Republicans’ closing election message on health baffles strategists, worries experts

First came GOP House Speaker Mike Johnson’s pledge last Monday to overhaul the Affordable Care Act if Donald Trump wins the presidential election. Then Howard Lutnick, the co-chair of Trump’s transition team, on Wednesday endorsed Robert F. Kennedy Jr.’s vaccine skepticism and suggested that a future Trump administration would empower Kennedy to help oversee vaccine data. Three days later, Kennedy announced that Trump would seek to remove fluoride from Americans’ drinking water as a Day 1 priority.

The statements add up to a surreal final week of campaigning for Republicans in which several of Trump’s top surrogates are introducing unconventional - and generally unpopular - ideas that pit them against the health-policy establishment ahead of Election Day on Tuesday. The assorted proposals also add up to an agenda that would likely damage public health. Policy experts say that if the Affordable Care Act is overhauled, vaccine confidence declines and fluoride is removed from public water systems, the nation could see a spike in the uninsured rate, a return of vaccine-preventable diseases and more oral health problems, particularly in vulnerable communities.

“The real danger extends beyond politics to public health,” said Kavita Patel, a physician and professor at Stanford University who has previously advised the Harris campaign. “This rhetoric could erode trust in essential health measures, potentially leaving millions vulnerable if these ideas translate into policy.”

Robert Blendon, a longtime pollster and professor at Harvard School for Public Health, has spent more than 50 years analyzing presidential campaigns. He said he could not recall a closing message on health policy like the “unusual” one that Republicans have offered in the past week.

“Independents favor a much more positive health policy message than being presented here by Republicans,” Blendon wrote in an email. He and other pollsters suggested that the stances could be a strategy to reach skeptical, antiestablishment voters in what is expected to be a close election against Vice President Kamala Harris.

The stances have also forced prominent Republicans to explain why top Trump surrogates are voluntarily attacking popular, ingrained health programs and public health interventions. The Affordable Care Act, which has become widely popular since Trump attempted to repeal it, has been credited for helping tens of millions of Americans gain health coverage since its 2010 passage. More than 90 percent of children born in the United States have been vaccinated against polio and measles, mumps and rubella, helping protect them from severe infectious diseases. Twelve presidential administrations - including Trump’s - have overseen recommendations to add fluoride to water, which has been praised as one of the great public health achievements of the 20th century.

“I’m laughing because I can’t believe that we’re having a conversation about fluoride,” Sen. Tim Scott (R-South Carolina) said on CNN on Sunday, refusing to weigh in on Kennedy’s comments.

The Trump campaign has repeatedly declined to specify its policy plans, telling The Washington Post in a statement on Saturday that Trump was focused on the election and could not address Kennedy’s remarks on fluoride.

But in an interview with NBC News on Sunday, Trump said he was open to removing fluoride from water.

“I haven’t talked to [Kennedy] about it yet, but it sounds okay to me,” Trump said, according to NBC News. He also declined to rule out banning vaccines.

Dueling messages to reach voters

The late-campaign pivot comes after GOP leaders have also tried to appeal to voters using more conventional messages, such as focusing on the high cost of prescription drugs. Health care ranks as the fourth-most important issue among battleground-state voters behind the economy, inflation and threats to democracy, according to a recent Washington Post-Schar School poll.

There may be a strategy behind Republicans’ late flurry of anti-public health stances, said Mollyann Brodie, executive vice president at KFF, a nonpartisan health care think tank. She noted that most voters say that issues such as the economy or abortion have influenced their vote - but those voters have probably already decided how to vote, or even cast a vote already.

Meanwhile, there are a number of disengaged voters with more narrow interests, such as frustration and skepticism over coronavirus vaccines, Brodie said. Republicans may be targeting these vaccine skeptics - who tend to be lower-educated, GOP-leaning and often younger men - with their recent messages questioning public health interventions, Brodie suggested.

“These closing appeals are to get every last ‘undecided’ voter to decide first to actually VOTE on Tuesday and to vote for the Trump/Vance ticket,” Brodie, who oversees KFF’s polling operation, wrote in an email.

[Trump escalates false claims of election fraud, setting stage to cry foul if he loses]

But Democrats are also treating Republicans’ recent comments on health policies and public health as a political gift, given that their party typically enjoys more support on health care issues. Harris has a 19-point lead on which candidate voters trust to handle abortion and a 9-point lead on health care costs, two of her strongest issues, according to KFF.

The Harris campaign seized on Johnson’s vow, issued at an event in Pennsylvania, to pursue “massive reform” of the Affordable Care Act - particularly when the House speaker agreed that a goal for early next year would be “no Obamacare.” Democrats said that the comment represented a pledge to repeal the health law.

Johnson’s office disputed Democrats’ interpretation, with a spokesman accusing Harris of “lying about Speaker Johnson” by claiming that he had pledged to repeal the law. But Johnson’s office declined to comment on what health-care changes the House speaker would pursue next year or whether he would rule out an attempt to repeal the Affordable Care Act.

The Trump campaign said that he did not support repealing the Affordable Care Act.

GOP leaders have generally backed away from proposals to overhaul the Affordable Care Act after the party’s failed repeal effort in 2017 catalyzed new support for the health law and led to a backlash with voters. Sixty-two percent of adults held favorable views of the law in April, KFF found, up from 43 percent in November 2016, the month that Trump was elected to the White House.

Republicans also have struggled to respond to questions on Kennedy and other Trump surrogates’ recent messages on vaccines, fluoride and other public heath interventions. Scott, who introduced legislation in 2018 to support the fluoridation of public water, did not respond to a request for comment on this story.

‘The narrowest message possible’

Many of the tensions have been driven by Kennedy, a longtime vaccine skeptic who suspended his independent presidential campaign in August and endorsed his onetime rival Trump in August. Kennedy and Trump surrogates soon unveiled a policy platform that was focused on removing chemicals from food, reducing the influence of industry on federal regulations, fighting chronic disease, and other initiatives that generally had bipartisan support - and all grouped under the platform “Make America Healthy Again,” a deliberate riff on Trump’s longtime slogan, “Make America Great Again.”

But that agenda has received less attention as the election approaches, with public health experts focusing more on Kennedy’s history of vaccine criticism and the possibility that he could soon oversee vaccine approvals and safety. The Washington Post reported last week that Kennedy is poised to hold a major role working on food and health in a potential Trump administration, possibly as a White House czar overseeing several health agencies.

Kennedy also has drawn scorn from critics who say that he knows little about the health system that he may soon be tapped by Trump to help regulate.

Those critics include life sciences executives, public health professors, former Trump health officials - and even Martin Shkreli, who became known as the “Pharma Bro” after hiking the price of a lifesaving drug and was sent to prison for financial crimes. Writing on social media last week, Shkreli slammed Kennedy’s pledge to overhaul the Food and Drug Administration, saying that Kennedy would attempt “to fix what is not broken.”

Trump has fed anxieties about Kennedy by repeatedly asserting that Kennedy will have a free hand to implement policy, telling supporters last Sunday that Kennedy will “go wild” on food and medicines in his administration. Trump on Friday also pledged that Kennedy would work on reproductive health issues in his administration - further alarming public health advocates who have asked why Kennedy, whose expertise is environmental law, is equipped for that role.

Trump’s decision to elevate Kennedy is a signal to Americans that a second Trump administration “would be infinitely more chaotic than the first,” said Lis Smith, a Democratic strategist.

“Usually at the end of a long campaign, you try to close with a unifying, broadly appealing message,” Smith wrote in a message. “Trump is doing the opposite - closing with the narrowest message possible.”