First came GOP House Speaker Mike Johnson’s promise last Monday to overhaul the Affordable Care Act if Donald Trump wins the presidential election. Then on Wednesday, Howard Lutnick, the co-chair of Trump’s transition team, endorsed Robert F. Kennedy Jr.’s vaccine skepticism. and suggested that a future Trump administration would allow Kennedy to oversee vaccine data. Three days later, Kennedy announced that Trump would try to remove fluoride from Americans’ drinking water as a Day 1 priority.
The statements add up to a surreal final campaign week for Republicans, with several of Trump’s top surrogates introducing unconventional — and generally unpopular — ideas that pit them against the health care policy establishment ahead of Election Day on Tuesday. The various proposals together form an agenda that would likely harm public health. Policy experts say that if the Affordable Care Act is overhauled, vaccine confidence declines and fluoride is removed from public water systems, the country could see a spike in the number of uninsured, a return of vaccine-preventable diseases and more oral health problems, especially in the vulnerable communities.
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“The real danger goes beyond politics and into public health,” said Kavita Patel, a physician and professor at Stanford University who previously advised the Harris campaign. “This rhetoric could undermine confidence in essential health measures, leaving millions vulnerable if these ideas translate into policy.”
Robert Blendon, a longtime pollster and professor at the Harvard School for Public Health, has spent more than fifty years analyzing presidential campaigns. He said he could not recall a closing message on health policy, such as the “unusual” message offered by Republicans last week.
“Independents favor a much more positive health policy message than the message presented here by Republicans,” Blendon wrote in an email. He and other pollsters suggested the positions could be a strategy to reach skeptical, anti-establishment voters in what is expected to be a close election against Vice President Kamala Harris.
The positions have also forced prominent Republicans to explain why top Trump surrogates are voluntarily attacking popular, entrenched health programs and public health interventions. The Affordable Care Act, which has surged in popularity since Trump tried to repeal it, has been credited with helping tens of millions of Americans obtain health care coverage since its passage in 2010. More than 90 percent of children born in the United States have been vaccinated against polio, measles, mumps and rubella, protecting them from serious infectious diseases. Twelve presidential administrations — including Trump’s — have overseen recommendations to add fluoride to water, hailed as one of the great public health achievements of the 20th century.
“I’m laughing because I can’t believe we’re having a conversation about fluoride,” Sen. Tim Scott (R-South Carolina) said on CNN on Sunday, declining to address Kennedy’s comments.
The Trump campaign has repeatedly declined to specify its policy plans, telling The Washington Post in a statement Saturday that Trump was focused on the election and could not address Kennedy’s comments on fluoride.
But in an interview with NBC News on Sunday, Trump said he was open to removing fluoride from water.
‘I haven’t spoken [Kennedy] I haven’t talked about it yet, but it sounds good to me,” Trump said, according to NBC News. He also refused to rule out a ban on vaccines.
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Dueling messages to reach voters
The late campaign pivot comes after Republican leaders have also tried to appeal to voters using more conventional messages, such as a focus on the high cost of prescription drugs. According to a recent Washington Post-Schar School poll, health care ranks fourth among battleground voters behind the economy, inflation and threats to democracy.
There may be a strategy behind Republicans’ late wave of anti-public health positions, says Mollyann Brodie, executive vice president at KFF, a nonpartisan health care think tank. She noted that most voters say issues like the economy or abortion influenced their vote — but those voters have likely already decided how to vote, or even cast a ballot.
Meanwhile, there are some disengaged voters with narrower interests, such as frustration and skepticism about coronavirus vaccines, Brodie said. Republicans may be targeting these vaccine skeptics — who tend to be less educated, Republican Party-leaning and often younger men — with their recent posts questioning public health interventions, Brodie suggested.
“These closing calls should ensure that every last ‘undecided’ voter decides first to actually VOTE on Tuesday and vote for the Trump/Vance ticket,” Brodie, who oversees KFF’s election operation, wrote in an email .
But Democrats also see Republicans’ recent comments on health policy and public health as a political gift, as their party generally enjoys more support on health care issues. Harris has a 19-point lead in which would-be voters trust her handling of abortion, and a 9-point lead on health care costs, two of her strongest points, according to KFF.
The Harris campaign seized on Johnson’s vow, delivered at an event in Pennsylvania, to pursue “major reform” of the Affordable Care Act — especially when the Speaker of the House of Representatives agreed that a goal for early next year would be “no Obamacare.” Democrats said the comment represented a pledge to repeal the health care law.
Johnson’s office disputed Democrats’ interpretation, with a spokesman accusing Harris of “lying about Speaker Johnson” by claiming he had promised to repeal the law. But Johnson’s office declined to comment on what health care changes the House speaker would pursue next year and whether he would rule out an effort to repeal the Affordable Care Act.
The Trump campaign said he did not support repealing the Affordable Care Act.
GOP leaders have generally backed away from proposals to overhaul the Affordable Care Act after the party’s failed repeal in 2017 catalyzed new support for the health law and sparked voter backlash. Sixty-two percent of adults had a favorable view of the law in April, KFF found, up from 43 percent in November 2016, the month Trump was elected to the White House.
Republicans have also struggled to respond to questions about recent messaging from Kennedy and other Trump surrogates on vaccines, fluoride and other public health interventions. Scott, who introduced legislation in 2018 to support fluoridation of public water, did not respond to a request for comment for this story.
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‘The narrowest possible message’
Much of the tension has been caused by Kennedy, a longtime vaccine skeptic who suspended his independent presidential campaign and endorsed his former rival Trump in August. Kennedy and Trump surrogates soon unveiled a policy platform focused on removing chemicals from food, reducing industry influence over federal regulations, combating chronic diseases and other initiatives that received generally bipartisan support – and all grouped under the “Make America Healthy” platform. Again,” a deliberate reference to Trump’s old slogan: “Make America Great Again.”
But that agenda has received less attention as the election approaches, with public health experts focusing more on Kennedy’s history of vaccine criticism and the possibility that he could soon oversee vaccine approvals and safety. The Washington Post reported last week that Kennedy is poised to play a major food and health role in a potential Trump administration, possibly as White House czar overseeing several health agencies.
Kennedy has also drawn scorn from critics who say he knows little about the health care system that Trump may soon help regulate.
Those critics include life sciences executives, public health professors, former Trump health officials — and even Martin Shkreli, who became known as the “Pharma Bro” after raising the price of a life-saving drug and going to jail was sent for financial crimes. Shkreli wrote on social media last week of Kennedy’s pledge to overhaul the Food and Drug Administration, saying Kennedy would try to “fix what isn’t broken.”
Trump has stoked concerns about Kennedy by repeatedly claiming that Kennedy will have a free hand to implement policies, telling his supporters last Sunday that Kennedy will “go wild” on food and medicine in his administration. Trump also promised Friday that Kennedy would work on reproductive health issues in his administration — further alarming public health advocates who questioned why Kennedy, whose expertise is in environmental law, is favoring that role equipped.
Trump’s decision to elevate Kennedy is a signal to Americans that a second Trump administration would be “infinitely more chaotic than the first,” said Lis Smith, a Democratic strategist.
“Usually at the end of a long campaign you try to end with a unifying, broadly appealing message,” Smith wrote in a post. “Trump does the opposite: he concludes with the smallest possible message.”
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