Federal regulators say it’s risky business. Samples of raw milk can contain bird flu virus and other pathogens linked to kidney disease, miscarriages, and death.

McAfee, founder and CEO of the Raw Farm, who also leads the Raw Milk Institute, says he plans to soon be in a position to change that message.

Robert F. Kennedy Jr., the anti-vaccine activist President Donald Trump has tapped to run the Department of Health and Human Services, recruited McAfee to apply for a job as the FDA’s raw milk standards and policy adviser, McAfee said. McAfee has already written draft proposals for possible federal certification of raw dairy farms, he said.

Virologists are alarmed. The Centers for Disease Control and Prevention recommends against unpasteurized dairy that hasn’t been heated to kill pathogens such as bird flu. Interstate raw milk sales for human consumption are banned by the FDA. A Trump administration that weakens the ban or extols raw milk, the scientists say, could lead to more foodborne illness. It could also, they say, raise the risk of the highly pathogenic H5N1 bird flu virus evolving to spread more efficiently, including between people, possibly fueling a pandemic.

“If the FDA says raw milk is now legal and the CDC comes through and says it advises drinking raw milk, that’s a recipe for mass infection,” said Angela Rasmussen, a virologist and co-editor-in-chief of the medical journal Vaccine and an adjunct professor at Stony Brook University in New York.

The raw milk controversy reflects the broader tensions President Donald Trump will confront when pursuing his second-administration agenda of rolling back regulations and injecting more consumer choice into health care.

Many policies Kennedy has said he wants to revisit — from the fluoridation of tap water to nutrition guidance to childhood vaccine requirements — are backed by scientific research and were established to protect public health. Some physician groups and Democrats are gearing up to fight initiatives they say would put people at risk.

Raw milk has gained a following among anti-regulatory conservatives who are part of a burgeoning health freedom movement.

“The health freedom movement was adopted by the tea party, and conspiracy websites gave it momentum,” said Paul Offit, director of the Vaccine Education Center at Children’s Hospital of Philadelphia, who has studied the history of the anti-vaccine movement.

Once-fringe ideas are edging into the mainstream. Vaccine hesitancy is growing.

Arkansas, Utah, and Kentucky are weighing legislation that would relax or end requirements for fluoride in public water. And 30 states now allow for the sale of raw milk in some form within their borders.

While only an estimated 3% of the U.S. population consumes raw milk or cheese, efforts to try to restrict its sales have riled Republicans and provided grist for conservative podcasts.

Many conservatives denounced last year’s execution of a search warrant when Pennsylvania agriculture officials and state troopers arrived at an organic farm tucked off a two-lane road on Jan. 4, 2024. State inspectors were investigating cases of two children sickened by E. coli bacteria and sales of raw dairy from the operation owned by Amish farmer Amos Miller, according to a complaint filed by the state’s agricultural department.

Bundled in flannel shirts and winter jackets, the inspectors put orange stickers on products detaining them from sale, and they left toting product samples in large blue-and-white coolers, online videos show. The 2024 complaint against Miller alleged that he and his wife sold dairy products in violation of state law.

The farm was well known to regulators. They say in the complaint that a Florida consumer died after being sickened in 2014 with listeria bacteria found in raw dairy from Miller’s farm. The FDA said a raw milk sample from the farm indicates it was the “likely source” of the infection, based on the complaint.

Neither Miller’s farm nor his lawyer returned calls seeking comment.

The Millers’ attorney filed a preliminary objection that said “shutting down Defendants would cause inequitable harm, exceed the authority of the agency, constitute an excessive fine as well as disparate, discriminatory punishment, and contravene every essential Constitutional protection and powers reserved to the people of Pennsylvania.”

Regulators in Pennsylvania said in a press release they must protect the public, and especially children, from harm. “We cannot ignore the illnesses and further potential harm posed by distribution of these unregulated products,” the Pennsylvania agricultural department and attorney general said in a joint statement.

Unpasteurized dairy products are responsible for almost all the estimated 761 illnesses and 22 hospitalizations in the U.S. that occur annually because of dairy-related illness, according to a study published in the June 2017 issue of Emerging Infectious Diseases.

But conservatives say raiding an Amish farm is government overreach. They’re “harassing him and trying to make an example of him. Our government is really out of control,” Pennsylvania Republican Sen. Doug Mastriano said in a video he posted to Facebook.

Videos show protesters at a February 2024 hearing on Miller’s case included Amish men dressed in black with straw hats and locals waving homemade signs with slogans such as “FDA Go Away.” A court in March issued a preliminary injunction that barred Miller from marketing and selling raw dairy products within the commonwealth pending appeal, but the order did not preclude sales of raw milk to customers out of state. The case is ongoing.

With Kennedy, the raw milk debate is poised to go national. Kennedy wrote on X in October that the “FDA’s war on public health is about to end.” In the post, he pointed to the agency’s “aggressive suppression” of raw milk, as one example.

McAfee is ready. He wants to see a national raw milk ordinance, similar to one that exists for pasteurized milk, that would set minimal national standards. Farmers could attain certification through training, continuing education, and on-site pathogen testing, with one standard for farms that sell to consumers and another for retail sales.

The Trump administration didn’t return emails seeking comment.

McAfee has detailed the system he developed to ensure his raw dairy products are safe. He confirmed the process for KFF Health News: cows with yellow-tagged ears graze on grass pastures and are cleansed in washing pens before milking. The raw dairy is held back from consumer sale until it’s been tested and found clear of pathogens.

His raw dairy products, such as cheese and milk, are sold by a variety of stores, including health, organic, and natural grocery chains, according to the company website, as well as raw dairy pet products, which are not for human consumption.

He said he doesn’t believe the raw milk he sells could contain or transmit viable bird flu virus. He also said he doesn’t believe regulators’ warnings about raw milk and the virus.

“The pharmaceutical industry is trying to create a new pandemic from bird flu to get their stock back up,” said McAfee, who says he counts Kennedy as a customer. His view is not shared by leading virologists.

In December, the state of California secured a voluntary recall of all his company’s raw milk and cream products due to possible bird flu contamination.

Five indoor cats in the same household died or were euthanized in December after drinking raw milk from McAfee’s farm, and tests on four of the animals found they were infected with bird flu, according to the Los Angeles County Department of Health.

In an unrelated case, Joseph Journell, 56, said three of his four indoor cats drank McAfee’s raw milk. Two fell sick and died, he said. His third cat, a large tabby rescue named Big Boy, temporarily lost the use of his hind legs and had to use a specialized wheelchair device, he said. Urine samples from Big Boy were positive for bird flu, according to a copy of the results from Cornell University and the U.S. Department of Agriculture.

McAfee dismissed connections between the cats’ illnesses and his products, saying any potential bird flu virus would no longer be viable by the time his raw milk gets to stores. He also said he believes that any sick cats got bird flu from recalled pet food.

Journell said he has hired a lawyer to try to recover his veterinary costs but remains a staunch proponent of raw milk.

“Raw milk is good for you, just not if it has bird flu in it,” he said. “I do believe in its healing powers.”

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The orders he issued soon after reentering the White House have policymakers, health care executives, and patient advocates trying to read the tea leaves to determine what’s to come. The directives, while less expansive than orders he issued at the beginning of his first term, provide a possible road map that health researchers say could increase the number of uninsured Americans and weaken safety-net protections for low-income people.

However, Trump’s initial orders will have little immediate impact. His administration will have to take further regulatory steps to fully reverse Biden’s policies, and the actions left unclear the direction the new president aims to steer the U.S. health care system.

“Everyone is looking for signals on what Trump might do on a host of health issues. On the early EOs, Trump doesn’t show his cards,” said Larry Levitt, executive vice president for health policy at KFF, the health policy research, polling, and news organization that includes KFF Health News.

A flurry of executive orders and other actions Trump issued on his first day back in office included rescinding directives by his predecessor, former President Joe Biden, that had promoted lowering drug costs and expanding coverage under the Affordable Care Act and Medicaid.

Executive orders “as a general matter are nothing more than gussied up internal memoranda saying, ‘Hey, agency, could you do something?’” said Nicholas Bagley, a law professor at the University of Michigan. “There may be reason to be concerned, but it’s down the line.”

That’s because making changes to established law like the ACA or programs like Medicaid generally requires new rulemaking or congressional action, either of which could take months. Trump has yet to win Senate confirmation for any of his picks to lead federal health agencies, including Robert F. Kennedy Jr., the anti-vaccine activist and former Democratic presidential candidate he has nominated the lead the Department of Health and Human Services. On Monday, he appointed Dorothy Fink, a physician who directs the HHS Office on Women’s Health, as acting secretary for the department.

“We’re getting rid of all of the cancer — I call it cancer — the cancer caused by the Biden administration,” Trump told reporters as he signed some of the executive orders in the Oval Office on Jan. 20. His order rescinding more than 70 Biden directives, including some of the former president’s health policies, said that “the previous administration has embedded deeply unpopular, inflationary, illegal, and radical practices within every office of the Federal Government.”

During Biden’s term, his administration did implement changes consistent with his health orders, including lengthening the enrollment period for the ACA, increasing funding for groups that help people enroll, and supporting the Inflation Reduction Act, which boosted subsidies to help people buy coverage. After falling during the Trump administration, enrollment in ACA plans soared under Biden, hitting record highs each year. More than 24 million people are enrolled in ACA plans for 2025.

The drug order Trump rescinded called on the Centers for Medicare & Medicaid Services to consider tests to lower drug costs. The agency came up with some ideas, such as setting a flat $2 copay for some generic drugs in Medicare, the health program for people 65 and older, and having states try to get better prices by banding together to buy certain expensive cell and gene therapies.

That Trump included the Biden drug order among his revocations may indicate he expects to do less on drug pricing this term or even roll back drug price negotiation in Medicare. Or it may have been slipped in as simply one more Biden order to erase.

The White House did not respond to a request for comment.

Biden’s experiments in lowering drug prices didn’t fully get off the ground, said Joseph Antos of the American Enterprise Institute, a right-leaning research group. Antos said he’s a bit puzzled by Trump’s executive order ending the pilot programs, given that he has backed the idea of tying drug costs in the U.S. to lower prices paid by other nations.

“As you know, Trump is a big fan of that,” Antos said. “Lowering drug prices is an easy thing for people to identify with.”

In other moves, Trump also rescinded Biden orders on racial and gender equity and issued an order asserting that there are only two sexes, male and female. HHS under the Biden administration supported gender-affirming health care for transgender people and provided guidance on civil rights protections for transgender youths. Trump’s missive on gender has intensified concerns within the LGBTQ+ community that he will seek to restrict such care.

“The administration has forecast that it will fail to protect and will seek to discriminate against transgender people and anyone else it considers an ‘other,’” said Omar Gonzalez-Pagan, senior counsel and health care strategist at Lambda Legal, a civil rights advocacy group. “We stand ready to respond to the administration’s discriminatory acts, as we have previously done to much success, and to defend the ability of transgender people to access the care that they need, including through Medicaid and Medicare.”

Trump also halted new regulations that were under development until they are reviewed by the new administration. He could abandon some proposals that were yet to be finalized by the Biden administration, including expanded coverage of anti-obesity medications through Medicare and Medicaid and a rule that would limit nicotine levels in tobacco products, Katie Keith, a Georgetown University professor who was deputy director of the White House Gender Policy Council under Biden, wrote in an article for Health Affairs Forefront.

“Interestingly, he did not disturb President Biden’s three executive orders and a presidential memorandum on reproductive health care,” she wrote.

However, Trump instructed top brass in his administration to look for additional orders or memorandums to rescind. (He revoked the Biden order that created the Gender Policy Council.)

Democrats criticized Trump’s health actions. A spokesman for the Democratic National Committee, Alex Floyd, said in a statement that “Trump is again proving that he lied to the American people and doesn’t care about lowering costs — only what’s best for himself and his ultra-rich friends.”

Trump’s decision to end a Biden-era executive order aimed at improving the ACA and Medicaid probably portends coming cuts and changes to both programs, some policy experts say. His administration previously opened the door to work requirements in Medicaid — the federal-state program for low-income adults, children, and people with disabilities — and previously issued guidance enabling states to cap federal Medicaid funding. Medicaid and the related Children’s Health Insurance Program cover more than 79 million people.

“Medicaid will be a focus because it’s become so sprawling,” said Chris Pope, a senior fellow at the Manhattan Institute, a conservative policy group. “It’s grown after the pandemic. Provisions have expanded, such as using social determinants of health.”

The administration may reevaluate steps taken by the Biden administration to allow Medicaid to pay for everyday expenses some states have argued affect its beneficiaries’ health, including air conditioners, meals, and housing.

One of Trump’s directives orders agencies to deliver emergency price relief and “eliminate unnecessary administrative expenses and rent-seeking practices that increase healthcare costs.” (Rent-seeking is an economic concept describing efforts to exploit the political system for financial gain without creating other benefits for society.)

“It is not clear what this refers to, and it will be interesting to see how agencies respond,” Keith wrote in her Health Affairs article.

Policy experts like Edwin Park at Georgetown University have also noted that, separately, Republicans are working on budget proposals that could lead to large cuts in Medicaid funding, in part to pay for tax cuts.

Sarah Lueck, vice president for health policy at the Center on Budget and Policy Priorities, a left-leaning research group, also pointed to Congress: “On one hand, what we see coming from the executive orders by Trump is important because it shows us the direction they are going with policy changes. But the other track is that on the Hill, there are active conversations about what goes into budget legislation. They are considering some pretty huge cuts to Medicaid.”

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For years, the federal government has steered clear of regulating junk food, fast food, and ultra-processed food.

Now attitudes are changing. Some members of President-elect Donald Trump’s inner circle are gearing up to battle “Big Food,” or the companies that make most of the food and beverages consumed in the United States. Nominees for top health agencies are taking aim at ultra-processed foods that account for an estimated 70% of the nation’s food supply. Based on recent statements, a variety of potential politically charged policy options to regulate ultra-processed food may land on the Trump team menu, including warning labels, changes to agribusiness subsidies, and limits on which products consumers can buy with government food aid.

The push to reform the American diet is being driven largely by conservatives who have taken up the cause that has long been a darling of the left. Trump supporters such as Robert F. Kennedy Jr., whose controversial nomination to lead the Department of Health and Human Services still faces Senate confirmation, are embracing a concept that champions natural foods and alternative medicine. It’s a movement they’ve dubbed “MAHA,” or Make America Healthy Again. Their interest has created momentum because their goals have fairly broad bipartisan support even amid a bitterly divided Congress in which lawmakers from both sides of the aisle focused on the issue last year.

It’s likely to be a pitched battle because the food industry wields immense political influence and has successfully thwarted previous efforts to regulate its products or marketing. The category of “food processing and sales companies,” which includes Tyson Foods and Nestle SA, tallied $26.7 million in spending on lobbying in 2024, according to OpenSecrets. That’s up from almost $10 million in 1998.

“They have been absolutely instrumental and highly, highly successful at delaying any regulatory effectiveness in America,” said Laura Schmidt, a health policy professor at the University of California-San Francisco. “It really does feel like there needs to be a moment of reckoning here where people start asking the question, ‘Why do we have to live like this?’”

“Ultra-processed food” is a widely used term that means different things to different people and is used to describe items ranging from sodas to many frozen meals. These products often contain added fats, starches, and sugars, among other things. Researchers say consumption of ultra-processed foods is linked — in varying levels of intensity — to chronic conditions like diabetes, cancer, mental health problems, and early death.

Nutrition and health leaders are optimistic that a reckoning is already underway. Kennedy has pledged to remove processed foods from school lunches, restrict certain food additives such as dyes in cereal, and shift federal agricultural subsidies away from commodity crops widely used in ultra-processed foods.

The intensifying focus in Washington has triggered a new level of interest on the legal front as lawyers explore cases to take on major foodmakers for selling products they say result in chronic disease.

Bryce Martinez, now 18, filed a lawsuit in December against almost a dozen foodmakers such as Kraft Heinz, The Coca-Cola Co., and Nestle USA. He developed diabetes and non-alcoholic fatty liver disease by age 16, and is seeking to hold them accountable for his illnesses. According to the suit, filed in the Philadelphia Court of Common Pleas, the companies knew or should have known ultra-processed foods were harmful and addictive.

The lawsuit noted that Martinez grew up eating heavily advertised, brand-name foods that are staples of the American diet — sugary soft drinks, Cheerios and Lucky Charms, Skittles and Snickers, frozen and packaged dinners, just to name a few.

Nestle, Coca-Cola, and Kraft Heinz didn’t return emails seeking comment for this article. The Consumer Brands Association, a trade association for makers of consumer packaged goods, disputed the allegations.

“Attempting to classify foods as unhealthy simply because they are processed, or demonizing food by ignoring its full nutrient content, misleads consumers and exacerbates health disparities,” said Sarah Gallo, senior vice president of product policy, in a statement.

Other law firms are on the hunt for children or adults who believe they were harmed by consuming ultra-processed foods, increasing the likelihood of lawsuits.

One Indiana personal injury firm says on its website that “we are actively investigating ultra processed food (UPF) cases.” Trial attorneys in Texas also are looking into possible legal action against the federal regulators they say have failed to police ultra-processed foods.

“If you or your child have suffered health problems that your doctor has linked directly to the consumption of ultra-processed foods, we want to hear your story,” they say on their website.

Meanwhile, the FDA on Jan. 14 announced it is proposing to require a front-of-package label to appear on most packaged foods to make information about a food’s saturated fat, sodium, and added sugar content easily visible to consumers.

And on Capitol Hill, Sens. Bernie Sanders (I-Vt.), Ron Johnson (R-Wis.), and Cory Booker (D-N.J.) are sounding the alarm over ultra-processed food. Sanders introduced legislation in 2024 that could lead to a federal ban on junk food advertising to children, a national education campaign, and labels on ultra-processed foods that say the products aren’t recommended for children. Booker cosigned the legislation along with Sens. Peter Welch (D-Vt.) and John Hickenlooper (D-Colo.).

The Senate Committee on Health, Education, Labor and Pensions held a December hearing examining links between ultra-processed food and chronic disease during which FDA Commissioner Robert Califf called for more funding for research.

Food companies have tapped into “the same neural circuits that are involved in opioid addiction,” Califf said at the hearing.

Sanders, who presided over the hearing, said there’s “growing evidence” that “these foods are deliberately designed to be addictive,” and he asserted that ultra-processed foods have driven epidemics of diabetes and obesity, and hundreds of billions of dollars in medical expenses.

Research on food and addiction “has accumulated to the point where it’s reached a critical mass,” said Kelly Brownell, an emeritus professor at Stanford who is one of the editors of a scholarly handbook on the subject.

Attacks from three sides — lawyers, Congress, and the incoming Trump administration, all seemingly interested in taking up the fight — could lead to enough pressure to challenge Big Food and possibly spur better health outcomes in the U.S., which has the lowest life expectancy among high-income countries.

“Maybe getting rid of highly processed foods in some things could actually flip the switch pretty quickly in changing the percentage of the American public that are obese,” said Robert Redfield, a virologist who led the Centers for Disease Control and Prevention during the previous Trump administration, in remarks at a December event hosted by the Heritage Foundation, a conservative think tank.

Claims that Big Food knowingly manufactured and sold addictive and harmful products resemble the claims leveled against Big Tobacco before the landmark $206 billion settlement was reached in 1998.

“These companies allegedly use the tobacco industry’s playbook to target children, especially Black and Hispanic children, with integrated marketing tie-ins with cartoons, toys, and games, along with social media advertising,” Rene Rocha, one of the lawyers at Morgan & Morgan representing Martinez, told KFF Health News.

The 148-page Martinez lawsuit against foodmakers draws from documents made public in litigation against tobacco companies that owned some of the biggest brands in the food industry.

Similar allegations were made against opioid manufacturers, distributors, and retailers before they agreed to pay tens of billions of dollars in a 2021 settlement with states.

The FDA ultimately put restrictions on the labeling and marketing of tobacco, and the opioid epidemic led to legislation that increased access to lifesaving medications to treat addiction.

But the Trump administration’s zeal in taking on Big Food may face unique challenges.

The ability of the FDA to impose regulation is hampered in part by funding. While the agency’s drug division collects industry user fees, its division of food relies on a more limited budget determined by Congress.

Change can take time because the agency moves at what some critics call a glacial pace. Last year, the FDA revoked a regulation allowing brominated vegetable oil in food products. The agency determined in 1970 that the additive was not generally recognized as safe.

Efforts to curtail the marketing of ultra-processed food could spur lawsuits alleging that any restrictions violate commercial speech protected by the First Amendment. And Kennedy — if he is confirmed as HHS secretary — may struggle to get support from a Republican-led Congress that champions less federal regulation and a president-elect who during his previous term served fast food in the White House.

“The question is, will RFK be able to make a difference?” said David L. Katz, a doctor who founded True Health Initiative, a nonprofit group that combats public health misinformation. “No prior administration has done much in this space, and RFK is linked to a particularly anti-regulatory administration.”

Meanwhile, the U.S. population is recognized as among the most obese in the world and has the highest rate of people with multiple chronic conditions among high-income countries.

“There is a big grassroots effort out there because of how sick we are,” said Jerold Mande, who served as deputy undersecretary for food safety at the Department of Agriculture from 2009 to 2011. “A big part of it is people shouldn’t be this sick this young in their lives. You’re lucky if you get to 18 without a chronic disease. It’s remarkable.”

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Durante años, el gobierno federal ha evitado regular la comida chatarra, la comida rápida y los alimentos ultraprocesados.

Ahora, las actitudes están cambiando. Algunos miembros del círculo íntimo del presidente Donald Trump se están preparando para luchar contra las “grandes empresas alimentarias”, es decir, las compañías que producen la mayor parte de los alimentos y bebidas que se consumen en el paía.

Los candidatos a las principales agencias de salud están apuntando a los alimentos ultraprocesados, que representan aproximadamente el 70% del suministro de alimentos de Estados Unidos.

Según declaraciones recientes, una variedad de posibles opciones de normas con carga política para regular los alimentos ultraprocesados ​​pueden llegar al menú del equipo de Trump, incluidas las etiquetas de advertencia, los cambios en los subsidios a la agroindustria y los límites a los productos que los consumidores pueden comprar con la ayuda alimentaria del gobierno.

El impulso para reformar la dieta estadounidense está siendo impulsado en gran medida por los conservadores que han asumido la causa que durante mucho tiempo ha sido la favorita de la izquierda.

Los partidarios de Trump, como Robert F. Kennedy Jr., cuya controversial nominación para dirigir el Departamento de Salud y Servicios Humanos aún enfrenta la confirmación del Senado, están adoptando un concepto que defiende los alimentos naturales y la medicina alternativa.

Es un movimiento que han denominado “MAHA”, o Make America Healthy Again (Hagamos a América saludable de nuevo). Su interés ha cobrado impulso porque sus objetivos tienen un apoyo bipartidista bastante amplio, incluso en medio de un Congreso amargamente dividido en el que los legisladores de ambos partidos se centraron en el tema el año pasado.

Es probable que sea una batalla campal porque la industria alimentaria ejerce una inmensa influencia política y ha frustrado con éxito los esfuerzos anteriores por regular sus productos o su comercialización. La categoría de “empresas de procesamiento y venta de alimentos”, que incluye a Tyson Foods y Nestlé SA, registró un gasto de $26,7 millones en actividades de lobby en 2024, según OpenSecrets. En 1998 fueron $10 millones.

“Han sido absolutamente instrumentales y muy, muy exitosos en retrasar cualquier efectividad en la regulación en Estados Unidos”, dijo Laura Schmidt, profesora de política de salud en la Universidad de California-San Francisco. “Realmente parece que debe haber un momento de ajuste de cuentas aquí donde la gente comience a preguntarse, ‘¿Por qué tenemos que vivir así?’”

“Alimentos ultraprocesados” es un término ampliamente utilizado que significa cosas diferentes para distintas personas y se utiliza para describir artículos que van desde refrescos hasta muchas comidas congeladas. Estos productos a menudo contienen grasas, almidones y azúcares agregados, entre otras cosas. Los investigadores dicen que el consumo de alimentos ultraprocesados ​​está vinculado, en diferentes niveles de intensidad, a enfermedades crónicas como diabetes, cáncer, problemas de salud mental y muerte prematura.

Los líderes en nutrición y salud son optimistas de que ya se está llevando a cabo un ajuste de cuentas. Kennedy se ha comprometido a eliminar los alimentos procesados ​​de los almuerzos escolares, restringir ciertos aditivos alimentarios como los colorantes en los cereales y redireccionar los subsidios agrícolas federales de los cultivos básicos ampliamente utilizados en los alimentos ultraprocesados.

La intensificación de la atención en Washington ha desencadenado un nuevo nivel de interés en el frente legal, ya que los abogados exploran casos para enfrentarse a los principales fabricantes de alimentos por vender productos que, según ellos, provocan enfermedades crónicas.

Bryce Martínez, que ahora tiene 18 años, presentó una demanda en diciembre contra casi una docena de fabricantes de alimentos como Kraft Heinz, The Coca-Cola Co. y Nestlé USA. Desarrolló diabetes y enfermedad del hígado graso no alcohólico a los 16 años, y está tratando de hacerlos responsables de sus enfermedades.

Según la demanda, presentada en el Tribunal de Causas Comunes de Philadelphia, las empresas sabían o deberían haber sabido que los alimentos ultraprocesados ​​eran dañinos y adictivos. La demanda señalaba que Martínez creció comiendo alimentos de marca muy publicitados que son básicos en la dieta estadounidense: refrescos azucarados, Cheerios y Lucky Charms, Skittles y Snickers, comidas congeladas y envasadas, por nombrar solo algunos.

Nestlé, Coca-Cola y Kraft Heinz no respondieron a los correos electrónicos en los que se solicitaban comentarios para este artículo. La Consumer Brands Association, una asociación comercial para fabricantes de bienes de consumo envasados, cuestionó las acusaciones.

“Intentar clasificar los alimentos como poco saludables simplemente porque están procesados, o demonizar los alimentos ignorando su contenido nutricional completo, engaña a los consumidores y exacerba las disparidades en materia de salud”, dijo Sarah Gallo, vicepresidenta sénior de política de productos, en una declaración.

Otros bufetes de abogados están a la caza de niños o adultos que creen que fueron perjudicados por consumir alimentos ultraprocesados, lo que aumenta la probabilidad de demandas.

Un grupo de abogados de Indiana especializado en lesiones personales dice en su sitio web: “estamos investigando activamente casos de alimentos ultraprocesados ​​(UPF)”. Y abogados litigantes de Texas también están estudiando la posibilidad de emprender acciones legales contra los reguladores federales que, según ellos, no han controlado los alimentos ultraprocesados.

“Si usted o su hijo han sufrido problemas de salud que su médico ha vinculado directamente con el consumo de alimentos ultraprocesados, Queremos escuchar su historia”, dicen en su sitio web.

Mientras tanto, el 14 de enero la Administración de Drogas y Alimentos (FDA)  anunció que propone exigir que aparezca una etiqueta en la parte de adelante del paquete en la mayoría de los alimentos envasados ​​para que la información sobre el contenido de grasas saturadas, sodio y azúcar agregado de un alimento sea fácilmente visible para los consumidores.

Y en el Capitolio, los senadores Bernie Sanders (independiente de Vermont), Ron Johnson (Republicano de Wisconsin) y Cory Booker (demócrata de New Jersey) están haciendo sonar la alarma sobre los alimentos ultraprocesados.

En 2024, Sanders introdujo una legislación que podría conducir a una prohibición federal de la publicidad de comida chatarra dirigida a niños, una campaña nacional de educación y etiquetas en alimentos ultraprocesados ​​que digan que los productos no están recomendados para pequeños. Booker firmó la legislación junto con los senadores Peter Welch (demócrata de Vermont) y John Hickenlooper (demócrata de Colorado).

En diciembre, el Comité de Salud, Educación, Trabajo y Pensiones del Senado tuvo una audiencia para examinar los vínculos entre los alimentos ultraprocesados ​​y las enfermedades crónicas, durante la cual el comisionado de la FDA, Robert Califf, pidió más fondos para la investigación.

Las empresas alimentarias han aprovechado “los mismos circuitos neuronales que intervienen en la adicción a los opioides”, dijo Califf en la audiencia.

Sanders, que presidió la audiencia, dijo que hay “evidencia creciente” de que “estos alimentos están diseñados deliberadamente para ser adictivos”, y afirmó que los alimentos ultraprocesados ​​han impulsado epidemias de diabetes y obesidad, y cientos de miles de millones de dólares en gastos médicos.

La investigación sobre los alimentos y la adicción “se ha acumulado hasta el punto de haber alcanzado una masa crítica”, dijo Kelly Brownell, profesora emérita de Stanford y una de las editoras de un manual académico sobre el tema.

Los ataques de tres bandos —abogados, el Congreso y la administración Trump, todos aparentemente interesados ​​en presentar batalla— podrían generar suficiente presión para desafiar a las grandes empresas alimentarias y posiblemente impulsar mejores resultados de salud en Estados Unidos, que tiene la más baja expectativa de vida entre los países de altos ingresos.

“Tal vez deshacerse de los alimentos altamente procesados ​​en algunas cosas podría realmente cambiar rápidamente el porcentaje de la población estadounidense que es obesa”, dijo el virólogo Robert Redfield, que dirigió los Centros para el Control y Prevención de Enfermedades (CDC) durante la administración Trump anterior, en comentarios en un evento en diciembre organizado por The Heritage Foundation, un grupo de expertos conservador.

Las acusaciones de que las grandes empresas alimentarias fabricaron y vendieron a sabiendas productos adictivos y nocivos se parecen a las acusaciones formuladas contra las grandes tabacaleras antes de que se alcanzara el histórico acuerdo de $206.000 millones, en 1998.

“Supuestamente, estas empresas utilizan el manual de estrategias de la industria tabacalera para dirigirse a los niños, especialmente a los niños negros e hispanos, con vínculos de marketing integrados con dibujos animados, juguetes y juegos, junto con publicidad en las redes sociales”, dijo a KFF Health News René Rocha, uno de los abogados de Morgan & Morgan que representa a Martínez.

La demanda de Martínez contra los fabricantes de alimentos, de 148 páginas, se basa en documentos que se hicieron públicos en un litigio contra las empresas tabacaleras que eran dueñas de algunas de las marcas más importantes de la industria alimentaria.

Se hicieron acusaciones similares contra los fabricantes, distribuidores y minoristas de opioides antes de que aceptaran pagar decenas de miles de millones de dólares en un acuerdo de 2021 con los estados.

La FDA finalmente impuso restricciones al etiquetado y la comercialización del tabaco, y la epidemia de opioides condujo a una legislación que aumentó el acceso a medicamentos que salvan vidas para tratar la adicción.

Pero el celo de la administración Trump al enfrentarse a las grandes empresas alimentarias puede enfrentar desafíos únicos.

La capacidad de la FDA para imponer regulaciones se ve obstaculizada en parte por la financiación. Mientras que la división de medicamentos de la agencia recauda tasas de usuario de la industria, su división de alimentos depende de un presupuesto más limitado determinado por el Congreso.

El cambio puede llevar tiempo porque la agencia avanza, según algunos críticos, a ritmo de tortuga. El año pasado, la FDA revocó una regulación que permitía el aceite vegetal bromado en productos alimenticios. La agencia determinó en 1970 que el aditivo no era generalmente reconocido como seguro.

Los esfuerzos para limitar la comercialización de alimentos ultraprocesados ​​podrían impulsar demandas que aleguen que cualquier restricción viola la libertad de expresión comercial protegida por la Primera Enmienda. Y Kennedy —si es confirmado como secretario del Departamento de Salud y Servicios Sociales (HHS)—  puede tener dificultades para obtener el apoyo de un Congreso liderado por  republicanos, que defiende una menor regulación federal, y de un presidente que durante su mandato anterior sirvió comida rápida en la Casa Blanca.

“La pregunta es: ¿podrá RFK marcar una diferencia?”, dijo David L. Katz, médico fundador de True Health Initiative, un grupo sin fines de lucro que combate la desinformación sobre salud pública. “Ninguna administración anterior ha hecho mucho en este ámbito, y RFK está vinculado a una administración particularmente antirregulatoria”.

Mientras tanto, la población estadounidense es reconocida como una de las más obesas del mundo y tiene la tasa más alta de personas con múltiples enfermedades crónicas entre los países de altos ingresos.

“Hay un gran esfuerzo de base debido a lo enfermos que estamos”, dijo Jerold Mande, quien se desempeñó como subsecretario adjunto para la seguridad alimentaria en el Departamento de ASgricultura entre 2009 y 2011.

“En gran parte, esto se debe a que la gente no debería estar tan enferma tan temprano en la vida. Tienes suerte si llegas a los 18 años sin una enfermedad crónica. Es extraordinario”, observó.

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The picks hold different views on matters such as limits on abortion, the safety of childhood vaccines, the covid-19 response, and the use of weight-loss medications. The divide pits Trump picks who adhere to more traditional and orthodox science, such as the long-held, scientifically supported findings that vaccines are safe, against often unsubstantiated views advanced by Kennedy and other selections who have claimed vaccines are linked with autism.

The Trump transition team and the designated nominees mentioned in this article did not respond to requests for comment.

It’s a potential “team of opponents” at the government’s health agencies, said Michael Cannon, director of health policy studies at the Cato Institute, a libertarian policy organization.

Kennedy, he said, is known for rejecting opposing views when confronted with science.

“The heads of the FDA and NIH will be spending all their time explaining to their boss what a confidence interval is,” Cannon said, referring to a statistical term used in medical studies.

Those whose views prevail will have significant power in shaping policy, from who is appointed to sit on federal vaccine advisory committees to federal authorization for covid vaccines to restrictions on abortion medications. If confirmed as HHS secretary, Kennedy is expected to set much of the agenda.

“If President Trump’s nomination of RFK Jr. to be secretary is confirmed, if you don’t subscribe to his views, it will be very hard to rise in that department,” said Amesh Adalja, an infectious disease specialist and senior scholar at the Johns Hopkins Center for Health Security. “They will need to suppress their views to fit with RFK Jr’s. In this administration, and any administration, independent public disagreement isn’t welcome.”

Kennedy is chair of Children’s Health Defense, an anti-vaccine nonprofit. He has vowed to curb the country’s appetite for ultra-processed food and its incidence of chronic disease. He helped select Trump’s choices to lead the Centers for Disease Control and Prevention, the Food and Drug Administration, and the National Institutes of Health. If confirmed, he would lead them from the helm of HHS, with its more than $1.7 trillion budget.

Clashes are likely. Kennedy has supported access to abortion until a fetus is viable. That puts him at odds with Dave Weldon, the former Florida congressman whom Trump has chosen to run the CDC. Weldon, a physician, is an abortion opponent who wrote one of the major laws allowing health professionals to opt out of participating in the procedure.

Weldon would head an agency that’s been in the crosshairs of conservatives since the covid pandemic began. He has touted his “100% pro-life voting record” on his campaign website. (He unsuccessfully ran earlier this year for a seat in Florida’s House of Representatives.)

Trump has said he would leave decisions about abortion to the states, but the CDC under Weldon could, for example, fund studies on abortion risks. The agency could require states to provide information about abortions performed within their borders to the federal government or risk the loss of federal funds.

Weldon, like Kennedy, has questioned the safety of vaccines and has said he believes they can cause autism. That’s at odds with the views of Marty Makary, a Johns Hopkins surgeon whom Trump plans to nominate for FDA commissioner. The British American said on the “Brian Kilmeade Show” on Fox News Radio that vaccines “save lives,” although he added that it’s good to question the U.S. vaccine schedule for children.

The American Academy of Pediatricians encourages parents and their children’s doctors to stick to the recommended schedule of childhood vaccines. “Nonstandard schedules that spread out vaccines or start when a child is older put entire communities at risk of serious illnesses, including infants and young children,” the group says in guidance for its members.

Jay Bhattacharya, a doctor and economist who is Trump’s selection to lead NIH, has also supported vaccines.

Kennedy has said on NPR that federal authorities under his leadership wouldn’t “take vaccines away from anybody.” But the FDA oversees approval of vaccines, and, under his leadership, the agency could put vaccine skeptics on advisory panels or could make changes to a program that largely protects vaccine makers from consumer injury lawsuits.

“I do believe that autism does come from vaccines,” Kennedy said in 2023 on Fox News. Many scientific studies have discredited the claim that vaccines cause autism.

Ashish Jha, a doctor who served as the White House covid response coordinator from 2022 to 2023, noted that Bhattacharya and Makary have had long and distinguished careers in medicine and research and would bring decades of experience to these top jobs. But, he said, it “is going to be a lot more difficult than they think” to stand up for their views in the new administration.

It’s hard “to do things that displease your boss, and if [Kennedy] gets confirmed, he will be their boss,” Jha said. “They have their work cut out for them if they’re going to stand up for their opinions on science. If they don’t, it will just demoralize the staff.”

Most of Trump’s picks share the view that federal health agencies bungled the pandemic response, a stance that resonated with many of the president-elect’s voters and supporters — even though Trump led that response until Joe Biden took office in 2021.

Kennedy said in a 2021 Louisiana House oversight meeting that the covid vaccine was the “deadliest” ever made. He has cited no evidence to back the claim.

Federal health officials say the vaccines have saved millions of lives around the globe and offer important protection against covid. Protection lasts even though their effectiveness wanes over time.

The vaccines’ effectiveness against infection stood at 52% after four weeks, according to a May study in The New England Journal of Medicine, and their effectiveness against hospitalization was about 67% after four weeks. The vaccines were produced through Operation Warp Speed, a public-private partnership Trump launched in his first term to fast-track the shots as well as other treatments.

Makary criticized covid vaccine guidance that called for giving young children the shots. He argued that, for many people, natural immunity from infections could substitute for the vaccine. Bhattacharya opposed measures used to curb the spread of covid in 2020 and advised that everyone except the most vulnerable go about their lives as usual. The World Health Organization warned that such an approach would overwhelm hospitals.

Mehmet Oz, Trump’s choice to head the Centers for Medicare & Medicaid Services, an agency within HHS, has said the vaccines were oversold. He promoted the use of the anti-malaria drug hydroxychloroquine as a treatment. The FDA in 2020 revoked emergency authorization of hydroxychloroquine for covid, saying that it was unlikely to be effective against the virus and that the risk of dangerous side effects was too high.

Janette Nesheiwat, meanwhile, a former Fox News contributor and Trump’s pick for surgeon general, has taken a different stance. The doctor described covid vaccines as a gift from God in a Fox News opinion piece.

Kennedy’s qualms about vaccines are likely to be a central issue early in the administration. He has said he wants federal health agencies to shift their focus from preparing for and combating infectious disease to addressing chronic disease.

The shifting focus and questioning of vaccines concern some public health leaders amid the spread of the H5N1 bird flu virus among dairy cattle. There have been 60 human infections reported in the U.S. this year, all but two of them linked to exposure to cattle or poultry.

“Early on, they’re going to have to have a discussion about vaccinating people and animals” against bird flu, said Georges C. Benjamin, executive director of the American Public Health Association. “We all bring opinions to the table. A department’s cohesive policy is driven by the secretary.”

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“First 100 days,” said Means, a former consultant to Big Pharma who uses the social platform X to focus attention on chronic disease. “What should be done to reform the FDA?”

The question was more than rhetorical. Means is among a cadre of health business leaders and nonmainstream doctors who are influencing President Donald Trump’s focus on health policy.

Trump’s return to the White House has given Means and others in this space significant clout in shaping the nascent health policies of the new administration and its federal agencies. It’s also giving newfound momentum to “Make America Healthy Again,” or MAHA, a controversial movement that challenges prevailing thinking on public health and chronic disease.

Its followers couch their ideals in phrases like “health freedom” and “true health.” Their stated causes are as diverse as revamping certain agricultural subsidies, firing National Institutes of Health employees, rethinking childhood vaccination schedules, and banning marketing of ultra-processed foods to children on TV.

Public health leaders say the emerging Trump administration’s interest in elevating the sometimes unorthodox concepts could be catastrophic, eroding decades of scientific progress while spurring a rise in preventable disease. They worry the administration’s support could weaken trust in public health agencies.

Georges Benjamin, executive director of the American Public Health Association, said he welcomes broad intellectual scientific discussion but is concerned that Trump will parrot untested and unproven public health ideas he hears as if they are fact.

Experience has shown that people with unproven ideas will have his ear and his “very large bully pulpit,” he said. “Because he’s president, people will believe he won’t say things that aren’t true. This president, he will.”

But those in the MAHA camp have a very different take. They say they have been maligned as dangerous for questioning the status quo. The election has given them an enormous opportunity to shape politics and policies, and they say they won’t undermine public health. Instead, they say, they will restore trust in federal health agencies that lost public support during the pandemic.

“It may be a brilliant strategy by the right,” said Peter McCullough, a cardiologist who has come under fire for saying covid-19 vaccines are unsafe. He was describing some of the election-season messaging that mainstreamed their perspectives. “The right was saying we care about medical and environmental issues. The left was pursuing abortion rights and a negative campaign on Trump. But everyone should care about health. Health should be apolitical.”

The movement is largely anti-regulatory and anti-big government, whether concerning raw milk or drug approvals, although implementing changes would require more regulation. Many of its concepts cross over to include ideas that have also been championed by some on the far left.

Robert F. Kennedy Jr., an anti-vaccine activist Trump has nominated to run the Department of Health and Human Services, has called for firing hundreds of people at the National Institutes of Health, removing fluoride from water, boosting federal support for psychedelic therapy, and loosening restrictions on raw milk, consumption of which can expose consumers to foodborne illness. Its sale has prompted federal raids on farms for not complying with food safety regulations.

Means has called for top-down changes at the U.S. Department of Agriculture, which he says has been co-opted by the food industry.

Though he himself is not trained in science or medicine, he has said people had almost no chance of dying of covid-19 if they were “metabolically healthy,” referring to eating, sleeping, exercise, and stress management habits, and has said that about 85% of deaths and health care costs in the U.S. are tied to preventable foodborne metabolic conditions.

A co-founder of Truemed, a company that helps consumers use pretax savings and reimbursement programs on supplements, sleep aids, and exercise equipment, Means says he has had conversations behind closed doors with dozens of members of Congress. He said he also helped bring RFK Jr. and Trump together. RFK Jr. endorsed Trump in August after ending his independent presidential campaign.

“I had this vision for a year, actually. It sounds very woo-woo, but I was in a sweat tent with him in Austin at a campaign event six months before, and I just had this strong vision of him standing with Trump,” Means said recently on the Joe Rogan Experience podcast.

The former self-described never-Trumper said that, after Trump’s first assassination attempt, he felt it was a powerful moment. Means called RFK Jr. and worked with conservative political commentator Tucker Carlson to connect him to the former president. Trump and RFK Jr. then had weeks of conversations about topics such as child obesity and causes of infertility, Means said.

“I really felt, and he felt, like this could be a realignment of American politics,” Means said.

He is joined in the effort by his sister, Casey Means, a Stanford University-trained doctor and co-author with her brother of “Good Energy,” a book about improving metabolic health. The duo has blamed Big Pharma and the agriculture industry for increasing rates of obesity, depression, and chronic health conditions in the country. They have also raised questions about vaccines.

“Yeah, I bet that one vaccine probably isn’t causing autism, but what about the 20 that they are getting before 18 months,” Casey Means said in the Joe Rogan podcast episode with her brother.

The movement, which challenges what its adherents call “the cult of science,” gained significant traction during the pandemic, fueled by a backlash against vaccine and mask mandates that flourished during the Biden administration. Many of its supporters say they gained followers who believed they had been misled on the effectiveness of covid-19 vaccines.

In July 2022, Deborah Birx, covid-19 response coordinator in Trump’s first administration, said on Fox News that “we overplayed the vaccines,” although she noted that they do work.

Anthony Fauci, who advised Trump during the pandemic, in December 2020 called the vaccines a game changer that could diminish covid-19 the way the polio vaccine did for that disease.

Eventually, though, it became evident that the shots don’t necessarily prevent transmission and the effectiveness of the booster wanes with time, which some conservatives say led to disillusionment that has driven interest in the health freedom movement.

Federal health officials say the rollout of the covid vaccine was a turning point in the pandemic and that the shots lessen the severity of the disease by teaching the immune system to recognize and fight the virus that causes it.

Postelection, some Trump allies such as Elon Musk have called for Fauci to be prosecuted. Fauci declined to comment.

Joe Grogan, a former director of the White House’s Domestic Policy Council and assistant to Trump, said conservatives have been trying to articulate why government control of health care is troublesome.

“Two things have happened. The government went totally overboard and lied about many things during covid and showed no compassion about people’s needs outside of covid,” he said. “RFK Jr. came along and articulated very simply that government control of health care can’t be trusted, and we’re spending money, and it isn’t making anyone healthier. In some instances, it may be making people sicker.”

The MAHA movement capitalizes on many of the nonconventional health concepts that have been darlings of the left, such as promoting organic foods and food as medicine. But in an environment of polarized politics, the growing prominence of leaders who challenge what they call the cult of science could lead to more public confusion and division, some health analysts say.

Jeffrey Singer, a surgeon and senior fellow at the Cato Institute, a libertarian public policy research group, said in a statement that he agrees with RFK Jr.’s focus on reevaluating the public health system. But he said it comes with risks.

“I am concerned that many of RFK Jr.’s claims about vaccine safety, environmental toxins, and food additives lack evidence, have stoked public fears, and contributed to a decline in childhood vaccination rates,” he said.

Measles vaccination among kindergartners in the U.S. dropped to 92.7% in the 2023-24 school year from 95.2% in the 2019-20 school year, according to the Centers for Disease Control and Prevention. The agency said that has left about 280,000 kindergartners at risk.

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“Primeros 100 días”, escribió Means, ex consultor de la industria farmacéutica que utiliza la plataforma social X para enfocar la atención en las enfermedades crónicas. “¿Qué se debería hacer para reformar la FDA (Administración de Drogas y Alimentos)?”.

La pregunta no era meramente retórica. Means forma parte de un grupo de líderes del sector salud y médicos no convencionales que están influyendo en el enfoque de Donald Trump sobre políticas de salud.

El regreso de Trump a la Casa Blanca ha otorgado a Means, y a otros en esta área, una influencia significativa para moldear las políticas de salud incipientes de la nueva administración y sus agencias federales. También ha dado un nuevo impulso a “Hacer América saludable de nuevo” (Make America Healthy Again o MAHA), un movimiento controversial que desafía las ideas predominantes sobre la salud pública y las enfermedades crónicas.

Sus seguidores expresan sus ideales con frases como “libertad sanitaria” y “salud verdadera”. Sus causas declaradas son tan diversas como reformar ciertos subsidios agrícolas, despedir empleados de los Institutos Nacionales de Salud (NIH), replantear el calendario de vacunación infantil y prohibir la publicidad televisiva de alimentos ultraprocesados dirigida a niños.

Los líderes de salud pública advierten que el interés de la emergente administración Trump por elevar conceptos a veces poco ortodoxos podría ser catastrófico, erosionando décadas de progreso científico y provocando un aumento de las enfermedades prevenibles. Les preocupa que el apoyo de la administración debilite la confianza en las agencias de salud pública.

Georges Benjamin, director ejecutivo de la Asociación Americana de Salud Pública, dijo que da la bienvenida a debates científicos amplios, pero le preocupa que Trump repita como hechos ideas de salud pública no comprobadas.

“La experiencia ha mostrado que personas con ideas no probadas tendrán su atención y su ‘gran plataforma de poder’”, dijo. “Porque es el presidente, la gente creerá que no dice cosas que no sean ciertas. Pero este presidente, lo hará”.

Sin embargo, los partidarios de MAHA tienen una perspectiva muy diferente. Alegan que han sido difamados como peligrosos por cuestionar el statu quo. La elección les ha dado una enorme oportunidad para moldear las políticas, y aseguran que no socavarán la salud pública. En cambio, dicen que restaurarán la confianza en las agencias federales de salud que perdieron apoyo público durante la pandemia.

“Puede ser una estrategia brillante de la derecha”, dijo Peter McCullough, cardiólogo criticado por decir que las vacunas contra covid-19 no son seguras, describiendo algunos de los mensajes de la campaña electoral que normalizaron sus perspectivas. “La derecha decía que nos importan los problemas médicos y ambientales. La izquierda perseguía derechos sobre el aborto y una campaña negativa contra Trump. Pero a todos debería importarles la salud. La salud debería ser apolítica”.

El movimiento es mayormente anti-regulación y anti-gobierno grande, ya sea respecto a la leche cruda o a la aprobación de medicamentos, aunque implementar cambios requeriría más regulación. Muchos de sus conceptos también cruzan hacia ideas defendidas por algunos de la extrema izquierda.

Robert F. Kennedy Jr., el activista anti-vacunas nominado por Trump para dirigir el Departamento de Salud y Servicios Humanos (HHS), ha pedido el despido de cientos de empleados de los NIH, eliminar el flúor del agua, aumentar el apoyo federal a la terapia psicodélica y flexibilizar las restricciones sobre la leche cruda, cuyo consumo puede exponer a enfermedades transmitidas por alimentos.

La venta de leche sin pasteurizer ha provocado redadas federales en granjas por no cumplir con las regulaciones de seguridad alimentaria.

Means ha abogado por cambios drásticos en el Departamento de Agricultura, que, según dice, ha sido dominado por la industria alimentaria.

Aunque no tiene formación en ciencias ni medicina, ha afirmado que las personas casi no tienen probabilidades de morir de covid-19 si están “metabólicamente saludables”, refiriéndose a hábitos de alimentación, sueño, ejercicio y manejo del estrés. También ha dicho que alrededor del 85% de las muertes y costos de salud en el país están relacionados con condiciones metabólicas prevenibles causadas por alimentos.

Co-fundador de Truemed, una empresa que ayuda a los consumidores a utilizar ahorros y programas de reembolso en suplementos, ayudas para dormir y equipos de ejercicio, Means dice haber tenido conversaciones a puerta cerrada con decenas de miembros del Congreso. También afirmó haber ayudado a reunir a RFK Jr. y Trump. RFK Jr. apoyó a Trump en agosto tras finalizar su campaña presidencial independiente.

“Tuve esta visión durante un año, en realidad. Suena muy místico, pero estaba en una carpa de sudor con él en Austin en un evento de campaña seis meses antes, y simplemente tuve esta fuerte visión de él junto a Trump”, dijo Means recientemente en el podcast The Joe Rogan Experience.

El que alguna vez dijo que nunca sería “trumpista” dijo que, después del primer intento de asesinato contra Trump, sintió que fue un momento poderoso. Means llamó a RFK Jr. y trabajó con el comentarista político conservador Tucker Carlson para conectarlo con el ex presidente. Según Means, Trump y RFK Jr. tuvieron semanas de conversaciones sobre temas como la obesidad infantil y las causas de la infertilidad.

“Realmente sentí, y él sintió, que esto podría ser una realineación de la política estadounidense”, afirmó Means.

En este esfuerzo lo acompaña su hermana, Casey Means, médica formada en la Universidad de Stanford y coautora junto a su hermano del libro Good Energy, que trata sobre cómo mejorar la salud metabólica. El dúo ha culpado a las grandes farmacéuticas y a la industria agrícola por el aumento de las tasas de obesidad, depresión y enfermedades crónicas en el país. También han planteado dudas sobre las vacunas.

“Sí, apuesto a que una vacuna probablemente no está causando autismo, pero ¿qué pasa con las 20 que se están recibiendo antes de los 18 meses?”, comentó Casey Means en el episodio del podcast de Joe Rogan junto a su hermano.

El movimiento, que desafía lo que sus adherentes llaman “el culto a la ciencia”, ganó tracción significativa durante la pandemia, impulsado por una reacción contra los mandatos de vacunas y uso de máscaras que proliferaron bajo la administración Biden. Muchos de sus seguidores afirman que atrajeron a personas que creían haber sido engañadas sobre la eficacia de las vacunas contra covid-19.

En julio de 2022, Deborah Birx, coordinadora de respuesta al covid-19 en la primera administración Trump, dijo en Fox News que “exageramos con las vacunas”, aunque señaló que sí funcionan.

Anthony Fauci, quien asesoró a Trump durante la pandemia, calificó en diciembre de 2020 a las vacunas como un cambio de juego que podría reducir covid-19 de manera similar a lo que hizo la vacuna contra la poliomielitis para esa enfermedad.

Sin embargo, con el tiempo quedó claro que las vacunas no necesariamente previenen la transmisión y que la efectividad del refuerzo disminuye con el tiempo, lo que algunos conservadores dicen que llevó a una desilusión que ha impulsado el interés en el movimiento por la libertad sanitaria.

Oficiales federales de salud afirman que el lanzamiento de la vacuna contra covid fue un punto de inflexión en la pandemia y que las vacunas reducen la gravedad de la enfermedad al enseñar al sistema inmunológico a reconocer y combatir el virus que la causa.

Tras las elecciones, algunos aliados de Trump, como Elon Musk, han pedido que Fauci sea procesado. Fauci se negó a comentar.

Joe Grogan, ex director del Consejo de Política Doméstica de la Casa Blanca y asistente de Trump, dijo que los conservadores han intentado explicar por qué el control gubernamental de la atención médica es problemático.

“Han ocurrido dos cosas. El gobierno se excedió por completo y mintió sobre muchas cosas durante covid, y no mostró compasión por las necesidades de las personas fuera del covid”, comentó. “RFK Jr. apareció y articuló de manera muy simple que no se puede confiar en el control gubernamental de la atención médica, estamos gastando dinero, y no se está logrando que la gente sea más saludable. En algunos casos, puede estar enfermando a las personas”.

El movimiento MAHA capitaliza muchos de los conceptos de salud no convencionales que han sido favoritos de la izquierda, como la promoción de alimentos orgánicos y el concepto de “la comida como medicina”.

Pero en un entorno de política polarizada, la creciente prominencia de líderes que desafían lo que llaman el “culto a la ciencia” podría llevar a una mayor confusión y división pública, advierten algunos analistas de salud.

Jeffrey Singer, cirujano y miembro principal del Instituto Cato, un grupo de investigación de políticas públicas libertario, dijo en un comunicado que está de acuerdo con el enfoque de RFK Jr. en reevaluar el sistema de salud pública. Pero señaló que conlleva riesgos.

“Me preocupa que muchas de las afirmaciones de RFK Jr. sobre la seguridad de las vacunas, las toxinas ambientales y los aditivos alimentarios carezcan de evidencia, hayan alimentado temores públicos y contribuido a una disminución en las tasas de vacunación infantil”, afirmó.

La vacunación contra el sarampión entre los niños de jardín de infantes cayó al 92.7% en el año escolar 2023-24 comparada con el 95.2% en el año escolar 2019-20, según los Centros para el Control y la Prevención de Enfermedades (CDC). La agencia dijo que eso ha puesto en riesgo a unos 280.000 niños preescolares.

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Trump, long an ACA opponent, expressed interest during the campaign in retooling the health law. In addition, some high-ranking Republican lawmakers — who will now have control over both the House and the Senate — have said revamping the landmark 2010 legislation known as Obamacare would be a priority. They say the law is too expensive and represents government overreach.

The governing trifecta sets the stage for potentially seismic changes that could curtail the law’s Medicaid expansion, raise the uninsured rate, weaken patient protections, and increase premium costs for millions of people.

“The Republican plans — they don’t say they are going to repeal the ACA, but their collection of policies could amount to the same thing or worse,” said Sarah Lueck, vice president for health policy at the Center on Budget and Policy Priorities, a research and policy institute. “It could happen through legislation and regulation. We’re on alert for anything and everything. It could take many forms.”

Congressional Republicans have held dozens of votes over the years to try to repeal the law. They were unable to get it done in 2017 after Trump became president, even though they held both chambers and the White House, in large part because some GOP lawmakers wouldn’t support legislation they said would cause such a marked increase in the uninsured rate.

Similar opposition to revamping the law could emerge again, especially because polls show the ACA’s protections are popular.

While neither Trump nor his GOP allies have elaborated on what they would change, House Speaker Mike Johnson said last month that the ACA needs “massive reform” and would be on the party’s agenda should Trump win.

Congress could theoretically change the ACA without a single Democratic vote, using a process known as “reconciliation.” The narrow margins by which Republicans control the House and Senate mean just a handful of “no” votes could sink that effort, though.

Many of the more ambitious goals would require Congress. Some conservatives have called for changing the funding formula for Medicaid, a federal-state government health insurance program for low-income and disabled people. The idea would be to use budget reconciliation to gain lawmakers’ approval to reduce the share paid by the federal government for the expansion population. The group that would be most affected is made up largely of higher-income adults and adults who don’t have children rather than “traditional” Medicaid beneficiaries such as pregnant women, children, and people with disabilities.

A conservative idea that would let individuals use ACA subsidies for plans on the exchange that don’t comply with the health law would likely require Congress. That could cause healthier people to use the subsidies to buy cheaper and skimpier plans, raising premiums for older and sicker consumers who need more comprehensive coverage.

“It’s similar to an ACA repeal plan,” said Cynthia Cox, a vice president and the director of the Affordable Care Act program at KFF, a health information nonprofit that includes KFF Health News. “It’s repeal with a different name.”

Congress would likely be needed to enact a proposal to shift a portion of consumers’ ACA subsidies to health savings accounts to pay for eligible medical expenses.

Trump could also opt to bypass Congress. He did so during his previous tenure, when the Department of Health and Human Services invited states to apply for waivers to change the way their Medicaid programs were paid for — capping federal funds in exchange for more state flexibility in running the program. Waivers have been popular among both blue and red states for making other changes to Medicaid.

“Trump will do whatever he thinks he can get away with,” said Chris Edelson, an assistant professor of government at American University. “If he wants to do something, he’ll just do it.”

Republicans have another option to weaken the ACA: They can simply do nothing. Temporary, enhanced subsidies that reduce premium costs — and contributed to the nation’s lowest uninsured rate on record — are set to expire at the end of next year without congressional action. Premiums would then double or more, on average, for subsidized consumers in 12 states who enrolled using the federal ACA exchange, according to data from KFF.

That would mean fewer people could afford coverage on the ACA exchanges. And while the number of people covered by employer plans would likely increase, an additional 1.7 million uninsured individuals are projected each year from 2024 to 2033, according to federal estimates.

Many of the states that would be most affected, including Texas and Florida, are represented by Republicans in Congress, which could give some lawmakers pause about letting the subsidies lapse.

The Trump administration could opt to stop defending the law against suits seeking to topple parts of it. One of the most notable cases challenges the ACA requirement that insurers cover some preventive services, such as cancer screenings and alcohol use counseling, at no cost. About 150 million people now benefit from the coverage requirement.

If the Department of Justice were to withdraw its petition after Trump takes office, the plaintiffs would not have to observe the coverage requirement — which could inspire similar challenges, with broader implications. A recent ruling left the door open to legal challenges by other employers and insurers seeking the same relief, said Zachary Baron, a director of Georgetown University’s Center for Health Policy and the Law.

In the meantime, Trump could initiate changes from his first day in the Oval Office through executive orders, which are directives that have the force of law.

“The early executive orders will give us a sense of policies that the administration plans to pursue,” said Allison Orris, a senior fellow at the Center on Budget and Policy Priorities. “Early signaling through executive orders will send a message about what guidance, regulations, and policy could follow.”

In fact, Trump relied heavily on these orders during his previous term: An October 2017 order directed federal agencies to begin modifying the ACA and ultimately increased consumer access to health plans that didn’t comply with the law. He could issue similar orders early on in his new term, using them to start the process of compelling changes to the law, such as stepped-up oversight of potential fraud.

The administration could early on take other steps that work against the ACA, such as curtailing federal funding for outreach and help signing up for ACA plans. Both actions depressed enrollment during the previous Trump administration.

Trump could also use regulations to implement other conservative proposals, such as increasing access to health insurance plans that don’t comply with ACA consumer protections.

The Biden administration walked back Trump’s efforts to expand what are often known as short-term health plans, disparaging the plans as “junk” insurance because they may not cover certain benefits and can deny coverage to those with a preexisting health condition.

The Trump administration is expected to use regulation to reverse Biden’s reversal, allowing consumers to keep and renew the plans for much longer.

But drafting regulations has become far more complicated following a Supreme Court ruling saying federal courts no longer have to defer to federal agencies facing a legal challenge to their authority. In its wake, any rules from a Trump-era HHS could draw more efforts to block them in the courts.

Some people with ACA plans say they’re concerned. Dylan Reed, a 43-year-old small-business owner from Loveland, Colorado, remembers the days before the ACA — and doesn’t want to go back to a time when insurance was hard to get and afford.

In addition to attention-deficit/hyperactivity disorder and anxiety, he has scleroderma, an autoimmune disease associated with joint pain and numbness in the extremities. Even with his ACA plan, he estimates, he pays about $1,000 a month for medications alone.

He worries that without the protections of the ACA it will be hard to find coverage with his preexisting conditions.

“It’s definitely a terrifying thought,” Reed said. “I would probably survive. I would just be in a lot of pain.”

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Trump, que durante mucho tiempo se opuso a ACA, expresó durante la campaña su interés en modificar la ley de salud. Además, algunos legisladores republicanos de alto rango —que ahora tendrán el control tanto de la Cámara de Representantes como del Senado— han dicho que para ellos sería una prioridad renovar la histórica legislación de 2010, conocida como Obamacare. Afirman que es una ley demasiado cara y que representa una intromisión excesiva del Gobierno.

El futuro gobernante prepara el terreno para hacer cambios potencialmente sísmicos que podrían limitar la expansión de Medicaid, aumentar la tasa de personas sin seguro, debilitar las protecciones para los pacientes y elevar los costos de las primas para millones de personas.

“Los planes republicanos no dicen que vayan a derogar ACA, pero el conjunto de sus políticas podría equivaler a lo mismo o a algo peor”, dijo Sarah Lueck, vicepresidenta de política sanitaria del Center on Budget and Policy Priorities, un instituto de investigación y política. “Los cambios podrían sobrevenir a través de la legislación y de las regulaciones. Estamos alerta ante cualquier cosa porque sabemos que podrían adoptar muchas formas”.

En estos años, los republicanos del Congreso han votado docenas de veces intentando derogar la ley. No pudieron lograrlo en 2017, después que Trump se convirtiera en presidente, a pesar de que tenían la Casa Blanca y mayoría en ambas cámaras.

Esto ocurrió, en gran parte, porque algunos legisladores del GOP no quería apoyar una legislación que, explicaban, podía causar un aumento tan marcado en la tasa de personas sin seguro.

En esta oportunidad podría surgir una oposición similar a reformar la ley, especialmente porque las encuestas muestran que las protecciones que establece ACA son populares.

Aunque ni Trump ni sus aliados del Partido Republicano han dado detalles sobre lo que cambiarían, el presidente de la Cámara de Representantes, Mike Johnson, dijo en octubre que ACA necesita una “reforma profunda” y que esa política estaría en la agenda del partido.

Teóricamente, el Congreso podría cambiar ACA sin un solo voto demócrata, utilizando un proceso conocido como “reconciliación”. Sin embargo, como los republicanos controlan la Cámara de Representantes y el Senado por márgenes estrechos, sólo un puñado de votos en contra podría hundir ese esfuerzo.

Muchos de los objetivos más ambiciosos requerirían la intervención del Congreso. Algunos conservadores han pedido que se modifique la fórmula de financiamiento de Medicaid, el programa de seguro médico del gobierno federal y estatal para personas de bajos ingresos y con discapacidades.

La idea sería utilizar la reconciliación presupuestaria para convencer a los legisladores de que  aprueben una reducción de la parte de los recursos que paga el gobierno federal para la población cubierta por la expansión.  El grupo que se vería más afectado está compuesto en gran parte por adultos de ingresos más altos y adultos sin hijos, en lugar de los beneficiarios “tradicionales” de Medicaid, como las mujeres embarazadas, los niños y las personas con discapacidades.

Una iniciativa conservadora que permitiría que las personas utilicen los subsidios de ACA para comprar en el mercado planes de salud que no cumplen con la ley, probablemente necesitaría de la aprobación del Congreso.

Esto podría provocar que las personas más saludables utilicen los subsidios para comprar planes más baratos y limitados, lo que aumentaría las primas para los consumidores de mayor edad y más enfermos, que necesitan una cobertura más completa.

“Es algo parecido a un plan de derogación de ACA”, dijo Cynthia Cox, vicepresidenta y directora del programa de la Ley de Cuidado de Salud a Bajo Precio en KFF. “Es una derogación con otro nombre”.

“Trump hará lo que crea que puede hacer sin consecuencias”, dijo Chris Edelson, profesor adjunto de Gobierno en American University. “Si quiere hacer algo, simplemente lo hará”.

Los republicanos tienen otra opción para debilitar ACA. Pueden simplemente no hacer nada.

Los subsidios temporales y mejorados que reducen los costos de las primas —y que contribuyeron a alcanzar la tasa de personas sin seguro más baja de la historia del país— expirarán a finales del próximo año si el Congreso no actúa. Según datos de KFF, en promedio, las primas se duplicarían o más para los consumidores subvencionados en 12 estados que se inscribieron a través del mercado federal de ACA.

Esto significaría que menos personas podrían permitirse esta cobertura. Y aunque es probable que aumente el número de personas cubiertas por planes ofrecidos por empresas, según estimaciones federales se proyecta que habrá 1.7 millones más de personas sin seguro cada año entre 2024 y 2033.

Muchos de los estados que se verían más afectados, incluidos Texas y Florida, están representados en el Congreso por republicanos, lo que podría hacer que algunos legisladores no estén convencidos de permitir que los subsidios caduquen.

La administración Trump también podría optar por dejar de defender la ley contra las demandas que buscan modificar algunas de sus partes esenciales.

Uno de los casos más notables cuestiona el requisito de ACA de que las aseguradoras cubran algunos servicios preventivos, como las pruebas gratuitas de detección del cáncer y el asesoramiento sobre el consumo de alcohol. En la actualidad, unas 150 millones de personas se benefician de este requisito de cobertura.

Si el Departamento de Justicia retirara su petición después que Trump asuma el cargo, los demandantes no estarían obligados a cumplir con el requisito de cobertura, lo que podría inspirar desafíos similares con implicaciones más amplias. Según Zachary Baron, director del Centro de Política Sanitaria y Derecho de la Universidad de Georgetown, una sentencia reciente deja la puerta abierta a que otras empresas y aseguradoras presenten recursos judiciales en busca de la misma reparación.

Mientras tanto, Trump podría iniciar cambios desde su primer día en el Despacho Oval a través de órdenes ejecutivas, que son directivas que no pasan por las aprobaciones del Congreso, y que tienen fuerza de ley.

“Las primeras órdenes ejecutivas nos darán una idea de las políticas que la administración planea seguir”, dijo Allison Orris, investigadora principal del Centro de Prioridades Presupuestarias y Políticas. “Las señales tempranas a través de órdenes ejecutivas enviarán un mensaje sobre qué tipo de orientación, regulaciones y políticas podrían venir después”.

De hecho, Trump se basó en gran medida en estas órdenes ejecutivas durante su mandato anterior. Una orden de octubre de 2017 ordenó a las agencias federales que comenzaran a modificar ACA y, como resultado, aumentó el acceso de los usuarios a planes de salud que no cumplían con la ley.

Al principio de su nuevo mandato, Trump podría emitir órdenes similares, utilizándolas para iniciar el proceso de cambios obligatorios a la ley, como por ejemplo con una supervisión más estricta para prevenir fraudes.

La administración podría tomar desde el principio otras medidas que vayan en contra de ACA, como recortar los fondos federales destinados a la divulgación y asistencia para inscribirse en estos planes. Estas acciones ya disminuyeron la inscripción durante la administración anterior de Trump.

El nuevo presidente también podría utilizar regulaciones para implementar otras propuestas conservadoras, como aumentar el acceso a planes de salud que no cumplan con las protecciones al consumidor que tiene ACA.

La administración Biden revirtió los esfuerzos de Trump para ampliar los llamados “planes de salud de corto plazo”, y los calificó como “seguros basura” porque pueden no cubrir ciertos beneficios y, también, negar la cobertura a personas con problemas de salud preexistentes.

Se espera que la administración de Trump utilice regulaciones para deshacer la decisión de Biden, permitiendo que los consumidores mantengan y renueven estos planes de corto plazo por períodos mucho más largos.

Sin embargo, redactar regulaciones se ha vuelto mucho más difícil debido a un fallo de la Corte Suprema que establece que los tribunales federales ya no están obligados a respaldar automáticamente las decisiones de las agencias federales cuando se cuestiona su autoridad legal. Como resultado, cualquier nueva regla emitida por el HHS durante una administración de Trump podría enfrentar más intentos de bloqueo en los tribunales.

Algunas personas con planes de ACA cuentan que están preocupadas. Dylan Reed, un pequeño empresario de 43 años, de Loveland, Colorado, recuerda los días anteriores a la existencia de ACA y no quiere volver a una época en la que era difícil conseguir seguro de salud, y también pagarlo.

Además del trastorno por déficit de atención con hiperactividad (TDAH) y ansiedad, Reed padece de esclerodermia, una enfermedad autoinmune asociada con dolores de las articulaciones y entumecimiento en las extremidades. Incluso con su plan de ACA, calcula que paga alrededor de $1,000 al mes solo en medicamentos.

Le preocupa que, sin las protecciones de ACA, le resulte difícil encontrar cobertura debido a sus enfermedades preexistentes.

“Definitivamente es un pensamiento aterrador”, confiesa Reed. “Probablemente sobreviviría, pero con mucho dolor”.

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Las repercusiones se sentirán mucho más allá de Washington, DC, e incluso podrían erosionar las protecciones al consumidor de la Ley de Cuidado de Salud a Bajo Precio (ACA), imponer requisitos de trabajo para Medicaid, recortar fondos para la red de seguridad, y desafiar a las agencias federales que protegen la salud pública.

Las restricciones al aborto podrían endurecerse a nivel nacional, con un posible esfuerzo para restringir el envío por correo de medicamentos abortivos.

Con la inclusión de Robert F. Kennedy Jr., líder del movimiento anti vacunas, en el círculo de asesores de Trump, intervenciones de salud pública con respaldo científico riguroso —como la fluoración del agua potable o la vacunación infantil— podrían también estar en la mira.

Trump derrotó a la vicepresidenta Kamala Harris con 277 votos del Colegio Electoral, según declaró la agencia de noticias Associated Press (AP) a las 5:34 am ET del miércoles 6. Obtuvo el 51% del voto a nivel nacional, en comparación con el 47.5 % de Harris, según las proyecciones de AP.

La victoria de Trump dará una plataforma mucho más amplia a los escépticos y críticos de los programas y acciones de salud federales. En el peor de los casos, las autoridades de salud pública temen que el país podría ver aumentos en enfermedades prevenibles, un debilitamiento de la confianza pública en la ciencia, y la adopción de políticas basadas en ideas desacreditadas, como el supuesto vínculo entre vacunas y autismo.

Trump declaró en una entrevista con NBC News el 3 de noviembre que “tomaría una decisión” sobre la prohibición de algunas vacunas, diciendo que consultaría con Kennedy, calificándolo como “un tipo muy talentoso”.

Aunque Trump ha dicho que no intentará nuevamente derogar ACA, su administración enfrentará una decisión inmediata el próximo año sobre si respaldar una extensión de los subsidios para las primas mejorados para los planes de seguro del Obamacare. Sin estos subsidios, se proyectan aumentos pronunciados de las primas que reducirían la inscripción. La tasa actual de personas sin seguro, de aproximadamente un 8%, casi con seguridad aumentaría.

Los detalles de sus políticas aún no han avanzado mucho más allá de los “conceptos de un plan” que Trump mencionó durante su debate con Harris, aunque el vicepresidente electo JD Vance dijo que la administración buscaría inyectar más competencia en los mercados de ACA.

Se proyecta que los republicanos obtendrán una mayoría en el Senado, además de la Casa Blanca, mientras que el control de la Cámara de Representantes aún no se había resuelto al miércoles temprano.

Las encuestas muestran que ACA ha ganado apoyo entre el público, incluidas disposiciones como las protecciones para condiciones preexistentes y la posibilidad de que los jóvenes permanezcan en los planes de salud familiars hasta los 26 años.

Los seguidores de Trump y otros que han trabajado en su administración dicen que el ex presidente quiere mejorar la ley de manera que reduzca los costos. Señalan que ya ha demostrado ser firme en cuanto a reducir los altos precios de la atención médica, aludiendo a esfuerzos durante su presidencia para promover la transparencia de precios en los costos médicos.

“En cuanto a asequibilidad, lo veo construyendo sobre el primer mandato”, dijo Brian Blase, quien se desempeñó como asesor de salud de Trump de 2017 a 2019. En comparación con una administración demócrata, dijo, habrá “mucho más enfoque” en “minimizar el fraude y el despilfarro”.

Los esfuerzos para debilitar ACA podrían incluir recortes de fondos para la promoción de inscripciones, permitir a los consumidores comprar más planes de salud que no cumplan con las protecciones al consumidor, y permitir a las aseguradoras cobrar primas más altas a las personas con enfermedades.

Los demócratas dicen que esperan lo peor.

“Sabemos cuál es su agenda”, dijo Leslie Dach, presidente ejecutivo de Protect Our Care, una organización de políticas y defensa de la atención médica en Washington, DC. Dach trabajó en la administración Obama ayudando a implementar ACA. “Van a aumentar los costos para millones de estadounidenses y les quitarán cobertura a millones, y, mientras tanto, darán exenciones fiscales a los ricos”.

Theo Merkel, director de la Private Health Reform Initiative en el Instituto Paragon de Salud, de orientación conservadora y dirigido por Blase, dijo que los subsidios mejorados de ACA, que se extendieron bajo la Ley de Reducción de la Inflación (IRA) en 2022 no mejoran los planes ni reducen las primas. Dijo que solo ocultan el bajo valor de los planes con mayores subsidios gubernamentales.

Otros partidarios de Trump dicen que el presidente electo podría apoyar la preservación de la autoridad de Medicare para negociar precios de medicamentos, otra disposición de la IRA.

Trump ha defendido la reducción de los precios de los medicamentos y, en 2020, promovió un modelo de prueba que habría vinculado los precios de algunos medicamentos en Medicare a costos más bajos en el extranjero, dijo Merkel, quien trabajó en la primera Casa Blanca de Trump. La industria farmacéutica demandó con éxito para bloquear el programa.

Dentro del círculo de Trump, algunos nombres ya han sido mencionados como posibles líderes para el Departamento de Salud y Servicios Humanos (HHS). Estos incluyen al ex gobernador de Louisiana, Bobby Jindal, y Seema Verma, quien dirigió los Centros de Servicios de Medicare y Medicaid (CMS) durante su administración.

Kennedy, quien suspendió su campaña presidencial independiente y respaldó a Trump, ha dicho a sus seguidores que Trump le prometió el control del HHS. Trump dijo públicamente antes del día de las elecciones que le daría a Kennedy un papel importante en su administración, aunque podría tener dificultades para obtener la confirmación del Senado para un puesto en el gabinete.

Mientras que Trump ha prometido proteger a Medicare y ha dicho que apoya la financiación de beneficios para el cuidado en el hogar, ha sido menos específico sobre sus intenciones para Medicaid, que brinda cobertura a personas de bajos ingresos y con discapacidades. Algunos analistas de salud esperan que el programa sea especialmente vulnerable a recortes de gastos, lo que podría ayudar a financiar la extensión de exenciones fiscales que expiran a fines del próximo año.

Los posibles cambios incluyen la imposición de requisitos de trabajo a los beneficiarios en algunos estados. La administración y los republicanos en el Congreso también podrían intentar cambiar la forma en que se financia Medicaid. Actualmente, el gobierno federal paga a los estados un porcentaje variable de los costos del programa. Los conservadores han buscado durante mucho tiempo poner un límite a las asignaciones federales a los estados, lo que según los críticos llevaría a recortes drásticos.

“Medicaid será un gran objetivo en una administración Trump”, dijo Larry Levitt, vicepresidente ejecutivo de políticas de salud en KFF, una organización sin fines de lucro de información sobre salud que incluye a KFF Health News.

Es menos claro el futuro potencial de los derechos de salud reproductiva.

Trump ha dicho que las decisiones sobre las restricciones al aborto deben dejarse a los estados. Trece estados prohíben el aborto con pocas excepciones, mientras que otros 28 restringen el procedimiento según la duración gestacional, según el Instituto Guttmacher, una organización de investigación y políticas centrada en el avance de los derechos reproductivos. Antes de las elecciones, Trump dijo que no firmaría una prohibición nacional del aborto.

Medidas estatales para proteger los derechos al aborto fueron adoptadas en cuatro estados, incluido Missouri, donde Trump ganó por aproximadamente 18 puntos, según informes preliminares de AP. Los votantes en Florida y Dakota del Sur rechazaron medidas a favor del derecho al aborto.

Trump podría actuar para restringir el acceso a medicamentos abortivos, utilizados en más de la mitad de los abortos, ya sea retirando la autorización de la Administración de Drogas y Alimentos (FDA) para los medicamentos o aplicando una ley del siglo XIX, la Ley Comstock, que los opositores al aborto dicen que prohíbe su envío. Trump ha dicho que, en general, no usaría la ley para prohibir el envío de medicamentos por correo.

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