Ever since President-Elect Trump nominated Robert F. Kennedy Jr (RFK) to run the Department of Health and Human Services (HHS), the spotlight has been on improving the health of Americans as much as his alternative take on some widely accepted practices.
Whether it’s that RFK is a known vaccine skeptic or that he recently questioned why the United States has fluoridated drinking water, long proven to prevent tooth decay, physicians are on alert about what the next 4 years have in store for healthcare.
“It’s a positive development that healthcare is front and center of the national discussion,” said Gary Price, MD, president of The Physicians Foundation, a national nonprofit organization representing the interests of more than 1.1 million physicians in the United States. “However, there are several issues that must be confronted, including access, the cost of healthcare, and the well-being of the healthcare workforce. I’m hopeful that bipartisan solutions to these problems can emerge now that they’re front and center.”
Because healthcare tops the list of key topics the next administration purports to focus on, and there’s a long list of issues affecting doctors, Medscape Medical News reached out to several physicians to find out what issues they’re concerned with — and what they predict might happen after President Trump is inaugurated.
Issue #1: Vaccines
The pandemic and the politicization of vaccines have made RFK’s potential appointment alarming, saidKeith English, MD, professor and chair of the Department of Pediatrics and Human Development at the College of Human Medicine at Michigan State University in Lansing, Michigan. “RFK has been an anti-vaccine conspiracist for decades and has allied himself with some of the worst individuals who have tried to undermine vaccines,” he said. “He has repeatedly said numerous things that are false about vaccines, and this can negatively impact the health of children.”
Support for immunization is critically important, added Michael Gerling, MD, an orthopedic spine surgeon with offices in New York and New Jersey. “If RFK does, in fact, get into office, the hope is that he isn’t going to undermine the well-documented public health benefits of vaccines,” Gerling told Medscape Medical News.
This worries physicians because disease outbreaks are still occurring — not only globally but also across the country.
“We’ve experienced a pertussis outbreak, and we’ve also seen what happens when individuals don’t get vaccinated for tetanus,” said Laura Carravallah, an internist in Flint, Michigan. “We had two patients — one child and one adult — who had to be intubated in the ICU [intensive care unit] for weeks to survive. It was awful.”
It’s similar to measles, English said. “From 2000 to 2016, more than 20 million measles deaths were prevented, according to the World Health Organization (WHO),” he said. “It’s the most contagious of all the vaccine-preventable diseases, and there’s still a lot of measles around the world.”
Because vaccine hesitancy has remained an issue since the pandemic, doctors need to speak respectfully with patients about their concerns — no matter what the administration opts to recommend.
“If somebody says they don’t want a vaccine, I ask them for more information,” Carravallah added. “I say, ‘Can you tell me something more about that?’ or ‘Can you explain what you’re concerned about?’ This is critically important in this environment.”
Finally, instead of making personal attacks against RFK, English said that physicians and professional organizations should instead suggest nominees they think are better suited for this critical government role.
“We should keep explaining why it’s so important for the person in this job to support immunization,” English said. “We could suggest that previous leaders like Admiral Giroir and Robert Redfield would be good choices to lead HHS — and urge Congress to confirm somebody that’s knowledgeable and qualified to do the job.”
Issue #2: Medicare/Medicaid
For years, private practitioners have dropped their Medicare and Medicaid patients due to cuts in reimbursements, and this has the potential to continue with the new leadership, said Noah Greenspan, PT, a Medicare provider, and board-certified clinical specialist in cardiovascular and pulmonary physical therapy in New York City.
“Every year, they lower the amount we get paid,” he said, adding that while he was once paid $155-$165 per visit, he is now paid $110-$120 per visit. “This year, we’ll get a 2.8% cut, and, while that doesn’t sound like a lot, if this happens every year, you’re getting paid less and less over time, and this doesn’t match what it takes to rent a space or order the equipment you need — none of that stuff ever goes down in price.”
Carravallah said that Medicare Advantage Plans are also having an impact.
“These plans are supposed to cut waste, but there’s no evidence that they improve service,” she said. “The insurance companies must make a profit, but this doesn’t improve service. Instead, this drives up drug costs and increases the hassle factor. There’s no reason to think that Medicare Advantage Plans will improve patient health either.”
Issue #3: In Vitro Fertilization (IVF)
IVF was a significant election issue this year, which was an unwanted challenge for infertility specialists — and one in six people who struggle with infertility, according to the WHO.
“Having IVF reach the national stage was surreal for those of us who have been practicing a long time,” said Thomas Molinaro, MD, reproductive endocrinologist, chief medical officer, and an infertility specialist at IVI-RMA North America, a global reproductive medicine group.
Because laws vary by state and coverage depends on where patients live (only 19 states require insurance coverage for infertility), support at the national level is something Molinaro hopes becomes standard policy.
“There has been some state legislation in the past that has made some providers nervous,” Molinaro said. “Federal government protections could be a good benefit to have in terms of the right to have IVF and prevent discrimination against couples with infertility.”
This matters because the average IVF cycle can cost anywhere from $12,000 to $17,000.
“Most patients are paying out of pocket so more support from the government in terms of the importance of IVF, mandates for coverage, and fertility preservation, which has become important for patients going through cancer treatments, makes us feel optimistic,” he added. “We hope that with the new administration, our mission will be even more supported than it has been in the past.”
Issue #4: Women’s Reproductive Health & Abortion
A doctor’s ability to treat women appropriately for issues they may have during a pregnancy has been severely challenged this year and this greatly concerns Kecia Gaither, MD, MPH, director of perinatal services/maternal fetal medicine at NYC Health + Hospitals/Lincoln in the Bronx, New York.
“We want women who are having miscarriages to be able to access the appropriate medical and surgical intervention without them becoming sick or, worse, bleeding to death,” Gaither said. “There are already women who have lost their lives because they had a miscarriage and didn’t get the appropriate services because their physicians were afraid to treat them.”
And should an abortion be necessary, the choice should remain between the patient and her physician, Gaither added.
“In my line of work, there are a lot of anomalous issues that can occur with fetuses,” she said. “Women are being denied the option of whether or not they wish to maintain their pregnancies when there are congenital and structural anomalies — babies without the tops of their heads, hearts, and intestines on the outside of the body. There are dwarfing sequences that are lethal, or there’s a finding of Trisomy 13 and 18,” she said. “To have these women forced to continue their pregnancies in cases like this is very concerning.”
Government restrictions on women’s healthcare have already affected the career choices that doctors are making.
“For this reason, a lot of doctors aren’t doing obstetrics anymore,” Gaither said. “This leaves me feeling very concerned about the number of providers who will be available to care for women, especially those who are underserved.”
Issue #5: The Affordable Care Act (ACA)
The ACA, or Obamacare became law in 2010 during the Obama administration and provided coverage for 21.3 Americans in 2024. At the same time, the plan has been criticized due to issues related to tax increases, higher premiums, and an added workload for physicians themselves.
“There have been proposals made during the recent campaign to modify the ACA,” Gerling said. “Cost-cutting, efficiency, and transparency measures are important —everybody agrees with that. The question is, ‘are you going to put people in the role of modifying these things who have the qualifications, experience, and credibility?’”
In addition, while politicians may agree that everybody deserves healthcare, delivering that care is another matter.
“We know it doesn’t play out like that,” Greenspan said. “There’s a vast socioeconomic disparity in terms of access to care depending on who you are.”
As for what healthcare measures the new administration will enact or change on day one, the physicians Medscape Medical News spoke with agree that there’s no way to predict what will come up first.
“There’s a lot of talk about cutting Medicare and Medicaid or revising Obamacare,” Gaither said. “There are going to be millions of people impacted by these decisions, and that’s very worrisome to me.”
Lambeth Hochwald is a New York City–based journalist who covers health, relationships, trends, and issues of importance to women. She’s also a longtime professor at NYU’s Arthur L. Carter Journalism Institute.