Barbarians at The Gate-What Consumers Can Expect from The Trump Administration

Now that President-Elect Trump’s opinions and omissions can create harmful consequences, this is your Jumping-Off-the-Cliff guide to staying informed, develop an action plan and mitigate damages from his reign. First, the cliff notes on his cabinet and chief staff members:

What’s at Stake	Nominee	Perspectives	Analysis
Your Health The Secretary of Health and Human Services controls the following agencies: Centers for Medicare and Medicaid, Food and Drug Administration, administers the Affordable Care Act, and grants more money for medical research than any other agency in the world.	Tom Price, Republican from Georgia, He is an orthopedic surgeon, and represents one of the healthcare sectors with expensive medical devices and lucrative profit margins for health systems. Resentful of the 3% medical device tax his industry pays to fund the Affordable Care Act for low-income Americans.	Wants to get rid of Obama Care and replace it with another insurance based payment system. Questions the value of the Centers for Medicare and Medicaid innovation through Demonstration Projects. He wants to reduce the footprint of government policy making in healthcare. Though he wants consumers to shoulder more responsibility for their health care, he questions the value of performance assessment as a component of government funding and oversight by government agencies. CMS’s Accountable Care Organization program has been successful and 31% of 2015 participants received bonuses. There are 400 healthcare systems participating in this program. Would he impinge on medical research by eliminating stem cell research as his predecessor George Bush did?	By defunding CMS, the nation would have no national bully pulpit to pressure healthcare suppliers, drug companies, and insurance companies on cost and accountability. Medicare is the most effective tool we have for making changes in U.S. healthcare with an integrated national platform. Medicare Shared Savings programs saved the CMS 1.6 million in 2015. (David Muhlestein, 2016) Would he repeal the Sunshine Act which requires federal reporting of pharmaceutical industry influence on universities and medical training to avoid conflicts of interest? (American Medical Association, 2016) Would he abolish the successful Accountable Care Organization Program which rewards health-driven clinical outcomes? He will also eliminate birth control under Medicaid plans.
Your Air and Water The Environmental Protection Agency sets standards for air & water quality, extracts fines from offenders, and litigates as required for compliance with federal and state laws.	Scott Pruitt, Republican Attorney General from Oklahoma and former senator, is decidedly not part of the beltway. He will drain the swamp and poison your well.	The EPA was created by the Nixon Administration and is responsible for improvements in air and water quality throughout the nation. Pruitt wants to gut the Clean Water and Clean Air Acts signed by the Obama Administration. Has pledged to dismantle the EPA and is in the back pocket of the oil and gas industry. He has been vociferous in his lawsuits against government regulations. Doesn’t think global warming is an issue. Wants to get out of the Paris Climate Change Accords, which were signed by 95 countries.	Carbon emissions are the greatest contributor to greenhouse gases causing global warming and the melting of the polar ice caps. Obama Administration clean air rules force power plants, especially coal powered ones, to reduce particulate emissions. The act established standards for emissions but allows flexibility for states to administer. States have already submitted plans for reaching targets.
Your Children’s Education  The Department of Education sets national standards for education (No Left Behind and Common Core), provides funding, and enforcement of standards.	Betsy DeVos, former chairwoman of the Michigan Republican Party, is from the Amway family of billionaires and has never attended a public school, nor have her children. She attended Calvin College, a private liberal arts college.   She is the sister of infamous military defense contractor, Eric Prince, founder of private mercenary group, Blackwater.	Wants to deconstruct the agency and give more responsibilities to states, counties, and individual districts to set curriculum. She is a huge supporter of charter schools, which are funded with public funds but operate like private schools. She advocates a school voucher system where the government would essentially provide support for private schools. In Michigan, 80% of the schools are run by private companies. She is does not believe in recognizing homosexuality.	Current Secretary of Education, John King, Jr, says there are a lot of charter schools which are doing poorly and are not taking the steps needed to improve performance. For a vision of what could happen to primary education in the country, look to the healthcare sector where competing private interests often increase costs and work against effective public health improvements.
Your Money The Department of the Treasury, oversees revenue collection through the IRS, and sets standards for currency and financial management for the nation.	Steve Mnunchin, former Goldman Saks executive and Hollywood film financier, is a Wall Street banker insider, who graduated from Yale.	No information is available for his position on the landmark Dodd-Frank Act which created liquidity standards for banks to prevent the financial collapse of the nation and the world. If the U.S. government hadn’t bailed out AIG Insurance, General Motors, Fannie Mae, Freddie Mac, and a host of banks the depression would have been much more severe. (ProPublica.org, 2016)	He is well-educated and more liberal than Trump’s Cabinet picks, but hews from the hedge fund world, which contributed to the 2007 economic collapse of the mortgage banking industry. The question is, will that experience inform better safeguards or is this a fox-in-the-hen-house scenario? Investment banks are chaffing to go back to the Wild West of deal making.
Your Liberty The Attorney General of the United States, oversees the administration of federal laws, court system, and enforcement for anti-trust and civil rights laws.	Jeff Sessions, Attorney General, Republican Senator from Alabama, and former Attorney General of Alabama. He was rejected by the Reagan Administration for a federal judicial appointment because of racist views.	Has a reputation of being anti-immigrant, anti-Muslim, and anti-gay (LBGTQ). One of the most conservative members of Congress often at odds with his own party. Is a supporter of the stop and frisk ethos.  Widely considered to have anti-minority views.	Concerns are; the gerrymandering of redistricting, potential repeal of the voting rights act, enforcement of election laws, and actions against those using their first amendment rights for protest and free assembly.
Your National Parks The Secretary of the Interior oversees the vaunted National Parks system, national forests, and all public lands, including the Bureau of Indian Affairs.	Ryan Zinke is a Republican freshman senator from Whitefish, Montana who is a former navy SEAL commander.	One of his most alarming views is he considers climate change to be unsettled. We don’t know anything about his governance perspectives. However, at least he is not a beltway insider. Montana has many tribal lands, including the Flathead Indian Reservation.	Maybe we could swap Zinke for Perry, because I would rather trust a military officer with protecting our nuclear plants. Concerns are he will use public lands as private sector resources for industry versus preservation.
Your World The Secretary of State is 4th in line to the presidency and is chief negotiator of foreign policy on behalf of the nation, also responsible for coordination and security of diplomatic posts. This person is a foil for the president.	Rex Tillerson, current chief executive of Exxon, is retiring this month. He has lucrative financial interests in countries which are considered enemies, including Russia.	Tillerson has a fifteen-year relationship with Putin, czar of Russia and advocates loosening of economic sanctions. Unlike other Trump nominees, he favors climate change action, including the carbon cap taxes on emissions. He also favors supporting the 2015 Paris Accords for Climate Change Action. He probably would favor the Keystone Pipeline completion.	The far-flung oil and gas interests of Exxon  and his personal wealth would be impacted by actions of the federal government. No one has the potential for more conflicts of interest except Trump. He would have the ability to push back against the dogma from uninformed views of other cabinet nominees, especially on energy and climate issues.
Transportation The Secretary of Transportation oversees highway safety and road construction projects.	Elaine Chao is former head of the Department of Labor and married to Senate Majority leader, Mitch McConnell.	One of Trump’s centerpiece platforms is the rebuilding of America, so Chao will be responsible for contract letting, management, and other infrastructure requirements.	Chao is perhaps the most experienced member of the cabinet, as she ran a large government agency under the Bush Administration.
Keeping the Lights On The Secretary of Energy has oversight of the nation’s nuclear arsenal, also sets policy on utilization of resources to develop and maintain the nation’s energy grid.	Rick Perry, is the former Texas Governor, failed presidential candidate, and middling Dancing with the Stars Contestant.	The only qualification Mr. Perry has for energy expertise, is his support of wind power in his home state. He has no scientific background and has suggested the Department of Energy could be eliminated. The current Secretary of Energy, Ernest Moniz is a nuclear physicist.	Perry wasn’t a strong advocate for Trump so perhaps the president elect is an advocate of recreational pot as there is no other explanation for this appointment.

Next Steps

Now is the time to study the issues for which you are most passionate and draft whitepapers and reach out to your elected officials. I have already reached out to my elected representatives on several points since November 8^th and have also published several opinions in the New York Times. This article is my third posting since the election and my 99^th since I started this column. The election of caustic Trump to one of the most influential positions in the world has not dulled my sense of liberty, but inspired more insights and energy to inform readers about critical resourcing issues. And this is the healthpolicymaven signing off and encouraging you to share this article with all who value their democracy.

Roberta Winter is a freelance journalist who publishes under the trademark healthpolicymaven, which has been in continuous use since 2007. She is a public policy and healthcare book reviewer for the New York Journal of Books, a technical writer, and author. Her consumer guidebook to the U.S. healthcare system was published by Rowman & Littlefield in 2013. https://www.amazon.com/Unraveling-U-S-Health-Care-Personal/dp/1442222972

Other Articles On the Republican Agenda To Jettison the Affordable Care Act
http://healthpolicymaven.blogspot.com/2016/06/republican-plan-to-replace-obamacare.html

http://healthpolicymaven.blogspot.com/2016/01/top-10-things-from-affordable-care-act.html

http://healthpolicymaven.blogspot.com/2015/10/affordable-care-act-program-shows.html

 References:

American Medical Association. (2016, December 16). Physician Financial Transparency Reports (Sunshine Act). Retrieved from American Medical Association : https://www.ama-assn.org/practice-management/physician-financial-transparency-reports-sunshine-act

David Muhlestein, R. S. (2016). Medicare Accountable Care Organization Results for 2015: The Journey Toward Better Quality and Lower Costs Continues. Health Affairs. Retrieved December 16, 2016, from http://healthaffairs.org/blog/2016/09/09/medicare-accountable-care-organization-results-for-2015-the-journey-to-better-quality-and-lower-costs-continues/

ProPublica.org. (2016). Bailout Recipients December 12, 2016. ProPublica.org. Retrieved December 15, 2016, from https://projects.propublica.org/bailout/list