Only 3 days since the last update, and yet there are 3 more distressing stories that have broken this week about the government’s negative impacts on public health:
1. Dr. Oz’s Centers of Medicare and Medicaid Services signed an agreement with the Department of Homeland Security to hand over the personal data of the 79 million people in the U.S. who are enrolled in Medicaid, including names, birthdates, home addresses, ethnicities, and social security numbers.
According to this new agreement, reported in STAT News among other places, ICE officials will now be given access to data on Medicaid patients so they can find “the location of aliens” across the US. HHS officials used to claim this upcoming agreement was only to find people who were improperly enrolled in Medicaid…to save taxpayer dollars, natch. But the now-signed data-sharing agreement makes the real intention clear: “ICE will use the CMS data to allow ICE to receive identity and location information on aliens identified by ICE.”
It’s true that undocumented people (as well as “permanent residents” with papers who have been here for less than five years, and some other legal immigrants) cannot legally enroll in Medicaid. However, all states are required by federal law to offer emergency Medicaid, which only covers lifesaving services in emergency rooms. As a previous adviser at CMS under Biden said, “Many people sign up for emergency Medicaid in their most desperate moments.” Imagine if you took this risk when you were desperate for care, perhaps being reassured that health information is highly protected in the U.S., and then found out your name, home address, and ethnicity were now being handed over to ICE.
Seven states (including CA, where I live) do permit people to enroll in their full Medicaid programs regardless of immigration status, through programs launched in 2024 or before. Each of these states did so with the stipulation that they would not bill the federal government to cover the health care costs of immigrants ineligible by federal rules. All the states — California, New York, Washington, Oregon, Illinois, Colorado, and Minnesota — have Democratic governors. Not a coincidence, I’m sure.
This new data-sharing agreement matters a lot to undocumented immigrants, and affects their likelihood of accessing healthcare here—including their children and other family members, even if here legally—even in an emergency. Imagine your father having a heart attack, and you have to decide whether to risk deportation in order to get him care in the emergency room. What would you do if your child injured themselves playing in the back yard, and was bleeding profusely? Would you take them to the hospital for stitches, or would you try to handle it yourself and hope they didn’t bleed out or get a terrible infection? You might not think undocumented people have a right to be here—but how do you feel about their children dying unnecessarily? Is that fair consequence?
We know it is not unfounded to fear that this will lead to unnecessary deaths. In 2019 under Trump 1.0, the Department of Homeland Security implemented the “public charge rule,” which applied to green card applicants within the United States. Basically this rule disqualified immigrants (even legal ones) who used programs like Medicaid from being able to then obtain a green card, under the principle that it was evidence they could be “primarily dependent on the government for subsistence.” In practice, this didn’t happen very much. (And the Biden administration put a stop to this 2019 rule in 2021.) But it didn’t matter. A lot of evidence piled up very quickly that showed that the rule had an immediate and long-lasting chilling effect on the care immigrants received in the U.S.—including emergency room visits, pediatrician wellness visits for children, and more.
Even in 2024, the effects of the public charge rule (which had not existed for years, and in practice didn’t actually prevent many green cards anyway) were still found to be present. So imagine what handing over home addresses of Medicaid enrollees to ICE will do to immigrants’ willingness to seek necessary medical care?
2. The Trump Administration is destroying 500 metric tons of food, $10 million worth of contraceptives, and 800,000 doses of Mpox vaccine rather than sending them to people who need them in other countries.
You may have already heard about the food being burned. But just in case not, the Atlantic broke the story on July 14 that almost 500 metric tons of emergency food destined to feed 1.5 million children in Afghanistan and Pakistan was being incinerated, rather than going to the mouths of these starving kids. Sometime before the end of Biden’s term in office, USAID bought $800,000 worth of high-energy biscuits intended to be used as a stopgap measure for children under 5 who have lost or fled their homes due to war or natural disaster, and are literally starving. They’ve been sitting in a warehouse in Dubai, waiting to be sent to Afghanistan and Pakistan, but after the Trump administration dismantled USAID in January there hasn’t been the infrastructure to distribute the food. According to the USAID workers who spoke to the Atlantic, federal workers repeatedly requested permission to ship the biscuits while they were still OK to eat. But the new rules post-DOGE said that no money or items intended for foreign aid can be moved without the approval of the new heads of American foreign assistance. None of the people now in charge bothered to respond to the requests, so now the food is now spoiling in the warehouse. In May, Secretary of State Marco Rubio told representatives on the House Appropriations Committee that he would ensure that food aid would reach its intended recipients before spoiling. But according to a written order seen by the reporter for the Atlantic, the order to incinerate the biscuits had already been sent. (Lies?! Say it ain’t so! I don’t believe it.) And now, the biscuits are officially wasted.
In case you’re not outraged enough about the food, yesterday a spokesperson for the State Department confirmed that the Trump administration has decided to destroy $9.7m worth of contraceptives (mostly IUDs and birth control implants) rather than send them abroad to women in Africa. To be clear, U.S. taxpayers already paid for these contraceptives. They were intended to support women in war zones and refugee camps, for whom getting pregnant would potentially be devastating. But since the U.S. is prohibiting any aid for organizations that provide abortion services or even talk to people about abortion as an option, the State Department can’t find anyone they can sell the contraceptives to and will destroy them instead. Oh, and it turns out part of the problem is that 1/3 of the contraceptives have USAID labels, and rebranding them could cost taxpayers several million dollars—so the U.S. government is willing to incinerate these taxpayer-funded, desperately needed contraceptives rather than distribute them with a label for an organization they’ve demolished. Women in refugee camps? Good luck to you. You probably won’t be raped. That’s not common in times of war </sarcasm>.
While we’re on the topic of government waste under the Trump administration, Politico recently reported that almost 800,000 Mpox vaccines destined for Africa are going to have to be destroyed, because they were allowed to languish until they were too close to their expiration date to be shipped and safely used. While the U.S. hasn’t disclosed how much was spent on these 800,000 vaccines, last year UNICEF said they were paying $65 per dose, “the lowest price on the market.” (I’ll spare you the calculator: $65 x 800,000 = $52 million U.S. taxpayer dollars wasted.) Maybe you’re not that worried about Mpox. After all, the U.S. had a Clade II outbreak in 2022 and “only” 58 people died, of more than 32,000 confirmed cases. But this was Clade II. In many parts of Africa the outbreaks are Clade I, which has a much higher death rate: more than 160,000 suspected cases with nearly 1500 deaths, including a lot of children. As U.S. taxpayers we already paid for the vaccines that could save lives…but we’re letting them go to waste.
3. HHS continues to delete and redefine terms like “gender,” “health equity,” and “social determinants of health” from assessment tools and databases.
In case you thought this was something that happened in January or February and then was reversed once a federal judge said it wasn’t OK, there’s still evidence that HHS is messing with our federal data. On July 14, HHS quietly received approval from the Office of Information and Regulatory Affairs (OIRA) to remove a question about gender and references to “gender norms” from project performance monitoring documents for a domestic violence prevention program known as DELTA AHEAD. All references to “health equity” were replaced with “optimal level of health for all, and especially for those at greatest risk,” and “social determinants of health” was replaced with “community conditions that can influence or increase the risk.” The next day, OIRA approved a request for HHS to delete questions related to gender identity, gender-affirming care for trans people, and a question about Hispanic/Latino ethnicity from assessment tools used to provide optimal HIV care for women, infants, children, and youth.
On July 10, HHS also asked OIRA for approval (still under consideration) to remove a question about gender and references to “sexual or gender identity” and “gender discrimination” from their performance monitoring survey tools for grantees funded under a grant to prevent Adverse Childhood Experiences (ACEs)—thing like child abuse, or witnessing violence or neglect in the home. They’ve also requested that “undocumented status” be eliminated as a response option for programs to indicate specific populations they serve, and that (similar to DELTA AHEAD) references to “health equity” be replaced with “health for all and especially for those at greatest risk,” and references to “social determinants of health” and “racial inequities” be removed.
Saying that we care about “health for all” instead of talking about health equity is like pretending that “All lives matter” is about caring about all people, instead of trying to suppress actions that will prevent Black people from experiencing worse police brutality or having worse health outcomes overall compared to white people. If we don’t collect data, we will no longer have evidence that consistently demonstrates that trans people or undocumented immigrants experience worse outcomes than others when it comes to HIV, ACEs, and domestic violence. But not having governmental evidence doesn’t mean it’s not true. It means the government is willing to go on record saying they don’t care.
What will next week bring? Let’s all stay tuned to find out.