This August the public learned two pieces of exciting medical news: The Food and Drug Administration had approved the first mRNA flu vaccine and an mRNA-based vaccine for melanoma had cleared a large-scale clinical trial. MRNA is the molecule that enabled scientists to develop the COVID vaccine in record time, saving millions of lives in the United States and many more throughout the world.

Neither achievement owes much, if anything, to Health Secretary Robert F. Kennedy, Jr. A year earlier, he had abruptly cancelled $500 million in funds for the development of mRNA vaccines, falsely declaring that “data show the vaccines fail to protect effectively against upper respiratory infections like COVID and flu.” Scientists using mRNA had to rely on private funding and foreign investment.

Kennedy’s decision exposed, once again, his dangerous ignorance about scientific inquiry. (Hint: It’s not seeking the opinion of discredited pundits.) Kennedy would do well to read the memoir of Katalin Kariko, the winner of the Nobel Prize for her work developing mRNA as a therapeutic agent.

Several reviewers read Kariko’s memoir as a story of triumph over adversity, and it certainly is that-- at least in part. She was born in January 1955, a year after Kennedy. Unlike his privileged childhood at the heart of the Kennedy clan, hers was spent in a small town in communist Hungary. The family lived in a one-room house without running water. When the local government forced Kariko’s father to leave his job as a butcher, he worked as a laborer. Because the secret police were everywhere, “one never quite knew who was listening.”

But communism had some compensations. Kariko had free health care and education through her doctoral degree and, after the birth of her daughter, excellent day care “for a nominal fee.” When her funding expired and she moved to the United States, she discovered that it was not the “bright and shiny” land she had imagined. Standing outside the locked gates of a community pool with her husband and daughter soon after their arrival, she realized that she had assumed that “we’d have access to everything the country offered. But now that we were here, I was beginning to understand. There were levels in America. We could be here, in this country, in this community, and still not be able to jump into a pool, even one that was right in front of us, even on a sweltering day.”

Moreover, the US scientific enterprise, unlike the one she had left in Hungary, was extremely pressured and fiercely competitive, basing evaluations on grants and publications rather than merit. Kariko worked first at Temple University under a tyrannical boss who yelled and slammed doors, valued her work only insofar as it benefitted him, and threatened her with deportation when she accepted a job at Johns Hopkins University. Instead, she moved to the University of Pennsylvania, where she worked for years in insecure and underpaid positions in various labs. She received the status and salary she deserved only after moving to a German biotech company, where she stayed for ten years.

Although Kariko’s book appeared too soon to mention the Nobel Prize in Physiology and Medicine she shared with her colleague, she chronicles the vast array of other awards and honors she received at universities, scientific institutes, and pharmaceutical companies. “All this attention, I didn’t need it,” she writes. “I hadn’t asked for any of it. I’d decided to value only the work itself—to do my work well and trust in where it might lead, even if it got there long after my own lifetime. Now, in an instant, here it all was: so much attention and gratitude, offering itself up to an extent that felt unreal.”

What Kariko can best teach Kennedy, however, is not how to overcome adversity but rather what scientific inquiry actually entails. She noted that working with RNA is exceptionally difficult because the material is fragile and short-lived. Nevertheless, she stressed, “Science is slow and repetitive even when you aren’t working with RNA.” She remembered her first job, in the chemistry laboratory at the prestigious Biological Research Center of the Hungarian Academy of Sciences: “I measured, I poured. I stirred. I heated and cooled and waited and watched. I prepared samples and mixed reagents and organized the freezer and washed endless amounts of laboratory glassware. And when I say that cleaning was endless, I mean it just never, ever stopped.”

Recalling the thousands of experiments she conducted at various Penn labs, she writes. “Maybe that sounds like a lot, but you have to understand how science works. . . In science, your overarching goal is to develop and tests hypotheses; to do this, you need results not from one single experiment but rather from a mountain of them. You need to do each experiment many different times, each time changing only one variable. For each experiment, you also need control studies, in which no variables are changed, so you have a point of comparison.”

To stay abreast of scientific breakthroughs and gain new insights for her own research, Kariko “read science journals all the time—hundreds of studies every month. I couldn’t get enough.” She often arrived at the laboratory long before her colleagues and left much later; occasionally she slept there. Although her health was often poor, she refused to take a break.

But Kariko does not credit her remarkable achievement solely to the indomitable drive and prodigious work ethic that enabled her to surmount the many obstacles she encountered. After chronicling her many awards and honors, she writes, “I believe my work made a difference. But for this to have been the case, so many things had to come together just so. There was so much luck involved. It makes me wonder: Who else was out there and didn’t have such luck? Who could use a little luck right now? What are we missing?” That is yet another message Kennedy should heed.

Many Trump loyalists justify his secrecy by noting that he is not first president to conceal serious health problems. The two presidents most frequently mentioned are Biden, who hid his cognitive difficulties until his disastrous debate performance exposed them to the world, and Franklin Delano Roosevelt. Although the deceptions of all three have received widespread criticism, Roosevelt’s charade (or “splendid deception,” in the words of historian Hugh Gallagher), must be considered within the context of the times.

Roosevelt was a 39-year-old handsome, charming politician when he was diagnosed with polio in 1921. Despite the widespread belief that his political career was over, he was elected president four times. He lost the use of both legs but gave the illusion of having overcome his impairments by demanding that journalists not photograph him in a wheelchair or walking with crutches and braces. In the history books, Roosevelt typically appears as radiantly healthy president.

Echoing the Horatio Alger myth, Roosevelt refused to admit to himself and others that hard work and determination could not always achieve recovery. Pursing arduous physical therapy long after doctors had concluded that it no longer could benefit him, he continued to believe he would be able to walk someday. He rejected his nomination to the Senate in 1926 because he was convinced that “my legs are coming back in such fine shape that if I devote another two years to them I shall be on my feet again without braces.” People living with post-polio disabilities who wrote to him for advice typically received this comforting reply: “You are making a brave fight for recovery and with this fine courage and determination you are bound to win.”

The polio crusade Roosevelt helped to launch disseminated a similarly upbeat message. Despite the devastation the disease inflicted on thousands of young lives, the massive fund-raising campaign told a story of triumph. The campaign was mounted by National Foundation for Infantile Paralysis (NFIP, later called the March of Dimes) founded in 1938 by Roosevelt and directed by Basil O’Connor, his former law partner. I remember the March of Dimes canisters prominently displayed on the counters of stores throughout my town. Most featured before and after photographs of adorable children. The 1946 poster child was “Donald,” shown first in a hospital bed with braces and bandages, staring forlornly at the outside world and then “striding briskly along, unsupported and radiating confidence.” Denial helped to sustain the myth that with enough willpower, combined with good medical care, polio survivors could overcome all obstacles. I was shocked to learn recently that “Donald” never achieved the full recovery the NFIP suggested.

The NFIP kept the level of enthusiasm high by drawing on the story of triumph not only for individuals but also for the scientists involved. We were continually promised an imminent research breakthrough. “The conquest of polio is now in sight,” the foundation claimed in 1949, five years before it launched the nationwide trial to test Jonas Salk’s vaccine.

Like Biden and Trump, Roosevelt undoubtedly believed that he could not be an effective president if the country knew about his physical weakness. But it also important to note that disability had extremely negative connotations throughout his presidency. “In our society” one sociologist wrote in 1963, “crippling not only signifies a relative loss of physical mobility but also suggests social abnormality, isolation, and, in the eyes of some, visible manifestation of inherent malevolence.” Although the 1930s, 1940s, and 1950s witnessed the first struggles by people with disabilities for dignity and equal rights, most disability activism was modest.

Roosevelt’s actions were consistent with the broader culture in another way as well. The 1940s and 1950s represented an era of denial. Parents of adopted children concealed the children’s birth stories from them as well as from most outsiders. Gay people remained in the closet. Both scientists and government officials insisted that the cold war national security state demanded the classification of a widening circle of knowledge. “Unwed” pregnant women were sent to institutions to hide the pregnancy and birth. Secrecy also was pervasive throughout medicine. A study conducted at the end of the decade found that 90 percent of physicians did not inform patients they had cancer. Some doctors used euphemisms, speaking of a “mass” or a “lesion,” rather than a “neoplasm” or “cancer.” A few asserted that a malignant tumor was benign. When treatment was necessary, doctors disclosed just enough information to obtain compliance. In that context, concealing physical impairments was not unusual.

Today we live in a very different world. Although many people with disabilities still experience shame, try to “pass” as able-bodied, and encounter discrimination, major pieces of legislation have promised them with equal access and protections. Moreover, public sharing of extremely personal information has become commonplace. In one week we recently learned that Alexandria Ocasio-Cortex was freezing her eggs, Brad Pitt had had suicidal ideation in the past, and Carly Simon had just received a Parkinson’s diagnosis.

Rather than being aligned with mainstream culture, Trump’s secrecy about his health expresses his long-standing belief that he can lie his way through any setback. As the journalist Thomas B. Edsall wrote in The New York Times, “Donald Trump can lay claim to the title of the most prodigious liar in the history of the presidency.”

His secrecy about his health also is connected to his grandiosity and MAGA’s alliance with toxic masculinity. Pete Hesgeth insists he must test the testosterone levels of his troops. He and Robert F. Kennedy, Jr. boast about the number of push ups they can do. Trump can’t be weak because that is the word he ascribes to anyone he considers his enemy.

On April 14, 2026, Jamie Raskin, Ranking Member of the House Judiciary Committee, introduced legislation to establish a Commission on Presidential Capacity to Discharge the Powers and Duties of Office. Under Section 4 of the 25^th Amendment, Congress can create a “body” that can declare the president is “unable to discharge the powers and duties of his office.” Although Republicans reject Raskin’s proposal, such a commission is long overdue.

Sources:

Jonathan Reiner, “I Was Dick Cheney’s Cardiologist. Trump Has Not Looked Well, and We Should Know Why,” New York Times, August 12, 2026.

Emily K. Abel, Sick and Tired: An Intimate History of Fatigue (University of North Carolina Press, 2021).

Margaret K. Nelson, Keeping Family Secrets: Shame and Silence in Memoirs from the 1950s (New York University Press, 2022).

Thomas B. Edsall, “This Is Why Trump Lies Like There’s No Tomorrow,” New York Times, June 28, 2023.

House Committee on the Judiciary, “Ranking Member Raskin Introduces Legislation Establishing Independent Commission on Presidential Capacity,” April 14, 2026, https://raskin.house.gov/2026/4/ranking-member-raskin-introduces-legislation-establishing-independent-commission-on-presidential-capacity

This is not Kennedy’s first attack on anti-depressants. He previously stated that they are more difficult to quit than heroin and that the drugs cause mass shootings. During his presidential campaign, he suggested that people with depression, along with those who have been diagnosed with ADHD or misuse drugs, should be sent to “wellness farms,” where they would grow their own organic food “because a lot of behavioral issues are food related.”

“Some of [Kennedy’s] recommendations are completely reasonable,” states Vera Feuer, a child and adolescent psychiatrist. Those include encouraging providers to inform patients about both the risks of antidepressants and how to safely taper off them. Mental health experts also acknowledge that little evidence-based research exists about the long-term effects of anti-depressants and the best way to discontinue their use.

Nevertheless, as Stephen B. Soumerai, a professor at Harvard Medical School, and Christine Y. Lu, a professor at the Sydney Pharmacy School at the University of Sydney, write, “Antidepressants aren’t perfect; no drug or treatment is. But as with vaccines, they are proven to save lives, to be of enormous value, and to have benefits that vastly outweigh any downsides.” Other mental health advocates and providers warn that Kennedy is simplifying an extremely complex problem.

Although numerous commentators point to the similarities between Kennedy’s fight against antidepressants and his campaign against vaccines, we hear little about the extent to which his disparagement of antidepressants also reflects widespread attitudes about depression. According to the National Academies of Sciences, Engineering, and Medicine, psychiatric disorders “are among the most highly stigmatized health conditions in the United States, and they remain barriers to full participation in society in areas as basic as education, housing, and employment.” People with depression may be especially reviled. “The fact is that most people are appalled by depression,” observes Andrew Solomon in his bestselling and award-winning book, The Noonday Demon. “Though some respond to a display of depression with increased sympathy and altruism, more respond with revulsion and disgust.”

The high premium placed on happiness in the United States helps to explain why depression generates such negative emotions. “The Declaration of Independence” asserts that we are entitled not only to “life and liberty” but also to “the pursuit of happiness.” If happiness eludes us, we have an obligation to strive for it. The positive psychology movement purports to explain how we can do so. The founder was Martin Seligman, the psychologist credited with developing the theory of learned helplessness. The author of Authentic Happiness as well as a host of other academic and self-help books, Seligman directs the Positive Psychology Center at the University of Pennsylvania. The center offers courses and training programs and sponsors research on such topics as grit, resilience, positive health, and the science of imagination.

The movement has rapidly spread to other colleges and universities. In 2018, Yale introduced a course titled “Psychology and the Good Life,” which sought to make not only individual students but also the entire campus happier. With 1,200 students (nearly a fourth of the undergraduate student body), it was Yale’s most popular class ever. Outside academia, articles in mass circulation magazines, TED talks, and such television programs as the Oprah Winfrey Show introduce the basic tenets of positive psychology to a large swath of the population. As the historian Daniel Horowitz writes, “It is hard to think of an academic specialty at the end of the twentieth century and the beginning of the twenty-first that so fully entered the popular realm and so greatly affected the lives of millions of people worldwide—one that, in effect, became a cultural movement.”

The anthropologist Emily Martin demonstrates that we view the manic phase of bipolar disorder in a far more positive light than the depressive. Mania is characterized by volubility, restlessness, risk-taking, unbounded energy, self-confidence, and enthusiasm. Because those qualities can enhance productivity and creativity, they are considered essential for success in the entertainment and business worlds.

Manic qualities are deemed especially desirable when they manifest as hypomania, a mild version of mania not linked to mental illness. John D. Gartner, a psychologist and author, celebrates the hypomanic traits of men (and only men) from each century who helped to make the country great--Christopher Columbus, John Winthrop, Alexander Hamilton, Andrew Carnegie, and Craig Venter. “Their irrational confidence, ambitious vision, and unstoppable zeal,” he claims, were necessary to change “the course of our history.”

Kay Jamison, professor of psychiatry at the Johns Hopkins School of Medicine, cites John Muir and Theodore Roosevelt to illustrate the benefits of what she calls “exuberance”: “Infectiously enthusiastic, stupendously energetic, they left the country a wilder and more beautiful place because of their vision and action.” By contrast, she describes depression as “the draining out of vital forces.”

Depression also is associated with weakness, a characteristic the Trump administration deplores. Even family members who devote themselves to caring for a person with depression occasionally wonder if the real problem is a lack of inner strength. The writer Nell Casey lovingly tended her sister during her serious bouts of serious depression. “And still,” Nell later confessed, “there are always private suspicions in the presence of the depressed: Is this person just spiritually weaker? And I stronger? Couldn’t it be worse? You have life! You have health!” Watching her sister “shuffle down hospital corridors—dirty sweatsocks, toes knocking into the backs of her ankles as she saunters up and down to nowhere,” Nell wants to shout, “Oh, for chrissakes, pick up your feet!”

Glorifying strength, power, and even brutality, the current administration can have no sympathy or compassion for people with depression. Trump often justifies his actions by saying he doesn’t “want to look weak”; he routinely calls anyone he dislikes “weak” as well as “stupid.” Announcing his plan to test the testosterone levels of men over 30, Pete Hesgeth explains that he wants his troops to be “strong, resilient and capable” to keep them at “the leading edge of lethality.” RFK, Jr. regularly posts pictures of his muscles as well as the strength training routine that has produced them. It is thus perhaps unsurprising that he views depression as a personal failing, needing only lifestyle changes, rather than a serious mental health condition requiring professional help, including, in some instances, medication.

Theresa Miskimen Rivera, president of the American Psychiatric Association, states that Kennedy “really ignores the larger reality, which is that too many patients really cannot access timely, comprehensive care that is needed for our nation.” Barriers to care include not only cost and the lack of providers but also the stigma surrounding depression. If Kennedy’s rhetoric and recent actions intensify that stigma, he will deter many more people from seeking essential help.

Sources:

National Academies of Sciences, Engineering, and Medicine; Division of Behavioral and Social Sciences and Education, “Overview,” Ending Discrimination Against People with Mental and Substance Use Disorders: The Evidence for Stigma Change (2016), www.nap.edu/catalog/23442/.

Andrew Solomon, Noonday Demon (Scribner, 2001).

Emily Martin, Bipolar Expeditions: Mania and Depression in American Culture (Princeton University Press, 2007).

Nell Casey,” Wish You Were Here,” in Unholy Ghost: Writers on Depression, ed. Nell Casey (New York: Harper, 2001).

Positive Psychology Center, “Our Mission,” https://ppc.sas.upenn.edu/our-mission.

David Shimer, “Yale’s Most Popular Class Ever: Happiness,” New York Times (January 26, 2018).

Daniel Horowitz, Happier: The History of a Cultural Movement that Aspired to Transform America (Oxford University Press, 2018) 5.

Sarah Ahmed, The Promise of Happiness (Duke University Press, 2009)

Barbara Ehrenreich, Bright-Sided: How Positive Thinking Is Undermining America (Henry Holt, 2009).

John D. Gartner, The Hypomanic Edge: The Link between Craziness and Success in America (Simon and Schuster, 2005).

Curtis E. Hartmann, “Unholy Ghost: Writers on Depression,” https://psychiatryonline.org/doi/10.1176/appi.ps.53.1.106.

Rhitu Chatterjee, “Psychiatrists Say RFK Jr.’s Take on SSRIs Is an ‘Oversimplification’ of The Problem,” NPR May 7, 2026.

Stephen B. Soumerai and Christine Y. Lu, “RFK Jr.’s War on Antidepressants Is Coming—and It Will Cost Lives,” StatNews, January 7, 2026.

Chelsea Cirruzzo and Lizzy Lawrence, “HHS Presses Ahead with Effort to Curb Antidepressant Use,” StatNews, July 13, 2026.

The website claims that increased physical activity combined with “real food” and something called “real life” will enable Americans to get to the “root cause” of disease. They will do no such thing. Medical researchers increasingly focus on the “social determinants” of health, including poverty, stress, poor working conditions, lack of access to good food and health care. Although the website claims that there are “No Excuses” for not exercising or eating healthier food, plenty exist. People who live in dangerous neighborhoods far from parks may decide the safest thing to do is to stay inside. Those who have extensive childcare responsibilities and long work hours often lack the time to engage in physically activity. And the many people who live in areas without supermarkets or grocery stores cannot buy healthy, fresh food.

By exhorting everyone to “Take Back Your Health,” the website also diverts attention from the government’s role in reducing health care access. The failure to extend the Affordable Care Act subsidies led to an average increase of 58 percent in premiums in 2026. As a result, approximately three million people dropped their coverage. Premiums are expected to rise again in 2027.

The photographs on the website change regularly, but three are especially noteworthy. One features RFK, Jr. and Pete Hesgeth looking fit and smug in T-shirts, suggesting a link between exercise and the manosphere; the recurrent use of the word “stronger” makes the same point.

In another photo Kennedy, this time dressed in a shirt and tie, pulls himself up on a high bar. This photo presumably calls attention to the “Pete & Bobby Challenge,” which urges “every American to Get Active, push their limits, and discover what they’re capable of.” The goal is to do 100 push-ups and 500 pull-ups in ten minutes or less. Every American? The high prevalence of disabilities, including fifty percent of those 75 and older (the fastest growing group), makes this an insensitive recommendation for a high proportion of the population.

The third photo displays Kennedy gazing at a national park, a reminder that visiting a national park is high on his list of good ways people can increase physical activity. Does Kennedy really not know that the parks are underfunded and overcrowded (“like LA at rush hour,” one visitor recently reported). After the “One Big, Beautiful Bill” cuts, the National Park Service lost nearly a quarter of its workforce. While attendance at the parks has soared, they now have approximately $24 billion in deferred maintenance. Trump has long advocated returning public lands to private interests, and his administration has diverted $67 million of park funds to his “beautification” projects, including those at the White House.

Some commentators remind us that advice to get more exercise is not new. Every president since Eisenhower has made the same plea. A recent New York Times article dates our current fitness craze to the decade between 1972 and 1982.

In fact, we can go back much farther. After the Civil War, enthusiasm for “physical culture” (a term akin to “physical fitness”) swept many sectors of American society. As compulsory public education expanded rapidly, a growing proportion of schools instituted physical education. Trained coaches and teachers gradually replaced the physicians who previously directed exercise regimens. In 1892, public schools in 83 cities employed a total of 137 specialists. By 1904, more than 100 settlement houses existed; most provided children and adolescents with other opportunities for supervised athletic recreation.

The American Association for the Advancement of Physical Education (later the American Alliance for Health, Physical, Education, Recreation and Dance), established in 1885, announced that its goals were “to awaken a wider and more intelligent interest in Physical Education; to acquire and disseminate knowledge concerning it; and to labor for the improvement and extension of gymnastics, games, and athletic pastimes in the education of children and youth.” Organized sports also grew. The National Association of Base Ball Players was established in 1867, the Rowing Association of America in 1871, the National Bowling League in 1875, and the National Association of Amateur Athletes of America in 1879. And people of all ages flocked to gymnasiums, where they trained and strengthened their muscles with the help of health lifts (weight lifting machines).

Although advocates argued that everyone needed strenuous physical activity, they deemed it especially critical for those who showed signs of neurasthenia, a term previously used for mental and physical exhaustion believed to be caused by a lack of nervous energy. After neurologist George Beard identified neurasthenia as a distinct disease entity in 1869, more and more people stressed the importance of strengthening muscles to combat the deleterious effects of excessive brain work.

Noting that children as well adults were at risk of neurasthenia, physical education advocates raised the alarm about the impact of mental strain and overwork at school. An 1885 article in The Sanitarian, a New York City public health journal, asserted that parents who believed education was “solely a matter of books and school-rooms… exhaust the children’s brains and nervous system with complex and multiple studies, and ruin their bodies by protracted imprisonment.” A Philadelphia doctor who studied the contribution of overwork to nervous disease found that more than one tenth of children suffered from nervousness. A major solution was to require various forms of exercise throughout the school day.

The belief in exercise as a neurasthenia cure also added to the lure of the west. Health seekers sent back glowing accounts not only of restorative scenery, but also of eating and sleeping outdoors, riding horses, and hunting buffalo, conquering ill health while conquering other forms of nature. Theodore Roosevelt’s apparent success in transforming himself from a sickly child into a vigorous cowboy provided a model for many men diagnosed with neurasthenia. Among them was Owen Wister, one of neurologist Weir Mitchell’s patients. Wister is best known for his famous cowboy novel, The Virginian, which he dedicated to his friend, Theodore Roosevelt. Set in Wyoming in the 1870s and 1880s, the book chronicles the adventures of the hero, known only as the Virginian. By the end of the book, he has vanquished his enemy and rescued a New England school teacher, whom he later marries. Published in 1902, the book sold 300,000 copies in its first year.

Exhortations to people to engage in more physical exercise have a long history, but they cannot solve the health problems that beset Americans. For that we need broad social and economic reforms, vaccine endorsements and mandates, and health care for all.

“Get Active,” getactive.gov.

Danielle Friedman, “The Decade that Changed Fitness Forever,” New York Times, January 14, 2025.

Grace Sparks, Lunna Lopes, Alex Montero, Marley Presiado, and Liz Hamel, “Americans’ Challenges with Health Care Costs,” KFF, April 30, 2026.

Jen Rose Smith, “’LA at Rush Hour.’ American National Parks Feeling the Strain thus Summer,” CNN, July 20, 2026.

Maxine Joselow and Andrea Fuller, “National Park Entrance Fees Are Funding Trump’s D.C. Projects,” New York Times, May 27, 2026.

Emily K. Abel, Sick and Tired: A Intimate History of Fatigue (University of North Carolina Press, 2021).

Cynthia Cox, “ACA Marketplace Enrollment Is Down by 3 Million after Big Jump in Premium Payments,” KFF, June 29, 2026.

“In Preliminary Rate Filings, ACA Marketplace Insurers Largely Propose Double-Digit Premium Increase for 2027, Following a Steep Climb This Year,” KFF, July 8, 2026.

Before the mid-19^th century, abortion in the U.S. generally was treated according to common law tradition which held that the procedure was legal before “quickening” (when fetal movement could be discerned). Abortions procured after quickening might be viewed as high misdemeanors for the abortionist if the woman died but they rarely were considered felonies. Prosecutions for women procuring abortions were unusual.

From the 1840s through the 1860s some states began to impose stricter regulations to punish abortionists but, still, rarely the pregnant woman involved. For example, the Iowa Supreme Court ruled in 1863 that the state law regulating abortion did not apply if the pregnant woman induced the procedure. In 19^th century medical and popular beliefs, a delayed menstruation could have various causes other than pregnancy, and women often sought abortions because they believed such delays endangered their general health. Thus, for decades in the 19^th century, U.S. abortion continued to be quietly practiced in private life and occasionally acknowledged in public discourse.

Information about pills, powders, oils, and potions as well as written instructions for their abortifacient use circulated widely, albeit often quietly, in U.S. newspapers, advertisements, books, pamphlets, and circulars. Material about abortion was frequently included with equally desirable (and equally semi-licit) information about contraception. Itinerant lecturers, male and female, crisscrossed swaths of rural and urban America speaking on sexual, physiological, anatomical, marital, and maternal matters. Some quietly dispersed information about procuring abortion (and some quietly sold abortifacients).

By today’s standards, of course, the nineteenth century’s abortion methods were far from safe or reliably effective. However, the dangers of those methods need to be assessed against the dangers of repeated pregnancies and childbirth in earlier eras. The continuing availability, indeed the growth in the numbers of purported abortifacients document the public’s continued willingness to try them—and to persevere in those trials even as the laws about abortion fluctuated.

In 1873, Congress passed the “Comstock Law” to suppress obscene literature and “articles of immoral use,” making it a felony to provide information about contraception and abortion. As a result, numerous states strengthened their laws against abortion, in some cases punishing the recipients as well as the senders of illegal information, books, medicines, and instruments. The forbidden articles included “any article whatever for the prevention of conception or for causing unlawful abortion.” Until the Supreme Court’s 1973 Roe v. Wade ruling, abortion was illegal, although prosecutions varied greatly by place and over time. Sporadic and unpredictable as they were, the prosecutions were often well-publicized, especially if they focused on the abortionists.

Mifepristone is far safer and far more predictably effective than earlier abortion medications. Like them, it is available by mail. As a result, women do not have to travel to designated medical clinics or providers (which do not exist in some states); they do not have to take off time from paid employment; and they do not have to face harassment from anti-abortion protesters outside medical facilities.

Although the drug has been legal in Europe for several decades, it did not win approval from the Federal Drug Administration (FDA) until 2000, and for many years women seeking mifepristone were required to visit an authorized medical facility and to undergo a medical examination. Access to the medication changed dramatically in December 2021 when court rulings made it legally obtainable through the mail via “telehealth.” Today, mifepristone’s “telehealth home abortions provide 67 percent of all US abortions. That is why anti-abortion activists focus on removing mail access to mifepristone even as its overall legality also comes under increasing attack. Since 2020, thirty-seven states have preserved the legality of the drug; thirteen have outlawed it, and twenty-six have restricted its availability.

Meanwhile, controversies surrounding all forms of abortion have escalated. In the summer of 2021 a new Texas law allowed citizens to file civil suits against those who aided access to abortion. Some anti-abortion activists have even proposed resuming enforcement of the Comstock law. In response, pro-abortion groups have used new forms of resistance including advocating for the adoption of state “shield laws” to protect those who provide abortion information or pills across state lines.

The Supreme Court, too, has become increasingly involved in the mifepristone battles. In January 2021 the Court reinstated restrictions on mail order mifepristone but then loosened them three months later. After the Fifth Circuit Court upheld a Louisiana law removing mail order access to mifepristone in May 2026, the Court issued a stay. At this time, therefore, the new attempts to reinstate national rules against mail order dispensing of mifepristone have been put on hold. The pause is not a victory for advocates of mifepristone. Rather, abortion opponents’ focus on removing mail order mifepristone is a first step in the broader goals of outlawing any medication abortion even in states where abortion is legal.

Whatever the near future holds, American women today, like those in the 19^th century, remain committed to obtaining abortions, while advocates continue to challenge attempts to outlaw them.

Sources

Anna Bernstein, Kimya Forouzan, Emma Stoskopf-Ehrlich, “Attacks on Shield Laws are the Next Step in Criminalizing Abortion Care,” Guttmacher, Sept. 10, 2025.

Borris, Eileen, “History on Trial: the Abortion Wars,” Women’s History Review, 19 Oct. 2022.

Brodie, Janet Farrell, “Mifepristone in the Context of American Abortion History,” Women and Politics 24:3 (2002): 101-119.

Brodie, Janet Farrell, “Menstrual Regulation in the Nineteenth-Century U.S.,” in Etienne Van deWalle and Elisha P. Renne, Regulating Menstruation: Beliefs, Practices, Interpretations. University of Chicago Press, 2001.

Brodie, Janet Farrell, Contraception and Abortion in 19^th-Century America. Cornell University Press, 1994.

Cohen, Patricia Cline, “What the Dobbs Decision Got Wrong Abou the History of Abortion Law Before Roe,” Washington Post, June 24, 2022.

Crighton, Elizabeth and Martina Eberto, “RU486 and Abortion Practices in Europe: From Legislation to Access,” Women and Politics, Oct. 15, 2008.

“FDA v. Alliance for Hippocratic Medicine, Harvard Law Review, 138:1, Nov. 2024.

Kelliher, Rebecca, Just Pills:” the Extraordinary Story of a Revolution in Abortion Care . Beacon Press, 2025.

Mohr, James C., Abortion in America; the Origins and Evolution of National Policy. Oxford University Press, 1978.

Reagan, Leslie J. When Abortion Was a Crime. University of California Press, new edition 2022.

Storer, Horatio R., On Criminal Abortion in America, J. B. Lippincott, 1860.

Mary Ziegler, After Roe: the Lost History of the Abortion Debate. Harvard University Press, 2015.

Janet Farrell Brodie is professor emerita of US history at Claremont Graduate University. Her most recent book is: The First Atomic Bomb: the Trinity Site in New Mexico (University of Nebraska Press, 2024).

The social model undergirds the decades-long fight for the passage of laws providing equal access and protections for people with disabilities. Congress passed the 1990 Americans with Disabilities Act, prohibiting discrimination against people with disabilities in jobs, schools, transportation, and many other places, only after people with disabilities shed their assistive devices and crawled on their hands up the Capitol Building stairs. Two years later Judith Heumann, a pioneering disability activist, led a 26-day sit-in at the Department of Health, Education, and Welfare (DHEW, now DHHS, the Department of Health and Human Services) in San Francisco, demanding that the government issue regulations implementing Section 504 of the 1973 Rehabilitation Act, which prohibits discrimination against people with disabilities in federally funded programs. And parents and advocates campaigned for years to allow children with various disabilities to sit beside other students in “mainstream” classes.

Two actions by the Trump administration in June 2026 threaten those advances. The first is the transfer of special education programs from the Department of Education to DHHS, led by Robert F. Kennedy, Jr. Those programs provide more than $15 billion through the 1975 Individuals with Disabilities Education Act to guarantee that children with disabilities have the right to a “free and appropriate education.” Michael Yudin, who served as assistant secretary of the Office of Special Education and Rehabilitation under President Obama, protests that special education “is not a health issue, this is not a medical issue, this is about educating kids with disabilities. We’re talking about making sure kids get a free, appropriate education in the least restrictive environment. What about health does that?”

The concerns cross party lines. Stephanie Smith Lee led the Office of Special Education Programs during the George W. Bush administration. “Children with disabilities are not a diagnosis,” she said. “These are students first and they need to be educated and they need to be educated alongside their general education peers—and the federal offices that oversee the education need to be in the same department.”

Disability activists also point to RFK, Jr.’s offensive comments about children with autism as a reason to keep special education outside his purview. In April 2025 he stated they “are kids who will never pay taxes, they’ll never hold a job, they’ll never play baseball, they’ll never write a poem, they’ll never go out on a date.” Although he later said that he was referring only to children with the most profound conditions, the damage was done. He also fueled fears of autism by citing greatly inflated figures on the recent rise of diagnoses, ignoring the broadening definition of the condition, the most obvious reason for the increase.

The second action was the release of a memo by the Department of Justice’s Office of Legal Counsel challenging the reigning interpretation of the 1999 Supreme Court decision in Olmstead v. L.C. That decision held that people with disabilities have a right to services in the community and cannot be forced to enter institutions. The Court explained that its ruling in the case “reflects two evident judgments.” The first is that “institutional placement of persons who can handle and benefit from community settings perpetuates unwarranted assumptions that persons so isolated are incapable of or unworthy of participating in community life.” The second is that “confinement in an institution severely diminishes the everyday life activities of individuals, including family relations, social contacts, work options, economic independence, educational advancement, and cultural enrichment.”

The decision helped to drive a dramatic change in Medicaid funding from institutions to home- and community-based services (HCBS). (Medicaid, a means-tested program for low-income people, is the major source of government funding for long term care.) Medicaid initially was based on an institutional model, appropriating only a negligible amount to HCBS. Even before the ruling, the government slowly began to correct that imbalance, most notably through a provision allowing states to apply for waivers to include more homecare under Medicaid. Olmstead accelerated the trend. The proportion of Medicaid funds directed to non-institutional services grew from 27 percent in 2000 to 45 percent in 2018. Today, nearly 75 percent of Medicaid recipients of long-term care use only home- and community-based services.

Robin Bolduc explains the benefits of providing care at home. She is a 69-year-old woman caring for her 72-year-old husband Bruce Goguen, who is quadriplegic and uses a ventilator to breathe. Both Robin and Bruce are eligible for Medicare, but that program covers only their doctors’ appointments and Bruce’s many medical procedures. Medicaid pays for his attendant care and all his medical equipment, including a wheelchair, ventilator, oxygen, and shower chair. “Medicaid allows him to live in our home rather than a nursing home or in a hospital,” Robin said. “He can be an important person in the lives of me, his children and his grandchildren. We have friends. We interact with neighbors. We have our dogs. We have a good life despite our challenges.”

But now the Department of Justice has declared that neither Section 504 of the 1973 Rehabilitation Act nor the 1990 Americans with Disabilities Act requires states to provide HCBS to people with disabilities who need support. Although the Office of Legal Counsel cannot change the law, the Executive Branch must follow its judgment. As a result, many people with disabilities who need care their families cannot provide will have to enter institutions. Others will receive no care at all. Nursing homes funded by Medicaid have lengthy waiting lists. And the supply of all nursing homes is contracting even as the population rapidly ages.

It easy to understand why the memo has appeared. The 2025 “One Big, Beautiful Bill Act” reduced Medicaid funding by $1.8 billion over ten years. Although HCBS are cheaper than institutional care, their rapid expansion means that they are the obvious ones to cut. Moreover, conservative policy makers have long disliked HCBS because they lack natural gatekeepers. Although few people willingly enroll in institutions, the fear is that the availability of HCBS encourages individuals to “come out of the woodwork” to demand care they might not otherwise want or need.

The memo also reflects Trump’s long history of demeaning people with disabilities. According to his nephew Fred Trump, he suggested that “maybe” people with disabilities “should just die.” In his first term, Trump mocked a journalist with disabilities and insisted on excluding wounded veterans from military parades because “Nobody wants to see that.” In September 2023, he questioned the choice of Luis Avila to sing “God Bless America” at General Mark Milley’s retirement party. Avila lost a leg, experienced brain damage, and had two heart attacks and two strokes during five combat tours. Trump asked Milley “Why do you bring people like that here? No one wants to see that, the wounded.” Unlike home- and community-based services, institutions keep people with disabilities out of sight.

During the 2024 campaign Trump often referred to both Biden and Harris as “mentally disabled” while touting his own genetic superiority. He also promised, “For those [unhoused people] who are severely mentally ill and deeply disturbed, we will bring them back to mental institutions, where they belong.” Trump’s July 25, 2025 Executive Order, “Ending Crime and Disorder on American Streets,” directed federal agencies to facilitate the commitment of unhoused people with mental health problems and substance use disorders to long-term institutions for “humane treatment.” (He never mentioned where he would find such facilities or the money to pay for them.)

Disability is not the story of someone else,” writes Kim E. Nielsen, a prominent historian of disability. “It is our story, the story of someone we love, the story of who we are or may become, and it is undoubtedly the story of our nation.” According to the US Census Bureau, 13 percent of Americans live with a disability, and the prevalence increases sharply with age. The number of people with a disability increases from 0.8 percent for those under five, 6.2 percent for those 5 to 7, 8.3 percent for individuals 18-34, 12.6 percent for people 35 to 64, 24.3 percent for those 65 to 74, and 45.9 percent for individuals 75 and over. We all have a stake in ensuring that the government treats everyone living with a disability with dignity and respect and endows them with equal rights.

Sources:

Cory Turner, “Trump Actions Signal Move toward Institutionalizing Disabled People, Advocates Warn,” Associated Press, July 1, 2026.

“DOJ Memo Stokes Fear among Disability Advocates of a Return to Institutionalization,” NPR, June 20, 2026.

Kim E. Nielsen, A Disability History of the United States (Beacon, 2022).

US Census Bureau, “Disability Status by Age Group,” April 14, 2024, https://www.census.gov/library/visualizations/2024/comm/disability-status-age-group.html

“Information and Technical Assistance on the Americans with Disabilities Act,” archives, US Department of Justice, Civil Rights Division, https://archive.ada.gov/olmstead

Michael C. Bender and Sheryl Gay Stolberg, “Disability Groups Fear RFK Jr.’s New Special Education Role,” New York Times, June 20, 2026.

Bobbi Dempsey, “’I Don’t Know How We Would Survive,’” New York Times, September 12, 2025.

Alice Burns, Abby Wolk, and Molly O’Malley Watts, “A Look at Waiting Lists for Medicaid Home-and Community-Based Services, from 2016 to 2025,” KFF Health News, November 20, 2025.

Mark A. Unruh, Vincent Mor, and Hye-Young Jung, “Colliding Forces—the Aging of the Baby Boom Generation and Contracting Nursing-Home Supply,” New England Journal of Medicine, 395, no. 2 (July 4, 2026).

In his first term, Trump attempted to end TPS for people from El Salvador, Honduras, Nepal, Nicaragua, and Sudan. The Biden administration rescinded those terminations. But soon after Trump returned to the White House, Kristi Noem, then DHS Secretary, announced plans to strip TPS from people from thirteen countries, including Venezuela, Haiti, Honduras, Nicaragua, Afghanistan, Cameroon, and Syria.

Civil rights groups filed numerous lawsuits to preserve the legal protections for people from those countries. In addition, on October 2 more than 100 Democratic members of Congress led by Senator Elizabeth Warren sent a letter to Kristi Noem, Health Secretary Robert F Kennedy Jr. and Labor Secretary Lori Chavez-DeRemer, protesting the TPS revocations and warning that “the most vulnerable Americans in need of healthcare will pay the price.” The following day the Supreme Court granted Noem’s request to remove TPS from the 600,000 Venezuelans living in the US.

The DHS first designated Haiti a TPS country in 2010, after a catastrophic earthquake killed hundreds of thousands of people and caused devastating damage. Two years later Syria received the same designation after “a brutal crackdown” by dictator Bashar al-Assad led to “deteriorating conditions.” DHS repeatedly extended both designations until Trump reentered the White House. Soon after his return, Haitian nationals filed suits in Washington, D.C. and New York to stop the terminations. Federal judges in both cities barred the Trump administration from ending legal protections for Haitian immigrants.

Mullin v. Doe overturned those decisions. Writing for the majority (which included Justice Amy Coney Barrett, the mother of two adopted children from Haiti), Justice Samuel A. Alito, Jr. claimed that although virtually all Haitians are Black, the decision did not violate the equal protection clause. He also argued that President Trump’s many statements about Haitians did not influence the Court because they were not “overtly racial.” In her dissent, Justice Elena Kagan expressed incredulity, noting that Trump’s comments were “so repellent and racially inflected that the majority declines to put them in print.” The remarks “fairly shout. . .that race entered into the President’s resolve to remove Haitians from this country,” including the following: Haitians in Ohio were “eating” neighbors’ pets; Haitians “probably have AIDS”; Haiti is a “shithole country,” which is “filthy, dirty, disgusting”; Haitian immigration is “like a death wish for our country; and Haitians are “poisoning the blood of the nation.” Justices Sonia Sotomayor and Ketanji Brown Jackson joined Kagan’s dissent.

The Supreme Court ruling will have a drastic impact on health services, especially in states with high concentrations of Haitians (Florida, New York, and Massachusetts). In 2023, 111,000 health care workers were Haitians. Most worked in elder care. According to Florida’s major health care union, thirty percent of the nursing home workers it represents will now be liable for expulsion.

Abigail Jackson, a White House spokesperson, justifies the TPS terminations this way: “There is no shortage of American minds and hands to grow our labor force. President Trump’s agenda to create jobs for American workers represents this administration’s commitment to capitalizing on that untapped potential while delivering on our mandate to enforce our immigration laws.” Studies by economists report that aggressive campaigns to deport immigrants often result in Americans losing their jobs. As Marcela Escobari, a researcher at the Brookings Institution, writes, “Immigrant and native workers are not simply substitutes for each other. They are complements. When you remove one, you often undermine the other.” American employees lose their jobs when the departure of immigrant workers forces nursing homes to close.

Moreover, Rachel Blumberg, the president and CEO of a senior residence in Boca Raton, Florida, points out that Americans “don’t want” the jobs she offers. “That’s why we’re so dependent on immigrants.” Because the United States tries to provide long-term care services on the cheap, the remuneration is paltry. In 2023 the median hourly wage was $13.50; the median annual income was $25,275. The many workers who can find only part-time employment must piece together several jobs, often working far more than 40 hours a week. Benefits are either inadequate or nonexistent. Since the TPS terminations began, Blumberg has had to dismiss 38 employees representing nine percent of her staff.

It will not be easy to find replacements. As Katie Smith Sloan, President and CEO of Leading Age, the national association of providers of services for older people, writes, “There is no workforce waiting in the wings capable of replacing the long-standing relations, in some cases built over years and even decades, that are so vital to quality care.” Jill Miller has lived in a Virginia not-for-profit-elder-care facility for eight years with her husband Carl. Asked what she thought about the loss of immigrant workers from TPS-designated countries, she responded, “I just can’t even imagine the impact it would have on those of us that are cared for on a daily basis if we were to suddenly lose them. They’re the backbone.”

Another reason Blumberg may be unable to fill the vacancies left by Haitian workers is that the TPS terminations have aggravated the labor shortage in long-term care. Both nursing homes and home-based services have lengthy waiting lists. The shortage is expected deepen as the population continues to age rapidly. Two prominent policy experts, Andrew R. Olenski and David C. Grabowski, estimate that the US will have a shortage of 2.9 million direct care workers (nursing assistants, home health aides, and personal care aides) by 2040. Mortality rates rise when nursing homes cannot hire sufficient staff and older and disabled people cannot find anyone to assist them at home. The direct-care labor shortage also means more work for family carers, many of them already are overwhelmed by unsustainable responsibilities.

Older Americans and their families are not the only ones who will suffer. People in Haiti who have relied on remittances from the US will lose essential income. And conditions in Haiti are so dangerous that the State Department advises Americans not to travel there. Although DHS Secretary Markwayne Mullin promises to provide air fare for Haitians willing to leave, no commercial airline flies to Port-au-Prince, the capital city. Mike DeWine, the Republican Governor of Ohio, explains why he considers the Supreme Court decision a “mistake”: “The situation in Haiti could hardly be much worse. The violent gangs run most of the country. The government barely functions. And the economy is in shambles.” Haitians who have devoted their lives to caring for older Americans may find no one to care for them when they are in need. According to Doctors without Borders, “Since violence escalated in early 2024, more than 60 percent of medical facilities in Port-au-Prince have been closed or are only partially functioning. Some have been looted, burned, and abandoned, while others face critical shortages of supplies, medicines, or staff. Many people are too afraid to seek health care, even if they are in urgent need.” The conditions elsewhere in the country are no better: “More than 1.4 million people in Haiti are internally displaced by the violence, having fled their homes to other parts of the country. Many are sheltering in areas without adequate medical care or other essential services.”

On January 29, 2025, nine days after President Trump’s second term began, he signed the Laken-Riley Act to facilitate the deportation of immigrants accused of crimes. “It’s a landmark law that we’re doing today,” he remarked. “It’s going to save countless lives.” In fact, his immigration policies have done just the opposite. The recent Supreme Court decision endorsing those policies threatens countless lives, including those of both older Americans in need of health care and Haitian immigrants forced to return home.

Sources:

Council on Foreign Relations, “What Is Temporary Protected Status?” July 9, 2025, https://www.cfr.org/backgrounder/what-temporary-protected-status

Michael Sainato, “Trump Gutting Protected Status for Immigrants Will Strain US Healthcare, Democrats Warn,” Guardian, September 30, 2025.

David M. Cutler, “Trump’s Most Important Health Policy May Be at the Border, JAMA Health Forum, February 27, 2025

Alice Miranda Ollstein, “’They’re the Backbone’: Trump’s Targeting of Legal Immigrants Threatens Health Sector,” Politico, May 31, 2025.

Andrea Hu, “She’s Cared for America’s Elderly for Decades. Trump Wants Her Gone by Sept. 8,” NPR, August 22, 2025.

Madeleine Ngo, “Trump’s Immigration Crackdown Hits Senior Care Work Force,” New York Times, July 18, 2025.

Lenore S. Azaroff, Steffie Woolhandler, and SharonTouw, “Deporting Immigrants May Further Shrink the Health Care Workforce,” JAMA, April 3, 2025.

Leading Age, “Supreme Court Ruling on Haiti, Syria TPS,” press release, June 25, 2026.

Gloria Oladipo, “US Homeland Security Secretary Tells Migrants to Seek Permanent Status or Leave,” Guardian, June 28, 2026.

Adam Liptak, “Justices Clash on Whether Race Played a Role in Trump’s Bid to Deport Haitians,” New York Times, June 25, 2029.

Doctors without Borders, “Haiti Has Become a Far More Dangerous Place to Live or Seek Medical Care,” https://www.doctorswithoutborders.org/latest/haiti-has-become-far-more-dangerous-place-live-or-seek-medical-care.

Andrew R. Olenski and David C. Grabowski, “Caring for an Aging America—The Looming Crisis of the Long-Term-Care Workforce,” New England Journal of Medicine, July 4, 2026.

Marcela Escobari, “ICE Surges Kill Jobs in Red and Blue Cities Alike,” New York Times, June 30, 2026.

Below is the interview Emily K. Abel, professor emerita at the UCLA Fielding School of Public Health, conducted with Andrea Sankar, professor emerita, Department of Anthropology, Wayne State University. Andrea has both received grants and awards from and reviewed grants for the National Institutes of Health (NIH), the major government agency responsible for biomedical and public health research and the National Science Foundation (NSF),

EKA: First, can you tell us how NIH currently awards grants?

AS: The Director of NIH, who oversees 27 differently focused institutes, establishes funding priorities, which then guide the different institutes, such as the National Institute of Cancer Research and Treatment and the National Institute on Aging. Because the Director is a political appointee, the policies of the current administration influence those priorities. For example, because of 9/11 and the anthrax scare, President George W. Bush’s administration emphasized biotech and bioterrorism; President William Clinton’s administration, while increasing NIH funding in general, focused on AIDS, which was highly visible at the time.

The various health institutes then widely publish their funding priorities and request research proposals targeting those priorities. In response, researchers throughout the country develop research proposals, which they send to the Center for Scientific Review (CSR). That center first checks that the proposals conform to NIH’s specialized style format and then decides which institute should receive them. Proposals that focus on topics not covered in the published funding priorities are termed “investigator initiated” proposals and are also sent to CSR to determine which institute should review tthem

My first research proposal spanned priorities at two different institutes. My doctoral and post-doctoral training was in gerontology with a focus on caregiving. As a post-doctoral fellow at the University of California-San Francisco, I was present when the AIDS epidemic emerged and it quickly became apparent that community and family based care would be important in handling the epidemic. I thus decided to write a proposal to study caregiving for people living with HIV/AIDS. CSR decided to send the proposal to the National Institute of Mental Health (NIMH), which traditionally was clinically oriented but now needed to respond broadly to the everyday world and needs of people with the disease.

After the institute receives proposals from CSR, it creates a review panel, called a “Study Section, composed of researchers from across the nation who have received NIH grants in the past and are experts in the subject and methodology addressed.

EKA: I remember that you participated in a study section. Can tell us what that entailed?

AS: It was a lot of work because you are reviewing detailed proposals for scientific studies. Study section members write extensive reviews for each proposal. They may write up to thirty or forty reviews, three times a year. If the topic is a high profile one, such as COVID, study section members may have to write as many as sixty reviews. Members have to answer structured questions, such as: Can the methodology answer the central research question posed? Is the study scientifically valid? Is it feasible, given the time, resources and funding? Is it scientifically and socially significant? Do the researchers have the required expertise? What training have they had? Have they done similar kinds of research before? Is the study ethical?

Study section members then meet, today usually on zoom, (formerly in-person) to discuss the proposals for two or two-and-a half days. Everyone is asked to vote on each proposal and to assign a score from one to nine --- one being the best, lower numbers indicating less support for funding.

Every member gets a list of all the proposals that will be discussed at the meeting. If there is any conflict, such as the member collaborated with the applicants in the past five years, is from the same institution, or knows the proposal writer personally, the member will be required to leave the discussion and can not have access to the score assigned.

All told, the process takes at least a full 40-hour week, several times a year.

EKA: Did you detect any political censorship?

AS: Not really. But we did have to deal with moral and ethical issues. I remember reviewing a grant proposed by a Christian community organization that wanted to use churches as sites to conduct interventions about AIDS prevention with teenagers. We wondered whether the interventions could harm the teens if the church had been very explicit about its ambivalence about or rejection of homosexuality.

EKA: What do you think about the new OMB proposals?

AS: They will diminish the importance of the scientific review, reducing it to just one, nonexpert voice among many rather than building on consensus decisions. In practice that opens the door to directing funding not on merit but on whether it aligns with shifting political agendas. I’m worried about decisions to fund proposals in this fashion because they reward projects that reinforce a government’s political agenda, such as its hostility towards LGBTQ+, minorities, or women and projects that confront inconvenient realties, such as the impact of pollution on under-resourced communities. I’m equally concerned about the implications of limiting collaborations with researchers around the world. In our work in Rwanda, these partnerships did more than support secondary prevention that limits the spread by HIV + persons to others but also deepened our understanding of the complex challenges people who are HIV positive face in protecting their sexual partners. These insights would be difficult, if not impossible, to create in isolation. How are US investigators going to help end the Ebola epidemic if they are cut off from the global research community? And if cut off, how will they ensure they can protect the American people?

The White House driven OMB proposal is not a procedural tweak; it is a shift from evidence to ideology. If scientific judgment becomes optional and global collaboration suspect, the consequences will not stay confined to grant panels—they will show up in the care people receive and the risks they face. The deadline to respond is July 13. Silence, here, is its own kind of decision.

See

https://ombcomment.netlify.app/

You can receive further information at:

and https://www.forbes.com/sites/judystone/2026/06/24/how-the-omb-rule-could-hurt-you-and-your-town/?streamIndex=0

Rather than cooperating with the global health community, the administration has instituted a blockade. Despite protests and a legal challenge, the regime is building a quarantine facility in Nairobi for US citizens who have contracted Ebola. In addition, the CDC has issued a rule prohibiting noncitizens, including “green card” holders, from affected countries from entering the US. Andrew Nixon, a Department of Health and Human Services (DHHS) spokesperson argues that travel bans are a “longstanding public health tool” to prevent the spread of disease. WHO, however, notes, “Such measures are usually implemented out of fear and have no basis in science.” Damien C. Tully, a professor at the London School of Hygiene and Tropical Medicine, explains that although travel restrictions often reassure the public, “outbreaks are controlled primarily at their source through investment in surveillance, diagnostics, health-care infrastructure, infection prevention and control, vaccinations, and therapeutics.”

Travel restrictions also encourage distrust, stigma, and discrimination. The campaign by Los Angeles health officials at the turn of the 20^th century against migrants from eastern states provides one example. Although notorious for its polluted air today, Los Angeles once billed itself as a health resort, particularly for those with “lung problems.” Soon after the arrival of the transcontinental railroad in 1876, publicists launched a massive campaign to portray the metropolis as the Promised Land and circulated countless stories of miraculous cures. Boosters touted the opportunity to live in an exclusively White and prosperous society as an additional advantage. An editorial in a prominent booster journal was titled “The Right Kind of People.”

But the railroads brought not only the middle-and-upper-class health seekers the boosters wooed abut also many poorer ones, who became associated with “tramps.” Nineteenth- century medical experts had assumed that tuberculosis, the most fearsome disease of the time, struck all segments of society equally, but turn-of-the-century authorities throughout the United States increasingly identified the disease with marginalized groups. The California State Board of Public Health declared that the state was “deluged at certain seasons of the year with patients, many too poor to return home.” A particularly important “fact” was that “seventy-five percent of the patients dying of tuberculosis” in the state had low incomes.

Robert Koch’s discovery of the tubercle bacillus in 1882 bred new worries. A recurrent theme in the writings of early twentieth century health officials was the failure of germs to respect class barriers. In 1906 the California State Board of Health complained that “infected strangers, living in dark and ill-ventilated rooms, eating at cheap restaurants and expectorating everywhere, will infect more natives than ten times the number who reside in good homes where care is exercised.” Unsurprisingly, the exclusion campaign focused on poor people.

The one major exception was the opening salvo, a 1900 request from the State Board of Health to bar the entry of all people with tuberculosis. Francis Marion Pottenger, a doctor who had accompanied his wife with TB to Southern California, protested that “unless the law will allow a discrimination to be made between the man with money and the man without, then such a measure cannot stand.” He later wrote that had the Board of Health’s quarantine bill passed, “it would have deprived Southern California of a great number of men and women who were to be counted among her most valued and influential citizens.”

After the bill’s defeat, officials sought to impose a quarantine by other means. State authorities sponsored a federal bill to discourage low-income people with tuberculosis from leaving the East, warning that California provided no free care to residents of other states. Charitable groups urged east coast branches to stop sending people with TB to the West and refused to assist those who arrived.

Welfare offices throughout the country historically had used settlement laws to transport nonresidents back to their communities of origin. Poor migrants who applied to Los Angeles charitable organizations were provided only with train fare home. An 1898 article in the Los Angeles Evening Express complained about a man with TB who was “late of New York, formerly of Russia and a direct descendant of Abraham.” He was “a little evaporated Russian with a perpetual whine and a silvery voice which sounded like a cheap phonograph with the rolls worn out.” His most notable feature, however, was “his nerve,” which “was something wonderful.” He had “coolly informed” a local charity that that he was too sick to work and needed assistance. The organization sent him to St. Louis, where he had family.” Although charitable groups claimed that they transported only those clients who were well enough to travel, it was not easy to make accurate assessments. The March 1902 case files of the Ladies and Hebrew Benevolent Society noted that a man they tried to send home had died when he reached the train station. Other people must have died en route.

Anxieties about attracting the wrong kind of people also retarded government efforts to provide tuberculosis care. The first attempt to establish a public sanatorium met defeat largely as a result of fears that it would attract impoverished health seekers. A proposal to enlarge the county hospital, housing the sickest people with TB, provoked a similar outcry. And a campaign to create a Jewish sanatorium elicited the complaint that the city would become “the mecca for indigent tubercular patients. Although both government authorities eventually established a broad range of free and low-cost TB services, Los Angeles lagged far behind East Coast municipalities

After the Great Depression struck, a vast number of migrants from other states began to pour into California, alarming health and welfare officers and engendering a new round of exclusionary policies. In 1936 the Los Angeles police officer James E. Davis organized what became known as the “bum brigade.” He sent 125 officers to the border to prevent indigent people from entering the state. The blockade provoked outrage and ridicule throughout the county, but LA charitable organizations praised it “for attempting “to turn back these hordes of unwelcome invaders.” Edythe Tate-Thompson, the Director of the California Bureau of Tuberculosis, was another supporter. Pointing to the plant quarantine stations at the California border, she explained that “very lax methods exist at the border beyond the examination of cotton and fruit for boll weevil and fruit fly. The lame, the halt, and the blind come across without notice being given them. It is to laugh when one considers the cost of illness, illiteracy, and delinquency compared with the fruit fly and the boll weevil.”

Health officials buttressed their campaign against migrants by claiming expertise not only about their physical status but also about their personal characteristics. George Parish, the director of the Los Angeles City Department of Health, described the typical migrant woman as a “drudge” and the children as a “happy-go-lucky lot” who “roam the streets.” Tate-Thompson employed eugenic rhetoric. “Having seen quite a good deal of these people,” she was “convinced that the majority of those coming from Oklahoma and Arkansas” were “primitives.” She doubted that “the older group” could be educated in any modern methods.”

Because the migrant population grew especially rapidly in Los Angeles, the metropolis quickly became a center of the anti-migrant campaign. The pace of removals there quickened. In 1937 and 1938 the Los Angeles Department of Charities transported approximately ninety clients a month (as opposed to less than four a month in 1913).

Health authorities participated actively in the drive to expel migrants. Tate-Thompson pressed the County Department of Charities to transport sick people and helped to arrange the trips. Medical social workers played similar roles. A social worker at the county hospital believed it was “so imperative” to remove the children in one family that she insisted that they could travel in the coach section of the train “in spite of the doctors’ orders.” Zudenka Buben, an official in the County Department of Health, discussed the case of a “non-resident American orphan boy, 16 years” who attended a tuberculosis clinic in 1933. Because he was “mentally delinquent” and a “food handler” and lived with his sister who had a small child, he had become a menace. The best solution was thus to send him away. “This boy would have continued to run the streets,” Buben later wrote, “and have become a burden on Los Angeles County had it not been for the quick action of the County Health Department diagnosing the case, giving him close supervision, and helping arrange the plan to have him returned to his legal residence.”

It is difficult to imagine the Trump administration paying attention to histories such as this one. Others, however, should view it as a cautionary tale. Whether or not travel bans work (and considerable evidence suggests they do not), they intensify prejudice, discrimination, and cruelty. We must do better.

Sources:

Damien C. Tully, “Travel Restrictions and Ebola Outbreaks: Public Health Implications,” Lancet, published on line, May 29, 2026.

“Kenyan Court Blocks US Plan to Open Quarantine Center to Treat Americans,” PBS, May 29, 2026.

Trevor Hunnicutt and Julie Steenhuysen, “Trump Seeks More than $1.4 Billion in Ebola Funding from Congress,” Reuters, June 24, 2026.

Sophie Gardner and Carmen Paun, “Ebola Response Puts Trump on Collision Course with Global Health Body,” Politico, May 30, 2026.

Sarah Owermohle, “Trump Admin. Shutting Key Researchers out of Global Virus Response Talks, Documents and Sources Reveal,” CNN, May 25, 2026.

“New Ebola Quarantine Rule Bars Entry of Noncitizens, including Green Card Holders, from Affected Countries,” KFF, May 29, 2026.

Emily K. Abel, Tuberculosis and the Politics of Exclusion: A History of Public Health and Migration to Los Angeles (Rutgers University Press, 2007).

Diversity, Equity, and Inclusion

Several cases stemmed from the Executive Orders President Trump issued on Diversity, Equity, and Inclusion (DEI) soon after returning to office, most notably #14173, “Ending Radical and Wasteful Government DEI Programs and Preferencing.” One case began in July 2025, when three Planned Parenthood organizations challenged a Policy Notice from the Department of Health and Human Services directing them to “align” their teen pregnancy programs with the Order. New regulations included bans on LGBTQ+ content and material that “normalizes or encourages sexual activity for minors.” On October 7, Judge Beryl A. Howell of the District Court for the District of Columbia ruled in favor of the organizations, granting them a motion for summary judgment and denying the government’s motion to dismiss. “The July Policy Notice reflects agency decision-making that is motivated solely by political concerns,” she wrote, “devoid of any considered process or analysis, and ignorant of the statutory emphasis on evidence-based programming. Just because a pronouncement comes from the President does not make it true, even if expressed in the form of an executive order, and even then, does not supersede the law. Yet, the Policy Notice points to little more than these orders for justification.”

Another case originated in the National Institutes of Health’s abrupt termination of research grants as part of the attack on DEI in February 2025. Two groups sued: the American Public Health Association along with other major health research organizations and a coalition of sixteen states.

On June 16, William G. Young, a Reagan appointee to the District Court, District of Massachusetts, held a combined hearing for both lawsuits. At the end of the morning session he remarked that the grant terminations represented discrimination against the LGBTQ community. He then stated that during his forty years on the bench, he had “never seen a record where racial discrimination was so palpable.” He ending by paraphrasing Joseph Welch’s famous question to Senator McCarthy: “Is it true of our society as a whole, have we fallen so low? Have we no shame?” Later that afternoon, Young granted a temporary restraining order.

On July 2, Young issued a supplementary final decision, writing that in January 20, 2025, the “administration began weaponizing what should not be weaponized—the health of all Americans through its abuse of. . . NIH systems, creating chaos and promoting an unreasonable and unreasoned agenda of blacklisting topics that has absolutely nothing to do with the promotion of science or research.” He pointed as “evidence of the NIH’s grant process being abused as a bludgeon” the termination of Columbia University grants as a result of “the Administration’s perception of inaction by Columbia with respect to campus unrest. . .How the scientific and research activities had any connection with unrest issues on Columbia’s campus is conspicuously never explained. The record evidence certainly reveals none.”

Although Young had repeatedly asked the NIH lawyers for a definition of DEI, none had been forthcoming. (Apparently the officials followed the standard for pornography of knowing it when they saw it.) Instead, Young continued, the lawyers “set [DEI] up as some sort of boogeyman.” Without defining the concept “DEI becomes whatever DEI means to the Public Officials untethered to anything.” He acknowledged that “every Administration has political priorities and enjoys the ability to make policy changes.” “But,” he continued, “the agencies that implement those changes have to have a reasoned and reasonable explanation for doing so. . .The Public Officials in their haste to appease the Executive simply moved too fast and broke things, including the law.”

On July 3, NIH filed an emergency motion to stay the District Court’s order in the Court of Appeals of the First Circuit. When that court denied the motion, the agency appealed to the Supreme Court, which used its emergency docket to partially grant the stay. Justice Ketanji Brown Jackson dissented. “Make no mistake” she wrote. Evidence in the District Court demonstrated that “the forward march of scientific discovery will not only be halted—it will be reversed. . .Years long studies will lose validity. Animal subjects will be euthanized. Life-saving medication trials will be abandoned. Countless researchers will lose their jobs.” Moreover, she continued, “scientific advancement lifts all boats. The harm is not just to researchers who will lose their livelihoods; vulnerable members of our society will also lose the benefits of their research.”

Conversion Therapy

Jackson was even more scathing in her dissent to the Supreme Court’s decision on March 31, 2026 supporting a challenge to Colorado’s ban on conversion therapy. “Ultimately,” she wrote, “because the majority plays with fire in this case, I fear that the people of this country will get burned.” The majority “appears to have made this momentous decision without adequately grappling with the potential long-term and disastrous implications of this ruling. The fallout could be catastrophic.” She continued, “The Court could be ushering in an era of unprofessional and unsafe medical care administered by effectively unsupervised healthcare providers. A state license used to mean something to the patients who entrust their care to licensed professionals. . .That stops today.” Jackson concluded that the Court’s decision “opens a dangerous can of worms. It threatens to impair States’ ability to regulate the provision of medical care in any respect. It extends the Constitution into uncharted territory in an utterly irrational fashion. And it ultimately risks grave harm to Americans’ health and wellbeing.”

Conditions in Detention Centers

When Sergio Alberto Barco Mercado, an immigrant from Peru, arrived at 26 Federal Plaza, Manhattan, (often called 26Fed) on August 8, 2025 for a scheduled citizenship hearing, ICE took him into custody and detained him at that facility. (The plaza was the site of numerous protests against ICE).Within hours of his arrest, Mercado sued the government, arguing that the conditions in the detention hold were inhumane. Four days later, Judge Lewis A. Kaplan of the District Court of the Southern District of New York granted a temporary restraining order, barring ICE from holding people at 26 Fed unless conditions were drastically improved.

When Kaplan certified the class of plaintiffs and granted a preliminary injunction on September 17, he issued an 86-page opinion. It began with a list of the conditions at 26 Fed that were “essentially undisputed.” Those included that the rooms housed as many as 90 detainees, many were held for more than 72 hours and denied attorney visits, and before August 18 detainees slept on the concrete floor, were provided with rations only twice a day, and could not bathe or shower.

Kaplan then elaborated. “Sleep is a basic human need,” he wrote. “Conditions that prevent or interfere with sleep in some circumstances may rise to the level of a constitutional violation.” Detainees not only had no chance to bathe or shower but also “were denied basic hygiene items, such as clean clothing, and adequate soap, sanitary wipes, toothbrushes, and menstrual products.” Dozens of detainees had to “share one or a few toilets, which sometimes were inoperable.” With only two small rations of food a day, “detainees were persistently hungry.” They also were denied medical care and access to lawyers.

Kaplan added that these conditions demonstrated “deliberate indifference,” a phrase courts have used interpreting the Eighth Amendment’s prohibition on cruel and unusual punishment: “The defendants, at a minimum, recklessly failed to act with reasonable care to mitigate the risk of the foregoing challenged conditions to the detainees at 26 Fed. These conditions were largely self-evident, subjects of widespread public reporting, and posed excessive risk to detainees’ health.”

Finally, Kaplan explained why the conditions should be considered punitive as well as inhumane: “Statements from senior officials suggest that harsh conditions of confinement are a deliberate feature of the enforcement program intended to induce self-deportation and to deter illegal immigration. Indeed, DHS has launched a national advertising campaign encouraging self-deportation, and Secretary Kristi Noem acknowledged that ICE selected a notoriously harsh state prison as an ICE detention center for aliens charged with violent crimes in part to encourage self-deportation.” Comments by the guards similarly suggested the conditions were “intended to be punitive and to induce self-deportation.”

On May 18, 2026, Judge P. Kevin Castel of the District Court of the Southern District of New York barred ICE from making arrests in New York City immigration courts.

Like some of the cases described in the May 11 post, some of the ones portrayed above have been overturned. But that is not the point. In these perilous times, judgments defending public health deserve far more attention.

Sources:

Mercado v. Noem, SDNY Kaplan (8/12/25) (TRO)

Mercado v Noem, SDNY Kaplan (9/17/25) (Preliminary Injunction)

American Public Health Association v. National Institutes of Health, D Ma Young (6/23/25) (Proposed Partial Final Judgment)

American Public Health Association v. National Institutes of Health, D Ma Young (7/2/25) (Preliminary Injunction)

Chiles v. Salazar, USSC Jackson (dissenting) (3.31.26)

Massachusetts v. Kennedy, D Ma Young (6/23/25) (hearing transcript)

National Institutes of Health v. American Public Health Association, USSC Jackson (8/21/25)

Planned Parenthood of Greater New York v. U.S. Department of Health and Human Services, DDC Howell (10.7.25)

A major reason is that the 1986 Emergency Medical Treatment and Active Labor Act (EMTALA) requires all hospitals receiving Medicare (virtually all facilities) to screen and stabilize all patients who arrive with emergency conditions, regardless of their ability to pay. The Act represented a response to terrifying stories about patient dumping that had begun to circulate a few years earlier. One of the first was published in 1981. A Chicago Tribune reporter had found “seriously ill patients lying on the floor” in Cook County Hospital’s emergency room. Although the hospital usually had between 90 and 125 patients who had been transferred from private hospitals each month, the facility had 365 in July and 560 in August. A very high proportion were members of racially marginalized groups. One woman had been sent from a private hospitals to receive a CAT-scan, although the transferring hospital knew that Cook County lacked the necessary equipment. “Officials at County don’t call this transferring,” the article noted. “They call it ‘dumping,’ a deliberate attempt to get rid of Medicaid patients.” Soon reports began to provide examples of the practice throughout the country.

Although patient dumping first began to receive widespread attention in the 1980s, it was not a new phenomenon. A century earlier, The New York Times began to report that private hospitals were sending patients who arrived by ambulance to Bellevue, the city’s public hospital. For example, when eight-year-old Julia Bictor was run over by a coal cart one December morning, an ambulance delivered her to Chambers Street Hospital. But at midnight, “the little sufferer was place in an ambulance and driven over three miles to Bellevue Hospital [New York’s public facility]. Five minutes after reaching the hospital on Twenty-Sixth Street the child expired.” The Bellevue night captain stated that although he had “seen many hard cases, this one was enough to touch the heart of a stone. The poor little thing had no covering but a bandage around its arm and waist, and sending a patient out in the night air in that condition certainly did not prove of benefit to it.”

Dumping did not end when patients reached public facilities. One historian notes that after receiving chronically ill patients from private facilities, public hospitals “shipped them as quickly as possible to isolated hospitals that cities had established for long-term care in out-of-the-way places—on nearby islands, as in Boston and New York, or in the far suburbs, as in Philadelphia, Chicago, and Washington.”

Trips to those island facilities were often harrowing ordeals. Homer Folks, the NYC Commissioner of Charities, later recalled that “the ‘stretcher cases”’ were placed in the long-open passageways” and “exposed to the wind and cold, and protected only by a blanket” during the half-hour trip across the river. Although Bellevue Hospital attendants transported patients to the dock, workhouse residents were responsible for helping them on and off the boat. By the time Folks wrote, reforms instituted in the late 1890s and early 1900s had greatly improved transportation to Blackwell’s Island. Nurses were now responsible for patients throughout the boat trip, and those on stretchers traveled in a special heated room. Nevertheless, the hospitals on Blackwell’s Island continued to direct the same criticism toward Bellevue that it had leveled against private hospitals—too many seriously ill dying patients were transferred, and the rigors of travel often accelerated the end.

New York was not unique. In 1903, the visiting medical staff of Long Island Hospital, Boston’s chronic disease facility, complained that the method used to transport patients from the city inflicted “discomforts and hardship, if not actual suffering” on patients who were “in the last stages of disease.” Delays in reaching the island were not only “inevitable” but also very dangerous for the very sick. Such “inadequate provision for their comfort would not be tolerated in hospitals wards” and “should not be during the trip.”

Care in these island facilities was often abysmal. A 1903 investigation of Long Island Hospital found extreme overcrowding as well as numerous examples of neglect and abuse. In May of that year, a nurse administered poison to four patients, two of whom died. In 1911 the New York City Charity Organization Society, the city’s major philanthropic organization, castigated the city for the “disgraceful” overcrowding in a Blackwell’s Island hospital. Beds “regularly lined” the halls, and many patients were forced to sleep on the floor.

Although the EMTALA has succeeded in reducing the long-standing practice of patient dumping, the Act contributed to the abysmal emergency-room conditions depicted in The Pitt; numerous ER doctors and nurses applauded the show for its realistic portrayal of the environment in which they work. The Act also did little to address the overall problem of access. Hospitals now are required to screen and stabilize everyone who arrives with an emergency condition, but the United States remains virtually the only high income country without a statutory right to ongoing care. Despite his lack of a medical degree, Noah Wyle’s role as the star of The Pitt has encouraged him to opine about the US health care system. He has condemned its “profit-driven” character and called for “universal coverage.”

Sources:

Beatrix Hoffman, “Emergency Rooms: The Reluctant Safety Net,” in History and Health Policy in the United States, ed. Rosemary A. Stevens, Charles E. Rosenberg, and Lawton R. Burns (Rutgers University Press, 2006), 150-272.

Emily K. Abel, The Inevitable Hour: A History of Caring for Dying Patients in America (Johns Hopkins University Press, 2013).

Ankita Shaw, “The Pitt’s Noah Wyle Blasts ‘Profit-Driven’ US Healthcare System,” Yahoo, March 25, 2026.

Even in an administration known for its cruelty toward poor people, the attacks on the Supplemental National Assistance Program (SNAP, formerly known as food stamps) stand out. Established in 1964, SNAP is the largest food assistance program in the US and a key component of its safety net. The program serves 42 million people, one in eight Americans; seventy percent are children, people with disabilities, or those over 65. Although funded by the Department of Agriculture (USDA), SNAP is administered by the states.

Health Secretary Robert F. Kennedy Jr.’s encouragement to states to ban the purchase of soft drinks and ultra-processed food with SNAP benefits is the one action that has received support from at least some public health advocates. By the beginning of March, 2026, the USDA had granted waivers to 22 states to do just that. The advocates who applaud that development argue that the government should not pay for food items associated with poor health. Others, however, point out that the prohibitions stigmatize SNAP recipients, that because the program provides only partial assistance, they can buy junk food with other money, and that the requirements have led to chaos and confusion. A February 2026 Politico article noted that some states have not provided lists of banned items; as a result, SNAP recipients and grocers are left “trying to figure out what even qualifies as ‘junk food.’ Is Gatorade? What about granola bars?” On March 11, the National Center for Law and Economic Justice, an advocacy group, filed a case challenging the state food restrictions.

The administration’s first major assault on SNAP occurred on July 4, 2025, when the One Big Beautiful Act (OBBA) cut $186 billion from the program, strengthened recipients’ work requirements, reduced the eligibility of some legal immigrants, and shifted more of the administrative burden from the federal government to the states.

The second attack took place on October 24, a few weeks after the government shutdown began, when the USDA suddenly announced that it would suspend November benefits. Because charitable food assistance programs (soup kitchens, food pantries, and food banks) could not fill the gap, anti-hunger advocates warned that SNAP recipients soon would run out of food.

On October 30, a group consisting of nonprofits and local governments as well as a union and a grocery store sued the government in the US District Court of Rhode Island. The following day Judge John H. McConnell, Jr. ruled against the government, noting that it had two accounts that could be used for this purpose, a contingency fund for emergencies and the National Child Nutrition Program funds.

In his written opinion released on November 1, McConnell ordered that “to alleviate the irreparable harm the Court found exists without timely payment of SNAP benefits,” the government must find the money to fund the payments. The administration had two choices: It could provide partial payments by November 3 or full payments by November 5.

The government failed to meet either deadline. On November 4, Trump threatened to defy the court order, writing on social media that SNAP payments “will be given only when the Radical Left Democrats open up government, which they can easily do, and not before!”

On November 6, McConnell rebuked the government for delaying payments for “political reasons” and ordered it to release the full benefits by the following day. Although USDA claimed that “the well has run dry,” McConnell again pointed out that the department could tap into two revenue sources--the $6 billion in contingency funds and the $23 billion in Child Nutrition Program funds. Referring to the latter, he wrote, “It defies belief that the Defendants would prioritize a hypothetical disruption in child food assistance, projected to occur no sooner than May of 2026 (if at all), over the very real and immediate risk of children being deprived of their food assistance today.”

On November 7, the Justice Department appealed to the US Court of Appeals for the First Circuit, contending that there was no “legal basis” for forcing the president to fund the payments in full. When that court refused to immediately suspend the District Court’s order, the administration filed an emergency motion in the Supreme Court. Late that night, Justice Jackson issued a stay to give the appeals court more time to consider the case.

By then some states already had started to pay full benefits. On November 8, the administration ordered those states to “undo” that work and threatened penalties for noncompliance.

On November 9, Judge Julie Rikelman, writing for a three judge panel of the US Court of Appeals for the First Circuit, ordered the administration to make full SNAP payments. “For low-income Americans,” she wrote, “SNAP is a vital bulwark against hunger and food insecurity. . . Without SNAP, tens of millions would go hungry—the first among a cascade of other health and financial harms that would befall those forced to go without enough food, particularly in the months leading up to winter.”

Even while acknowledging that the issue soon might become moot, the government refused to give up. On November 10, it returned to the Supreme Court for relief. The shutdown ended on November 12. The following day the administration withdrew its appeal.

Since early 2026, researchers have been able to document the dire consequences of the changes OBBA made to SNAP and the fall suspension of benefits. As Trump reported on February 24, participation in the program fell by six percent (2.4 million people) between July 2025 and December 2025. The drop was especially pronounced in Arizona, which sharply reduced staffing even as new administrative burdens increased. As a result, SNAP participation declined by an astonishing 47 percent. “Arizona is just the alarm bell,” warned Joseph Palomino, executive director of the Arizona Center for Economic Progress, a nonpartisan advocacy organization.

While Trump bragged about “lifting” people “off” of food assistance rather than pushing them off, Agriculture Secretary Brooke Rollins attributes the drop in SNAp enrollment to her vigorous assault on fraud. Only the luxury car models have changed since Reagan coined the term “welfare queen” in his presidential campaign. Linda Taylor, the woman he first smeared with that title, drove a Cadillac. Rollins claims that SNAP recipients own Ferraris, Bentleys, and Teslas.

In 2023 the historian Christopher Bosso wrote, “Barring a seismic shift in our politics—say, conservative Republicans win the presidency and amass congressional majorities—the Supplemental Nutrition Assistance Program will remain at the center of the nation’s nutrition and income-assistance safety net.” Bosso could not have foreseen the viciousness of a right-wing takeover of the government. The future existence of SNAP now hangs in the balance.

Emily K. Abel is Professor Emerita at the UCLA Fielding School of Public Health. Her forthcoming book is Listening to Dementia: Advocating for Dignity and Autonomy (NYU Press, August 2026)

Sources:

“Fact-Checking Trump’s State of the Union Speech,” New York Times, February 25, 2026.

Christopher Bosso, Why SNAP Works: A Political History—and Defense—of the Food Stamp Program (University of California Press, 2023).

Marcia Brown and Paula Friedrich, “Is Gatorade Unhealthy? Granola Bars? Take this Quiz to Understand Kennedy’s New SNAP Bans,” Politico, February 14, 2026.

Marion Nestle, “The Supplemental Nutrition Assistance Program (SNAP): History, Politics, and Public Health Implications,” American Journal of Public Health, vol. 109, no. 12 (December 2019).

Center for Budget and Policy Priorities, “SNAP Tracker: People Are Losing Food Assistance as the Republican Megabill Is Implemented,” https://www.cbpp.org/research/food-assistance/the-supplemental-nutrition-assistance-program-snap

Nicole Santa Cruz, “’The Alarm Bell’: Arizona’s Drop in SNAP Participation Signals Potential Nationwide Impact of Trump Legislation,” ProPublica, April 8, 2026.

Michael Sainato, “Trump Administration Claims Food Aid Fraud but Critics Say ‘There Is No Evidence,’” Guardian, May 4, 2026.

Rhode Island State Council of Churches v. Rollins, D RI McConnell (11.1.25)

Rhode Island State Council of Churches v. Rollins, D RI McConnell (11.6.25)

Rhode Island State Council of Churches v. Rollins, 1^st Circuit Court of Appeals Rikelman (11.9.25)

Some of the nation’s most vulnerable groups reside in nursing homes. Nevertheless, Tom Friedan, former director of the Centers for Disease Control and Prevention, warned on March 8, 2020 that nursing homes were “ground zero for Covid-19.” Two weeks later the nation learned that thirty of the forty-six deaths in Washington had occurred at the Life Care Center in Kirkland. One fourth of the residents had died and dozens of others were in the hospital. It was soon clear that the Kirkland facility was not an aberration. By June 26, the virus had killed 54,000 nursing home residents and workers, representing 43 percent of all U.S. fatalities.

The tragedy unfolding in nursing homes was, as two researchers noted, a “perfect storm.” They housed an elderly population with multiple health problems in close quarters. Moreover, increasing control by profit-making entities left facilities unprepared and unable to resist the virus. Most had severely inadequate staffing levels and inadequate infection control procedures.

Some pundits blamed nursing home staff for the high death toll, arguing that they disregarded safety protocols, traveled on public transportation, brought the virus from their communities, and worked at multiple facilities, thus spreading disease from one to another. In response, many other commentators pointed out that many administrators refused to provide adequate personal protective equipment, low wages and part-time jobs forced staff to seek employment at different institutions, few staff members could afford to travel by car, the lack of paid sick days compelled them to work when ill, and they transferred disease not only to their workplaces but also to their own communities with overcrowded homes and high rates of morbidity and mortality.

State governments sent whatever protective gear and testing equipment they could garner first to hospitals, leaving nursing homes to scrounge for supplies. Soon after the pandemic began, New York Governor Andrew Cuomo ordered nursing homes to accept patients discharged from hospitals even if they had been treated for Covid-19; the facilities were not allowed to test the patients to determine if they were still contagious or had been newly infected. In June the Associated Press estimated that hospitals had sent as many as 4,500 infected patients to New York nursing homes. New Jersey and California instituted similar policies.

The Trump administration sent hundreds of millions of dollars of stimulus payments to nursing homes but did little to ensure that the money went to improving patient care rather than to corporate owners’ pocketbooks. Although Seema Verma, the administrator of the Center for Medicare and Medicaid (CMS), vowed to strengthen nursing home inspections, eighty percent of the facilities were cleared of infection-control violations. Few of the others received significant penalties.

The most widely publicized CMS action occurred early in the pandemic. On March 13 it restricted all visitation by family members except to deliver “compassionate care” for residents near death. Although the CMS has no jurisdiction over assisted living facilities, most voluntarily followed those guidelines. Suddenly everyone seemed to discover the critical role families play in long-term care institutions. A geriatrician who served as the medical director of a long-term care facility wrote in the Journal of the American Medical Directors Association, “Family is not synonymous with visitor. The daughter who feeds her bedbound mother lunch or husband who combs and braids his wife’s hair every morning, despite her anoxic injury that prevents her spoken word, are not visitors in our buildings…Maintaining connections between residents and their loved ones has safety, socio-emotional, and ethical components.”

Family members also protested. Mary Daniels, the wife of a man with early onset Alzheimer’s disease in a Florida nursing home, founded “Caregivers for Compromise—Because Isolation Kills Too.” The goal was to restore visitation rights in a “safe and reasonable a way” by providing rapid COVID-19 testing for staff members and visitors and designating as an “essential caregiver” a family member who was screened and tested and previously had regularly visited a resident. After Daniel’s husband Steven entered the nursing home, she had gone every evening, to feed him his dinner, help him change into pajamas, and lie next to him in bed watching television. When the facility shut its doors, she applied first for a volunteer position and then for a paid one. At the end of June, the nursing home finally hired her as a dishwasher two days a week. After each shift, she and Steven were able to resume their evening ritual. Her story soon captured the attention of the national media. Capitalizing on her new-found fame, she established “Caregivers for Compromise.” It had 6,000 members within two weeks and 13,549 on October 28.

Other carers recounted their experiences during the pandemic in online support groups. “Yesterday I received the dreaded message from DW’s care unit,” wrote Chris. “Four Coronavirus diagnoses on March 18 (I didn’t know until the 19^th). This is an award receiving facility. Absolutely top notch.” He wondered if his wife was strong enough to fight off the virus and if he ever would see her again. “You folks that Pray,” I could use some help…Just when I thought the tears were all gone. Sorry can’t type any longer.”

In the middle of April, Susan discovered her father’s institution had accepted a hospital patient with Covid: “I just learned that my Dad’s facility has their first COVID case and that the patient was recently admitted after being discharged from the hospital. In addition to the facility taking supposedly ‘Non-COVID’ hospital transfers, they also were not quarantining these new admission patients. The new admissions, including the asymptomatic positive case, was allowed to mingle amongst residents, and the staff was not using extra PPE when interacting with these patients. There’s nothing I can do about it now.”

Joseph had taken advantage of the exemption for compassionate carers. After spending three days in his wife’s facility while she was dying, he wrote, “I was able to observe the other residents and the current routine and it was not pretty. Changing the routine of dementia folks is not a good thing. No visits from family and loved ones, no outside entertainments and programs allowed in, no ordinary hustle and bustle of an active facility. Some residents appeared lost and confused, some residents who [usually] were active were just sitting around, some residents who ordinarily were fairly peaceful were acting up and being more agitated and aggressive. The staff and activity directors were trying hard but were overwhelmed at times with the needs of the residents. Never really thought about it but visits and time spent by the family members and friends takes a little pressure off the staff.”

On April 15, Joseph wrote again: “Since my Sally passed away three weeks ago, three others have passed away in the memory care facility. Although Covid 19 is not in the facility, I blame that cursed virus. The change in routine, no visitors and whatever normalcy they had has been uprooted and that can be the catalyst that sends many with dementia down into a vicious spiral. No one is coming out of this unscathed.”

A few carers brought relatives home. Nancy wrote that her husband’s facility had requested that she hire a sitter because he was falling and losing weight. Unable to afford a full-time companion, she asked if she could stay with him a few hours in the evening. “I am having a hard time understanding why the sitter, a complete stranger, is allowed to be with him—and why I, living a very quiet and careful life, CAN’T! He has been in [the nursing home] since mid January. I believe now I was very naïve to think they could care for him as his disease progressed and of course, no one counted on the effects that Covid would bring. At what cost are we keeping so many people from their loved ones? My heart is broken tonight.” Six days later she wrote again. Because the facility had denied her request, she had removed her husband. “Only God knows how many days he has left but I am so thankful those days are going to be spent at home,” she wrote. “He is unable to speak and is so incredibly thin and weak, but he has smiled so much.”

“Disasters have the power to reveal who we are, what we value, what we’re willing—and unwilling to protect,” wrote sociologist Eric Klinenberg. The Covid-19 pandemic represents a case in point. As we fight to rebuild the nation’s pandemic preparedness, we also must fight to ensure that no group, no matter how old and sick, is ever again considered disposable.

Sources:

“Viral Outbreaks Show Urgent Need to Rebuild Disease Monitoring, Pandemic Preparedness,” Defend Public Health News Release, Mary 21, 2026, https://www.defendpublichealth.org/press-release/viral-outbreaks-show-urgent-need-rebuild-disease-monitoring-pandemic-preparedness.

Emily K. Abel, Elder Care in Crisis: How the Social Safety Net Fails Families (New York University Press, 2022).

Below is the transcript of an interview Emily Abel conducted by email in May 2026 with Joanne Leslie, who worked for nearly three decades on international health projects funded at least partially by USAID. Reflecting on her experiences, she helps us understand the program’s deficiencies as well as its accomplishments.

Question 1: What led you to a career in international public health and at what point did you get involved in projects funded by USAID?

Like many other idealistic college students in the 1960’s, I was inspired by President Kennedy’s establishment of the Peace Corps in 1961. Although less aware of the establishment of USAID later that same year, somewhere in the back of my mind I did link them as part of the same American effort to improve the lives of families in low-income countries. Prior to graduation from Reed College, I was accepted into the Peace Corps and assigned to Botswana (then known as Bechuanaland). I was tremendously excited but, unfortunately, family issues prevented me from going. The missed Peace Corps opportunity is undoubtedly part of what led me, almost a decade later, to apply to the International Health Program at the Johns Hopkins School of Hygiene and Public Health. From the start, a main motivation was to improve maternal and child health in low-income communities.

It was not my explicit goal to work for USAID, but given that it was the major bilateral donor in the international health arena, it was inevitable that I would find myself working on projects funded by USAID. In fact, before I finished my doctorate in public health, I was recruited by a USAID employee who was auditing one of my classes, to join a survey team being sent to Burkina Faso (then known as Upper Volta) to assess child health status (they needed a French speaking nutritionist on short notice and my classmate remembered that I spoke French.)

The four weeks I spent in Burkina Faso in early 1981 were perhaps the only time I was paid directly by USAID. Most of the rest of my 25-year career in international health I worked either as an independent consultant or was employed by one of the many NGOs that handled the bulk of the program work of USAID. The two places where I worked the longest, and probably made my most useful contributions were the International Center for Research on Women (ICRW) in Washington DC (1985 – 1988) and the Pacific Institute for Women’s Health in Los Angeles, which I helped to found and where I worked from 1993 to 1999. The fact that I chose to work for organizations with a major focus on women reflected my growing appreciation of the central role that women’s own health as well as their education and economic empowerment play in ensuring child health and survival.

Question 2: Looking back at the various projects associated with USAID that you participated in, what are some of your proudest accomplishments?

One of my longer-term involvements was as part of the implementation team for The Weaning Project (TWP), a multi-year, multi-country child nutrition program funded primarily by USAID. I worked on the team managing TWP in the Extreme North Region of Cameroon. In this very poor region of Cameroon, there was a critical issue of acute growth faltering during late weaning. Not only was the introduction of complementary foods frequently delayed until 9 to 12 months, but the traditional gruel was also often overly diluted for both economic reasons and, as the parents believed, to ensure digestibility. Our goal was to reduce child mortality and malnutrition by introducing a more collaborative approach to improving weaning practices. Through hiring local outreach workers fluent in the language spoken by mothers, we were able to develop culturally acceptable recipes that thickened and enriched the gruel with fat and local legumes to increase protein and caloric density. As a result, there was a measurable improvement in child nutritional status in the project villages. The lessons learned from TWP influenced the training of Cameroonian health workers to use a more participatory approach to weaning education and to use growth charts as a trigger for action.

During the same time, I was involved with TWP (from the early 1980’s to the mid 1990’s) the dominant paradigm in international child health and nutrition was the Child Survival Revolution developed by James Grant at UNICEF. This strategy focused on four key interventions that demonstrably reduced under-five morbidity and mortality when used consistently and correctly. The four pillars of the Child Survival Revolution were Growth Monitoring, Oral Rehydration, Breastfeeding and Immunization. However, through my work on multiple child health and nutrition projects, including but not limited to TWP, I became concerned about the mothers being simply viewed as vehicles to produce better child health. One of the things I am most proud of is that my colleagues at ICRW and I were among the earliest to insist that child health programs also focus on the nutritional needs of lactating women and take into account the opportunity costs to women of implementing the Child Survival Revolution. Our intention was not to undercut this important effort to improve child health and survival, but to make it more realistic and therefore sustainable by adding interventions to strengthen women’s health and their economic opportunities.

Although I appreciate the last accomplishment, I will mention, more in retrospect than I did during the years when I worked in international health, I am proud of the training aspect of most of the projects I worked on. (By extension I believe this would be true of the vast majority of USAID funded projects.) The learning was certainly a two way street, the outside consultants needing to learn about local skills and cultural practices, but I believe our in-country collaborators from senior health department officials to the young women we hired as field workers in Northern Cameroon learned important research and evaluation skills, learned to appreciate the critical role of prevention in public health and came to see themselves as valued members of a global, not just national or local, effort to reduce child morbidity and mortality. Especially now that USAID has been so abruptly and disastrously ended, I place some modest hope in the residual benefits of almost fifty years of public health training in so many low- and middle-income countries throughout the world.

Question 3: What were your dissatisfactions with USAID?

Most of the people I worked with during my international health career, including independent consultants, NGO staff, direct USAID employees, and our in-country collaborators, were highly motivated and hard workers. Over 25 years I encountered very little, if any, visible waste or fraud. However, one thing that was somewhat frustrating was to realize how much foreign assistance money actually went back to the United States in terms of travel costs (we always had to fly American carriers), fees to consultants and supplies purchased in the United States (often something similar could have been purchased in county for less but this was usually disallowed). An April 2026 New York Times article that focuses on the difficulty USAID employees are having finding employment a year after the agency was dismantled acknowledges that many had similar concerns: “Much of the $35 billion it managed in 2024 went to Washington-based contractors, not directly to people in need overseas. The success of many projects was hard to measure. But all of those interviewed said they were still incredulous that an agency that amounted to less than 1 percent of the federal budget had been so quickly obliterated and reduced to a skeletal operation within the State Department.”

In the early years of USAID there was a genuine lack of in-country professionals trained in most public health related fields, especially in sub-Saharan Africa where most of my projects were located. So I believe that we outside professionals played a valuable role in filling this gap, allowing much needed child survival and reproductive health projects to get off the ground in a timely way and thus to keep children alive who otherwise would have died. However, over the decades of my career (and I’m sure it is even more true today) increasing numbers of trained and experienced national or regional nutritionists, epidemiologists, behavioral scientists and others were available. Nonetheless, due to requirements that preference be given in most cases to hiring Americans, plus a certain amount of inertia, USAID projects were slow to fill roles where possible with national or regional professionals. This was another policy that increasingly bothered me and is part of why I eventually turned to teaching and working on local public health projects.

Another thing that was a source of frustration during my years working in sub-Saharan Africa were the shifting sands of US foreign policy objectives, especially which countries were viewed as strategic priorities for foreign assistance. Most of us working on USAID funded health and nutrition projects were interested in maximizing the benefits in terms of lives saved and economic development promoted, which would have argued for giving money based on health and economic data and on the effectiveness of intervention strategies. But USAID was part of the State Department and it was clear that there were other geopolitical considerations at play beyond where US foreign assistance dollars could be most cost-effective. As it happened, when I began my career, Burkina Faso was receiving quite a bit of assistance. In the late 1980’s it was apparently demoted as a focus of USAID work, not because health had improved or economic needs decreased but for political reasons that were not shared with me or my colleagues. I felt quite ashamed to explain to my Burkinabé public health colleagues that there would be no follow-on project; that the US had decided to cut assistance to their country because it wasn’t considered important any longer.

Question 4: Should the US ever be in a position to revive international aid, what reforms would you suggest?

To begin, it is important to distinguish between the role of the US government in providing foreign aid, primarily through the now demolished USAID program within the State Department, and the continuing collaboration and assistance provided by US foundations, such as the Bill and Melinda Gates Foundation, US non-profits with an independent donor base, such as Partners in Health and the many US academic institutions that work in the international health field. None of the latter can provide anything like the magnitude of financial assistance lost when USAID ended, but they have been able to back fill some critical programs and, perhaps more important, they preserve a corridor for valuable exchanges of information and some collaboration in research, evaluation and program delivery.

If and when there is a renewed commitment to US governmental assistance in global health, I would like to see more of the priority setting done by national and regional entities. While it will not always be the case that cash transfers to national ministries of health will be the most effective use of resources, it would be a starting point. (Forgiving or restructuring the international debt interest payments burdening many low-income countries would similarly free up critically needed resources.) It is undoubtedly the case that current health systems in many low- and middle-income countries have been distorted and are not programmatically efficient because they were built up around health issues for which external funding was available but might not have really been the priority concerns in the country. The fact that every decade seemed to bring a new global area of emphasis, moving from family planning, to child survival, to Millennium Development Goals, only exacerbated the challenge of building up a reliable, equitable, coherent national health system.

If in the future the US regains a serious humanitarian desire to contribute to improving health globally, we should support international health research more robustly and effectively. The work of Dr. Dean Karlan, when he was chief economist at USAID, and others have shown that it is possible to do high quality cost-effectiveness research to achieve much better programmatic efficiency for what will always be scarce resources to meet global health needs. Ideally, when supporting international health research, local context and local expertise would be appropriately privileged without excluding the valuable contributions that researchers from the US and other donor countries have made and can make in the future.

In summary, I would wholeheartedly endorse the view of Dr. Bill Foege, a giant of international health, who died in January of this year. According to Dr. Foege, future success in reducing global health inequities will rest on three pillars: scientific research, collaboration and commitment.

Sources:

“The Demise of USAID: Time to Rethink Foreign Aid?” Lancet, March 22, 2025.

Andrea Ferreira da Silva, et al., “Impact of Two Decades of Humanitarian and Development Assistance and the Projected Mortality Consequences of Current Defunding to 2030: Retrospective Evaluation and Forecasting Analysis,” Lancet Global Health 2026, published online February 2, 2016.

Nicholas Kristof, “Trump’s Most Lethal Policy,” New York Times, September 20, 2025.

Joanne Leslie, “Women’s Time: A Factor in the Use of Child Survival Technologies?” Health Policy and Planning, 4(1), 1989.

Elizabeth Bumiller and Eileen Sullivan, “A Year after U.S.A.I.D.’s Death, Fired Workers Find Few Jobs and Much Loss,” New York Times, April 21, 2026.

James W. Curran, “In Memoriam: William “Bill” Foege, Visionary Leader” American Journal of Public Health, June, 2026, published online May 13, 2026.

Santi Ruiz, “How to Fix Foreign Aid – USAID’s Chief Economist reflects on DOGE.” Statecraft, interview posted online (audio and transcript) July 31, 2025.

Joanne Leslie was a long-time consultant and researcher in international health, based first in Washington DC and later in Los Angeles. At the UCLA Fielding School of Public Health, where she worked for many years, she developed and taught a course called “Women’s Roles and Family Health,” inspiring a generation of current public health leaders.

Emily K. Abel is Professor Emerita at the UCLA Fielding School of Public Health. Her forthcoming book is Listening to Dementia: Advocating for Dignity and Autonomy (NYU P

Living in Los Angeles, I am acutely aware of the problem of hospice fraud. According to a March 2026 CBS News report, the number of hospice organizations in the county increased 1,500 percent between 2010 and 2022—more than six times the national average. In one year alone, LA county hospices overbilled Medicare by approximately $105 million. CBS investigators found 89 licensed hospice companies in one three-story building in Van Nuys, a neighborhood in the San Fernando Valley. Some are “ghost agencies,” charging Medicare for patients who receive no care.

What Oz fails to examine is a major reason why fraud is so prevalent in the hospice industry—the corporatization of long-term care services and especially the rapid growth of private equity (PE), a trend the Trump administration encourages. For-profit entities, including national chains and private equity firms, now own 72 percent of nursing homes, 84 of home-health agencies, and 74 percent of hospices. The growth of for-profit hospices is especially disturbing because hospices emerged from the social reform movements of the 1960s and early 1970s and for many years embodied the high ideals of the founders, delivering a compassionate alternative to high-tech hospital care for people near the end of life.

The history of US hospices begins with the 1963 visit by the British doctor Cecily Saunders. Saunders lectured widely about her research on pain control and her vision for St. Christopher’s in the Field, the hospice she soon established in England. Her talk at Yale had a profound impact on Florence Schorske Wald, the dean of the Yale School of Nursing, who remained in contact with Saunders for many years. In 1974 Wald and her colleagues established Hospice, Inc. (soon renamed the Connecticut Hospice) in New Haven. Wald then traveled frequently throughout the country, promoting the hospice philosophy. By the early 1980s, hundreds of hospices were in existence throughout the country.

We can explain the eager embrace of the hospice ideal in several ways. Elisabeth Kubler-Ross’s On Death and Dying appeared in 1969, publicizing longstanding critiques of American care for dying people, which hospices sought to address. Moreover, the hospice movement arose during a period of widespread social reform. Wald and her colleagues participated actively in social movements. As Wald later remarked, “during the course of our original research [for Hospice, Inc.], we were as apt to meet at vigils for peace, meetings in the black ghettoes of New Haven on behalf of their civil rights as we were in corridors, clinics, and meeting rooms of the medical center.” And various other groups challenged the established order by organizing what were called “counterinstitutions,” such as free schools, food cooperatives, and alternative newspapers.

One especially important similarity between hospices and other counterinstitutions was an initial indifference to finances. That cavalier attitude stemmed partly from a belief that a crass concern with money was antithetical to the hospice mission. Moreover, hospice leaders understood that all money comes with strings attached. Believing that traditional third-party payers had distorted the health care system, some of the first hospices relied entirely on volunteers and philanthropic funding.

But hospices could never separate completely from the health care system because they relied on it for resources, political acceptance and personnel. As a result, hospices gradually accommodated themselves to the established order and lost much of their distinctiveness.

More than any other event, the addition of hospices as a covered Medicare benefit in the 1983 Tax, Equity and Fiscal Responsibility Act (TEFRA) moved hospices into the mainstream. The legislation created a bureaucratic structure, imposing rigid rules on programs that had prided themselves on innovation and diversity. Growing popular support for hospice ideals undoubtedly facilitated the passage of the benefit. But that outcome was ensured by a Congressional Budget Office report, concluding that the government could save as much as $1,120 for each Medicare recipient who enrolled in hospice. Legislators set the hospice payment at 75 percent of the average cost for Medicare beneficiaries in the hospital, subsequently reducing it to 40 percent. The savings were to come from family carers. Robert Dole, who introduced the hospice provision in the Senate, later asserted that its passage “was possible because many believe, as I do, that it is less costly to care for a patient at home, foregoing expensive hospital treatment.” To many advocates of the hospice benefit, family members primarily represented a cheap form of labor. (Today, family members are often shocked to realize how inadequate hospice services are. “We send very, very sick, complicated patients [home] under the care of family members who are not trained professionals,” stated Diane Meier, a physician and professor of geriatrics and palliative care. “They are on call 24/7 and have to be alert to changes at all times. They don’t get to go home after an eight-hour shift.” Most hospices provide just one hour of care a day. The rest of the time, Meier concluded, “The family is on its own.”)

TEFRA also accelerated the transformation of a movement into an industry. Shortly after TEFRA’s enactment, a former president of the National Hospice Organization announced plans to open a chain of for-profit hospices. Since then, the number of for-profit institutions has steadily grown. By 2012, more than half of the agencies then in existence were for-profits; since then, the proportion has steadily increased.

As the number of for-profit hospices has grown, criticisms of their quality of care steadily accumulate. Megan Stainer, a licensed practical nurse, told New York Times reporter Paula Span that she always knew whether the dying people she cared for were enrolled in for-profit hospices or nonprofit ones. “There really were stark differences,” she said, “the nonprofit patients always had the most visits: nurses, chaplains, social workers.” Moreover, the nonprofit facilities always responded quickly to requests for medical equipment and supplies: “If you called and said, ’I need a specialized bed,’ with for-profits it could take days—days when the patient is in a bed that’s uncomfortable.” A 2023 RAND Corporation study helped to substantiate Stainer’s charges. The researchers found that family carers reported “substantially worse” experiences in for-profit hospices than in nonprofit ones. An October 2025 article in Health Affairs reported that private equity-owned hospices earn higher profits while spending less on patient care than other for-profit hospices.

Other reports have found that fraud occurs most frequently in for-profit hospices, especially those owned by private equity firms. The political scientist Laura Katz Olson explains why that is the case: “Hospice reimbursements are based on a fixed daily rate, regardless of a patient’s needs or what services are actually delivered. This is fodder for PE firms, which can seek out the most profitable patients, curtail services, and turn a blind eye to quality, all without financial or other penalties. Hospice is heaven-sent for the PE model.”

Oz’s battle against hospice fraud should begin by focusing on the financial incentives that encourage unscrupulous providers to enroll people who are not terminally ill, offer kickbacks to physicians, and promise services that fail to arrive. By encouraging the growth of for-profit organizations and attacking non-profit ones, the Trump administration encourages the fraud the regime claims it wants to eliminate.

Sources:

Andrea Sankar with C. M. Cassady, Dying at Home: Family Guide for Caregiving, third edition (Johns Hopkins University, 2024).

Emily K. Abel, Elder Care in Crisis: How the Social Safety Net Fails Families (New York University Press, 2022).

Emily K. Abel, Living in Death’s Shadow: Family Experiences of Terminal Care and Irreplaceable Loss (Johns Hopkins University Press, 2017).

Emily K. Abel, Prelude to Hospice: Florence Wald, Dying People, and Their Families (Rutgers University Press, 2018).

Laura Katz Olson, Ethically Challenged: Private Equity Storms US Health Care (Johns Hopkins University Press, 2022), 158.

Kim Christensen and Ben Poston, “End-of Life Care Has Boomed in California. So has Fraud Targeting Older Americans,” Los Angeles Times, December 9, 2020.

Ava Kofman, “How Hospice Became a For-Profit Hustle,” New Yorker, December 5, 2020.

Paula Span, “Hospice Is a Profitable Business, but Nonprofits Mostly Do a Better Job,” New York Times, July 10, 2023.

RAND Corporation, “Care Experiences Are Worse in For-Profit Hospices than in Not-for-Profit Hospices,” February 27, 2023, www.rand.org.

Laura M. Waters and Patricia Moyle Wright, “Hospice Fraud: Predicting Ability and Intent,” Illness, Crisis, and Loss, 3, no. 2 (1924).

Alexander Soltoff, Dunc Williams, and Robert Tyler Braun, “Private Equity-Owned Hospices Report Highest Profits, Lowest Patient Care Spending Compared with Other Ownership Models,” Health Affairs, 44, no. 10 (October 2025).

Rachel Gold, et al., “We Visited “Ground Zero” for Hospice Fraud: Los Angeles California,” CBS News, March 10, 2026.

Laura Geller, et al., “State Records Show 89 Hospice Companies at One Los Angeles Office Place. We Went to Look for Ourselves,” CBS News, March 19, 2026.

Emily K. Abel is Professor Emerita at the UCLA Fielding School of Public Health. Her book, Listening to Dementia: Advocating for Dignity and Autonomy, is forthcoming New York University Press in August 2026.

On January 20, 2025, Trump’s first day back in office, he issued Executive Order 14168, “Defending Women from Gender Ideology Extremism and Restoring Biological Truth to the Federal Government.” The order stated, “It is the policy of the United States to recognize two sexes, male and female” and directed the Executive Branch to “enforce all sex-protective laws to promote this reality.” One section of the order prohibited the Bureau of Prisons (BOP) from using federal funds for “any medical procedure, treatment, or drug for the purpose of conforming an inmate’s appearance to that of the opposite sex.” In February the administration issued two memoranda implementing the order. Soon after, the BOP denied incarcerated, transgender people access to hormone treatment and “social accommodations,” including undergarments, hair removal devices, and chest bands. The American Civil Liberties Union filed a suit challenging the order on behalf of two transgender men and one transgender woman in prison.

On June 3, Judge Royce Lamberth, a Reagan appointee to the District Court for the District of Columbia, granted a preliminary injunction, writing that “the memoranda are arbitrary and capricious because they provide no reasoned explanation for the denial of gender-affirming care [and] treat gender dysphoria different than other medical conditions with no justification.” Lamberth continued, “Nothing in the thin record before the Court suggests that either the BOP or the President consciously took stock of—much less studied—the potentially debilitating effects that the new policies could have on transgender inmates.” Lamberth concluded, “The BOP may not arbitrarily deprive inmates of medications or other lifestyle accommodations that its own medical staff have deemed to be medically appropriate without considering the implications of that decision.”

On January 28, Trump issued Executive Order 14187, titled “Protecting Children from Chemical and Surgical Mutilation.” This new order called gender-affirming care “the maiming and sterilizing of impressionable young children” and a “stain on our Nation’s history” that “must end.”

On April 22, Attorney General Pam Bondi issued a memorandum, “Preventing the Mutilation of American Children,” which suggested that being transgender is a harmful medical condition, that a high proportion of youth regret seeking gender affirming care, and that such care is comparable to female gender mutilation.

A number of states already had banned gender affirming treatment. On June 18, Supreme Court Justice Sonia Sotomayor (joined by Justices Ketanji Brown Jackson and Elena Kagan, in part) filed a dissent to the Supreme Court’s ruling upholding Tennessee’s ban on gender-affirming care to minors. “If left untreated, gender dysphoria can lead to severe anxiety, depression, eating disorders, substance abuse, self-harm, and suicidality,” Sotomayor explained. “Suicide, in particular, is a major concern for parents of transgender teenagers. . . When provided in appropriate cases, gender-affirming medical care can meaningfully improve the health and wellbeing of transgender adolescents, reducing anxiety, depression, suicidal ideation, and (for some patients), the need for more invasive surgical treatments later in life. That is why the American Academy of Pediatrics, American Medical Association, American Psychiatric Association, American Psychological Association, and the American Academy of Child Adolescent Psychiatry all agree that hormones and puberty blockers are ‘appropriate and medically necessary’ to treat gender dysphoria when clinically indicated.” She concluded that the Court “authorizes, without second thought, untold harm to transgender children and the parents and families who love them.” Sotomayor read the 31-page dissent from the bench, an unusual move taken only when a justice sharply disagrees with the majority.

On July 7, Bondi announced that she had sent “more than 20 subpoenas to doctors and clinics involved in performing transgender medical procedures on children,” requesting as many as 15 different documents. Those included some with the names, Social Security numbers, and home addresses of youth who had received gender affirming care as well as those of their parents. Bondi stated that the subpoenas targeted “medical professionals and organizations that mutilated children in the service of a warped ideology.”

Several judges have quashed the subpoenas, arguing that members of the administration know little about gender dysphoria and the importance of treating it and that Bondi sought the documents under false pretenses. On September 9, Judge Myong J. Juon of the District Court for the District of Massachusetts, ruled in favor of Boston Children’s Hospital (BCH), because “doctors have described GAC [gender-affirming care] as a medical necessity.” He continued, “The Administration has been explicit about its disapproval of the transgender community and its aim to end GAC.” Although Bondi claimed that the purpose of the subpoenas was to investigate fraud or unlawful off-label use of medications, it was “abundantly clear” that the “true purpose…is to interfere with the Commonwealth of Massachusetts’ right to protect GAC within its borders, to harass and intimidate BCH to stop providing such care and to dissuade patients from seeking such care.”

On October 27, Judge Jamal Whitehead of the District Court for Western District of Washington at Seattle, ruled in favor of QueerDoc, a small telehealth provider offering gender affirming care in ten western states. Following Juon, he argued that although the Government asserted it wanted the documents to conduct an investigation, the “intended effect” was to “downsize or eliminate…all gender-affirming care. No clearer evidence of improper purpose could exist than the Government’s own repeated declarations that it seeks to end the very practice it claims to be investigating.”

On November 21, Judge Mark Kearney of the District Court for the Eastern District of Pennsylvania, blocked the subpoena issued to the Children’s Hospital of Philadelphia, writing, “The Hospital has treated children facing. . . gender identity issues for the last eleven years consistent with Pennsylvania citizens approving the legality of gender-affirming medical care.” Using words from Bondi’s July 7 press release, he concluded, “The children’s and their families’ privacy interests in their highly sensitive and confidential medical and psychological treatment in a charged political environment, which considers their medical treatment a warped ideology, far outweigh the Department of Justice’s shifting need for the information in the challenged requests.”

On December 18, Health Secretary Robert F. Kennedy, Jr. issued the Kennedy Declaration, stating that gender affirming treatments for minors, such as puberty blockers, cross-sex hormones, and surgeries, “fail to meet professional[ly] recognized standards of care”; as a result, he would remove Medicare and Medicaid funding from hospitals that provide such procedures. On April 14, 2026, Judge Mustafa T. Kasubhai of the District Court for the District of Oregon ruled in favor of a coalition of 19 states and the District of Columbia which sued to invalidate the declaration. Kasubhai began by pointing to the need to protect US democracy in these perilous times: “Unserious leaders are unsafe. There is nothing more serious than our leaders’ dedication to the rule of law so that we might maintain the integrity of our constitutional democracy. . .This case demonstrates how disregard for the rule of law does not merely result in an abstract infraction. . .This case illustrates that when a leader acts without authority and in the absence of the rule of law, he acts with cruelty.” Like other judges, Kasubhai pointed to the administration’s ignorance about gender affirming treatment, adding, “The Kennedy Declaration amounts to nothing more than one man’s musings on gender-affirming care.”

In January 2026, the Federal Trade Commission (FTC) issued Civil Investigative Demands (CIDs) to three nonprofit organizations, the Endocrine Society, the World Professional Association for Transgender Health (WPATH), and the American Academy of Pediatrics, ostensibly to investigate their unfair marketing practices. All three organizations immediately sued. The cases regarding the Endocrine Society and WPATH were assigned to Chief Judge James E. Boasberg of the District Court for the District of Columbia. On May 7, 2026, he granted temporary restraining orders to both. Because he discussed the issues most fully in the Endocrine Society case, I concentrate on it.

His opinion began with a question: “How can we know when an agency’s use of its investigative tools shifts from legitimate to retaliatory?” He then proceeded to explain why the FTC’s demand was not legitimate. “One premise of the Society’s work is acceptance of the scientific and medical proposition that some individuals feel incongruence between their gender identity and their designated gender,” Boasberg wrote. “Such incongruence can lead to gender dysphoria, a hormone-related condition included in the Diagnostic and Statistical Manual of Mental Disorders.” Trump, by contrast, “has made no secret of his disdain for the concept of gender dysphoria,” issuing “a flurry of executive orders during the first few weeks of his second term.” Those orders “did not merely lambast the view that gender dysphoria is a medical condition and the proponents of treating it. They exhorted federal agencies to put a stop to any acknowledgment of gender dysphoria or that some individuals are transgender.”

Boasberg continued by noting that the FTC’s record “reflects acrimonious statements of Commission staff and leadership toward proponents of gender-dysphoria treatment that echo the Trump Administration’s characterizations.” He pointed in particular to a workshop held by the FTC in the summer of 2025 titled “The Dangers of ‘Gender-Affirming Care’ for Minors.” The FTC later hired one participant who recommended “’conducting thorough investigations’ of medical associations because such investigations would cause groups to ‘start losing members’ and ‘lose revenue streams.’” And, in fact, the “Society contends that it is experiencing deleterious effects on its speech and work as a rest of ongoing government scrutiny, culminating in the issuance of the CID.”

Some of these cases have been overturned, but that is not the point. In these scary days, it is especially important to focus on judgments defending gender affirming care, most of which garners little media attention. Future posts will address cases in other fields of public health.

Cases:

Kingdom v Trump, DDC Lamberth (6/3/25)

In re Subpoena, ED Pa K (WPATHearney (11/21/25)

Oregon v. Kennedy, D Or Kasubhai (4/18/26)

QueerDoc v. U.S. Department of Justice, WD Wa Whitehead (10/27/25)

In re Administrative Subpoena, D Ma Juon (9/9/25)

U.S. v. Skrmetti, Supreme Court (6/18/25) (Sotomayor dissenting)

Endocrine Society v. FTC, DDC Boasberg (5/ 7/ 26)

KFF, a health news site, discussed John Galvin. Although he needed a colonoscopy, he was waiting to schedule it until his 65^th birthday when he would qualify for Medicare. His ACA insurance premium had tripled to $2,460; his deductible had risen to $2,700.

On May 1, 2026, The New York Times reported that approximately 20 percent of enrollees in ACA plans are expected to lose coverage.

Why do these stories keep coming? The most immediate reason, of course, is that congressional Republicans refused to extend the ACA subsidies established by President Biden during the pandemic. The larger issue is that we lack a right to health care. Although the 1986 Emergency Medical Treatment and Labor Act requires hospitals to provide stabilizing treatment to everyone seeking care in the ER, the United States is virtually the only high income country without universal access to ongoing care for both acute and chronic illnesses.

When I used to ask my public health students why that is the case, they invariably responded that we are not a socialist country. When I pointed out that every child in the US has a right to education, they were stumped.

Unsurprisingly, racism was a major factor in preventing the US from guaranteeing a right to health care. A critical reason President Franklin Delano Roosevelt did not include a national health plan in the New Deal was that he needed the support of southern Democrats in Congress, who feared that such a plan would undermine segregation. (The New Deal policies that Congress accepted were designed to exempt workers in jobs held overwhelmingly by African Americans, such as domestic service and farming.)

The weakness of the US labor movement also helps to explain the nation’s unique arrangement for health care financing. In Europe, political parties aligned with the working class successfully fought for a wide range of social benefits. But in 1915, when the American Association for Labor Legislation (AALL), a progressive organization, proposed compulsory health insurance for low-waged workers, Samuel Gompers, the president of the American Federation of Labor, condemned the plan as “a menace to the rights, welfare, and liberty of American workers.” In 1938 organized labor finally reversed its stance. At a government-convened conference, union leaders finally acknowledged that health care should be guaranteed as a fundamental right. But the labor movement in the US never became the commanding presence it was in Europe and thus could not move the government to action.

When World War II began, labor unions supported the growth of job-based health insurance. Because the government imposed wage controls to prevent inflation, unions began to bargain for fringe benefits instead. Employment-based health insurance became especially attractive in 1943, when the IRS ruled that payments for health insurance were exempt from federal income taxes.

Physicians mounted the fiercest opposition to national health insurance. Even the establishment of the nonprofit Blue Cross and Blue Shield companies in the 1930s so alarmed the American Medical Association (AMA) that it declared, “No third party must be permitted to come between the patient and his physician in any medical relations.” Like the labor movement, the AMA began to alter its position on health care in the late 1930s, but the organization never went so far as to agree that everyone has a right to health care. Realizing that opposition to all health insurance was futile, the AMA decided to support voluntary plans--so long as they did not interfere with the physician/patient relationship.

The greatest threat to physicians emerged after the end of WWII, when soldiers returning from saving democracy abroad wondered why the values they fought for did not extend to the US. In 1945 Truman became the first president to propose universal health insurance. In words that might have enlightened my public health students, he stressed that “the health of American children, like their education, should be recognized as a definite public responsibility.” A week after Truman submitted his bill to Congress, Morris Fishbein, the longtime editor of the Journal of the American Medical Association, condemned the bill as embodying the worst elements of “socialized medicine.” The AMA warned that “Armageddon” had arrived.

Because Truman’s bill enjoyed widespread popularity, the AMA retained the first political public relations firm, Whitaker and Baxter, to aggressively campaign against it. The firm charged a hundred thousand dollars a year; the annual operating budget for the campaign against health insurance exceeded a million dollars, an astronomical amount in 1945. The AMA raised the funds by assessing its members a fee of twenty-five dollars a year.

Whitaker and Baxter’s crusade probably did more than anything else to cement the idea in the American mind that national health insurance was tantamount to socialism. An initial plan for the campaign read in part that the “immediate objective is the defeat of the compulsory health insurance program pending in Congress” and that the “long-term” objective is to put a permanent stop to the agitation for socialized medicine in this country.” Speaking before two hundred New England doctors, Whitaker stated, “Hitler and Stalin and the socialist government of Great Britain all have used the opiate of socialized medicine to deaden the pain of lost liberty and lull the people into non-resistance. Old World contagion of compulsory health insurance, if allowed to spread to our New World, will mark the beginning of the end of free institutions in America. It will only be a question of time until the railroads, the steel mills, the power industry, the banks and the farming industry are nationalized.”

After persuading a hundred members of Congress to allow him to read their constituents’ mail, Whitaker reported that at the start of the campaign, the mail “was running four and half to one in favor” of Truman’s bill. “Nine months later it was running four to one against.”

When Truman’s plan went down in defeat, he erupted in fury, telling reporters that there was “nothing in this bill that came any closer to socialism than the payments the American Medical Association makes to the advertising firm of Whitaker and Baxter to misrepresent my health program.”

As the AMA’s power gradually diminished in the late 1950s, insurance firms and employers took up the mantle. They were successful for nearly sixty years, lobbying so successfully against President Bill Clinton’s health plan that it never reached a vote in Congress.

Then, in 2010, almost a century after the AALL first proposed health reform, Congress passed the ACA during the Obama administration. To hear Republican denunciations of the act, one might think that socialism had arrived. Far from ushering in socialized medicine, however, the ACA is consistent with the nation’s capitalist and individualistic political culture. It is a market-based program relying on private insurance companies. Although the act expands access to healthcare, it fails to provide universal coverage. Nevertheless, since its passage, Republicans have tried to repeal or defund the act sixty times. The government’s failure to extend the subsidies is only the latest assault.

Even my students eventually acknowledged that the right to healthcare is NOT un-American. Somehow we have to convince the rest of the population.

Sources:

David Rothman, “A Century of Failure: Health Care Reform in America,” Journal of Health Policy Politics, Policy and Law, 18, no. 2 (1992): 273.

Jill Lepore, “The Lie Factory,” New Yorker, September 17, 2012.

Nancy Tomes, Remaking the American Patient: How Madison Avenue and Modern Medicine Turned Patients into Consumers (University of North Carolina Press, 2016).

Paul Starr, The Social Transformation of American Medicine: The Rise of a Sovereign Profession and the Making of a Vast Industry (Basic Books, 1982).

Meg Tanaka and Melody Petersen, “When a Doctor Visit Is Out of Reach,” Los Angeles Times, February 7, 2026.

Sam Whitehead, “Rising Health Costs Push Some Middle-aged Adults to Skip the Doc until Medicare,” KFF, March 23, 2026.

Reed Abelson and Margot Sanger-Katz, “Since Congress Let Obamacare Subsidies Expire, Millions Are Dropping Coverage,” New York Times, May 1, 2026.

KFF, a health news site, discussed John Galvin. Although he needed a colonoscopy, he was waiting to schedule it until his 65^th birthday when he would qualify for Medicare. His ACA insurance premium had tripled to $2,460; his deductible had risen to $2,700.

On May 1, 2026, The New York Times reported that approximately 20 percent of enrollees in ACA plans are expected to lose coverage.

Why do these stories keep coming? The most immediate reason, of course, is that congressional Republicans refused to extend the ACA subsidies established by President Biden during the pandemic. The larger issue is that we lack a right to health care. Although the 1986 Emergency Medical Treatment and Labor Act requires hospitals to provide stabilizing treatment to everyone seeking care in the ER, the United States is virtually the only high income country without universal access to ongoing care for both acute and chronic illnesses.

When I used to ask my public health students why that is the case, they invariably responded that we are not a socialist country. When I pointed out that every child in the US has a right to education, they were stumped.

Unsurprisingly, racism was a major factor in preventing the US from guaranteeing a right to health care. A critical reason President Franklin Delano Roosevelt did not include a national health plan in the New Deal was that he needed the support of southern Democrats in Congress, who feared that such a plan would undermine segregation. (The New Deal policies that Congress accepted were designed to exempt workers in jobs held overwhelmingly by African Americans, such as domestic service and farming.)

The weakness of the US labor movement also helps to explain the nation’s unique arrangement for health care financing. In Europe, political parties aligned with the working class successfully fought for a wide range of social benefits. But in 1915, when the American Association for Labor Legislation (AALL), a progressive organization, proposed compulsory health insurance for low-waged workers, Samuel Gompers, the president of the American Federation of Labor, condemned the plan as “a menace to the rights, welfare, and liberty of American workers.” In 1938 organized labor finally reversed its stance. At a government-convened conference, union leaders finally acknowledged that health care should be guaranteed as a fundamental right. But the labor movement in the US never became the commanding presence it was in Europe and thus could not move the government to action.

When World War II began, labor unions supported the growth of job-based health insurance. Because the government imposed wage controls to prevent inflation, unions began to bargain for fringe benefits instead. Employment-based health insurance became especially attractive in 1943, when the IRS ruled that payments for health insurance were exempt from federal income taxes.

Physicians mounted the fiercest opposition to national health insurance. Even the establishment of the nonprofit Blue Cross and Blue Shield companies in the 1930s so alarmed the American Medical Association (AMA) that it declared, “No third party must be permitted to come between the patient and his physician in any medical relations.” Like the labor movement, the AMA began to alter its position on health care in the late 1930s, but the organization never went so far as to agree that everyone has a right to health care. Realizing that opposition to all health insurance was futile, the AMA decided to support voluntary plans--so long as they did not interfere with the physician/patient relationship.

The greatest threat to physicians emerged after the end of WWII, when soldiers returning from saving democracy abroad wondered why the values they fought for did not extend to the US. In 1945 Truman became the first president to propose universal health insurance. In words that might have enlightened my public health students, he stressed that “the health of American children, like their education, should be recognized as a definite public responsibility.” A week after Truman submitted his bill to Congress, Morris Fishbein, the longtime editor of the Journal of the American Medical Association, condemned the bill as embodying the worst elements of “socialized medicine.” The AMA warned that “Armageddon” had arrived.

Because Truman’s bill enjoyed widespread popularity, the AMA retained the first political public relations firm, Whitaker and Baxter, to aggressively campaign against it. The firm charged a hundred thousand dollars a year; the annual operating budget for the campaign against health insurance exceeded a million dollars, an astronomical amount in 1945. The AMA raised the funds by assessing its members a fee of twenty-five dollars a year.

Whitaker and Baxter’s crusade probably did more than anything else to cement the idea in the American mind that national health insurance was tantamount to socialism. An initial plan for the campaign read in part that the “immediate objective is the defeat of the compulsory health insurance program pending in Congress” and that the “long-term” objective is to put a permanent stop to the agitation for socialized medicine in this country.” Speaking before two hundred New England doctors, Whitaker stated, “Hitler and Stalin and the socialist government of Great Britain all have used the opiate of socialized medicine to deaden the pain of lost liberty and lull the people into non-resistance. Old World contagion of compulsory health insurance, if allowed to spread to our New World, will mark the beginning of the end of free institutions in America. It will only be a question of time until the railroads, the steel mills, the power industry, the banks and the farming industry are nationalized.”

After persuading a hundred members of Congress to allow him to read their constituents’ mail, Whitaker reported that at the start of the campaign, the mail “was running four and half to one in favor” of Truman’s bill. “Nine months later it was running four to one against.”

When Truman’s plan went down in defeat, he erupted in fury, telling reporters that there was “nothing in this bill that came any closer to socialism than the payments the American Medical Association makes to the advertising firm of Whitaker and Baxter to misrepresent my health program.”

As the AMA’s power gradually diminished in the late 1950s, insurance firms and employers took up the mantle. They were successful for nearly sixty years, lobbying so successfully against President Bill Clinton’s health plan that it never reached a vote in Congress.

Then, in 2010, almost a century after the AALL first proposed health reform, Congress passed the ACA during the Obama administration. To hear Republican denunciations of the act, one might think that socialism had arrived. Far from ushering in socialized medicine, however, the ACA is consistent with the nation’s capitalist and individualistic political culture. It is a market-based program relying on private insurance companies. Although the act expands access to healthcare, it fails to provide universal coverage. Nevertheless, since its passage, Republicans have tried to repeal or defund the act sixty times. The government’s failure to extend the subsidies is only the latest assault.

Even my students eventually acknowledged that the right to healthcare is NOT un-American. Somehow we have to convince the rest of the population.

Sources:

David Rothman, “A Century of Failure: Health Care Reform in America,” Journal of Health Policy Politics, Policy and Law, 18, no. 2 (1992): 273.

Jill Lepore, “The Lie Factory,” New Yorker, September 17, 2012.

Nancy Tomes, Remaking the American Patient: How Madison Avenue and Modern Medicine Turned Patients into Consumers (University of North Carolina Press, 2016).

Paul Starr, The Social Transformation of American Medicine: The Rise of a Sovereign Profession and the Making of a Vast Industry (Basic Books, 1982).

Meg Tanaka and Melody Petersen, “When a Doctor Visit Is Out of Reach,” Los Angeles Times, February 7, 2026.

Sam Whitehead, “Rising Health Costs Push Some Middle-aged Adults to Skip the Doc until Medicare,” KFF, March 23, 2026.

Reed Abelson and Margot Sanger-Katz, “Since Congress Let Obamacare Subsidies Expire, Millions Are Dropping Coverage,” New York Times, May 1, 2026.

It is unsurprising that Kennedy had his answer ready because stress management is a key feature of the wellness movement he champions. Like the movement as a whole, the emphasis on stress helps to convert systemic problems into personal ones.

The story of stress typically begins with Hans Selye, a Czech physician and biochemist who fled the Nazis in the early 1930s and found employment at McGill University a few years later. The theory he formulated in a 1936 letter to the editor of the journal Nature and then elaborated in his many later articles and books derived from his experiments with rats. He argued that organisms responded to adverse conditions in three stages, first the “Alarm Stage,” when endocrine glands released hormones that had deleterious effects on the body, then the “Resistance Stage,” when organisms successfully reversed the physiological damages that had occurred, and finally the “Exhaustion Stage,” when the organisms lacked all energy for adaptation, leaving them vulnerable to various forms of disease and even death.

After military studies demonstrated that humans as well as laboratory rats could suffer the consequences, physiologists applied the notion of stress first to members of the armed forces and then to civilians. In 1967 psychiatrists Thomas H. Holmes and Richard H. Rahe devised “The Social Readjustment Rating Scale,” based on the premise that such ordinary life events as “death of a spouse,” “divorce,” “marriage,” and “personal injury or illness” could engender difficulties analogous to those that arose from combat. The scale permitted individuals to rate their own susceptibility to stress.

“By the 1980s,” historian Elizabeth Siegel Watkins writes, “’stress’ had become an established term in the American vernacular, used to describe feelings of pressure and tension and to explain the source of some diseases.” A signal event was a June 1983 Time magazine article. The cover of the issue screamed “STRESS!” and displayed the photograph of a man’s face contorted in agony. The article highlighted the deleterious effects of stress on the body: “Stress is now known to be a major contributor, either directly, or indirectly, to coronary heart disease, cancer, lung ailments, accidental injuries, cirrhosis of the liver and suicide—six of the leading causes of death in the U. S.” Stress also caused serious mental health problems, especially depression and anxiety. Two-thirds of visits to family doctors were stress-related.

During the same period, Americans became familiar with the notion of burnout, a state of complete exhaustion caused by severe, chronic stress. The term is often attributed to Graham Greene whose 1960 novel, A Burnt Out Case, describes Querry, a famous architect, who arrives at a Congo leper colony after losing all sense of the meaning of life. In 1974 psychologist Herbert Freudenberger used the label to describe the experiences of workers in free clinics, women’s centers, and hot lines. Because staff members were either low-paid or volunteers, idealism and dedication were essential. “But it is precisely because we are dedicated,” he wrote, “we walk into the burn-out trap.” In 1988, Freudenberger expressed his astonishment at the speed with which the term had become part of “the daily argot of our society.” Burnout had become “a buzz word, used to convey a great number of personal and social problems.”

The growing focus on stress spawned an enormous stress management industry. As early as 1981, the Institute of Medicine called attention to the “wide range of best-selling books [that] assert that people can avoid developing hypertension, heart attacks, depression, anxiety and many other disorders by changing their lifestyles in ways that reduce stress.”

Research on family care for older people illustrates the rapidity with which the notion of stress achieved prominence. Although family members historically delivered the great bulk of care to people who were sick or disabled, the topic did not attract attention until the early 1980s. In 1990, the sociologist Leonard I. Pearlin, a key player in the field, wrote with his colleagues, “It is difficult to imagine many situations that equal—let alone surpass—the stressfulness of caregiving to relatives and friends with severe chronic impairments.” As a result, caring “acted as a magnet in attracting the interest of stress researchers.”

Numerous researchers began to devise survey instruments about events carers typically considered stressful. The first was Steven H. Zarit’s 1981 “Burden Interview,” which has been cited thousands of times and translated into other languages. According to PubMed, the government’s database for articles in the biomedical and life sciences, the number of publications with the key words “caregiver,” “stress,” “elderly” steadily grew from 2 in 1980 to 47 in 1990, to 90 in 2000, to 282 in 2010, to 479 in 2020, and to 916 in 2025. By the end of that year, a total of 8,654 articles had appeared on that subject. The great majority of advice books for carers include large sections explaining how they can handle the stress they experience.

Tajeda reminded his audience that managing stress is “not just for the elite, but for all of us.” Kennedy’s rules, however, have little relevance for most of the people whose health he now is charged with protecting. Although a popular 1974 book, Type A Behavior and Your Heart, by two cardiologists, Meyer Friedman and Ray Rosenman, argued that white men in high status positions experienced the highest levels of stress, we now know that stress levels are highest among workers in low-waged jobs, especially those who are members of racially marginalized groups. A spirituality practice, of course, is available to all, but most of RFK Jr.’s suggestions are useless for the population. Those who work two or more jobs to make ends meet cannot find time to meditate, exercise, or get into nature. Those who live in dangerous neighborhoods cannot take the long walks Kennedy enjoys.

An administration truly committed to reducing stress levels would enact broad-based social, political, and economic reforms. The current regime is doing just the opposite.

Sources:

Sammy Tajeda,”How Do Our Health Leaders Manage the Stress of their Job,” October 2024, reposted March 2026,

Emily K. Abel, Sick and Tired: An Intimate History of Fatigue (University of North Carolina Press, 2021).

Long Covid refers to symptoms lasting at least three months after a positive-Covid test. Approximately twenty million people in the United States live with the condition. It closely resembles myalgic encephalomyelitis, often called chronic fatigue syndrome or ME/CFS. Both are post-viral illnesses. Both disproportionately affect women. And both have many of the same symptoms, most notably fatigue, brain fog, and depleted energy after physical or mental exertion. Indeed, the emergence of long Covid initially inspired hopes that ME/CFS would receive the attention it had long deserved; many ME/CFS advocacy groups extended their purview to include long Covid.

Another similarity between long Covid and ME/CFS is that people with both disorders face widespread skepticism that their symptoms are real. Like people with other invisible and “contested” diseases, including, Gulf War Syndrome, fibromyalgia, and multiple chemical sensitivities, those with ME/CFS and long Covid report going from doctor to doctor to find one who can explain the source of their troubles. Large proportions of both groups remain undiagnosed. Family members, friends, and colleagues doubt that people with the disorders suffer as much as they claim. Suspicious of workers who request accommodations, many employers fail to provide them.

Finally, people with both conditions played a major role in publicizing them. By 1990, two years after the Centers for Disease Control and Prevention chose the name chronic fatigue syndrome for a new cluster of symptoms, four national advocacy organizations and 400 local support groups existed. Jennifer Brea, the co-founder of #MEAction, a global advocacy group, was a twenty-eight-year-old-Harvard graduate student when she developed a host of symptoms. Because her doctors did not believe her account, she “went online.” There she discovered “thousands of people all over the world living with the same symptoms, similarly isolated, similarly disbelieved.”

As early as August 2020 (approximately seven months after the first Covid-19 cases were detected in the US), thousands of people with long Covid had joined support groups on Facebook. A 42-year-old police officer told an interviewer, “I was so scared. I was like—just with all the body changes, and all this weird stuff happening to your body, and the feelings, and so I joined that Facebook Long Covid group. I’ve got to tell you that made me feel so good, because there are thousands of people who have the exact same symptoms that I had…It gave me hope.”

Researchers have not always provided the validation sufferers want. For many years, the massive, but highly misleading, $5 million British study known as the PACE Trial heightened the belief that ME/CFS was not a legitimate disease. The study relied on the notion of “learned helplessness.” The psychologist Martin Seligman coined the term in the late 1960s after observing that animals repeatedly subjected to aversive stimuli gradually understood that they could not assert control and eventually stopped trying. Applied to humans, the concept describes individuals who believe that all attempts to alter a bad situation are doomed to failure and thus come to accept their fate. Linking learned helplessness to depression, Seligman sought ways to increase individuals’ resilience and was an enthusiastic supporter of cognitive behavior therapy.

The theory was especially prominent in Britain, where some of the most influential research on chronic fatigue syndrome was conducted. A leading investigator was Simon Wessely, professor of psychological medicine at the Institute of Psychiatry, King’s College, London, who wrote with his colleagues in 1991, that the symptoms of CFS produce “a state of ‘learned helplessness,’ being potent, aversive, and uncontrollable, and may also trigger or exacerbate the mood disorder that is found in many patients. Continuing attribution of all symptoms to a persistent, untreatable ‘virus,’ continued to increase helplessness, although it preserves self esteem. Avoidant behavior (which is reinforced by the advice currently offered to patients) sustains symptoms, by decreasing activity tolerance and increasing sensitivity to any stimulation.” The remedy was cognitive behavioral therapy to reorient patients’ understanding of their illness and lessen their fears about engaging in physical activity.

The PACE Trial, which British researchers launched in 2005, reminds us that the concept of learned helpless retained its hold over researchers for many years. Wessely was a major supporter. The 600 participants in the trial were randomly allocated to four treatments provided for twelve months by a group of doctors, occupational therapists, physiotherapists, and psychological therapists. One group received the standard specialist medical care (SSMC), including advice about coping with the illness and medications for insomnia and pain, if considered appropriate. The second group received SSMC plus adaptive pacing therapy (APT), which provided advice about how patients could gear their activities to their energy levels. The third group received the first two therapies plus both cognitive behavior therapy (CBT), which sought to correct the beliefs that hindered recovery, and graded exercise therapy (GET), which helped patients gradually increase their physical activities.

The ideas of learned helplessness pervaded the manual the CBT therapists received. The authors acknowledged that physical factors might trigger CFS but emphasized the psychological issues that prolonged it. A major goal was thus to encourage participants to “see symptoms as temporary and reversible and not as signs of harm or evidence of fixed disease pathology.”

The results generated enormous excitement. A 2011 article in The Lancet reported that GET and CBT were effective treatments for people with CFS. The popular press in both Britain and the US spread the news to a broad audience. The study also shaped medical care in both countries. The CDC, the Mayo Clinic, Kaiser Permanente, WebMD, and the American Academy of Family Physicians were among those that based their treatment protocol on the PACE trial’s recommendations.

But the results infuriated people with ME/CFS. “Patients like me were immediately skeptical,” commented science writer Julie Rehmeyer. “The results contradicted the fundamental experience of our illness.” One of the distinctive features of the disease is that even mild exertion can severely exacerbate the symptoms. “The researchers argued that patients…who felt sicker after exercise simply hadn’t built their activity up carefully enough,” Rehmeyer continued. “Start low, build slowly but steadily, and get professional guidance, they advised. But I’d seen how swimming for five minutes could sometimes leave me bedbound.”.

Soon researchers began to debunk the study. In February 2015 the Institute of Medicine (now the National Academy of Medicine) published Beyond Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Redefining an Illness. Defining ME/CFS as a “serious, debilitating” condition, the report condemned the “misconception that it is a psychogenic illness or even a figment of the patient’s imagination.” Later that year, the Virology Blog run by Vincent Racaniello, a prominent Columbia University microbiologist, posted a report concluding that the PACE trial violated basic scientific principles and that its treatment recommendations were useless and often harmful. The following month medical researchers at leading US universities, including Columbia, Stanford, and Berkeley, wrote an open letter to Richard Horton, the editor of the Lancet, urging the journal to obtain an independent review of the study. The journal also received a petition with 10,000 signatures demanding that it publish a retraction of its original article on the PACE findings. More recent studies report that brain changes in people with ME/CFS reduce their tolerance for physical and mental exertion and increase their fatigue.

Despite the many studies undermining the PACE Trial, the belief that ME/CFS and long Covid are imaginary or psychogenic disorders remains widespread. People living with both conditions thus continue to encounter derision and disbelief from health providers, family, friends, colleagues, and employers. The “sustained national effort” Kennedy promised for long Covid must be extended to ME/CFS and begin now.

Emily K. Abel is Professor Emerita at the UCLA Fielding School of Public Health. Her forthcoming book is Listening to Dementia: Advocating for Dignity and Autonomy (NYU Press, 2026).

Sources:

“HHS Advances Fight against Long COVID with Patient Roundtables and New National Efforts,” Press Release, Department of Health and Human Services, September 18, 2025.

Larry Au, et al., “Long Covid and Medical Gaslighting: Dismissal, Delayed Diagnosis, and Deferred Treatment,” SSM-Qualitative Research in Health, September 7, 2022.

Ferlicity Callard and Elisa Perego, “How and Why Patients Made Long Covid,” Social Science & Medicine, October 7, 2020.

Trisha Greenhalgh, et al., “Long Covid: A Clinical Update,” Lancet, August 17, 2024.

Ziyad Al-Aly., et al., “Long COVID, Science, Research, and Policy,” Nature Medicine, August 2024.

Katherine C. McNabb, “’It Was Almost Like It’s Set Up for People to Fail,’ A Qualitative Analysis of Experiences and Unmet Supportive Needs of People with Long Covid,” BMC Public Health, 2023.

Wolfson Institute of Preventive Medicine, “Pace Trial,” https://www.qmul.ac.uk/wiph/centres/centre-for-psychiatry-and-mental-health/research/pace-trial/

Bart Stouten, Ellen M. Goudsmit, and Neil Riley, “The PACE Trial in Chronic Fatigue Syndrome,” Lancet, May 28, 2011.

David Tuller, “Trial by Error,” Virology Blog, http://www.virology.ws/2015/10/21/trial-by-error-i/; http://www.virology.ws/2015/10/22/trial-by-error-ii/;http://www.virology.ws/2015/10/23/trial-by-error-iii/

Julie Rehmeyer, “Bad Science Misled Millions with Chronic Fatigue Syndrome: Here’s How We Fought Back,” STAT, September 26, 2016.

Jennifer Brea, “What Happens When You Have a Disease Doctors Can’t Diagnose?” TED Radio Hour, NPR, February 10, 2017.

Ed Yong, “Long-Haulers Are Redefining COVID-19,” Atlanticd, August 19, 2020.

Ed Yong, “Long COVID Has Forced a Reckoning for One of Medicine’s Most Neglected Diseases,” Atlantic, September 26, 2022.