abortions after 15 weeks.

“I would really like to have all the training possible,” she said, “so of course that would have still been a limitation.”

In June, she will start her residency at Swedish Cherry Hill hospital in Seattle.

According to new statistics from the Association of American Medical Colleges, for the second year in a row, students graduating from U.S. medical schools were less likely to apply this year for residency positions in states with abortion bans and other significant abortion restrictions.

Since the Supreme Court in 2022 overturned the constitutional right to an abortion, state fights over abortion access have created plenty of uncertainty for pregnant patients and their doctors. But that uncertainty has also bled into the world of medical education, forcing some new doctors to factor state abortion laws into their decisions about where to begin their careers.

Fourteen states, primarily in the Midwest and South, have banned nearly all abortions. 鈥� a preliminary copy of which was exclusively reviewed by 素人色情片Health News before its public release 鈥� found that the number of applicants to residency programs in states with near-total abortion bans declined by 4.2%, compared with a 0.6% drop in states where abortion remains legal.

Notably, the AAMC’s findings illuminate the broader problems abortion bans can create for a state’s medical community, particularly in an era of provider shortages: The organization tracked a larger decrease in interest in residencies in states with abortion restrictions not only among those in specialties most likely to treat pregnant patients, like OB-GYNs and emergency room doctors, but also among aspiring doctors in other specialties.

“It should be concerning for states with severe restrictions on reproductive rights that so many new physicians 鈥� across specialties 鈥� are choosing to apply to other states for training instead,” wrote Atul Grover, executive director of the AAMC’s Research and Action Institute.

The AAMC analysis found the number of applicants to OB-GYN residency programs in abortion ban states dropped by 6.7%, compared with a 0.4% increase in states where abortion remains legal. For internal medicine, the drop observed in abortion ban states was over five times as much as in states where abortion is legal.

In its analysis, the AAMC said an ongoing decline in interest in ban states among new doctors ultimately “may negatively affect access to care in those states.”

Jack Resneck Jr., immediate past president of the American Medical Association, said the data demonstrates yet another consequence of the post-Roe v. Wade era.

The AAMC analysis notes that even in states with abortion bans, residency programs are filling their positions 鈥� mostly because there are more graduating medical students in the U.S. and abroad than there are residency slots.

Still, Resneck said, “we’re extraordinarily worried.” For example, physicians without adequate abortion training may not be able to manage miscarriages, ectopic pregnancies, or potential complications such as infection or hemorrhaging that could stem from pregnancy loss.

Those who work with students and residents say their observations support the AAMC’s findings. “People don’t want to go to a place where evidence-based practice and human rights in general are curtailed,” said Beverly Gray, an associate professor of obstetrics and gynecology at Duke University School of Medicine.

Abortion in North Carolina is banned in nearly all cases after 12 weeks. Women who experience unexpected complications or discover their baby has potentially fatal birth defects later in pregnancy may not be able to receive care there.

Gray said she worries that even though Duke is a highly sought training destination for medical residents, the abortion ban “impacts whether we have the best and brightest coming to North Carolina.”

Rohini Kousalya Siva will start her obstetrics and gynecology residency at MedStar Washington Hospital Center in Washington, D.C., this year. She said she did not consider programs in states that have banned or severely restricted abortion, applying instead to programs in Maryland, New Hampshire, New York, and Washington, D.C.

“We’re physicians,” said Kousalya Siva, who attended medical school in Virginia and was previously president of the American Medical Student Association. “We’re supposed to be giving the best evidence-based care to our patients, and we can’t do that if we haven’t been given abortion training.”

Another consideration: Most graduating medical students are in their 20s, “the age when people are starting to think about putting down roots and starting families,” said Gray, who added that she is noticing many more students ask about politics during their residency interviews.

And because most young doctors make their careers in the state where they do their residencies, “people don’t feel safe potentially having their own pregnancies living in those states” with severe restrictions, said Debra Stulberg, chair of the Department of Family Medicine at the University of Chicago.

Stulberg and others worry that this self-selection away from states with abortion restrictions will exacerbate the shortages of physicians in rural and underserved areas.

“The geographic misalignment between where the needs are and where people are choosing to go is really problematic,” she said. “We don’t need people further concentrating in urban areas where there’s already good access.”

After attending medical school in Tennessee, which has adopted one of the most sweeping abortion bans in the nation, Hannah Light-Olson will start her OB-GYN residency at the University of California-San Francisco this summer.

It was not an easy decision, she said. “I feel some guilt and sadness leaving a situation where I feel like I could be of some help,” she said. “I feel deeply indebted to the program that trained me, and to the patients of Tennessee.”

Light-Olson said some of her fellow students applied to programs in abortion ban states “because they think we need pro-choice providers in restrictive states now more than ever.” In fact, she said, she also applied to programs in ban states when she was confident the program had a way to provide abortion training.

“I felt like there was no perfect, 100% guarantee; we’ve seen how fast things can change,” she said. “I don’t feel particularly confident that California and New York aren’t going to be under threat, too.”

As a condition of a scholarship she received for medical school, Blum said, she will have to return to Arizona to practice, and it is unclear what abortion access will look like then. But she is worried about long-term impacts.

“Residents, if they can’t get the training in the state, then they’re probably less likely to settle down and work in the state as well,” she said.

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A new regulation听听allows states to include adult dental care as a benefit that health insurers must cover under the Affordable Care Act. Following听, the proposal represents an election-year aspiration for the future of Obamacare: It doesn’t require states to do anything, even as it shows off听President Biden’s intention to make the ACA a more robust safety net.

“It’s huge, really significant,” said听Colin Reusch, director of policy at听Community Catalyst, a health coverage advocacy group. He said the new Biden administration rule represents “one of the first real changes” to coverage provisions of the law since it passed in 2010.

But like so much in health care, expanding access to dental services is a lot more complicated than it sounds.

An estimated听68.5 million听U.S. adults lacked dental insurance in 2023, according to the nonprofit听CareQuest Institute for Oral Health. That’s more than听2.5 times听the roughly听26 million听Americans of all ages听.

And millions of Americans lost dental coverage in the past year as part of the Medicaid “unwinding” that dropped low-income people who had been covered by the program during the pandemic.

At the same time,听听more than听$45 billion听in lost productivity annually, according to the听Centers for Disease Control and Prevention, and it’s linked to a long list of even more serious health problems, including heart disease and diabetes.

Still, efforts to expand U.S. dental coverage have long foundered on the shoals of cost. When people have dental insurance, they tend to use it. So including the coverage in a health insurance policy can raise overall premiums.

That’s one reason traditional Medicare coverage explicitly excludes most dental care. (Many private Medicare Advantage plans offer some dental coverage as an enticement for seniors to join.)

An effort to add a dental benefit to Medicare听was stripped听from Biden’s “Build Back Better” legislation before it was passed in 2022 as the Inflation Reduction Act. Instead, the administration听in which Medicare can cover dental care. Any progress on oral health 鈥� including giving states the option to require coverage for adults 鈥� is seen by advocates as a victory. Dental coverage for children is already an essential benefit under the ACA.

But whether they actually get coverage depends on states affirmatively adding dental benefits to benchmark plans in the ACA’s insurance marketplaces. Those plans not only determine what services Affordable Care Act insurance has to cover, but also set parameters for state-employee and many private-employer health plans.

Reusch said a few states are considering the change, but it will be a while until anything is certain. States have until May 2025 to decide whether to add dental care to benchmark ACA plans; the benefit wouldn’t be effective until the 2027 plan year.

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Algorithms make it possible for companies to fix prices without explicitly coordinating with one another, posing a new test for regulators policing the market, said Lina Khan, chair of the Federal Trade Commission, during a media event hosted by KFF.

“I think we could be entering a somewhat novel era of pricing,” Khan told reporters.

Khan is regarded as one of the most aggressive antitrust regulators in recent U.S. history, and she has paid particular attention to the harm that technological advances can pose to consumers. Antitrust regulators at the FTC and the Justice Department in the fiscal year that ended Sept. 30, 2022, according to Bloomberg News.

Last year, the FTC successfully blocked biotech company Illumina’s of cancer-screening company Grail. The FTC, Justice Department, and Health and Human Services Department launched a website on April 18, , to make it easier for people to report suspected anticompetitive behavior in the health care industry.

The American Hospital Association, the industry’s largest trade group, has often criticized the Biden administration’s approach to antitrust enforcement. In comments in September on proposed guidance the FTC and Justice Department published for companies, “the guidelines reflect a fundamental hostility to mergers.”

Price fixing removes competition from the market and generally makes goods and services more expensive. The agency has argued in court filings that price fixing “is still illegal even if you are achieving it through an algorithm,” Khan said. “There’s no kind of algorithmic exemption to the antitrust laws.”

By simply using the same algorithms to set prices, companies can effectively charge the same “even if they’re not, you know, getting in a back room and kind of shaking hands and setting a price,” Khan said, using the example of residential property managers.

Khan said the commission is also scrutinizing the use of artificial intelligence and algorithms to set prices for individual consumers “based on all of this particular behavioral data about you: the websites you visited, you know, who you had lunch with, where you live.”

And as health care companies change the way they structure their businesses to maximize profits, the FTC is changing the way it analyzes behavior that could hurt consumers, Khan said.

Hiring people who can “help us look under the hood” of some inscrutable algorithms was a priority, Khan said. She said it’s already paid off in the form of legal actions “that are only possible because we had technologists on the team helping us figure out what are these algorithms doing.”

Traditionally, the FTC has policed health care by challenging local or regional hospital mergers that have the potential to reduce competition and raise prices. But consolidation in health care has evolved, Khan said.

Mergers of systems that don’t overlap geographically are increasing, she said. In addition, hospitals now often buy doctor practices, while pharmacy benefit managers start their own insurance companies or mail-order pharmacies 鈥� or vice versa 鈥� pursuing “vertical integration” that can hurt consumers, she said.

The FTC is hearing increasing complaints “about how these firms are using their monopoly power” and “exercising it in ways that’s resulting in higher prices for patients, less service, as well as worse conditions for health care workers,” Khan said.

Policing Noncompetes

Khan said she was surprised at how many health care workers responded to the commission’s recent proposal to ban “noncompete” clauses 鈥� agreements that can prevent employees from moving to new jobs. The FTC issued its final rule banning the practice on Tuesday. She said the ban was aimed at low-wage industries like fast food but that many of the comments in favor of the FTC’s plan came from health professions.

Health workers say noncompete agreements are “both personally devastating and also impeded patient care,” Khan said.

In some cases, doctors wrote that their patients “got really upset because they wanted to stick with me, but my hospital was saying I couldn’t,” Khan said. Some doctors ended up commuting long distances to prevent the rest of their families from having to move after they changed jobs, she said.

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It’s hardly news that Biden, an 81-year-old devout Catholic, is uncomfortable talking about abortion rights 鈥� which he has supported for many years, though not always enthusiastically. The president took so long to utter the word after taking office that he inspired a satiric website:.

Restoring the protections of Roe v. Wade, which the Supreme Court overturned in 2022, was a key subject of his prime-time speech. Yet Biden managed to avoid “abortion.” Instead, he referred to Republican support for a “national ban on reproductive freedom” and talked about instances “when reproductive freedom was on the ballot.”

The word “abortion” appeared in prepared text for the speech in reference to first lady Jill Biden’s guest, Kate Cox. The Texas woman was denied an abortion under state law last year after her fetus was diagnosed with a terminal condition. But when Biden recognized Cox during the speech, he said Texas law “banned her ability to act.”

Asked at a Politico event Wednesday how she’d respond to people who want to hear Biden say the word “abortion” more often, his domestic policy adviser, Neera Tanden, said: “Look, he’ll say 鈥榓bortion.’ He said it just a few weeks ago.”

“To me,” she added, “actions speak louder than words.”

Biden gets a pass on his queasiness with the word from abortion rights advocates, who say there’s no question it’s a priority for the president and his administration.

“Note where it was in the speech,” said Christina Reynolds of Emily’s List, a PAC that seeks to elect women who support abortion rights. Reproductive rights came second in Biden’s remarks only to a warning about threats to Ukraine, democracy and free elections.

The Biden administration “has legislative accomplishments they can point to” on the issue, Reynolds said, including legal moves to defend access to the abortion pill mifepristone and the responsibilities of doctors under the Emergency Medical Treatment and Active Labor Act; allowing members of the military leave and travel funding to obtain abortions if they’re stationed in states with bans; and allowing Veterans Affairs to provide abortion counseling.

On Monday, while presenting Biden’s fiscal 2025 health-care budget, Health and Human Services Secretary Xavier Becerra repeatedly mentioned abortion rights. His wife is an obstetrician who specializes in high-risk pregnancies.

“We are doing what we can to fulfill the president’s mission to us to ensure that everyone in America has access to the health care that they need,” he told reporters.

Notable in the budget: Like other Democratic presidents, Biden aspires to do away with the Hyde Amendment, the long-standing appropriations language that generally prohibits federal tax dollars being used to provide abortions. Republicans annually ensure that the provision remains in U.S. law.

And Biden also proposed boosting funding for Title X services, which among other things support Planned Parenthood and other reproductive health-care providers 鈥� although they say the increase is inadequate.

“However Joe Biden feels about [abortion] personally,” Reynolds said, “he clearly believes it should be the woman’s decision.”

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“Let’s find consensus,” she urged at a GOP presidential debate in November. “Let’s make sure we make contraception accessible.”听

If only consensus were that easy. In some conservative circles, contraception is nearly as controversial a topic as abortion. And since the fall of Roe v. Wade almost two years ago, calls from the fringes of Haley’s party to also restrict birth control have gotten louder. Haley’s campaign did not respond to requests for comment.

At the same time, support for birth control remains strong among Democratic, Republican and independent voters, according to pollster and former Trump adviser Kellyanne Conway. Conway was among the GOP strategists pressing Republicans last year message.

The modern antiabortion movement was launched in the United States , led mostly , which opposes both abortion and most birth control. But it was in the late 1990s and early 2000s when conflation of the two issues began, said Clare Coleman, president and CEO of the National Family Planning & Reproductive Health Association, which represents publicly funded family planning organizations around the nation.

“So now if you oppose abortion you effectively oppose contraception, too,” she said.

Some of that reflected confusion. In 1998, the Food and Drug Administration approved the first “morning after” pill, a regimen of high-dose birth control pills that can prevent pregnancy if taken soon enough after sex. In 2000, just before President Bill Clinton left office, the FDA approved the abortion pill mifepristone, which 鈥� unlike the morning-after pill 鈥� can end an established pregnancy in its early stages.

The two medicines are regularly confused 2陆 decades later, even though the FDA in 2022 on the most common morning-after pill to emphasize that it does not cause abortion.

Contraception has also come under increased fire due to the federal Title X family planning program, which provides low-cost birth control, sexually transmitted infection testing and treatment, and other preventive services at more than 3,000 clinics nationwide. While Title X funds have never been allowed to be used for abortion, among its main grantees for decades have been Planned Parenthood affiliates, some of which provide abortion services (using nonfederal funds).

Planned Parenthood’s participation helped make Title X such a target for antiabortion forces that Congress has not formally reauthorized the program since 1985. Funding has continued in annual appropriations bills, but at declining levels.听

Fights over the program have been heated. The Supreme Court that a Reagan-era regulation could require federally funded Title X clinics to stop referring patients for abortion, but the rule never took full effect. Former president Donald Trump imposed a regulation to effectively kick Planned Parenthood out of the Title X program. The rule was reversed by the Biden administration in 2021.

Not all the controversy over birth control has been directly attributable to abortion, however. In some pharmacists began to refuse to fill prescriptions for morning-after pills, and even regular birth control methods, because they said providing the medications violated their beliefs. In some cases, pharmacists refused to return written prescriptions to patients, making it harder to get the medications elsewhere.

But those fights were skirmishes compared with the conflagration over language in the Affordable Care Act requiring insurance companies to cover FDA-approved contraception at no upfront cost to patients.

Although churches and other religious entities were not subject to the mandate, and the so religiously affiliated entities such as schools and hospitals would not have to directly pay for contraception, there were at one point more than 100 separate lawsuits making their way through federal courts.

Eventually, the Supreme Court ruled that not only are religiously affiliated entities exempt from the mandate, but also

Fast-forward to 2024. Efforts to establish in state or federal law that life begins at conception 鈥� 鈥� would redefine many forms of contraception, including IUDs and many birth control pills, as murder. Late last week the Alabama Supreme Court ruled that are “persons” and those who destroy them can be held liable for their demise.

“Embryos, to me, are babies,”Haleysaid in response to the ruling during 测别蝉迟别谤诲补测.听

Even some Republicans who don’t outright promote the fallacy that contraceptives cause abortion have questioned the value of birth control.

“Widespread use of contraception has in my view come with a cost,” Hadley Heath Manning of the conservative Independent Women’s Forum last summer, “facilitating a culture of cheap sex that has created mass confusion, pain and regret in the world of dating and family formation.”

So much for consensus.

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If the justices rule as expected, based on this month’s oral arguments, they could dramatically change the way federal health agencies operate. “The upheaval caused 鈥� would be immense,” argues a friend of the court brief filed on behalf of the听American Cancer Society听and a dozen other health groups.

On its face,听Relentless Inc. v. Department of Commerce听补苍诲听Loper Bright Enterprises v. Raimondo听(the two cases were heard together) are about whether commercial herring fishermen should pay for government observers assigned to their boats.听But those who brought the case are trolling for much bigger fish: overturning a 40 year-old Supreme Court precedent that undergirds modern federal regulation.

Under the “Chevron doctrine” 鈥� named after the 1984 case听鈥� in cases where statutes are ambiguous, federal courts are supposed to defer to the interpretation of laws by the agencies implementing them, as long as that interpretation is “reasonable.”

The fishing groups (backed in part by a group funded by) want the court to overturn听Chevron, thereby transferring much of the power to interpret federal law from the executive bureaucracy to Congress and federal judges.

That could lead to real turmoil for the health-care system, according to the groups that filed the friend of the court brief. It would suddenly put long-standing regulations that govern drug safety, public health and Medicare and Medicaid 鈥� insurance programs that together cover more than a third of all Americans 鈥� in jeopardy of fresh legal challenges.

“It’s just a matter of stability and certainty,” said听Sarah Somers, legal director of the听National Health Law Program听and an author of the brief, in an interview on the听素人色情片Health News听podcast “What the Health?”

For example, the听Centers for Medicare & Medicaid Services, said Somers, “has the expertise, has the time, has the resources, and has the duty to figure out what these particular terms and statutes mean, and how the programs should work.”

While federal bureaucrats are often treated as punching bags by politicians and voters, many are hired because of their expertise in fields that most Americans would probably agree demand regulation 鈥� like drug safety.

“The idea of courts, every single drug that’s challenged in every single forum, having to delve into what that means without deference to the agency would be just a recipe for chaos, really,” Somers said.

Cases challenging federal health care policy can arise all across the country. In the absence of听Chevron, “if you have hundreds of district courts and courts of appeals coming up with different interpretations of these terms, you’re going to have a lot of problems,” Somers said.

There is also the possibility of reopening cases that have already been decided. Without the rule requiring lower courts to defer to agency interpretations, “litigants will come out of the woodwork seeking to open those decisions and contending that they didn’t actually address what they now say is the relevant question,” Solicitor General听Elizabeth B. Prelogar听told the court during oral arguments on Jan. 17.

That ability to look back, particularly by “big interests that have a lot of time and resources to devote to litigation,” said Somers, could result in “a great deal of uncertainty, a lot of disruption, and a lot of problems for the courts and for all the entities that function under these systems.”

A decision in the case is expected later this year.

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“Vamos a luchar por un cuidado de salud mucho mejor que el Obamacare. Obamacare es una catástrofe”, dijo Trump en en Iowa el 6 de enero.

El desconcertante resurgimiento de una de las cruzadas políticas más perjudiciales de Trump ocurre en un momento en el que la ley de salud de la era Obama es y que en 2017, cuando Trump y los republicanos del Congreso demostraron ser incapaces de aprobar su propio plan para reemplazarla.

Ese esfuerzo fallido fue en gran parte la razón por la cual los republicanos perdieron el control de la Cámara de Representantes en las elecciones de medio término de 2018.

A pesar de las promesas repetidas, Trump nunca presentó su propio plan para reemplazar el Obamacare. Y gran parte de lo que la administración Trump logró en materia de atención médica lo revirtió la administración Biden.

Sin embargo, Trump logró algunos cambios de política significativos que todavía hoy están vigentes, incluidos los esfuerzos para brindar que cobran los hospitales y pagan las aseguradoras de salud.

Intentar pronosticar las prioridades de Trump en un segundo mandato es aún más difícil ya que cambia frecuentemente de posición sobre los temas, y lo hace muchas veces.

La campaña de Trump no respondió a una solicitud de comentario.

Quizás el logro más grande de Trump es algo de lo que rara vez habla en su campaña. La “Operation Warp Speed”, durante su administración, logró crear, probar y llevar al mercado una vacuna contra covid-19 en menos de un año, mucho más rápido de lo que vaticinaron incluso las predicciones más optimistas.

Sin embargo, muchos de los seguidores de Trump no apoyan, e incluso se oponen con fuerza, a estas vacunas.

La siguiente es una lista de los “antecedentes” de Trump sobre la atención de salud.

Salud pública

La respuesta de Trump a la pandemia domina su historial general en esta área.

Más de 400,000 estadounidenses murieron por covid durante el último año de Trump en el cargo. Sus prohibiciones de viaje y otros esfuerzos para evitar la propagación global del virus fueron ineficaces, su administración fue más lenta que otros gobiernos en desarrollar una prueba diagnóstica y confrontó públicamente con funcionarios de salud de su propio gobierno sobre estas respuestas.

Antes de las elecciones de 2020, Trump reanudó grandes mitines y otros eventos públicos de campaña que muchos expertos en salud pública consideraron imprudentes frente a un virus altamente contagioso y mortal. Él mismo las pautas de salud pública después de contraer covid y terminar hospitalizado.

Al mismo tiempo, a pesar de lo que muchos vieron como una pública por parte de la Casa Blanca, Trump firmó un contra covid (después de amenazar con vetarlo).

También presidió algunos de los de los Institutos Nacionales de Salud (NIH) en este siglo. Y las vacunas basadas en ARNm desarrolladas por la “Operation Warp Speed” fueron un asombroso avance científico al que se le atribuye y sentar las bases para futuras vacunas contra otras enfermedades, .

Aborto

La mayor “contribución” de Trump a la política del aborto fue indirecta: nombró a tres jueces de la Corte Suprema que fueron fundamentales para revocar el derecho constitucional al aborto.

Durante su campaña de 2024, Trump tomado partido en el candente tema.

Desde que la Corte Suprema revocó Roe v. Wade en 2022, Trump se ha lamentado que el tema ha sido políticamente perjudicial para los republicanos; criticó a uno de sus rivales, el gobernador de Florida Ron DeSantis, por firmar una prohibición del aborto a las seis semanas de embarazo; y prometió con “ambos lados” sobre el aborto, prometiendo que “por primera vez en 52 años, tendremos un problema que podremos dejar atrás”.

Hasta ahora, ha evitado explicar cómo lo haría, o si apoyaría una prohibición nacional del aborto más allá del número de semanas.

Sin embargo, hace poco, Trump parece haber sobre su crítica a la prohibición de seis semanas en Florida y con importantes opositores al aborto, cuyo apoyo lo ayudó a ser elegido en 2016, y a quienes devolvió el favor con una larga lista de cambios de política durante su presidencia.

Entre las acciones contra el aborto llevadas a cabo por la administración Trump estuvo la reinstalación de la que prohíbe otorgar fondos federales a organizaciones internacionales que respaldan los derechos al aborto.

Esta regulación apuntó a y otras entidades que ofrecen abortos participen en el programa federal de planificación familiar llamado Título X; y estableció regulaciones destinadas a facilitar que y los empleadores se negaran a participar en actividades que violaran sus creencias religiosas y morales; y otros cambios que dificultaron a los científicos de los NIH realizar investigaciones utilizando .

Todas esas normas han sido revertidas por la administración de Biden.

Seguro médico

A diferencia de las políticas de Trump sobre salud reproductiva, muchas de las acciones de su administración relacionadas con el seguro médico aún están vigentes.

Por ejemplo, en 2020, Trump promulgó el No Surprises Act, una medida bipartidista destinada a proteger a los pacientes de facturas médicas inesperadas derivadas de disputas por pagos entre proveedores de atención médica y aseguradoras. La ley se incluyó en el paquete de ayuda contra covid de $900 mil millones que Trump rechazó antes de firmar, aunque expresó su apoyo para poner fin a las facturas médicas sorpresa.

Su administración también impulsó 鈥攁 pesar de las vehementes objeciones de funcionarios de la industria de salud鈥�, que requieren que los hospitales publiquen lo que cobran por servicios, y que las aseguradoras proporcionen costos estimados para procedimientos. aún están en vigor, aunque los hospitales en particular han sido lentos en cumplirlos.

Medicaid

Aunque Trump prometió programas de beneficios populares como Medicare, Medicaid y el Seguro Social, su administración no cumplió esa promesa. La legislación para derogar ACA que Trump respaldó en 2017 habría impuesto recortes importantes a Medicaid, y su Departamento de Salud y Servicios Humanos (HHS) alentó a los estados a exigir a los beneficiarios de Medicaid que demostraran que trabajaban para recibir seguro médico.

Precios de medicamentos

Uno de los temas en los que la administración Trump fue más activa fue en reducir el precio de los medicamentos recetados para los consumidores, una prioridad principal tanto para votantes demócratas como republicanos. Pero muchos de esos planes en los tribunales.

Un plan de la era Trump que nunca se implementó habría vinculado el precio de algunos medicamentos costosos cubiertos por Medicare a los precios en otros países. Otro habría requerido que las compañías farmacéuticas en sus anuncios televisivos.

Una regulación que permite a los estados importar medicamentos más baratos de Canadá sí en noviembre de 2020. Sin embargo, la Administración de Drogas y Alimentos (FDA) recién , desde Florida. Canadá ha dicho que no permitirá exportaciones que pongan en riesgo la escasez de medicamentos en su país, dejando en duda si la política es viable.

Trump también promulgó medidas que informar a los pacientes cuando el precio en efectivo de un medicamento es más bajo que el costo utilizando su seguro. Antes, los farmacéuticos podían tener la prohibición de hacerlo, dependiendo de sus contratos con aseguradoras y administradores de beneficios farmacéuticos.

Libertad médica

Trump logró una gran victoria para la facción libertaria del Partido Republicano cuando promulgó el , destinado a facilitar que los pacientes con enfermedades terminales accedan a medicamentos o tratamientos aún no aprobados por la FDA.

Pero cuántos pacientes han logrado obtener tratamiento utilizando la ley porque está dirigida a la FDA, que tradicionalmente ha otorgado solicitudes de “uso compasivo” de medicamentos aún no aprobados. El obstáculo, que la ley no aborda, es conseguir que las compañías farmacéuticas liberen dosis de medicamentos que aún se están probando y que pueden ser escasos.

Trump dijo en un foro de Fox News el 10 de enero que la ley había “salvado miles y miles” de vidas. No hay evidencia que respalde esa afirmación.

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“We’re going to fight for much better health care than Obamacare. Obamacare is a catastrophe,” Trump in Iowa on Jan. 6.

The perplexing revival of one of Trump’s most politically damaging crusades comes at a time when the Obama-era health law is even and than it was in 2017, when Trump and congressional Republicans proved unable to pass their own plan to replace it. That failed effort was a big part of why Republicans lost control of the House of Representatives in the 2018 midterms.

Despite repeated promises, Trump never presented his own Obamacare replacement. And much of what Trump’s administration actually accomplished in health care has been reversed by the Biden administration.

Still, Trump secured some significant policy changes that remain in place today, including efforts to bring charged by hospitals and paid by health insurers.

Trying to predict Trump’s priorities in a second term is even more difficult given that he frequently changes his positions on issues, sometimes multiple times.

The Trump campaign did not respond to a request for comment.

Perhaps Trump’s biggest achievement is something he rarely talks about on the campaign trail. His administration’s “” managed to create, test, and bring to market a covid-19 vaccine in less than a year, far faster than even the most optimistic predictions.

Many of Trump’s supporters, though, don’t support 鈥� and some even vehemently oppose 鈥� covid vaccines.

Here is a recap of Trump’s health care record:

Public Health

Trump’s pandemic response dominates his overall record on health care.

More than 400,000 Americans died from covid over Trump’s last year in office. His travel bans and other efforts to prevent the global spread of the virus were ineffective, his administration was slower than other countries’ governments to develop a diagnostic test, and he publicly clashed with his own government’s health officials over the response.

Ahead of the 2020 election, Trump resumed large rallies and other public campaign events that many public health experts regarded as reckless in the face of a highly contagious, deadly virus. He after contracting covid himself and ending up hospitalized.

At the same time, despite what many saw as by the White House, Trump signed a massive (after first threatening to veto it). He also presided over some of the for the National Institutes of Health’s budget since the turn of the century. And the mRNA-based vaccines Operation Warp Speed helped develop were an astounding scientific breakthrough credited with while laying the groundwork for future shots to fight other diseases .

Abortion

Trump’s biggest contribution to abortion policy was indirect: He appointed three Supreme Court justices, who were instrumental in overturning the constitutional right to an abortion.

During his 2024 campaign, Trump has been on the red-hot issue. Since the Supreme Court overturned Roe v. Wade in 2022, Trump has bemoaned the issue as politically bad for Republicans; criticized one of his rivals, Florida Gov. Ron DeSantis, for signing a six-week abortion ban; and with “both sides” on abortion, promising that “for the first time in 52 years, you’ll have an issue that we can put behind us.”

He has so far avoided spelling out how he’d do that, or whether he’d support a national abortion ban after any number of weeks.

More recently, however, Trump appears to have over his criticism of Florida’s six-week ban and more with key abortion opponents, whose support helped him get elected in 2016 鈥� and whom he repaid with a long list of policy changes during his presidency.

Among the anti-abortion actions taken by the Trump administration were a reinstatement of the “” that bars giving federal funds to international organizations that support abortion rights; a regulation to and other organizations that provide abortions from the federal family planning program, Title X; regulatory changes designed to make it easier for and employers to decline to participate in activities that violate their religious and moral beliefs; and other changes that made it harder for NIH scientists to conduct from elective abortions.

All of those policies have since been overturned by the Biden administration.

Health Insurance

Unlike Trump’s policies on reproductive health, many of his administration’s moves related to health insurance still stand.

For example, in 2020, Trump signed into law the No Surprises Act, a bipartisan measure aimed at protecting patients from unexpected medical bills stemming from payment disputes between health care providers and insurers. The bill was included in the $900 billion covid relief package he opposed before signing, though Trump had expressed support for ending surprise medical bills.

His administration also pushed 鈥� over the vehement objections of health industry officials 鈥� that require hospitals to post prices and insurers to provide estimated costs for procedures. also remain in place, although hospitals in particular have been slow to comply.

Medicaid

While first-time candidate Trump popular entitlement programs like Medicare, Medicaid, and Social Security, his administration did not stick to that promise. The Affordable Care Act repeal legislation Trump supported in 2017 would have , and his Department of Health and Human Services later encouraged states to require Medicaid recipients in order to receive health insurance.

Drug Prices

One of the issues the Trump administration was most active on was reducing the price of prescription drugs for consumers 鈥� a top priority for both Democratic and Republican voters. But many of those proposals by the courts.

One Trump-era plan that never took effect would have pegged the price of some expensive drugs covered by Medicare to prices in other countries. Another would have required drug companies to in their television advertisements.

A regulation allowing states to import cheaper drugs from Canada , in November 2020. However, it took until January 2024 for the FDA, under Trump’s successor, to approve the , from Florida. Canada has said it won’t allow exports that risk causing drug shortages in that country, leaving unclear whether the policy is workable.

Trump also signed into law measures to disclose to patients when the cash price of a drug is lower than the cost using their insurance. Previously pharmacists could be barred from doing so under their contracts with insurers and pharmacy benefit managers.

Veterans’ Health

Trump is credited by some advocates for overhauling Department of Veterans Affairs health care. However, while he did sign a major bill allowing veterans to obtain care outside VA facilities, White House officials also of the spending needed to pay for the initiative.

Medical Freedom

Trump scored a big win for the libertarian wing of the Republican Party when he signed into law the “,” intended to make it easier for patients with terminal diseases to access drugs or treatments not yet approved by the FDA.

But how many patients have managed to obtain treatment using the law because it is aimed at the FDA, which has traditionally granted requests for “compassionate use” of not-yet-approved drugs anyway. The stumbling block, which the law does not address, is getting drug companies to release doses of medicines that are still being tested and may be in short supply.

Trump said in a Jan. 10 Fox News town hall that the law had “saved thousands and thousands” of lives. There’s no evidence for the claim.

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Some background: Ehrenfeld is a Wisconsin anesthesiologist, researcher and medical school professor who also directs a health-care philanthropy in his state. He’s an Afghanistan combat veteran, the first openly gay president of the AMA and a national advocate for LGBTQ+ rights.

This transcript has been edited for clarity and brevity. You can hear the whole interview later today on “What the Health?”

Rovner: Congress is coming back and working on a budget, or so we hear. I know physicians are facing, again, a cut in Medicare pay, but that’s not the only AMA priority here in Washington at the moment, right? [Note: A 3.37 percent cut to Medicare physician payments took effect Jan. 1.]

Ehrenfeld: It’s unconscionable. And so we’re optimistic that we can get a fix, hopefully retroactive, as the omnibus consolidation work goes forward.

Physicians continue to struggle. My parents lost their own primary care physician because of a challenge with their primary care doctor not being able to take Medicare anymore. And what we’re seeing is more and more doctors just stopping seeing new Medicare patients, or opting out of the program entirely.

Rovner: Now we have the Supreme Court 鈥� none of whom have an M.D., as far as I know 鈥� about to decide whether doctors [treating] women with pregnancy emergencies , all of which may conflict. What’s the AMA doing to help doctors navigate these very choppy and changing legal waters? 听

Ehrenfeld: Choppy is a good word for it. It’s confusing. And since the Dobbs decision, we have been working with all of our state and federation partners to try to help physicians navigate this. It’s unbelievable that now physicians are having to call their attorneys, the hospital legal counsel, to figure out what they can and can’t do. And, obviously, this is not a picture that supports women’s health. So we are optimistic that we might get a positive ruling with this EMTALA decision on the Supreme Court. But, obviously, there’s a long way that we need to go to make sure that we can maintain access for reproductive care.

Rovner: Do you think that’s something that has dawned on the rest of the members of the AMA that this is not necessarily about abortion, this is about the ability to practice medicine? 听

Ehrenfeld: If you look at some of these socially charged restrictive laws, whether it’s in transgender health or abortion access, or other items, we take the same foundational approach, which is that physicians and patients ought to be making their health-care decisions without legislative interference.听

Rovner: It’s not just abortion and reproductive health where lawmakers are trying to dictate medical practice, but also care for transgender kids and adults and even treatment for covid and other infectious diseases. What are you doing to fight the sort of “pushing against” scientific discourse? 听

Ehrenfeld: Our foundation in 1847 was to get rid of quackery and snake-oil salesmen in medicine. And yet here we are trying to do some of those same things with misinformation, disinformation. And obviously, even if you look at the attack on PrEP, preexposure prophylaxis for HIV prevention 鈥� making it basically zero out-of-pocket cost for many Americans 鈥� [not providing PrEP is] just unconscionable. We have treatments. We know that they work. We ought to make sure that patients and their physicians can have access to them.

Rovner: Artificial intelligence can portend huge advances and also other issues, not all of which are good. How is the AMA trying to push [medicine] more toward the former, the good things, and less toward the latter, the unintended consequences? 听

Ehrenfeld: We need to make sure that we have appropriate regulation. The [Food and Drug Administration] doesn’t have the framework that they need. 听We just need to make sure that those changes only let safe and effective algorithms, AI tools, AI-powered products come to the marketplace.

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