Within the first few days of his second term, Donald Trump’s threat to the country’s health was evident. The Trump administration has already ordered federal health agencies to cease public communications, directed agencies to cancel meetings to review biomedical research, and pardoned 23 individuals who violently interfered with patients’ care at reproductive health clinics—all without a confirmed secretary for Health and Human Services (HHS). Trump has promised to let his HHS secretary nominee, Robert F. Kennedy Jr., “Go wild.” RFK Jr. faces his first of two confirmation hearings this week, on January 29, and a vote will follow sometime in the coming weeks.
HHS houses a number of agencies, including the Food and Drug Administration (FDA), the Centers for Disease Control and Prevention (CDC), the National Institutes of Health (NIH) and the Centers for Medicare and Medicaid Services (CMS). Project 2025 outlines a plan to use these agencies to surveil women’s use of reproductive health services, eliminate access to abortion pills and expand “conscience” objections to give anti-choice doctors legal cover for refusing to provide life-saving care. Under the guise of “Make America Healthy Again,” Trump and RFK Jr. are poised to compromise women’s safety, pandemic protections and access to all kinds of healthcare for those most vulnerable.
Ms. spoke with Dr. Michele Goodwin, the co-faculty director of the O’Neill Institute for National and Global Health Law at Georgetown University and executive producer of Ms. Studios, to understand the devastating health consequences of a Trump-RFK Jr. team, where we can focus our energy in response, and how to hold on to hope over the next four years.
Morgan Carmen: To start us off, what healthcare-related impacts are you most concerned about with Trump in the White House and Kennedy [RFK Jr.] as the pick for HHS? And what do they have the power to do?
Dr. Michele Goodwin: Broadly, we should be concerned about America’s health, and when I say America’s: there’s the health of the nation, the health of the people, it’s the health of Earth’s climate… What we have is a person coming back into office who made very clear that matters of women’s health could become politicized, criminalized, weaponized, and that is exactly what happened with the former president, now president-elect. Having nominated and gotten through the confirmation process three Supreme Court Justices who led the way and helped to overturn Roe v. Wade and Planned Parenthood v. Casey, which has unleashed a tidal wave of chaos in the United States: where pregnant people have been bleeding out, pregnant women in parking lots are being helicoptered out of Idaho, where there have been women gestating deceased fetuses but provided no relief—gestating fetuses that had no skulls, girls now going into middle school or elementary school as mothers, and women who have died directly as a result of not being able to get the healthcare that they needed during their pregnancies in states like Georgia and Texas.
On top of that, we’ve come through a period of a pandemic and a global pandemic, one that affected us significantly in the United States. In the first three months of COVID reaching the United States, there were more Americans who died than in 19 years of the Vietnam War…added to the Korean War, Afghanistan and Iraq, that’s how many deaths.
The person who is coming in, not confirmed yet, but to become Secretary of Health and Human Services is a vaccine denialist, someone who is opposed to various vaccines. And already, there are members of Congress who also are denialist about COVID even existing. I gave testimony before a Congressional hearing where there were United States representatives who believed that COVID maybe had an impact for two weeks, but that was it. Of course, that wasn’t the reality at all. There were millions of Americans who became affected by COVID…the extent to the horror was significant.
If one has a sense that vaccines are harmful, then this could lead to [f]ederal policies, or state-level policies that then are upheld by courts, where children may no longer need vaccines—the vaccines that have been required now for decades upon decades in order to keep people healthy. Dating back to the Supreme Court case in 1905…Jacobson v. Massachusetts, giving states the authority to impose inoculation. What happens when states say, “Well, we no longer see this as important”? Literally hundreds of millions of lives have been saved in the United States, and quality of life [improved] for hundreds of millions of Americans, due to vaccines.
In terms of the concerns, they are deep and they are broad, but I think that we should also recognize this as not just on the individual level, but the ramifications that can be for whole communities, whole neighborhoods. During smallpox outbreaks, chickenpox outbreaks, during times of polio, it wasn’t just the individual family that…could contain then the illness that wreaked havoc upon a child’s body or an adult’s body. It was the level of contagion that affected an entire community, and communities upon communities, and that is the deep and growing concern for now.
Carmen: I want to ask you a little bit more about vaccines and infectious diseases. RFK Jr.’s ‘Make America Healthy Again’ plan seems to shift the focus from infectious diseases to chronic diseases, and Project 2025 talks about changing NIH research priorities away from anything related to abortion or gender-affirming care or anything related to what you just talked about.
What do you think are the ramifications of changing these priorities at the federal level?
Dr. Goodwin: Our ability to be a contributor to saving lives in the United States and around the world is a direct result of a care and appreciation for health and science, a respect for scientific deliberation, a respect for the innovations that can come from science, and also from what we’ve learned through science. [We’ve learned] what actually may be a carrier for disease, what actions can be taken in order to prevent disease, how diseases are transferred from a person to a person or an animal to a person or a bug to a person, such as mosquitoes to human beings. So much of what we’ve learned about the human body, how it functions, the human genome, what connects us.
I say this as a grounding point because all of that matters, and without access to research, when research is threatened, when it is constrained, when there is a lack of regard and respect for health and science, that is when we see some of the worst atrocities unfold, right?
With [scientific research] being threatened… being weaponized or curated where only certain aspects of research matter and others don’t—that is just simply dangerous.
Dr. Michele Goodwin
There is a lot to be said about not just health and science but also bioethics, the ethics of research, all of which has been part of a longer journey. It’s not that any of this has been perfect in the United States. There’s a reason why we have protocols that are associated with research. There’s a reason why at our universities we have institution review boards that review proposals for research because we know that scientific advancement can outpace law.
But when government decides that research is no longer necessary or that research becomes weaponized or that research becomes politicized, then it undermines the health for an entire society and it undermines the health and safety even for an entire global community, and I think that’s the threat to understand. [Research is] how we’ve benefited with things such as the air bags in a car. That’s actually a part of health and science research. That is designing a dummy of a right proportion and weight in a car speeding at a certain distance in order to be able to save lives.
There are so many things that connect with health—and also some controversy there, too, because those dummies are weighted for men and sized for men and not for women… But so much of what gives us assurance at being able to navigate through our society is related to health and science. The ways in which people are able to get the kind of medical treatment and care that is calibrated to actually benefit them and render a good outcome is through scientific research. And with that being threatened or that being weaponized or curated where only certain aspects of research matter and others don’t—that is just simply dangerous.
Carmen: I want to pick up on the thread about reproductive healthcare that you mentioned earlier. You said that we’re already in a state of crisis with reproductive healthcare in America. We also know that Project 2025 plans to have the FDA revoke mifepristone approval. It wants to threaten states that refuse to report on residents’ abortions or that require health insurance companies to cover abortion care with Medicaid funding.
What do you think is in store for us when it comes to abortion access and access to reproductive healthcare, specifically related to what HHS can do?
Dr. Goodwin: Well, there’s a heightened concern and worry and a heightened misogyny that has now made its way into the political landscape in profound ways. Fifty years ago, Roe v. Wade was a seven to two decision. Five of those seven justices were Republican appointed. And so, it is not fully accurate of a message to say that this criminalization has been a Republican agenda because it hasn’t been. In Roe v. Wade itself, and then followed by Planned Parenthood v. Casey, five of those justices who saved Roe were all Republican appointed.
So, it’s not a Republican agenda one could say over these last 50 years, but it has been a political agenda, a political agenda by those who are not interested in the flourishing of women. It’s an agenda that overlaps with being disgruntled about Brown v. Board of Education, an agenda that imbeds itself in racist tropes, an agenda that is connected with anti-democratic values such as suppression of voting rights, right?
The space and time that we’re in is deeply concerning and worrying for many of the reasons that I said before, which are truly life and death because the United States leads all industrialized countries in terms of maternal mortality and maternal morbidity, and I’m concerned about that only worsening in the years to come with what is being proposed under Project 2025, [especially] if that becomes part of a federal agenda.
Fifty years ago, ‘Roe v. Wade‘ was a seven to two decision. Five of those seven justices were Republican appointed… So, it’s not a Republican agenda one could say over these last 50 years, but it has been a political agenda, a political agenda by those who are not interested in the flourishing of women.
Dr. Michele Goodwin
Carmen: Earlier, I heard you talk about what the federal government might influence or induce states to do in terms of negative changes for healthcare access. Are there ways for states to stand up to HHS in such a way that we might have safe haven states for healthcare?
Dr. Goodwin: Well, generally states can pass policies where the federal government leaves them off. So, for example, in our United States Constitution we don’t have a right to an education, but that’s been embedded as a state measure, interestingly enough, coming out of slavery. It was an agenda item for people who had been formerly enslaved. The first of our public schools, and the expansion of them, was something that was done by people who had been formerly enslaved.
In the same regard, nothing stops a state from advancing more healthcare. We saw that before the Dobbs decision. States like California actually had for decades instantiated in the state’s constitution a right to privacy, to reproductive privacy, and it went beyond that after the Dobbs decision with ballot initiative number one truly securing unquestionably a right to reproductive health, justice and rights. So, states can advance a health agenda that is not necessarily put forward by the federal government. That’s an important item. I’m glad that you raised that because those who are interested in figuring out what they can do can act locally, and this is an important time for it.
They can act locally, and they can also look globally as well. We need not be handcuffed to the ways in which we’ve done things in the United States. We can actually look abroad in other places where there are far more humanitarian healthcare regimes, where it is a fundamental right—a human right—to have access to healthcare, and that’s an agenda worth fighting for in states across the United States.
Carmen: It is shaping up to be a rough next four years, particularly for the most vulnerable among us. Are there reasons that you feel hopeful?
Dr. Goodwin: That’s a great question, and it’s important to keep hope even in times where it’s been really difficult. I will say, Morgan, one of the aspects that makes it really difficult in these times actually comes from a community whose political leadership has often been ignored, and that’s Black women. The way in which it’s been explained is that Black women have this commitment to the Democratic party and that really makes short shrift of their intellectual priorities, their political priorities, their care about constitutionalism and democracy.
What I’ve been sharing is two things, because I do want to get to the point of hope. Black women have held out hope for this nation, for its democracy, [through] having a political agenda that reflects the best aspirations of its constitution. And when you think about it, what group could wish for that more than a group of people who have been subjected to labor exploitation, sexual exploitation, whose children had been subjected to that. Individuals who had literally been treated as chattel no higher than mules in the field and whose sexual exploitation really served as a financial backdrop to the American South in fueling the economy of the United States.
The practice of democracy and the practice of hope string together like pearls around one’s neck for Black women.
Dr. Michele Goodwin
These people from the very start had very significant thinking, thought leadership, about what it would take in order to make the United States a more just, humane place that really could live up to the values that were espoused in its constitution. And that’s been a continuum. When you look at Ruby Bridges’s mother, placing her child forward for not only our nation but the world to be able to see, that [was] not just because Ruby Bridges’s mother wants her to be able to read. Ruby Bridges went to school knowing how to read—her mother had already done that. But her mother was shining a light on that which was a gap in terms of our commitment to what is expressed in our constitution and shining that light.
When I think about a measure of hope, I think that the project of constitutionalism in this country for Black women has, in fact, been a project of hopefulness about a nation that could finally live up to its ideals, and for people who shied away from being grievance voters. When you think about it, there would be centuries’ worth of grievance that Black women could have: their children being snatched away from them… The practice of democracy and the practice of hope string together like pearls around one’s neck for Black women.
So, when I think about a project for hope going forward, perhaps one on that line might be turning to and thinking about the brilliant thought leadership of Black women and understanding what their courage has meant over time as lessons for our democracy. A hopeful agenda would be that in these times, we might think about the wisdom left behind by Black women who have a lot to say and a lot of leadership to give about making our country one that can spread its wings of charity, compassion, dignity and accountability for all of its people and all of its children.
Carmen: I think that’s a really incredible way to end. Thank you so much, Professor Goodwin.
This interview has been edited for clarity and length.
