With candidates and voters centered on the economic system, immigration and abortion, the 2024 presidential election has been unusually gentle on well being coverage. However former President Donald J. Trump’s latest pledge to let Robert F. Kennedy Jr. “go wild on well being” has put the problem entrance and heart within the last days of the marketing campaign.
With an help from Mr. Kennedy — an environmental lawyer who has no medical or public well being levels — Mr. Trump put the highlight on a trifecta of well being insurance policies: fluoridated water, vaccines and the Reasonably priced Care Act, this system popularly often called Obamacare, which has offered well being protection to almost 50 million Individuals during the last 10 years.
As president, Mr. Trump would have solely restricted authority to make modifications in these areas, even when Republicans gained management of each homes of Congress. However he would have the bully pulpit. Right here’s what you want to know concerning the three points:
FLUORIDE
Over the weekend, Mr. Kennedy declared on social media that, if elected president, Mr. Trump would advise communities to cease including fluoride to ingesting water. Mr. Kennedy described the compound as “an industrial waste related to arthritis, bone fractures, bone most cancers, IQ loss, neurodevelopmental problems and thyroid illness.” In an interview with NBC Information on Sunday, Mr. Trump mentioned the concept of taking out fluoridation “sounds OK to me.”
What’s fluoride and why is it in our ingesting water? Fluoride is a mineral that happens naturally in water, though it will also be a byproduct of trade. Including fluoride to public water methods started as an experiment in Grand Rapids, Mich., in 1945, after a dentist on the Nationwide Institutes of Well being theorized that it would stop cavities in enamel. Over the following 11 years, tooth decay in Grand Rapids dropped by 60 %.
Different communities rapidly adopted swimsuit. As of 2022, greater than 209 million individuals, or 72.3 % of the U.S. inhabitants served by public water provides, had entry to fluoridated water, in line with the Facilities for Illness Management and Prevention, which lists fluoridation as one of many “10 nice public well being achievements of the twentieth century.”
What do well being consultants say about fluoride? Consultants agree that extreme publicity to fluoride over an extended time period may cause well being issues. The dangers embody dental fluorosis, a situation that leaves the enamel trying pitted or brown; skeletal fluorosis, which may trigger joint ache or osteoporosis; and decrease I.Q. in kids.
However the C.D.C. and the American Dental Affiliation say that fluoridated water doesn’t pose any of those dangers on the degree at present beneficial by the Environmental Safety Company, which units the secure normal at 0.7 milligrams of fluoride per liter of ingesting water. The federal Public Well being Service recommends water fluoridation at that degree. Municipalities that fluoridate their water usually observe the rules.
A latest evaluation by the federal authorities’s Nationwide Toxicology Program discovered that fluoride ranges at or above 1.5 milligrams per liter — greater than twice the E.P.A. beneficial degree — are “constantly related to decrease I.Q. in kids.” However, the report added, “extra research are wanted to totally perceive the potential for decrease fluoride publicity to have an effect on kids’s I.Q.”
Why do we want fluoridated water when it’s already in toothpaste and dentists give fluoride remedies? Critics of fluoridation say getting fluoride from toothpaste or the dentist makes fluoridated water pointless.
However public well being consultants, together with the American Dental Affiliation, see fluoridated water as an equalizer — a approach for youngsters and adults to get sufficient fluoride to stop cavities even when they lack entry to good dental care. A latest research in Canada discovered that eradicating fluoride from water was related to a rise in tooth decay.
Why is there controversy about fluoride now? Fluoride has lengthy generated controversy. Within the Fifties conspiracy theorists thought it was a Communist plot to poison Individuals’ brains — a notion that the filmmaker Stanley Kubrick ridiculed in his 1964 basic movie “Dr. Strangelove.” However a court docket case has as soon as once more landed fluoridation within the information.
Final month, a federal decide in California sided with the anti-fluoridation motion in concluding that fluoridated water poses an “unreasonable threat of damage to well being or the surroundings,” even on the E.P.A.-recommended ranges. The decide ordered the company to revise its laws for fluoride; the federal government has not mentioned whether or not it should attraction the choice.
Can the president ban fluoride in ingesting water? No. Consuming water in the US is a matter of native, not federal, management. The extent of naturally occurring fluoride in ingesting water differs across the nation. Some cities and counties, notably Portland, Ore., don’t fluoridate their water; the Fluoride Motion Community, an anti-fluoridation group, reviews that some communities have suspended fluoridation within the wake of the California decide’s ruling.
VACCINES
Mr. Kennedy is among the nation’s main vaccine skeptics, and Mr. Trump — who has expressed doubts about vaccination though his administration was chargeable for fast-tracking growth of the Covid-19 vaccine — seems to embrace Mr. Kennedy’s views. In the course of the NBC Information interview on Sunday, Mr. Trump was requested if “banning sure vaccines is likely to be on the desk,” in gentle of Mr. Kennedy’s opinions on the topic.
The previous president responded, “Nicely, I’m going to speak to him and speak to different individuals, and I’ll decide, however he’s a really proficient man and has sturdy views.”
Might Mr. Trump, as president, ban sure vaccines? The brief reply is not any. In the US, public well being is the province of the states, not the federal authorities. Additionally, vaccines are licensed by the Meals and Drug Administration, and the president can not unilaterally take away a lawful product from the market — no less than not with no authorized combat, mentioned Lawrence O. Gostin, an professional in public well being legislation at Georgetown College.
That mentioned, a president might exert stress on the F.D.A. to reverse its approval for a specific vaccine. Mr. Trump might additionally appoint judges predisposed to limiting the facility of federal businesses, together with the F.D.A. In a landmark resolution earlier this yr, the Supreme Courtroom vastly lowered the facility of federal businesses by overturning the case of Chevron v. Pure Sources Protection Council, one of the vital cited in American legislation.
Mr. Trump might appoint well being officers who publicly criticize vaccination, which is probably going, on condition that he has mentioned he expects to offer Mr. Kennedy a giant position in his administration. That will virtually definitely have the impact of discouraging vaccination. “There’s quite a lot of mischief that may be finished,” Mr. Gostin mentioned. “However a flat out ban? No.”
THE AFFORDABLE CARE ACT
Mr. Trump insisted over the weekend he “by no means talked about” ending this system popularly often called Obamacare, and “by no means even thought of such a factor.” That’s information to those that recall his fervent effort in 2017 to get Congress to repeal the legislation — solely to see Senator John McCain, Republican of Arizona, return to Washington after mind surgical procedure to forged the deciding vote in opposition to the repeal.
What’s behind the conflicting messages? Mr. Trump was most likely making an attempt to distance himself from Home Speaker Mike Johnson, who promised throughout a latest marketing campaign swing by means of Pennsylvania that Republicans would embark on a “huge reform” of the Reasonably priced Care Act if Mr. Trump was elected.
“No Obamacare?” a voter referred to as out. “No Obamacare,” Mr. Johnson agreed.
Can the president undo Obamacare on his personal? No. As Mr. Trump found in 2017, that may take an act of Congress. Nonetheless, the president might use his government authority in quite a few methods to undercut the legislation or prohibit entry to this system.
He might, for instance, in the reduction of the finances for “navigators” — outreach professionals who assist individuals discover and enroll in well being plans. In January 2021, President Biden issued an government order aimed toward strengthening Medicaid and the Reasonably priced Care Act. Mr. Trump might simply reverse that.
If Congress have been to repeal the Reasonably priced Care Act, what would come subsequent? When Mr. Trump was requested throughout his debate in opposition to Vice President Kamala Harris whether or not he had a alternative plan for the legislation, he mentioned he had the “ideas of a plan.” Larry Levitt, the chief vice chairman for well being coverage on the Kaiser Household Basis, has written that there’s “some fact in that assertion.”
In Mr. Trump’s 2020 finances, Mr. Levitt writes, Mr. Trump proposed repealing the growth of Medicaid and the premium subsidies that, underneath the legislation, make insurance coverage extra inexpensive for low-income households; he would have changed each with a block grant to the state. Mr. Trump additionally referred to as for capping federal Medicaid spending.
Trump’s conceptual alternative plan would have repealed the Reasonably priced Care Act’s premium subsidies and the Medicaid growth, changing them with a block grant to states. It might have additionally capped federal Medicaid spending. All instructed, Trump’s plan would have reduce obligatory spending on well being care by $1.5 trillion over a decade, in line with the Congressional Finances Workplace.
