The Trump administration had adopted policies condemning a sizable group of its core MAGA supporters — miners, firemen, manufacturing workers — to slow deaths from diseases that cut off their ability to breathe.
President Trump’s attacks on the regulation of toxic chemicals in the air and water, on strong vaccination policies, on rules restricting power plant pollution are part and parcel of what amounts to a killing spree cloaked as deregulation.
Take just one example, albeit a major one.
Medical and public health experts estimate that the Trump administration’s decision to eliminate nearly all assistance provided by the U.S. Agency for International Development will result in an estimated additional 14 million dead worldwide by 2030.
Add to this the estimates of rising numbers of preventable deaths in the United States from increased rates of respiratory disease, illnesses of the unvaccinated and elevated exposure to toxic chemicals and lethal pollutants emanating from coal-powered plants, all of it enabled by Trump’s deregulatory policies.
Experts in health care don’t hold back in their assessments of the Trump administration.
“My overall sense is that Trump is the worst president on health we have had,” David M. Cutler, a professor of applied economics at Harvard, wrote by email in reply to my inquiries.
The One Big Beautiful Bill Act, Cutler noted,
will lead to less insurance coverage and consequently health losses. The most recent estimates are 10 million uninsured. The A.C.A. subsidies, if not extended, are projected to reduce insurance coverage by another four million.
Natasha Sarin at Yale reviewed the literature and concluded that 16 million uninsured would result in 140,000 deaths over a decade. Based on that, one would forecast 122,000 deaths from 14 million uninsured. This is obviously subject to uncertainty, but the direction is clear.
The administration’s anti-vaccine policies, Cutler continued, will add more: “We are now experiencing diseases that we thought we had eliminated.”
Along similar lines, Benjamin Sommers, a professor of health care economics at Harvard’s T.H. Chan School of Public Health, wrote by email, “The Trump administration is aggressively rolling back decades of progress in expanding health insurance and improving prevention through vaccination, which will lead to financial strain, barriers to care, and preventable deaths for many Americans.”
Sommers made his own calculation of the number of deaths he expects to result from the health care cuts in Medicaid in the One Big Beautiful Bill Act and the rising costs of policies available in the Obamacare marketplace: “If you take Congressional Budget Office’s number for the O.B.B.B.A., combined with the effect of letting the enhanced marketplace subsidies expire after 2025, about 16 million people become uninsured — about half Medicaid and half marketplace.”
Sommers estimated in an earlier paper that “Medicaid expansion prevented one death per year for every 239 to 316 adults gaining Medicaid. In reverse, this would imply that the Medicaid cuts could cause between 24,000 to 32,000 deaths per year.”
Similarly, Sommers and his colleagues found that when Massachusetts expanded health coverage in a precursor to the Affordable Care Act, there was “one death prevented for every 830 adults gaining insurance. This means 8.2 million losing marketplace coverage would translate to another 10,000 deaths or so.”
Sommers acknowledged his estimates “are all extrapolations and imprecise,” but notes that they “give you a general idea.”
One thing stands out in Trump’s loosening of regulations of toxic chemicals, his anti-vaccination policies and his health care cuts. He is inflicting a disproportionate share of the worst kind of harms on the families of the men and women who love him the most: white working-class voters, especially those living in the industrial Midwest and Appalachia.
Take mine workers, who backed Trump in 2024 by margins of 3 to 1 or better.
What did the Trump administration do after these voters sent him back to the White House?
He and his top aides cut or eliminated crucial protections overseen by the Occupational Safety and Health Administration, the National Institute for Occupational Safety and Health and the Mine Safety and Health Administration.
In doing so, the Trump administration is opening the door to a surge in respiratory lung diseases. David Michaels, a professor in George Washington University’s environmental and occupational health department, wrote by email:
The current administration has decided to make the ancient disease silicosis great again. The Department of Labor announced it will not enforce the Mine Safety and Health Administration’s standard that lowered the permissible exposure limit in coal mines to the same level that OSHA applies in factories and construction sites.
Silicosis is a lung disease caused by breathing silica dust. The tiny particles, according to the Cleveland Clinic, damage “immune cells in the tiny air sacs in your lungs (alveolar macrophages) — they’re part of your respiratory system’s core line of defense.”
Those with silicosis, according to the clinic, are also vulnerable to autoimmune diseases like scleroderma, rheumatoid arthritis and lupus, chronic bronchitis, chronic kidney disease, lung cancer and tuberculosis.
“You can’t cure or reverse silicosis,” the clinic’s doctors write. “Severe cases can affect your ability to do daily activities. It can also be fatal.”
Trump’s deregulatory drive comes at a bad time, Michaels pointed out:
The Centers for Disease Control just released a study that found dust disease deaths among coal miners is increasing, even though, according to the report, coal workers’ pneumoconiosis is a preventable, progressive occupational lung disease caused by inhaling respirable coal mine dust, a complex mixture commonly containing coal, crystalline silica and other silicate minerals.
In addition, Michaels wrote, “the Trump administration’s decision to delay and probably kill the Mine Safety and Health Administration’s new silica exposure standard is likely a death sentence for scores of coal miners.”
Michaels pointed me to an analysis by Good Jobs First, a pro-labor think tank, which found that in the first eight months of Trump’s second term, “the average number of inspections OSHA completed and closed per month dropped 36 percent, from 1,021 to just over 650.”
A study published in the journal Science, Michaels continued, “found that every workplace inspection results in a 9.4 percent decline in injury rates over the following four years.”
While the exact number of deaths is incalculable, Trump’s cuts in medical and scientific research, along with the termination of grants and punitive actions taken against major universities, will also have lasting harmful effects on life here and abroad.
In an essay published in The Lancet in June, “The Potential Impact of the Trump Administration Policies on Health Research in the U.S.A.,” Steven H. Woolf, a professor of family medicine and population health at Virginia Commonwealth University; Sandro Galea, dean of the Washington University School of Public Health; and David R. Williams, professor of public health at Harvard, write:
For more than 80 years, the U.S. government has invested in biomedical, clinical, and public health research, making it a world leader in science and cutting-edge advances in health. These discoveries led to historic reductions in morbidity and mortality from chronic diseases, fewer fatalities from motor vehicle crashes and other injuries, and the almost complete eradication of once fatal infectious diseases such as poliomyelitis.
Despite this record, Woolf and his colleagues note:
Trump and his administration are dismantling the country’s health research infrastructure. The campaign began when a team led by Elon Musk started firing federal employees of health agencies, including government scientists, in unprecedented numbers. The administration cut health research funding across the board.
These moves, they write,
have shaken U.S. research institutions. Threatened by massive losses in federal funding, universities have been forced to freeze faculty hires, downscale or terminate research programs, alter curricula and pause enrollment of new graduate students.
A climate of fear has descended on academia, with many engaging in anticipatory obedience — taking pre-emptive steps not yet required by law to placate the administration and keep federal dollars flowing.
“While the Trump administration has committed to ‘making America healthy,’” Woolf, Galea and Williams argue, “its actions to destabilize the research enterprise could stall, if not reverse, efforts to improve population health.”
“In the meantime,” they add, “the enterprise responsible for so much progress in domestic and global health hangs in the balance.”
It is particularly difficult to estimate the number of lost lives that will result from research that will not be done because of administration cuts, withheld grants and punitive actions, but analysts have come up with some illuminating approaches to the problem.
In a JAMA article from May called “Cutting the N.I.H. — The $8 Trillion Health Care Catastrophe,” Cutler, whom I quoted at the outset, and Edward Glaeser, a Harvard professor of economics, calculated the consequence if the Trump administration reaches its goal of cutting biomedical research funding by 43 percent. (It has not been successful so far.)
Such a cut, they determined, “would be associated with a 15.3 percent reduction in patents associated with new drugs,” which, in turn, “will lead to 15.3 percent fewer new therapies.”
If “biomedical research remains as important in the future as in the past,” Cutler and Glaeser continue,
a 15.3 percent reduction in new therapies would lead to a reduction in life expectancy of 0.24 years per person over the next 25 years. In a population of more than 340 million, this reflects 82 million fewer years of life.
Economists use various methods to estimate the value of life and typically find that years of life are valued at roughly between $100,000 and $200,000 per year. Even using the lower value in calculations, the lost health from the N.I.H. cuts translates into more than $8.2 trillion ($100,000 × 82 million years).
What, then, about the effects of a centerpiece of Trump administration health policy under the guidance of Robert F. Kennedy, Jr., the secretary of health and human services? Kennedy has withdrawn support for certain vaccinations, promoted the discredited notion that vaccinations cause autism and consistently encouraged the anti-vaccine movement.
The disproportionate impact of the administration’s anti-vaccine policies on MAGA voters grows out of the polarization over vaccinations that emerged during the Covid epidemic. Opponents of vaccinations increasingly aligned with the Republican Party, and the anti-vaccine movement soon became a powerful constituency on the right.
A September 2020 Pew Research survey found that 44 percent of Republicans said they would get a Covid vaccination and 56 percent said they would not, the near mirror opposite of Democrats, 58 percent of whom said they would get the shot and 42 percent said they would not.
This split is now playing out in the debate over the panoply of vaccinations administered to children, including measles, rubella, mumps and hepatitis B.
Kindergarten vaccination rates reached a high of 95.2 percent in the 2016-17 and 2017-18 school years, according to the Centers for Disease Control and Prevention, and then began a slow but steady decline that coincided with the outbreak of Covid, falling to 92.1 percent in the 2024-25 school year.
A 3.1 percentage point drop may not seem like much, but in practice it is very significant.
Epidemiologists contend that a 95 percent childhood vaccination rate, especially in the case of measles, is crucial to achieving what they call herd immunity — when enough people in a given geographic area “have immunity to disease that it no longer spreads easily,” eliminating the threat of epidemics.
In this context, 95 percent is a tipping point and falling below it opens the door to a cascading series of adverse developments that worsen as the gap between herd immunity and the actual rate widens. One of those adverse developments is a rising death toll.
In an article in April in The Journal of American Medicine, “Modeling Re-emergence of Vaccine-Eliminated Infectious Diseases Under Declining Vaccination in the U.S.,” Mathew V. Kiang, Kate M. Bubar, Yvonne Maldonado, Peter J. Hotez and Nathan C. Lo write:
Over a 25-year period and under a scenario with current state-level vaccination rates, the simulation model predicted there would be 851,300 cases of measles, 190 cases of rubella, 18 cases poliomyelitis, and 8 cases of diphtheria. Under this scenario, we projected 851 cases with postmeasles neurological sequelae, 170,200 hospitalizations and 2,550 deaths.
If Trump, Kennedy and the anti-vaccine movement were to succeed in pushing down vaccination rates by 25 percentage points, the authors estimate that
26.9 million cases of measles would occur within the 25-year period, 790 cases of rubella, 87,600 cases of poliomyelitis and 11 cases of diphtheria. Under this scenario, we projected there would be 26,900 cases of postmeasles neurological sequelae, 100 cases of paralytic poliomyelitis, 1 case of congenital rubella syndrome, 5.4 million hospitalizations due to all infections and 80,600 deaths due to all infections.
There are now fewer than 10 cases of post-measles neurological sequelae annually in the United States, and even an increase to 26,900 over 25 years would mean the illness hit just 0.008 percent of a population of 340 million. It is, however, an illness you would not want to wish on anyone, especially in its most virulent form, subacute sclerosing panencephalitis.
MedlinePlus, a part of the U.S. National Medical Library, describes a four-stage symptomatic evolution of subacute sclerosing panencephalitis the disease in patients:
Stage I: There may be personality changes, mood swings, or depression. Fever and headache may also be present. This stage may last up to 6 months. Stage II: There may be uncontrolled movement problems including jerking and muscle spasms. Other symptoms that may occur in this stage are loss of vision, dementia, and seizures. Stage III: Jerking movements are replaced by writhing (twisting) movements and rigidity. Death may occur from complications. Stage IV: Areas of the brain that regulate breathing, heart rate, and blood pressure are damaged. This leads to coma and then death.
Again, who would suffer most from declining vaccination rates? Those living in areas where the anti-vaccine movement and support for Trump have been strongest. His policies are killing his own.
How would Trump react if the experts I have been talking to tried to brief him on the consequences of his policies? My guess: boredom.
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