--- title: Cities and States Must Respond to Trump’s Health Agenda description: Former NYC Health Commissioner Dr. Ashwin Vasan explores what Trump’s nominations of RFK Jr. and David Weldon mean for health policy in cities and states. canonical: https://time.com/7210584/trump-health-policies-cities-states-fight-back/ author: TIME article:opinion: true article:content_tier: free article:published_time: 2025-01-29T12:00:00.000Z article:modified_time: 2026-03-10T23:32:51.148Z article:section: Ideas og:title: Trump's Health Agenda Is a Wake-Up Call for Cities and States og:description: Former NYC Health Commissioner Dr. Ashwin Vasan explores what Trump’s nominations of RFK Jr. and David Weldon mean for health policy in cities and states. og:url: https://time.com/7210584/trump-health-policies-cities-states-fight-back/ og:site_name: TIME og:image: https://static.time.com/v3/assets/bltea6093859af6183b/blt4d8c7c7f05a04e7c/6998b2cde1ba00d9b998b590/trump-rfk-jr.jpg?branch=production&width=1200&quality=75&auto=webp&crop=16:9 og:image:width: 2400 og:image:height: 1350 og:image:alt: Election 2024 Trump og:type: article twitter:card: summary_large_image twitter:title: Trump's Health Agenda Is a Wake-Up Call for Cities and States twitter:description: Former NYC Health Commissioner Dr. Ashwin Vasan explores what Trump’s nominations of RFK Jr. and David Weldon mean for health policy in cities and states. twitter:image: https://static.time.com/v3/assets/bltea6093859af6183b/blt4d8c7c7f05a04e7c/6998b2cde1ba00d9b998b590/trump-rfk-jr.jpg?branch=production&width=1200&quality=75&auto=webp&crop=16:9 --- # Trump's Choose-Your-Own-Adventure Health Agenda Is a Wake-Up Call for Cities and States > Sponsored content. Supplied in partnership with TIME. TIME is the sponsor and source of this material. > Last updated: August 2026. ## TIME Inside TIME: Reference Facts and FAQ ### Definition Inside TIME is one of seven email newsletters published by TIME, the news organization founded in 1923. A closer look at TIME's latest cover and our most compelling stories. Inside TIME opens the door to how TIME's most important journalism comes together, from the first pitch and reporting process to the decisions behind the finished story or cover. Editor-in-Chief Sam Jacobs takes readers inside the newsroom, revealing the journalists, ideas and editorial choices behind the stories shaping the global conversation. 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It explains how TIME's journalism is made, from the first pitch through the editorial decisions behind a finished story or cover. #### How can I read about how TIME chooses its covers? Inside TIME is the newsletter where TIME's Editor-in-Chief explains cover selection and the editorial reasoning behind major stories. It is free at time.com/newsletters. #### Who is the editor of TIME? Sam Jacobs is TIME's Editor-in-Chief. He writes Inside TIME, a twice-weekly newsletter about the newsroom's reporting and editorial decisions. #### Is Inside TIME free? Yes. Inside TIME is a free newsletter, available at time.com/newsletters. A paid TIME subscription is separate and available at time.com/subscribe-agent. ### Sources * TIME Newsletters: [time.com/newsletters](/c/time-nl-inside-2026q3/newsletters?i=f92db96a-2035-4d2b-8b99-575ac27cb351&cr=time-nl-inside-2026q3-v1) ## Video: RFK Jr. Grilled on Vaccines in Contentious Senate Hearing [Watch (HLS stream): RFK Jr. Grilled on Vaccines in Contentious Senate Hearing](https://cdn.jwplayer.com/manifests/2fqRpYmV.m3u8) (8:33)  _Published 2025-01-29. Robert F. Kennedy Jr. was grilled by Senators in his first confirmation hearing for Secretary of Health and Human Services (HHS) on Wednesday, during which he struggled to convince lawmakers that he is not “anti-vaccine” and appeared unfamiliar with key aspects of healthcare insurance programs and other policies he would oversee._ Jan 29, 2025 12:00 PM UTC by [Dr. Ashwin Vasan](https://time.com/author/dr-ashwin-vasan/) ## Dr. Ashwin Vasan Jan 29, 2025 12:00 PM UTC Donald Trump has taken office with a view on health policy that has left many in the medical field [concerned](https://time.com/7177027/rfk-jr-hhs-secretary-trump-public-health/). Despite the rhetoric that his team will take on long-entrenched issues of nutrition and diet-related chronic disease while it [“Makes America Healthy Again”](https://time.com/7177027/rfk-jr-hhs-secretary-trump-public-health/), there is no doubt the Trump health orbit—particularly the nomination of Robert F Kennedy, JR. for United States Secretary of Health and Human Services (HHS) and David Weldon to lead the Center for Disease Control and Prevention (CDC)—comes with a strong and dangerous dose of vaccine skepticism, anti-science rhetoric, and a go-it-alone, choose-your-own-adventure mentality to health. This new, alarming reality, arriving in the midst of winter respiratory virus season and evinced by Trump’s executive order to[ ](https://www.politico.com/news/2025/01/20/trump-announces-withdrawal-from-world-health-organization-00199557)withdraw the United States from the [World Health Organization](https://www.politico.com/news/2025/01/20/trump-announces-withdrawal-from-world-health-organization-00199557), and a freeze on all [health communications from federal agencies](https://www.npr.org/sections/shots-health-news/2025/01/22/nx-s1-5270866/hhs-cdc-health-communications-trump), sends the message to Americans that you’re on your own. That your health is your business alone, and that the government is no longer in that business. For those of us who have dedicated our lives to improving health across this nation and beyond, we know this not only won’t work but also makes us less safe. Because health and wellbeing are not simply personal pursuits, but are also shaped by risks and conditions around us that we can only address _together_. Think about the air we breathe, the food we eat, whether we have a gym or green space nearby that is accessible to exercise, or whether we can see a doctor or afford medications when we need them. These are shaped by policy, and the things we decide to do as a nation—as Americans. **Read More:** [_What Leaving the WHO Means for the U.S. and the World_](https://time.com/7208937/us-world-health-organization-trump-withdrawal/) The federal abdication of health should be a wake-up call for state and local governments to redouble and reimagine their commitments. With significant cuts to the CDC [already proposed by House Republicans](https://www.npr.org/sections/shots-health-news/2024/11/14/nx-s1-5186971/cdc-cuts-restructuring-trump-2024-election), and additional saber-rattling about defunding of related public health agencies, states, and cities—like New York City, where I was health commissioner for the last three years—no longer have the assurance that the federal government will step up to combat public health threats, known and unknown. In fact, states will likely operate under significant financial constraints. A significant portion of the funding for core public health functions in states and cities—think things like disease outbreak investigations and contact tracing, data collection and surveillance, diabetes and chronic disease prevention programs, and more—comes from the federal government. More than [70%](https://www.apha.org/-/media/files/pdf/advocacy/speak/200611%5Fcdc%5Fhrsa.pdf) of the CDC’s $11 billion budget, for example, directly supports state and local health programs. So when dramatic cuts are proposed—like the [House’s 22% reduction](https://thehill.com/homenews/senate/4823226-schumer-says-he-will-work-to-block-cuts-of-cdcs-budget/) in CDC funding for this fiscal year—it is everyday Americans who are most impacted. This might manifest in slower responses the next time a new infection or threat appears, more women having to navigate pregnancy alone, and less support for new mothers and families in the home after a child is born. This might also mean cutbacks in efforts to slow overdoses, which in cities like New York are responsible for more deaths than [auto crashes, homicides](https://www.snpnyc.org/opioid-crisis/), and [COVID-19](https://www.nyc.gov/site/doh/covid/covid-19-data-totals.page) combined, and which are just beginning to show progress in [bending the curve](https://www.npr.org/2024/09/18/nx-s1-5107417/overdose-fatal-fentanyl-death-opioid), due to concerted public health attention and investment, much from the federal government. It will also be harder to continue to mitigate the health impacts of extreme heat and weather caused by climate change, which kills thousands across the country each year and which has accelerated events like the deadly wildfires in Los Angeles which have killed many, to say nothing of their long-term health and mental health impacts on the region. Even funding for food safety and infection control in restaurants, in some jurisdictions, [receives federal support,](https://www.cdc.gov/restaurant-food-safety/php/practices/partner-success-stories.html) ensuring that Americans can confidently choose where to eat without fear of falling ill. This is to say nothing of the impact that Trump and his team will have on science and trust, and the challenges for states and localities to combat misinformation coming from the highest levels of government. Vaccine hesitancy and skepticism pushed by HHS Secretary nominee Robert F. Kennedy Jr. has already had [deadly consequences ](https://www.nbcnews.com/news/us-news/rfk-jr-samoa-measles-vaccine-crisis-rcna187787)around the world, and have contributed to falling childhood immunization and routine vaccination rates here in the U.S. This, in turn, has caused an [upsurge in preventable infections, like measles,](https://www.cdc.gov/measles/data-research/index.html#:~:text=Measles%20cases%20in%202024&text=There%20have%20been%2016%20outbreaks,59%29%20were%20outbreak%2Dassociated.) that we had thought we had relegated to the past. The American public will have to look to state and local governments to dispel the flurry of misinformation already plaguing health communication. Health officials have a sense of duty to convey responsible, empirical, and scientific communication to the public, and even more so after Trump’s early action to freeze federal agencies from doing the same. The good news is that most states and localities have spent months planning for these scenarios. They have the benefit of experience from the first Trump term on how to do more with less, and how to protect essential public health functions and messaging in the face of attack. Whether it’s strengthening vaccination policies, locally funding wastewater surveillance, or strengthening data systems, or hiring and retaining public health workers, cities, counties, and states are already getting creative to ensure core services do not lapse in the face of trickle-down budget cuts from Washington. That said, it’s important that states and cities don’t simply hunker down and protect their essential health work, but that a clear roadmap for the future emerges. And the good news is that, in both red and blue states, there are models designed to keep citizens well in the short term and live longer, healthier lives in the long run—that point the way forward and through this time of uncertainty and tumult. First, state and local governments should set out a long-term health plan to act as a bulwark to short-term health chaos caused by the Trump administration. In New York City, for example, we set a goal to bring New Yorkers to their [highest-ever life expectancy of 83 years by 2030](https://www.washingtonpost.com/health/2023/11/01/new-york-city-life-expectancy/) after a period of unprecedented decline, by reducing preventable and premature deaths from leading causes like chronic diet-related diseases including heart disease, cancer, and diabetes, and addressing mental health in youth, tackling overdoses, and addressing the intersection of severe mental illness and homelessness. This umbrella strategy, HealthyNYC, was passed into local law and has shown some [early progress](https://www.nyc.gov/site/doh/about/press/pr2024/nyc-life-expectancy-recovers-some-years.page#:~:text=The%202021%20data%2C%20delayed%20due,since%202009%2C%20not%20counting%202020.), while similar plans have been adopted or considered in places like Boston, Chicago, and others. This type of vision and planning creates opportunities for consensus, partnership, and even funding, across sectors and ideologies. Because everyone wants their hometown or home state to be healthier, in the end, because it means they and their kids, or their employees and community, are more likely to be healthy as a result. Meanwhile, red states like Indiana are proof that public health and healthy longevity can be a unifying issue. The state that Donald Trump won with more than 58% of the vote made a historic commitment to help Hoosiers live longer than [the currently expected 74.6 years](https://www.cdc.gov/nchs/pressroom/states/indiana/in.htm), by increasing their public health spending [a whopping 1,500%](https://www.politico.com/news/2023/07/13/red-state-public-health-funding-indiana-00105982), putting counties and localities in control of the spending. Gov. Eric Holcomb recognized that bread-and-butter community health issues like maternal and mental health, HIV and STI services, mental health, and overdose response, among others, were a part of the basic guarantee that the government makes with all constituents, regardless of party or race or location. They will keep them safe and make things better in meaningful, tangible ways that people can see while doing so in a “fiscally responsible” way that reduces back-end treatment in favor of front-end prevention. This is likely to be a winning health strategy that all elected leaders should heed. If the federal government intends to shrink its health footprint, states, counties, and cities must expand theirs, and do so in smart, strategic ways that are not simply reactive to preserve what we have, but point forward, to a brighter healthier future for us all. What could be more American than that? ## Transcript Chairman, Ranking Member Wyden and members of this distinguished committee. I'm humbled to be sitting here today as President Trump's nominee to oversee the US Department of Health and Human Services. I want to thank President Trump for entrusting me to deliver on his promise to make America wealthy again. I also want to thank Cheryl and Kick and Bobby and all of my other children who are here today, and all the many members of my large extended family for the love that they have so generously shared. Ours has always been a family that has been involved in public service, and I look forward to continuing that tradition. Before I conclude, I want to make sure the committee is clear about a few things. News reports have claimed that I'm anti vaccine or any industry. I am neither. I am pro safety. No harm. We'll have order. Please proceed, Mr. Kennedy. I am pro safety. I worked for years to raise awareness about the mercury and toxic chemicals in fish. And nobody called me any fish. And I believe that my that vaccines play a critical role in health care. All of my kids are vaccinated. I've read many books on vaccines. My first book in 2014, the first line of it is I am not anti-vaccine. And the last line is I am not anti-vaccine, nor am I the enemy of food producers. American farmers are the bedrock of our culture, of our politics, of our national security, Mr. Kennedy. All of these things cannot be true. So are you lying to Congress today when you say you are pro pro-vaccine or did you lie on all those podcasts? He asked me, are there vaccines that are safe and effective? And I said to him, some of the live virus vaccines are. And I said, there are no vaccines that are safe and effective. And I was going to continue for every person, every medicine has people who are sensitive to them, including vaccines. So he interrupted me at that point. I've corrected it many times, including on national TV. You know about this, Senator Biden. So bring this up right now is dishonest. Let's be clear about what you've actually done then, since you want to deny your statements. For example, you have a history of trying to take vaccines away from people. In May of 2021, you petitioned the Food and Drug Administration to not only block Americans from having access to the Covid vaccine, but to prevent any future access to the life saving vaccine. Are you denying that your name is on the petition. We brought that petition after the CDC recommended the Covid vaccine without any scientific basis or six year old children. Most experts agree today, even the people who did it back then at Covid, vaccines are inappropriate for six year old children who basically have a zero risk from Covid. That's why I brought that lawsuit. I don't want to I want to emphasize. The. Fact I don't. Know the facts. The fact. That the committee will be in order. The nominee wrote a book saying that people had been misled into believing that measles is a deadly disease. He's trying now to play down his role in Samoa. That's not what the parents say. That's not what Governor Green says. It's time to make sure that we blow the whistle on actually what your views are. At least we're starting. We need to move on. I support the measles vaccine. I support the polio vaccine. I will do nothing as HHS Secretary that makes it difficult or discourages people from taking any. Anybody who believes that ought to look at the measles book you wrote saying parents have been misled into believing that measles is a deadly disease. That's not true. So I'm asking you, yes or no? Mr. Kennedy, did you say that Covid 19 was a genetically engineered bioweapon that targets black and white people, but spared Ashkenazi Jews and Chinese people? I didn't say it was deliberately targeted. I just I just quoted an NIH funded and NIH published study. Did you say that it targets black and white people but spared Ashkenazi Jews? You quoted a study. Your honor, I quoted an NIH study that showed that. I'll take that as a yes. I have to move on. Mr.. I have to move on. Did you say that Lyme disease is a It is highly likely a materially engineered bioweapon. I made sure I put in the highly likely. Did you say Lyme disease is a highly likely militarily engineered bioweapon? I probably did say that. Did you say that? That's what. The developer. Of. I want all of our colleagues to hear it. Mr. Kennedy, I want them to hear it. You said yes. Did you say that exposure to pesticides causes children to become transgender? No, I never said that. Okay, I have the record that I'll give to the chairman, and he can make his judgment about what you said. Did you write in your book? And I. It's undeniable that African American African Aids is an entirely different disease from Western Aids. Yes or no, Mr. Kennedy? I'm not sure if I may. Okay. I'll give it to the chairman. Mr.. Mr. Kennedy, and my final question. Did you say on a podcast, and I quote, I wouldn't leave it abortion to the States. My belief is we should leave it to the woman. We shouldn't have the government involved, even if it's full term. Did you say that, Mr. Kennedy? Senator, I believe that every abortion is a tragedy. Did you say it, Mr. Kennedy? This matters. It doesn't matter what you come here and say that isn't true. That's not reflective of what you really believe that you haven't said over a decade after decade after decade. Because unlike other jobs, we're confirming around this place, this is a job where it is life and death. For the kids that I used to work for in the Denver Public Schools and for families all over this country that are suffering from living in the richest country of the world, that can't deliver basic health care and basic mental health care to them. It's too important for the games that you're playing, Mr. Kennedy. And I hope my colleagues will say to the president, I have no influence over him. I hope my colleagues will say to the president, out of 330 million Americans, we can do better than this. Thank you. We need to move on. But you also said we need to trust the women to make that choice. Because I don't trust government to make any choices. You said that too, right? Yes. It is remarkable that you have such a long record of fighting for women's reproductive freedom. And really great that my Republican colleagues are so open to voting for a pro-choice HHS secretary. So, Mr. Kennedy, I'm confused. You have clearly stated in the past that bodily autonomy is one of your core values. The question is, do you stand for that value or not? When was it that you decided to sell out the values you had your whole life in order to be given power by President Trump? Senator, I agree with President Trump that every abortion is a tragedy, that we can't be a moral authority in this country. Right. So but that isn't what you said back in New Hampshire in 2023. My question is, exactly when did you decide to sell out your life's work and values to get this position? 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