The unseen consequences of another Trump presidency on children’s health

The kids will not be all right.

In the aftermath of President-elect Donald Trump’s victory, one overshadowed issue demanding immediate attention is the impact his electoral policies are likely to have on children’s health. While political appointments and immigration policy consume the media’s oxygen, the reality is a Trump presidency poses major concerns for the health of the most vulnerable members of our society: our children.

As a pediatrician, I watched helplessly during Trump’s first term as he cut health-care funding, oversaw a major increase in the number of uninsured children, raised anti-immigrant fervor to a level that intimidated my patients from using the social safety net programs for which they were eligible and eroded trust in public health measures such as vaccines.

With his return to the White House, those same policies are poised to resurface and accelerate, as an emboldened president-elect and Congress advance even more radical policies that jeopardize the well-being of my patients in ways both profound and lasting ways.

Health-care coverage

Children need access to affordable, quality health insurance to see physicians when sick and provide preventive care to keep them healthy. Roughly 50% of American children rely on public health insurance programs such as Medicaid and the Children’s Health Insurance Program for coverage. From 2016-20, roughly 750,000 to 1 million children lost public health insurance coverage, making it impossible for me and other pediatricians to care for them and forcing them to turn to emergency rooms for basic health care, or in many cases, to forgo any care at all.

During those years, I saw uninsured children being admitted to the hospital for asthma because they couldn’t obtain basic medications. Other patients couldn’t access immunizations, lead screening, renew prescriptions or see a pediatric specialist. That meant children with diabetes couldn’t see an endocrinologist or those with heart conditions couldn’t make appointments with a pediatric cardiologist.

In Trump’s first term, he proposed a $7 billion cut to the Children’s Health Insurance Program and proposed repealing the Affordable Care Act, also known as Obamacare. While that effort was blocked, his administration eroded access to care for many families, cutting funding for outreach programs that help enroll eligible children in public health coverage and allowing states to create artificial obstacles such as overly burdensome paperwork to renew coverage they were entitled to.

In his second term, I am bracing for further reductions in public health-care spending, ultimately exacerbating disparities in access to care for my patients. For children in lower-income families, this could lead to delayed diagnoses and untreated conditions. Issues such as childhood obesity, mental health problems and developmental disorders will go unaddressed.

Education

Education is linked to health outcomes and socioeconomic status, which potently influences your overall health. Children who receive a high-quality education are more likely to thrive physically, socially and emotionally.

Trump proposes diverting resources to private, for-profit institutions, reducing public education funding. In his first term, Trump requested lower funding levels for the Department of Education, proposing reductions of $9 billion, or 13%, in his first budget. The result will be a drastic reduction in the quality of public education, which disproportionately affects children in lower-income areas who rely on these schools. Poor education correlates with poorer health outcomes.

Empowered by single-party congressional majorities, the president-elect has pledged to eliminate the Department of Education, which provides up to 40% of the funding for special education programs nationally. These programs are essential for my patients with cognitive and behavioral issues who, after receiving extra attention in elementary school, are often in regular classrooms by sixth grade. Absent this support, schools will be coerced into mainstreaming kids too soon, which can set these high-risk children back years in terms of educational development.

Vaccines

Trump’s rhetoric during the COVID pandemic — in which he dismissed the severity of the first wave of the disease, promoted untested treatments like hydroxychloroquine, mocked mask mandates and minimized the benefits of vaccine programs — severely injured the public’s confidence in public health. With the recent nomination of anti-vaxxer Robert F. Kennedy Jr. for secretary of the Department of Health and Human Services, Trump aims to deal that confidence a lethal blow.

Kennedy continues to claim childhood vaccines are insufficiently tested, though they are the most studied and rigorously tested medical products. For example, take Tirzepatide, which isn’t a vaccine but a commonly used medication for Type 2 diabetes. It was tested on roughly 2,000 patients prior to receiving approval from the Food and Drug Administration. Contrast that to the oral rotavirus vaccine, which in 2006 was studied in over 70,000 children, with another 44,000 studied after the vaccine was introduced. Vaccines are safe, effective and more rigorously studied than everything else in your medicine cabinet.

Kennedy continues to promote the false claim that vaccines cause autism and likens childhood vaccine requirements — the most effective means of curtailing the spread of vaccine-preventable diseases in schools and effectively used in every state — to the Holocaust. All this while the Centers for Disease Control and Prevention report global measles cases surged by 20%, causing 10.3 million cases worldwide and killing 107,000 people. Whooping cough cases in the United States are also surging, back to prepandemic levels with roughly 10,000 cases per year. As a pediatrician who lived through New York’s 2019 measles outbreak, I know firsthand how easily our immunization safety net can be weakened.

Trump’s policies represent a disregard for the future of the nation and put at risk the health of the entire pediatric population. No matter your political beliefs, we cannot allow the health of the nation’s children to be threatened.

Pediatricians know children must be a priority, but under Trump’s leadership, our children will be an afterthought.

Dr. Shetal Shah is a member of the national Pediatric Policy Council and practicing physician.