As the 2024 presidential election heads into its final stretch, issues like the economy, immigration, and abortion have dominated the political conversation. However, former President Donald J. Trump has recently brought health policy into the spotlight with a pledge to let Robert F. Kennedy Jr. lead on health-related matters. This move has refocused attention on several controversial health topics: fluoride in drinking water, vaccines, and the Affordable Care Act (ACA), also known as Obamacare, which provides health coverage to nearly 50 million Americans.
While President Trump would have limited power to make significant changes in these areas without Congressional support, he could use his platform to influence public debate. Here’s an overview of the three key issues at the center of this debate:
Fluoride in Drinking Water
Over the weekend, Robert F. Kennedy Jr., an environmental lawyer with no medical background, raised the issue of fluoride in drinking water, calling for its removal. He criticized fluoride as a toxic industrial byproduct linked to a variety of health problems, including arthritis, bone fractures, and developmental issues in children. Mr. Trump, in a recent NBC interview, said he was open to the idea of ending water fluoridation, which he described as “OK.”
Fluoride is a naturally occurring mineral found in water, though it can also be a byproduct of industrial processes. The practice of adding fluoride to public water began in 1945 as an experiment in Grand Rapids, Michigan, when researchers discovered that fluoride helped reduce tooth decay. By 2022, more than 209 million people, or 72% of Americans on public water systems, had access to fluoridated water.
Health experts generally agree that excessive fluoride exposure can lead to health risks such as dental fluorosis (stained or pitted teeth) and skeletal fluorosis (bone pain or fractures). However, agencies like the Centers for Disease Control and Prevention (CDC) and the American Dental Association maintain that fluoride at the current level of 0.7 milligrams per liter does not pose significant health risks. A recent study did find that higher levels of fluoride may be linked to lower IQ in children, but further research is needed.
The controversy surrounding fluoride is not new, with conspiracy theories about its safety dating back to the 1950s. A recent court ruling in California sided with anti-fluoridation activists, declaring that fluoride poses an “unreasonable risk.” While local governments make the decision on whether to add fluoride to their water, a federal ban would be highly unlikely.
Vaccines and Public Health
Robert F. Kennedy Jr. is a well-known vaccine skeptic, and his views appear to have gained traction with Donald Trump. In a recent interview, Trump hinted at potentially banning certain vaccines, although he emphasized that he would need to consult with Kennedy and others before making any decisions. Despite this, experts argue that the president has no authority to ban vaccines outright.
In the U.S., vaccine regulation falls under the jurisdiction of the states, and vaccines are approved by the Food and Drug Administration (FDA), which the president cannot unilaterally overrule. While a president could pressure the FDA to reconsider approval for certain vaccines, a complete ban would be highly challenging from a legal standpoint.
However, President Trump could appoint officials who are critical of vaccination, potentially discouraging people from getting vaccinated. This could have significant implications, especially as the nation continues to recover from the COVID-19 pandemic. Public health experts warn that anti-vaccine rhetoric could further erode trust in life-saving vaccines.
The Affordable Care Act
While Trump has recently distanced himself from promises to repeal the Affordable Care Act (ACA), this issue remains a key point of contention in the race. In 2017, Trump made a vigorous attempt to repeal Obamacare, but his efforts were blocked by Republican Senator John McCain, who cast the decisive vote against the repeal.
Despite his recent comments, Trump’s campaign still faces pressure from conservative leaders like House Speaker Mike Johnson, who has pledged to overhaul the ACA if Republicans regain control of Congress. However, even if Republicans manage to repeal the ACA, it would require Congressional action — not a presidential order.
That said, the president does have the power to weaken the ACA through executive actions. For instance, Trump could reduce funding for programs that help people navigate the health insurance marketplace or limit Medicaid expansion. In his previous term, Trump proposed replacing the ACA’s subsidies with block grants to states and cutting federal Medicaid spending by $1.5 trillion over ten years.
Trump’s position on health care remains fluid, as he balances the demands of his conservative base with his desire to appeal to voters in swing states. His conceptual plan to replace the ACA with block grants and reduced federal spending on health care would significantly reshape the U.S. health system, though it’s unclear whether such reforms would gain broad support.
Conclusion
As the 2024 election draws near, health policy is becoming an increasingly prominent topic, especially with the involvement of Robert F. Kennedy Jr. in Trump’s campaign. While some of the ideas put forward, such as banning certain vaccines or eliminating fluoridated water, are unlikely to be implemented without significant legal challenges, they highlight the growing influence of health policy in the race. With the future of the Affordable Care Act still uncertain, voters will have to decide whether they want to maintain the current system or embrace a new direction under a potential Trump administration.
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