Healthcare Musings For January 2, 2026

2 January 2026

Dear Interested Readers,

 

Looking Back At ‘25 With Regrets, Looking Forward to ‘26 With Hope

 

Most Sunday mornings, my wife and I record CBS Sunday Morning hosted by veteran TV journalist Jane Pauley. We often don’t listen to it until later on Sunday after church, or sometimes later in the week, as we did this week, because we were traveling on Sunday. One of the first segments this week, after the introductory review of the subjects to be presented, was a very brief segment of a few good things that happened in 2025, presented by David Pogue. It was entitled “Sunny Side Up.” There wasn’t much to celebrate. The review of the year’s upside included the report of a company in Massachusetts that is making biodegradable plastic out of sugar and a brief interview with Dr. Robert Wachter, Chief of Medicine at UCSF, who has a book coming out in February, A Giant Leap: How AI Is Transforming Healthcare and What That Means for Our Future, that anticipates the potential benefits of AI as a diagnostic tool. 

 

I don’t know about you, but I am glad that 2025 is over. It was a year of events that I could have done without. Many of those regrettable events were precipitated by an executive order from President Trump. He has already issued more executive orders in one year than he did in his entire first term and more than every president since Carter has issued over any four-year term. Although the president strenuously denied any knowledge of Project 2025 before he was elected, he has completed 50% of the Project 2025 objectives in less than a year. Through executive orders, the firings of employees who were still probationary, the antics of DOGE under the leadership of Elon Musk, and by-outs of long-established employees, the Federal bureaucracy has lost almost 250,000 employees, 10% of the workforce. An article by Eileen Sullivan in the New York Times earlier this week noted that it may be years before we feel the full impact of this rapid change in the federal workforce. Healthcare and the EPA were hit hard. She writes:

 

The administration distributed about $13 billion in National Institutes of Health grants from February to June of this year, which is about $8 billion less than it did during the same time period a year earlier, according to the Government Accountability Office. This includes grants for cancer research, cuts that have been described as America’s retreat from the war on the disease.

Another agency that has been hard hit is the Environmental Protection Agency, which lost about 25 percent of its work force.

“E.P.A. is a skeleton of what it once was,” said Francesca Grifo, the former scientific integrity official at the agency, describing it as “an agency that cared about the air that people breathe, the water they drink, the land on which they live.”

 

I doubt that I am telling you anything that you did not already know or suspect. What you may not realize is that, even though it has taken the president less than a year to reshape the Federal workforce radically, it will probably take more than a decade to repair what has already been damaged. Perhaps the most dramatic change in government function is our aid to other nations, which many believe was a worthwhile investment in our own future. U.S.A.I.D. is gone. Even if it were replaced tomorrow, there would be years of international skepticism about our trustworthiness as a partner. 

 

Because it is a holiday week and my usual writing time has been altered, I decided to use AI to help me with the question, “How has Project 2025 impacted healthcare this year?” The quick summary answer I received did not surprise me:

 

As of late December 2025, several actions aligning with the proposals of Project 2025 have impacted U.S. healthcare this year, particularly in areas of reproductive health, LGBTQ+ care, federal health programs (Medicare/Medicaid), and biomedical research. 

Key impacts in 2025 include:

Reproductive Health

• Abortion and Contraception Access: The administration has taken steps to severely limit abortion access, including rescinding Biden-era guidance that required hospitals receiving federal funds to provide emergency abortion care under EMTALA. There are also efforts to use the 1873 Comstock Act to criminalize the mailing of abortion-related items, including medication abortion pills.

• Funding Restrictions: The government has prohibited funding for Planned Parenthood health clinics and reimposed the “domestic gag rule” on Title X family planning grantees, which prevents providers from offering abortion referrals or counseling on abortion options.

• Privacy Protections: Guidance to protect the privacy of people receiving reproductive healthcare under HIPAA is being rolled back, and states may be required to report data on individuals traveling across state lines for abortions. 

LGBTQ+ Healthcare and Rights

• Military Healthcare: The Pentagon halted new hormone treatments and surgical procedures for transgender service members, and gender dysphoria was listed as a medical condition disqualifying individuals from military service.

• Discrimination Protections: Efforts are underway to weaken Section 1557 of the Affordable Care Act (ACA), which prohibits discrimination in healthcare settings based on sex, effectively rolling back protections for LGBTQ+ individuals.

• Data Collection & Terminology: Federal agencies, including the CDC, are being directed to stop collecting data on gender identity and to use only biological sex distinctions in federal rules and grants. 

Federal Health Programs and Research

• Medicare Privatization: The administration has moved to make Medicare Advantage, a system of private health plans, the default enrollment option for all Medicare beneficiaries, which critics argue benefits corporations and limits patient choice.

• Medicaid Changes: Proposals to cut significant funding from Medicaid, impose work requirements, and potentially implement lifetime caps on benefits are being considered or enacted, putting coverage at risk for millions of low-income and disabled individuals.

• Research Cuts: The National Institutes of Health (NIH) faced significant budget cuts (around 40%) this year, leading to the cancellation of numerous research grants, including studies related to LGBTQ+ health, cancer, and HIV prevention.

• Affordable Care Act (ACA): There are ongoing efforts to weaken ACA protections, such as allowing insurers to deny coverage for pre-existing conditions in non-subsidized plans and promoting “junk” insurance plans with high out-of-pocket costs and limited benefits. 

Public Health Agencies

• CDC and FDA Authority: The CDC’s authority has been limited, with recommendations to split it into two agencies (one for data collection and one for policy) and restrict its ability to issue prescriptive guidance on matters like vaccines and masks. The FDA’s drug approval processes are also under review. 

 

Perhaps the most long-term damage done during the first year of Trump’s second term has been the consequences of his appointment of Robert F. Kennedy, Jr., as Secretary of Health and Human Services. Once again, I turned to Google’s new AI function to obtain a summary of the damage Mr. Kennedy has done to the future of health in America. Remember that Kennedy oversees the NIH, CDC, and Medicare and Medicaid through CMS. I asked Google AI to:

 

Please review the impact of Robert F. Kennedy, Jr’s appointment as Secretary of HHS.

 

Google answered:

 

There is some overlap in the lists of damage caused during the first year of Trump’s attack on American healthcare, but it’s hard to understate the harm. I can’t understand how undermining proven vaccine policy and future development of RNA vaccines can benefit us. How will hampering the CDC’s work and drastically cutting funds for medical research “make America healthy again”? What do I know? Perhaps it is the leading edge of Trump’s “concept of a plan.” That must have been another one of his thousands of pravarications. We are still waiting for clarification of his concept of a plan. Maybe it will come in 2026.

 

An area of change that has been particularly concerning to me is the attack on efforts across our society to improve diversity, equity, and inclusion (DEI). It is hard to imagine improvements in the Social Determinants of Health in a country as pluralistic (diverse) as ours without attention to ensure equity and inclusion in healthcare, education, housing, and employment. Once again, I turned to AI and asked for an overview of the extent of the president’s pushback on decades of effort in public and private domains to improve the climate for DEI. My request was, “Please review the extent of the president’s efforts to undermine DEI.” What I got back was:

 

In 2025, President Trump has taken extensive measures to dismantle Diversity, Equity, and Inclusion (DEI) initiatives across the federal government, while simultaneously pressuring the private sector and educational institutions to follow suit. 

Federal Government Actions

Upon taking office in January 2025, the President issued several executive orders (EOs) to purge DEI from the federal workforce: 

• Abolition of DEI Offices: EO 14151, “Ending Radical and Wasteful Government DEI Programs and Preferencing,” mandated the immediate termination of all DEI and DEIA offices and positions across all federal agencies.

• Personnel Reductions: The Office of Personnel Management (OPM) directed agencies to place DEI-focused employees on administrative leave and submit plans for a permanent reduction-in-force by January 31, 2025.

• Censorship of Materials: Agencies were ordered to remove all DEI-related training, resources, and terminology from websites and official communications.

• Hiring Reforms: New directives emphasize “merit-based” hiring and strictly prohibit the consideration of race, sex, or religion in federal employment decisions. 

Federal Contracting and Grants

The administration has significantly altered the requirements for entities receiving federal funds: 

• Revocation of EO 11246: The President revoked a landmark 1965 executive order that required federal contractors to implement affirmative action programs to ensure equal opportunity.

• Mandatory Certifications: Contractors and grantees must now certify that they do not operate “illegal DEI” programs that violate federal anti-discrimination laws. Violations can lead to litigation under the False Claims Act.

• Funding Pauses: In January 2025, the Office of Management and Budget (OMB) temporarily paused many federal grant and loan programs to review them for alignment with the new anti-DEI priorities. 

Private Sector and Education Pressures

While executive orders primarily govern the federal branch, the administration is leveraging the Department of Justice (DOJ) to target private entities: 

• Strategic Enforcement Plan: The DOJ and OMB were tasked with identifying “sectors of concern” and the “most egregious” DEI practitioners in the private sector for potential civil compliance investigations.

• Investigations of Major Entities: Agencies must identify up to nine potential investigation targets, including publicly traded corporations, large non-profits, and universities with endowments exceeding $1 billion.

• Educational Funding Threats: The Department of Education has issued guidance threatening to withhold federal funding from schools and colleges that maintain DEI programs or weigh race in decision-making. 

Specific Sector Impacts

• Military: The administration abolished all DEI offices in the Defense Department, banned minority cadet clubs at West Point, and restricted gender-affirming healthcare for service members.

• Foreign Service: A 2025 memorandum removed DEIA from the Foreign Service tenure and promotion criteria.

• Aviation: The “Ending DEI Madness” memorandum directed the FAA to stop Biden-era diversity hiring programs and return to merit-based hiring. 

 

I doubt any of the items I have enumerated in this letter will be a surprise to my readers. At best, what I have done is bring together some of the disappointments many of us have shared this year in one document. Perhaps less obvious to some is the reality that if Trump left office tomorrow and were replaced by politicians who he would say come from the radical left, like Gavin Newsom, Gretchen Whitmer, or Josh Shapiro, it would take several years to reverse the losses that have occurred since noon on January 20, 2024. The earliest that could happen is January 20, 2029. It is disturbing to realize that the first chance to halt the decline through usual governmental action won’t come until the 120th Congress is seated on January 3, 2027, assuming Democrats regain control of the House of Representatives in the November 2026 midterm elections. 

 

So what might we expect to happen in 2026 before November? My guess is that there will be entrenchment and some advance of what has already happened. Project 2025 is still 50% incomplete. What is most frightening to consider is what might happen as Trump begins to feel the pressure of the approaching midterms. Will he double down on what has already been a destructive course of action, or will he start to worry about the midterms and slow down his destructive pace? Will he create some “foreign adventure” like the invasion of Venezuela? Will he sell Ukraine out to Putin and claim that he is a peacemaker?

 

Perhaps a more important question is what the more moderate Republicans and MAGA enthusiasts in the House and Senate do as they begin to worry that his mismanagement of foreign affairs, the economy, and healthcare has damaged their reelection prospects. Will they abandon the posture of sycophants, which has served them well until now? Is Margory Taylor Greene leading the way, or is she the exception? Time will tell. I expect whatever happens will be unpredictable. What is predictable is that, no matter what happens in 2026, the injuries of 2025 will take years to repair once the recovery finally begins. It is a fact that it always takes much longer to build or rebuild something than it takes to destroy it. Another fact worth repeating is that almost always things end sadly and badly when you are dealing with a narcissist. I hope I am wrong, but I suspect that during the run-up to the November elections over the first ten months of 2026, we will experience more of what was hard to take in 2025.

 

Iced In For The New Year

 

I don’t mind snow, but ice can be a disaster. We arrived home from our Christmas trip to Colorado in the midst of an ice storm. After the icy storm passed, the trees were thickly coated in ice, and the roads and walkways were like skating rinks. There was a lot of wind with the ice, so all over town, trees lost limbs or just snapped and collapsed on power lines. Many neighbors spent most of Monday night in the dark. Following an ice storm in 2009 that caused power outages lasting more than a week, we installed a propane-powered generator that kicks in after about 45 seconds of darkness. It was a good investment that, three or four times a year, I am glad that I made. 

 

Birches bend to the ground in large arcs, making them look like they are bowing in prayer. Maples, oaks, and pines just snap and fall over or lose limbs. I have a cluster of birches at the corner of my deck that overlooks the lake. As you can see in the picture I used for the header of this letter, the icy birches bend over the deck and block the sliding door from our living room onto the deck.

 

All along the roads in town, birches are bending to the ground. We have had more snow since the picture was taken, and the temperature has remained mainly in the teens. It was 13 degrees at three PM yesterday, and it was close to zero overnight. We will not get out of the twenties until sometime late next week, so we will be living with the bowing birches for many days to come. Along some roads, there are so many bending and bowing birches that it creates the sense of a long tube or perhaps a vaulted cathedral. The scene is quite beautiful, especially when sunlight shines through the ice. 

 

One must learn to adjust to adverse circumstances, be they meteorological or political. Life goes on even when the environment becomes difficult. I have figured out how to tolerate the ice while I am waiting for the eventual melt. I am trying to learn how to ignore the president and enjoy life while waiting for him to go away. On my daily walks while pondering what is yet to come, I am careful not to fall. I have new heated gloves that let me walk in temperatures as low as 11-12 degrees. I am hoping to figure out how to tolerate the unsettling political weather until there may be some relief in November. We must rise to meet all of our challenges in the New Year.

Be well,

Gene