President Trump & A Republican Congress: What Might It Mean?


Craig Klugman

Publish date

Tag(s): Legacy post
Topic(s): Clinical Trials & Studies Cultural Environmental Ethics Health Care Health Policy & Insurance Health Regulation & Law Media Politics Public Health Reproductive Ethics Science

by Craig Klugman, Ph.D.

In a 2000 episode of The Simpsons, a flash forward shows Lisa being elected the first heterosexual female U.S. President. Her biggest challenge is fixing the economy: “As you know, we’ve inherited quite a budget crunch from President Trump.” Did this animated show predict the 2016 election?

I am currently reading Chernow’s Hamilton biography, which lends a great deal of insight into the current election. From our Constitutional beginning, there has been a philosophical split in this country between those like Hamilton who viewed a strong federal government and an industrialized nation. On the other hand Jefferson and Madison led the antifederalists. They preferred a weak central government, strong states, and an agricultural nation. This is a debate we have been having since the 1790s and seemingly is the same one we are having today with a society still ideologically split along rural/urban lines.

This election came down to two dichotomies in our society: between rural and urban; and between college educated and not-college-educated. The United States elected a television celebrity and real estate mogul to run the country. So what does a Trump presidency and Republican control of both the House and Senate mean for our future? All I can offer are broad strokes since his positions and his policies have switched over the years and even during the campaign. The main thing that there is general agreement upon by the pundits and policy experts is that we can expect a great deal of uncertainty.

A lot will depend on how much of a “Republican” Trump is. He may or may not have a Republican Congress on his side depending on whether he follows their agenda. His short political history suggests that he will not. He may want to take a back seat to ruling and let the Republicans go forward with their agenda. His longer history shows that Trump will support those things that support his own interests and will approach the government like a business with him acting as a CEO rather than as a political leader.

Within the first days of the new Congress there will be a vote to repeal the Affordable Care Act. This means that 20 million people who had health insurance from the marketplace or because they stayed on their parent’s insurance would be suddenly uninsured. Lifetime caps on insurance would return and people with pre-existing conditions might be unable to get insurance.

With at least one Supreme Court nomination and likely another one coming up in the next four years, the Supreme Court will remain firmly conservative for a generation. This likely means a rolling back of abortion rights, if not a reversal of Roe v. Wade. Congress is also likely to pass a bill severely limiting if not making abortion illegal and perhaps declaring an embryo a human person which would make many types of embryonic research illegal. And there is likely to be a move to define marriage as between one man and one woman.

Federal spending on science, public health, and education are likely to decrease. A long-time Republican dream has been to dissolve the Department of Education and the Environmental Protection Agency. The CDC and NIH are very likely to lose funding. Planned Parenthood will also likely lose most, if not all, federal funding. Overall, this means less research on medicine, public health, the environment, and women’s health. Expect a reversal of environmental regulations with fewer government reviews (expect a rollback of energy rules and CAFE standards) and restrictions including a rejection of the Paris Climate Treaty (he has reported that he does not believe in climate change).

Another change may be in medical marijuana and recreational marijuana programs. Massachusetts and California (Nevada, Maine and Arizona were too close to call as of this posting) voted to join Colorado, Washington, Alaska, Oregon, and Washington DC with legalized marijuana. Florida, Arkansas and North Dakota join other states with medical marijuana programs. However, remember that under federal law, marijuana is illegal for any use as a schedule I substance. That these laws have proliferated and that no one has been prosecuted on the federal level is owed to the Obama administration directive to the Department of Justice to let the state laws sit unchallenged. If Trump truly is an anti-federalist then he may leave the decisions to the states. However, the permissiveness is an executive order and Trump is likely to reverse many of Obama’s orders meaning these state laws may be superseded and the Justice department may crack down.

Colorado passed death with dignity so that state will be struggling with how to implement this new option.

Having run on a divisive campaign, likely there will be many more restrictions on voting. A loss of protections for people who identify as a member of a minority community—immigrants, LBGQT, people of color, people who are differently-abled—will translate to more cases of discrimination and more “religious protection” laws that permit people to discriminate based on belief. Likely there will be a rollback of affirmative action and a toughening of standards to prove being a victim of workplace harassment. Immigration will be rolled back with immediate halts on immigration from Mexico and people of the Islamic faith.

In other realms, a huge tax cut will be coming for the upper socioeconomic groups which will necessitate a decrease in social services and so-called entitlement programs. Our international relations will be in disarray since Trump has stated he will not support our international treaties and alliances, most likely rolling back NAFTA, TPP, NATO and instituting huge trade tariffs.

In regards to health and bioethics, will President Trump have a bioethics presidential commission? It depends on whether his family has interest in that area and if someone in bioethics has been on his campaign team.

We remain a deeply divided nation: Although Trump won the electoral college, Clinton won the popular vote. The take home message is that we face a time of great uncertainty and that even though Trump ran as a Republican, he is clearly his own person and is unlikely to simply tow the party line. The anti-federalists have won this round.

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