Trump is adept at using his willingness to be wildly inconsistent to destabilize opponents. But he is unduly fond of using blunt instruments like tariffs that he can impose unilaterally, with insufficient consideration of whether they will work all that well, let alone what bad unintended effects they might generate.
What Trump has done so far can be likened to punching through enemy lines with tank columns at several vulnerable spots. The initial assault has breached established positions. But what comes next? Does the aggressor have enough logistical support, and infantry and air power to exploit the breaches, press into the enemy terrain, take and hold ground, ultimately seizing swathes of territory?1 Or will the tanks rattle around in the enemy’s rear, inflicting damage in a contained area before they run out of gas and ammo?
It’s far too early too tell, but the safest bet is that Trump will wind up somewhere between these two extreme possibilities. We’ll get some early indications via the caliber of Team Trump responses to predictable challenges. For instance, the Trump executive order revoking birthright citizenship ran into a buzzsaw of lawsuits, including one from 24 state attorneys general. That suit produced an injunction and tart criticism from a Reagan-appointed Federal judge. But the matter will be litigated, which is sure to include appeals. Trump’s executive order contends that it is consistent with a carveout in the 14th Amendment:
But the Fourteenth Amendment has never been interpreted to extend citizenship universally to everyone born within the United States. The Fourteenth Amendment has always excluded from birthright citizenship persons who were born in the United States but not “subject to the jurisdiction thereof.”
Some readers have pointed out that conventional accounts of the precedents are misleading and so Trump losing is far from a given.2 We will get an idea of the caliber of Trump’s legal thinking via its court filings, which will give more insight both into how well prepared his team is as well as the depth of his bench.
On another front, ICE started immigration raids yesterday, a day behind the promised schedule, starting with New Jersey and Indiana. Again the Trump team pushed beyond legal boundaries, engaging what Newark’s mayor said were warrantless searches that resulted in citizens, including a a US veteran, being detained. Recall that everyone on US soil has due process rights.
On another front, Congresscritters regard Trump’s halt of the Supreme-Court-mandated sale or closure of TikTok and his joint venture scheming to be flouting the ruling, but as I read the account of the pearl-clutching in Politico, no one appears willing to Do Something about it.
But Trump’s actions within the Federal bureaucracy at the moment are causing the most stir. Later in this post, we reproduce a KFF Health News article which is comparatively chill about the impact of the Trump executive orders on the health care front, pointing out that most need follow through, and in many cases legislation, before they have any impact.
But the lead story in the Wall Street Journal tonight describes how widespread spending and activity freezes are creating chaos, including with programs that are beneficial to Trump constituencies and/or not on any particular Trump hit list. Remember that refusing to spend appropriated funds would be subject to legal challenge, while holding up spending to conduct a review as to whether how it has been done is compliant or inefficient is defensible.
Again, as with tariffs, Trump is wielding yet another blunt instrument, with at least some of the motivation a dominance display. But the knock-on effects are large. If you’ve ever worked on a large project in a bureaucracy, or between companies, you likely have seen that missing a deadline, having a key decision postponed, or a “shit happens” event like a big storm forcing the rescheduling of a critical planning meeting, you’ve probably seen how a single consequential delay often pushes out the completion date disproportionately. And what we see here is not a single delay but almost total freezes, with the restart (if any) time frames uncertain. And since this includes vendor payments, some businesses like research labs could even close if the wait is too long.
From Swaths of U.S. Government Grind to a Halt After Trump Shock Therapy in the Journal:
The Transportation Department temporarily shut down a computer system for road projects. Health agencies stopped virtually all external communications in a directive that risked silencing timely updates on infectious diseases. A hiring freeze left agencies wondering how parts of the government could adapt to new demands. Confusion loomed over how agencies should disburse funds allocated by the previous administration…
New leadership at the Department of Health and Human Services halted all external communications from the health agencies through Feb. 1. Food and Drug Administration employees scrambled to clarify that they could still issue critical safety alerts, while scientists said that their grant-review meetings had been canceled, potentially endangering funding for their health research.
The communications pause caught the attention of Congress, with Sen. Amy Klobuchar (D., Minn.) urging Agriculture Department nominee Brooke Rollins to ask why the Centers for Disease Control and Prevention’s messages to farmers on bird flu had been halted. “We’re concerned,” Klobuchar said.
Some of these communication pauses were due, no joke, to language policing, as in to change “pregnant persons” back to “pregnant women”. But the overkill is producing The Gang That Couldn’t Shoot Straight results.
Later in the same article:
Meetings to review potential NIH grants—the lifeblood of American science—were canceled during the communications stoppage…
Some federal workplaces rescinded job offers to comply with a hiring freeze issued from the White House earlier this week. That included the Department of Veterans Affairs’ hospitals and clinics, according to Jacqueline Simon of the American Federation of Government Employees labor union. The White House also directed two of its offices to come up with a plan to shrink the federal workforce….
Most agencies were under a hiring freeze that could last up to 90 days, but it could run longer at the Internal Revenue Service, even as the agency enters tax season and the period in which it normally hires many seasonal employees. Rather than the standard 90 days, the Trump order that freezes hiring said that the Treasury Department must sign off before the IRS can hire again. The agency canceled a Thursday webinar to give résumé tips to potential applicants.
So tax refunds will be issued even later for 2024. A last set of tidbits:
Agencies were also scrambling to understand a Trump executive order that instituted an immediate pause on the distribution of funds from former President Joe Biden’s 2021 infrastructure law and his 2022 climate law….
The order told agencies to review cash disbursements and submit reports on their status within 90 days. Many of those funds had been promised to companies through loan contracts, which are legally binding, experts said.
The order set off a wave of confusion about which funds needed to be halted.
A story from STAT describes the potential damage from blind application of the Trump DEI rollback:
The deletion of references to DEI issues appears to be playing out across government sites….The Trump administration even shut down the White House’s Spanish-language page.
But the scrubbing of clinical trial-related pages is notable because of how it could affect the ways researchers both inside and outside government, as well as companies, test drugs and medical devices. Under the Biden administration, the FDA had urged industry to enroll more people of color and women in trials, and released draft guidance in June 2024 about how it should do so. It is unclear whether that guidance will ever be finalized, or whether the webpage removals mean the Trump administration intends to abandon efforts to diversify clinical trials.
Scientists have focused on the issue of diversity in clinical studies both because lacking a diverse population can lead to skepticism from patients who could be helped by medicines and because some drugs do work differently in people of different backgrounds.
On a more cheerful note, KFF Health News looked at key Trump health care executive orders, and found that by themselves, they amounted more to being statements of intent rather than initiatives. So it’s far from clear how much will be translated into actual programs.
By Julie Appleby and Stephanie Armour. Originally published at KFF Health News
President Donald Trump’s early actions on health care signal his likely intention to wipe away some Biden-era programs to lower drug costs and expand coverage under public insurance programs.
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 pricingthis 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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1 If readers see this analogy as apt, it means that Trump is actually waging a traditional war, albeit on an unusually intense scale, as opposed to something more Clausewitzian, designed to erode the enemy’s capacity to fight and eventually, his will to endure. But I think the latter could work only in the US with some sort of actual revolution. The fact that Trump is still very much using the existing bureaucratic apparatus means its own procedures, governance, and legal oversight can be used to thwart or impede him.
2 For instance, from Peter Steckel:
The EO ending birthright citizenship is a trap if I have ever seen one. Putting on my legal hat here, the issue of birth right citizenship has NEVER been decided by the Supreme Court. The two previous decisions refer to the idea of birth right citizenship in what is referred to as “dicta”, or verbiage around the issue being decided by the Supreme Court that is not necessary to decide the instant legal matter under review. Novices often mistake “dicta” as part of a Court ruling – in a strict sense it is not – when in reality it is the “legalese” version of “uhhhhhhhhh” before a thought is voiced…
The first SC decision to deal with this issue came about in U.S. v. Wong Kim Ark, in which the Court ruled that a child born on US soil (and the child of legal Chinese immigrants) could not be excluded from returning to the US under the Chinese Exclusion Act because he was “born of the soil.” What folks don’t appreciate is the legal immigrants portion of the ruling. It was extended, via dicta, to the children of non-legal aliens in the late 1960s.
This matter will be contentious but given the Court’s make up it will not be the slam dunk the left believes…
Americans often (and historically inaccurately) portray the French response to Hitler’s operation Fall Gelb as a nation of cowards capitulating at the first sneeze. Watching this unfold it’s clear Trump knows his is a nation of cowards, easily manipulated. We’re watching the bureaucratic equivalent of which units fall easily, which have the discipline and courage to hold their ground. When you think of it, it’s a strategically good opening move, he’ll likely move past and around the holdouts, focus on obliterating the weaklings first, which is actually what a typical bully does in many other contexts. So from this we can probably surmise the broad strokes of what will become his overall big arrow strategy for the next few years.
There is no need for mass raids / round-ups at businesses. Find one, then arrest the owner, plant manager and HR manager up to the C-Suite. Springdale, Arkansas for example would be a great place to start. On the books as a felony since the Eisenhower Administration.
Bingo! Until that happens, officials who claim to be against undocumented immigrants aren’t really serious.
“persons who were born in the United States but not “subject to the jurisdiction thereof.””
The only thing this could mean is people here diplomatically. Everyone else is subject to US laws, etc.
If you actually read the argument Yves linked to, or spend 10 minutes researching the history of the 14th amendment, you’d see that your statement is not true.
First, this amendment came after the civil war to nullify the Dred Scott ruling, which found that people of African descent cannot be citizens of the US. It had nothing to do with clarifying the citizenship of diplomats.
Second, the language about being “subject to the jurisdiction thereof” was very much centered on the Native American population at the time, who were still members of their respective tribes, and who drafters assuredly did NOT want birthright citizenship to apply to.
Third, if you look at the applicable case law (Elk v. Wilkins, US v. Wong Kim Ark), you’ll find that this is not a clearly settled question, despite your assertion. The Elk ruling asserts that a Native American who denounces their tribal allegiance does not automatically become subject to the jurisdiction of the US, without some explicit act of the US granting it. The Wong Kim Ark ruling asserts that a child of legal immigrants is conferred citizenship. The language in this ruling is ambiguous with regard to children of illegal immigrants, giving Trump a legal avenue to pursue and leading to the situation we’re in now.
So, as Yves stated and you ignored, this is not a clearly settled legal question like you think.
Hope you don’t mind but I took a screenshot of your reply for future reference. The Native American angle was new to me but makes perfect sense so thank you for sharing.
But none of these are analogous to the immigrant population, are they?
If there’s a ruling that says “a child of legal immigrants is conferred citizenship” Trump seems to figure that won’t matter anyway if he decides to de-legalize the status of the parents.
Trump immigration enforcement memo targets migrants who entered legally under Biden
https://www.reuters.com/world/us/trump-immigration-enforcement-memo-targets-migrants-who-entered-legally-under-2025-01-24/
The Indian Citizenship Act of 1924 says that Indigenous Americans born in the US are citizens.
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.
Pot calling the kettle black. I’ve been waiting for substantive changes/improvements to U.S. Healthcare affordability since Bill designated Hillary as lead in charge of doing something. And, all we have had since, is drift, drip, of ever increasing cost.
On the DEI front, saw a screencap of the ATF leadership webpage from the 21st and the 22d. The Director for DEI is now listed as “Senior Executive”. Suspect that will be the case for many agencies.