The first 100 days...and beyond.
What in the Health?! April 30, 2025
Well, today marks the end of the 2025 version of the infamous “first 100 days” of any new presidency. What a wild ride it’s been. For brevity I’m not going to try to recap the highlights, but if you’re interested you can check out this update over at Medpage Today, which gives an overview of some key damaging health-related orders haphazardly implemented and then quietly reversed over the last 100 days. It’s been chaos. The chaos is intentional. But so are the harms. Even when orders have been reversed, many of the harm already wrought cannot be taken back. Once a house has burned down, you can’t just say “Oh, I changed my mind, we’ve turned the water on at the hydrant again.” And at this point I think it goes without saying that most of the gutting of our health infrastructure in the last 100 days has not been reversed.
So looking forward, what’s happening?
The irony of this one would be amusing if it wasn’t so awful and life-threatening: despite RFK Jr.’s speech in Nashville on April 24 when he said that his 14 years of using heroin have informed his policy perspectives, per the leaked HHS budget for FY 2026 (which RFK Jr. and the Trump Administration are expected to finalize and formally release about 3 weeks from now), if they get their way then a $56 million federal program that distributes naloxone nationwide will be eliminated. Let’s be clear: the United States is in a fatal overdose crisis. The drug supply in this country has become increasingly toxic, and people using drugs are dramatically more likely to die than was true years ago, as you can vividly see from this figure from the National Institute on Drug Abuse:
In 2023, not on that figure, 114,000 people died; that bar would have stretched right off the top of the graph, with its Y-axis that stops at only 100,000. If you don’t know, dramatically more people die of overdoses in the United States compared to every other country on the planet, even when you take into account how large the US population is:
But importantly, CDC recently announced that overdose deaths in the US declined 24% from 2023 to 2024. The numbers are finally turning around, in a way we haven’t seen in a long time. Why? Naloxone. Naloxone is a safe and non-addictive medicine that rapidly reverses an opioid overdose, saving someone’s life. In large part, this reduction in overdose deaths is being attributed to deep investment at the federal, state, and local level in programs designed to get naloxone into the hands of people who can reverse an opioid overdose. If HHS eliminates their federal naloxone program, thousands more people will die unnecessarily. If we are not going to take steps to make the drug supply less toxic, we need to take measures that will help people who use drugs to stay alive. Drug use should not be a death sentence. RFK Jr., of all people, should know that. The good news? This isn’t an executive order, it’s a series of proposed cuts that will move through the normal budget process the US will undergo this year. Congress will draft, debate, and vote on actual funding bills, and will decide whether to follow the Trump Administration’s recommendations. If you care about someone who uses drugs, or if you think it’s wrong to devalue the lives of people who use drugs so our government can pay for tax cuts for the wealthy, call your senators and representatives today. Tell them that budget cuts for naloxone distribution are an abhorrent decision to make in the face of such a deadly crisis.
Speaking of that leaked HHS budget, the CDC’s Division of HIV Prevention is also recommended to be completely eliminated. (The “reductions in force” have already decimated the staffing for the Division, but this would finish it off.) If it doesn’t change by the time the final recommendations are released in mid-May and if Congress follows these recommendations, the impact on states’ ability to continue their work to prevent HIV will be profound. The Division of HIV Prevention currently passes 89% of its funding directly to state and local HIV programs. In states like Alabama and Mississippi, 100% of their HIV prevention efforts are funded with this money—so if it’s cut, the state will have to find other funds or all HIV prevention programs statewide will vanish. A recent analysis from amfAR found that if funding is completely eliminated from the Division of HIV Prevention, this will lead to approximately 143,486 new HIV infections by 2030, 14,676 additional AIDS related deaths, and $60.3B in additional lifetime healthcare costs.
Turning our focus away from HHS for a moment, the Trump Administration’s Department of Justice also decided to get in on the action last week, cancelling almost 400 grants it was providing to organizations working on things like supporting victims of gun violence. According to a list seen by Reuters, cancelled grants included “grants that supported crime victims, including for transgender victims; hotlines used by crime victims; grants to fight human trafficking that have gone to organizations working with immigrants; programs to curb juvenile delinquency and safeguard incarcerated youth; and funding for state-run hate-crime reporting.” The National Center for Victims of Crime had nearly $3 million in grants cancelled, which were being used to fund crime-victim hotlines and initiatives to provide support and counseling to victims of crimes. The reason? The canceled grants "no longer support the department's priorities."
During the April 1 firings of more than 10,000 HHS employees, every single one of the CDC experts in lead poisoning were fired. Here’s an example of why that matters: for the last 75 years, whenever there has been some sort of infectious disease outbreak or other mysterious illness, state health department staff can request an “Epi-Aid” from CDC—urgent assistance from federally trained epidemiologists colloquially known as “disease detectives.” On April 10, Wisconsin asked for help to address newly discovered lead poisoning in Milwaukee. Lead poisoning results in developmental delays in children, and heart attacks in adults. The response from CDC, the first time in 75 years since the program started? “I sincerely regret to inform you…we will be unable to support you with this.” Sorry, we have no one to send. They were all fired, ostensibly to reduce government waste. You’re on your own. (I guess this is all part of Making America Healthy Again.)
Let’s end this update talking about Medicaid. On April 10, the House narrowly adopted the budget framework that the Senate already passed. This budget blueprint allows for up to $5.3 trillion in tax cuts over the next 10 years, including a $1.5 trillion increase in tax cuts above and beyond those in the 2017 cuts Trump implemented as part of the Tax Cuts and Jobs Act during his first term (these were set to expire in 2025 but would be renewed). How will this be accomplished? With $1.5 trillion in cuts to the federal budget per the House version of the bill, including an order for the House Energy and Commerce Committee to cut $880 billion in spending. Budget analysts say these cuts are mathematically impossible without making significant cuts to Medicaid.
Why is this such a big deal? Well first, Medicaid (including the Children’s Health Insurance Program, or CHIP) provides health coverage to nearly 80 million Americans. You can go to this chart to explore who relies on Medicaid in your congressional district, state, or the country as a whole…everything from the total number of people enrolled to the percent of births covered by Medicaid.
If federal Medicaid funding is cut, most states won’t be able to backfill the lost money, since most states are required to balance their budgets. If they do put more money into Medicaid, they’d have to cut other state programs to offset it, like from education, social services, transportation, etc…or they’d have to raise taxes. We all know how unpopular that would be.
I already noted that many states call their Medicaid programs something else (like SoonerCare in Oklahoma or Cardinal Care in Virginia) so many people who will be directly affected may not even realize it (yet). There’s a reason that 12 House Republicans from districts where they might actually lose an election recently sent a letter to Speaker Mike Johnson and other House leadership explaining, “We cannot and will not support a final reconciliation bill that includes any reduction in Medicaid coverage for vulnerable populations.” Cutting Medicaid is hugely unpopular among the majority of voters, regardless of political affiliation. The February 2025 KFF Health Tracking Poll found that fewer than 1 in 5 adults (17%) want to see Congress decrease federal spending on Medicaid. Two in 5 (40%) said they wanted Medicaid funding to stay about the same, and 42% said they’d like to see Congress increase spending on Medicaid. A huge number of Republicans, especially those in rural areas, do not want to see cuts to this program.
A recent op-ed by two experts on these issues published in MSNBC said it very well: “We don’t want Medicaid cuts because we all benefit from this lifesaving program. Medicaid covers us in recessions and after unexpected layoffs. Medicaid covers our children when our employers don’t offer us coverage. Medicaid, not Medicare, pays for in-home care and nursing homes for those of us who cannot pay about $10,000 a month out-of-pocket nursing home rates. Medicaid enables millions of us to get preventive and primary care, so that hospitals aren’t overwhelmed by providing emergency care to people made sicker from lack of access.”
As Congress returns from break on Monday and begins the intensive budget reconciliation process to try to agree on “one big, beautiful” bill they can pass by Memorial Day, they need to hear from you. Cuts to Medicaid have the potential to hurt every one of us, and will hurt many millions of Americans. This isn’t the way to pay for tax cuts, and it’s definitely not the way to Make America Healthy Again.