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Prescription for Dysfunction: How Trump’s Grievance Agenda Hurts American Healthcare
A perspective from Nathan Boucher
Donald Trump’s presidency has been characterized by a politics of grievance—marked by retribution, ideological rigidity, and a combative approach to governance. This posture has had profound consequences for healthcare delivery in the United States, undermining access, affordability, and equity across the system.
Undermining the Affordable Care Act (ACA). From the outset, Trump made dismantling the ACA a central goal. When legislative repeal failed, his administration pursued administrative sabotage: slashing outreach funding, shortening enrollment periods, and promoting short-term “junk” insurance plans that lacked essential protections like coverage for preexisting conditions or maternity care. These actions destabilized insurance markets and led to higher premiums for comprehensive plans.
The repeal of the individual mandate further eroded the ACA’s risk pool, driving up costs for those who remained insured. The Congressional Budget Office estimated that premiums increased by an average of 6% due to this policy shift.
Medicaid Cuts and Work Requirements. In 2025, the Trump administration introduced a tax bill that includes $880 billion in Medicaid cuts over the next decade. These cuts were primarily due to a new work requirement for Medicaid eligibility, mandating able-bodied adults under 65 to work, study, or perform community service for at least 80 hours per month, beginning in late 2026. These changes are projected by the Congressional Budget Office to result in 10 million Americans losing coverage by 2034.
Additionally, a late addition to the GOP-backed tax and immigration bill passed by the House in 2025 removes Medicaid coverage for gender transition care for all ages, expanding previous proposals that targeted only minors. This sweeping prohibition stems from amendments introduced to satisfy conservative holdouts and aligns with broader Republican efforts to restrict transgender healthcare.
Cuts to Public Health Infrastructure. Trump’s grievance-driven governance has also targeted public health institutions. In 2025, the administration implemented drastic workforce reductions at the National Institute for Occupational Safety and Health (NIOSH), with around 85% of NIOSH’s 1,100 staff initially terminated under a reduction in force directive. Although some were later reinstated, critics warn that the cuts undermine the safety of U.S. workers and impair preparedness for public health emergencies.
Similarly, the administration imposed significant budget cuts that eliminated over 32,000 AmeriCorps member positions across the U.S. This sudden move canceled nearly $400 million in funding, affecting early-career professionals in community service roles, including those providing crucial support in healthcare, education, and disaster recovery.
Politicizing Women’s and LGBTQ+ Health. Trump’s policies have also targeted women’s and LGBTQ+ health. The administration rescinded federal grants supporting programs for victims of domestic and sexual violence, and women’s healthcare and reproductive rights have been systematically undermined. These include defunding Title X programs, halting enforcement of reproductive health laws, canceling maternal mortality research funding, and hobbling assistance for victims under the Violence Against Women Act.
Additionally, Executive Order 14182, titled “Enforcing the Hyde Amendment,” signed by Trump in January 2025, ends federal funding for elective abortions and revokes prior related orders, directing agencies to implement the policy.
Erosion of Scientific and Regulatory Integrity. Trump’s administration has also eroded scientific and regulatory integrity in healthcare. The administration rolled back policies to limit drug spending by Medicaid and Medicare, rescinding the executive order urging the Center for Medicare and Medicaid Innovation (CMMI) to pursue new payment and healthcare models to limit drug spending. These actions have raised concerns about the administration’s commitment to evidence-based policymaking and the potential for increased healthcare costs.
Trump’s grievance-fueled presidency has inflicted lasting damage on U.S. healthcare delivery. By prioritizing ideological battles over evidence-based policymaking, his administration has undermined access to care, destabilized insurance markets, and eroded public health infrastructure. The cumulative effect is a healthcare system less equipped to serve the needs of all Americans, particularly the most vulnerable.
Nathan Boucher is associate professor in medicine, nursing, and public policy at Duke University.
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