• Trump’s signature legislative achievement, a trillion-dollar tax cut for corporations and high-income individuals, opened a budget hole he used to justify cutting food subsidies and health care.
• Although Trump’s effort to repeal the Affordable Care Act failed, he weakened its coverage and increased the number of uninsured people by 2·3 million.
• Trump’s hostility to environmental regulations has already worsened pollution—resulting in more than 22,000 extra deaths in 2019 alone.
• More people died, and more Americans lost trust in their institutions due to the federal government’s decisions in the early days of the COVID-19 pandemic.
• Disdain for science and cuts to global health programs and public health agencies have impeded the response to the COVID-19 pandemic, causing tens of thousands of unnecessary deaths.
• (Source: The Lancet)

Although Trump’s actions were singularly damaging, many represent an aggressive acceleration of neoliberal policies that date back 40 years.

There is a building consensus among experts on how Trump’s healthcare policies led to more deaths of Americans. Some experts believe that his policies, such as repealing the Affordable Care Act’s mandate and expanding short-term health plans, made it more difficult for people to get health insurance and led to some delaying or forgoing needed medical care. Others argue that these policies had little or no impact on mortality rates.

According to a 2019 Commonwealth Fund study, repealing the individual mandate led to an estimated 13 million people losing health insurance coverage. The study also found that repealing the individual mandate was associated with an increase in the number of people who delayed or forwent needed medical care.

A 2020 study by the Urban Institute found that the expansion of short-term health plans was associated with an increase in the number of people who were uninsured for at least part of the year. The study also found that the expansion of short-term health plans was associated with an increase in the number of people who had difficulty paying their medical bills.

Perhaps his biggest failure was during COVID.

In the final year of Donald Trump’s presidency, more than 450,000 Americans died from COVID-19, and life expectancy fell by 1.13 years, the most significant decrease since World War II. Many of the deaths were avoidable; COVID-19 mortality in the U.S. was 40 percent higher than the average of the other wealthy nations in the Group of Seven (G7).

The Trump administration failed to take the coronavirus outbreak seriously. In late February, while other high-income countries ramped up testing and developing tracing procedures, President Donald Trump stated that “the Coronavirus [was] very much under control.” During these critical early weeks and months, the United States should have been stockpiling protective gear for frontline workers and making testing widely available. In contrast, South Korea, a country whose first confirmed case of COVID-19 coincided with that of the United States, bought 720,000 masks for employees of businesses considered at risk of exposure to the coronavirus. When asked if the U.S. federal government would supply personal protective equipment (PPE) to states, President Trump said it would not act as a “shipping clerk.”

The failures of the Trump administration’s approach did not begin when the pandemic started. Each of the administration’s four budget proposals has recommended slashing funding for the Centers for Disease Control (CDC). In 2018, the CDC cut its epidemic prevention activities, which help “train front-line workers in outbreak detection and work to strengthen laboratory and emergency response systems in countries where disease risks are greatest,” by 80 percent; moreover, it significantly scaled back its focus on emerging infectious diseases in several of the world’s hot spots, including China.

Faced with the pandemic, Trump suppressed scientific data, delayed testing, mocked and blocked mask-wearing, and convened mass gatherings where social distancing was impossible. Despite the mounting threats of COVID-19 and global warming, he pulled the U.S. out of the World Health Organization and the Paris climate accord. He installed industry insiders in regulatory posts tasked with protecting Americans from environmental and occupational hazards; their regulatory rollbacks resulted in 22,000 excess deaths from such hazards in 2019 alone. He pushed through a $1.9 trillion tax cut for the wealthy, creating a budget hole that he then used to justify cutting food and housing assistance for the needy. He tried, but failed, to repeal the ACA, then bent every effort to undermine it, pushing up the number of uninsured Americans by 2.3 million. He denied entry to refugees fleeing violence, abused immigrant detainees, and penalized immigrants for accessing essential social services.