100 days of health care upheaval
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Illustration: Aïda Amer/Axios
In 100 days, President Trump and his administration have not only upended the status quo for health care and challenged mainstream science, but slashed the workforce that's supposed to execute on their vision.
Why it matters: Trump may have downplayed health care as a key issue during his campaign, but it quickly became a flashpoint after he appointed Robert F. Kennedy Jr. as the nation's top health official.
- The choice signaled an unconventional approach that's already challenged facts, redefined medical research and given the health secretary unprecedented power.
The big picture: The Health and Human Services Department accounts for the biggest portion of domestic spending and made an inevitable target for the sweeping changes Trump said he'd make to the federal government.
- But the speed and depth of cuts, many directed by DOGE, have sown chaos in all corners of the health system and left drug companies, universities, providers and patients bracing for more upheaval.
State of play: Due to layoffs and voluntary departures, HHS is on track to have 20,000 fewer employees than it had 100 days ago.
- Kennedy, with the White House's blessing, announced a plan last month to create a new Administration for a Healthy America within HHS and cut or fold several other operating divisions into the new office.
- The administration has struggled to come up with a response to a measles outbreak that's killed three people this year.
- Kennedy also launched a controversial data collection effort to find the cause of autism that's alarmed public health experts and patient advocacy groups.
Between the lines: Kennedy's core followers and segments of Trumpworld love the changes. Others say the actions have already set America back years.
- "The first 100 days have been a chaotic, incompetent mess, from a health perspective," said Georges Benjamin, executive director of the American Public Health Association, which successfully sued to pause an administration freeze on grants and loans.
- Americans are split on whether they approve of the health agenda so far, according to a new poll from Harvard and the de Beaumont Foundation. Roughly 48% of U.S. adults surveyed said they believe the Centers for Disease Control and Prevention will function better in the next four years, while 52% said it'll be worse off.
What they're saying: The first 100 days of the administration have brought about a cultural shift, where people are increasingly talking about chronic disease, said Calley Means, a special government employee in the White House and health care entrepreneur.
- Kennedy has started conversations about phasing out food dyes and ending food companies' ability to self-affirm the safety of their ingredients show that the administration is serious about reform, rather than optimizing programs that don't work, he said.
- "The administration is aligned on delivering on President Trump's mandate to lower health care and prescription drug costs while getting to the bottom of America's chronic disease epidemic," White House spokesperson Kush Desai told Axios.
Zoom out: Some health experts have warned that some of the administration's actions so far undermine its key goal of preventing and ending chronic disease.
- For example, the administration slashed National Institutes of Health funding for research overhead costs — a plan that was halted by a federal judge. It's also cut at least 780 individual research grants, including to scientists studying chronic illnesses, per KFF Health News.
What to watch: Tariffs could be the next big shake-up for health care. Trump exempted pharmaceuticals from his initial "reciprocal" tariffs, but said industry-specific tariffs are coming. Medical device companies are already seeing tariff effects.
- The Republican-led Congress also wants to cut federal Medicaid funding, which has hospitals, physicians, states and others on edge.
- Trump also signed executive orders doubling down on price transparency in health care and calling for lower drug prices, signaling more to come in both arenas.
