Intended for healthcare professionals


Healthcare in Trump’s first year

BMJ 2018; 360 doi: (Published 16 January 2018) Cite this as: BMJ 2018;360:k173
  1. Robert Steinbrook, editor at large
  1. JAMA Internal Medicine, San Francisco, CA, USA
  1. robertsteinbrook{at}

A seemingly endless rollercoaster ride

As year one of the Trump era in the United States draws to a close on 20th January, medicine and healthcare remain on a seemingly endless rollercoaster ride. The future of the Affordable Care Act (ACA) and payment reform are uncertain, and women’s access to reproductive healthcare has suffered. There are ongoing concerns about the scientific independence of federal health agencies and budget support for their programmes. Meanwhile, President Trump has proclaimed himself a “very stable genius” on Twitter. Physicians are as baffled as foreign leaders about the meaning of his frequent Twitter posts.1 The policy and political atmospheres are increasingly surreal.

A secretary of the Department of Health and Human Services (DHHS) has come and gone amid criticism of his use of expensive chartered flights, and the director of the Centers for Disease Control and Prevention (CDC) has faced questions about financial conflicts of interest and her ability to function effectively.2 Alex Azar, the current DHHS nominee, is the former president of the US division of Eli Lilly, where the price of insulin and other company drugs substantially increased …

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