Greetings, dear readers, and welcome to our 2025 wrap-up!
In the US, 2025 has been a very challenging year for many in clinical and public health practice and research. With funding cuts, layoffs, and reductions-in-force, many of our readers (and yours truly) had to face the fact that our livelihoods were no longer secure. It is fitting, indeed, that our theme for this year was Political Determinants of Health.
We’ve talked about the theme for years, beginning with a 2018 commentary by contributor Ranit Mishori and continuing through the pandemic. In this post, we recap some notable writing that has focused on the issue this year.
January to March
We kicked off January with a post by Cole Ettinghoff about Project 2025, the roadmap for the second Trump administration published by the Heritage Foundation before the 2024 election. While the plan has not yet been fully implemented, it is early days yet. Keep in mind that, as Cole points out, “There are unquestionably two top priorities explicitly and repeatedly stated: 1) the elimination of abortions in the United States and 2) to significantly increase the emphasis on the role of the traditional, nuclear family.”
In February, our co-editor Greg Stevens wrote about how Chappell Roan got the country talking about the uninsured again. As he reminded us, “The problem of the uninsured remains, affecting nearly 1 in 10 people in the U.S.” Now, with the inability of Congress to extend the subsidies in the ACA Marketplace, we may soon see that number rise again. Lack of insurance has immense effects on health.
March saw several posts by our co-editor Ben King on our theme for the year. His post defending Medicaid made it clear how important that program is to the nation’s health. The program is also uniquely vulnerable to politics, since the funding comes from both the federal government and the states. Individual states set eligibility and other policies, such as work requirements, that have huge effects on who can get Medicaid.
April to June
By early April, the cuts to public health and healthcare agencies were beginning to become clear. Contributor Allison T. Brill wrote an important post about 5 ways we can advocate for public health in times like these. As she wrote, “As public health and healthcare leaders and experts, we are in a unique position to speak out against these injustices. We have deep understanding, experience, and expertise in health systems change, patient-centered care, and how policies impact health outcomes.”
In May, Greg Stevens discussed how the American Public Health Association had released a statement “describing the ways in which Robert F. Kennedy, Jr. is a “danger to the public’s health” and calling for his resignation — an excellent example of advocacy by our professional organization. As the year has worn on, we’ve seen multiple examples of this danger, especially when it comes to vaccines.
In June, new contributor Emma DiFiore wrote a piece on the importance of Medicaid in primary care. As a primary care physician in Texas, one of 10 states that still haven’t expanded Medicaid benefits, she notes that Texas leads all states in leaving low-income adults without affordable health coverage. Further, “Funding threats are setting in motion a cascade of consequences policymakers will not be able to ignore for long, including worsening health inequities, rising emergency care costs, poorer health outcomes, and an erosion of the primary care workforce.”
July to September
The US’s other publicly funded insurance program, Medicare, is also susceptible to politics. Long considered untouchable because of the voting power of seniors, of late the program has been pushed more and more toward privatization (via Medicare Advantage, or Part C). Greg Stevens wrote a post in July about some proposed changes to Medicare, including changes to primary care and other physician payments. As he wrote, “Though the changes are controversial, they might be just what primary care needs.”
In August, as new contributor Stephanie Kasperick wrote, we saw the return of measles to the US, with cases in 41 states. She said:
As a Texas resident and public health student, I have been familiar with initial measles outbreaks since January. I have tracked the public response, government response, case numbers, and annual school immunization rates posted by the Texas Department of State Health Services (DSHS). With this data in mind, I believe the catalyst to these outbreaks is an interaction of three factors: social/traditional media, government behavior towards vaccination, and the option for personal choice exemptions to immunizations.
Her conclusion? “The ongoing politicization of vaccinations, healthcare, and public health influences the government’s response to outbreaks… We must begin the depoliticization of immunizations before we lose more lives to preventable, recurring outbreaks.”
October to December
Yet another example of the politicization of health arrived in October, when, as Ben King wrote, the “FDA announced it would start a process to add language to acetaminophen labels noting a possible association with autism and ADHD when used during pregnancy.” Ben reminds us that association does not equal causation. As he concludes, “Right now, the best advice hasn’t changed. If you’re pregnant and need to treat pain or fever, acetaminophen is the recommended over-the-counter choice.”
Finishing out the year, in early December, Ben wrote about the upcoming spikes in healthcare premiums for ACA Marketplace plans. To recap:
The stalemate in Congress that prolonged the most recent government shutdown was driven in part by an effort to secure an extension of ACA subsidy enhancements that have kept out-of-pocket premium costs historically low. As negotiations failed, it became clear that millions of Americans will soon face premiums that rise far faster than wages or inflation.
Stay Tuned for More
Here at The Medical Care Blog, we’re not giving up. We will continue to write and publish about the political determinants of health, and we will continue to advocate for the public’s health. The administration’s targeting of academics and researchers will not intimidate us. We will persevere. Are you with us?
Lisa M. Lines