The new Trump administration will erode the medical profession
Unlike the first, Donald Trump’s second campaign was not focused on the Affordable Care Act or health care policy. An Associated Press poll found that most voters did not consider health care very motivating, with only 8% of voters surveyed ranking it as a top issue.
Nevertheless, the results of this election will damage the medical profession. In the past four years we have seen an incredible erosion in the ability of physicians to set the norms and standards for their practices. Instead, judges, politicians, and activists — many without any medical training — have substituted their own judgment for what is appropriate medical care. The legal erosion of the medical profession will only accelerate under the second Trump administration.
Historically, law, medicine, and divinity have been self-regulating. Medical professional organizations, specialty societies, and organizations run by physicians are the ones who develop both standards of care and standards of practice, including who may become a physician. And the self-regulation of the medical profession allows physicians and patients broad latitude to make the appropriate decision in each case.
But the past four years have seen a significant erosion in the ability of physicians to self-regulate. First, during the pandemic trust in physicians plummeted. One survey, published in the Journal of the American Medical Academy, indicated that between April 2020 and January 2024, trust in physicians and hospitals fell from 71.5% to 40.1%. The same study suggested that individuals with lower trust in the medical profession were less likely to have been vaccinated for Covid-19. Public trust is a necessary component of self-regulating professions. The post-pandemic prevailing general distrust of physicians leaves the medical profession vulnerable to attacks on its ability to self-regulate.
Dobbs v. Jackson Women’s Health, the Supreme Court case that struck down the federal right to receive abortion care, has provided the blueprint for substituting political judgment in place of medical expertise. States rushed in to criminalize abortion care, usually without significant involvement by physicians. This shows how unworkable the exceptions for the health or life of the patient in most abortion bans are. In Texas, for example, a physician must determine that a patient has a “life-threatening physical condition” that either places her at “risk of death” or “serious risk of substantial impairment of a major bodily function” before providing an abortion. But this requirement already deviates from the medical standard of care, which is to intervene before a patient develops a life-threatening physical condition. And physicians are now vulnerable to criminal charges, fines of hundreds of thousands of dollars, and even prison time should they try to provide evidence-based care to patients who need abortions.
Trump himself has certainly played a leading role in the crumbling of physician self-regulation. His appointees to the Supreme Court created the majority that struck down Roe v. Wade. His advice on combatting Covid-19 was often counter to that of his own experts, such as when he suggested injecting bleach.
And Trump is only doubling down on his attacks on the medical profession by courting the Make America Healthy Again movement. Make American Healthy Again is spearhead by vaccine-skeptic Robert F. Kennedy Jr., who promises to end the “FDA’s war on public health.” That may translate to ending fluoridation of water, against the recommendations of the American Dental Association and the Centers for Disease Control and Prevention. It will almost certainly mean a pressure to roll back approvals of vaccines and even removing some vaccines from the market, despite almost universal medical consensus of the importance of vaccinations against many illnesses. Kennedy, notably, does not have any medical expertise or training but will likely be empowered to “go wild” on health as Trump has stated.
There is also a concern that Trump will “clean house” at the federal agencies, removing civil servants he perceives as disloyal to himself and his agenda. During his last few months in office in 2020, Trump issued an executive order, “Schedule F,” that would have exempted from employment protections federal positions of “of a confidential, policy-determining, policy-making, or policy-advocating character.” This would have made it easy for Trump to replace up to 50,000 federal workers — including those in health-focused agencies with relevant degrees and years of training. By removing career civil servants, it will be easier for Kennedy, or another Trump appointee, to push through controversial, untested initiatives.
But Kennedy is not the only challenge to the medical profession’s control of health care in the coming years. This fall, in Braidwood v. Becerra, the 5th Circuit Court of Appeals concluded that the ACA improperly incorporated the preventive care recommendations issued by the U.S. Preventive Services Task Force (USPSTF), an independent, volunteer group of experts in diseases prevention and evidence-based medicine. The Appointments Clause of the Constitution, the 5th Circuit argued, prevents public policy from being driven by a group of experts who are not overseen by government officials and are not appointed as “officers of the United States” themselves.
Braidwood is alarming not only because it can undo the no-cost preventive care mandate but because right now many other public health and health policy standards are set by similar expert nongovernmental panels. Indeed, the Braidwood plaintiffs are attempting to widen this case to include review of the ability of the Advisory Committee on Immunization Practices and the Health Resources and Services Administration to also make recommendations regarding preventive care. This case will likely be argued in front of the Supreme Court set up by Trump to be skeptical of expertise, potentially one that may even include additional Trump appointees. The outcome may further limit the influence of medical and public health experts by preventing government agencies from being able to incorporate their recommendations, standards, and other conclusions into regulations.
At the state level, the same playbook that was used to shut physicians out of the regulation of abortion will be applied in other areas. Many states are already banning gender-affirming care, especially for minors. This term the Supreme Court will hear United States v. Skrmetti, which focuses on Tennessee’s ban on all gender-affirming care medical treatments for minors. These bans go against the recommendations of major American medical groups, such as the American Academy of Pediatrics, American Psychiatric Association, and the American Medical Association.
If the court upholds the ban on gender-affirming care, it could open the floodgates for states seeking to ban or limit access to politically disfavored health care. For example, the Braidwood plaintiffs argued that the provision of no-cost HIV pre-exposure prophylaxis promotes sexual promiscuity and intravenous drug use. A state, using a similar approach to banning abortion or gender-affirming care, could criminalize the provision of PrEP. Substance use treatments, IVF, and vaccines have all been politically controversial at times and may be caught in the crosshairs again.
These bans would likely come from the states — in part because under the police power they have broader latitude to regulate health care — and result in the medical profession losing control of best practices and standards of care. But the Trump administration will likely empower the state politicians and advocates looking to criminalize health care in part because Trump has already flagged banning gender-affirming care as a priority for his first day in office.
Much has been made of the particulars of Project 2025 and other Trump-connected plans for health care. Some, like the focus on chronic illnesses, may be good. But overall, Trump and his team show little respect for physicians and other public health experts. This comes at a time when the ability of the medical profession to self-regulate, including determining which treatments are appropriate to offer patients, is under attack.
Medical leadership must find ways in the next four years to regain public trust and to emphasize to the public that the patient and the physician, not the lawmaker, must be the health care decision-makers. Their ability to determine the scope of medicine may depend on it.
Carmel Shachar is an assistant clinical professor of law at Harvard Law School. She also serves as faculty director of the Health Law and Policy Clinic at the Center for Health Law and Policy Innovation of Harvard Law School.
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