People with disabilities say President Trump's DEI purge is eroding health care, education and legal protections they've only won in recent decades.

Why it matters: The Trump administration has taken actions that undermine accessibility measures — critical for leveling the playing field for people with disabilities — as part of its efforts targeting diversity, equity, and inclusion efforts.

• "It's very clear that there is an orchestrated attack by conservatives to dismantle the rights of people with disabilities," said Shawn Murinko, a Washington resident who has cerebral palsy.

State of play: Trump last month ordered an end to all federal programs that mandate or invoke accessibility, alongside diversity, equity and inclusion.

• The Department of Justice said it will penalize programs that promote accessibility.
• Trump has pledged to close the Department of Education, which enforces protections for students with disabilities in school.
• Meanwhile, Food and Drug Administration officials said the word "disabled" was banned from external communications, though the White House later claimed that was an error.
• Cuts to National Institutes of Health funding also threaten existing and future disability research.
• The federal government is one of the largest employers for people with disabilities, but return-to-office mandates could force some out of their jobs.

Reality check: "Disability is a natural part of the human experience," said Katy Neas, chief executive officer of The Arc, which serves people with intellectual and developmental disabilities.

• "All people will probably face disability at some point in their life, whether it's due to illness, injury or age, and disability affects every family, regardless of race, ethnicity, sex, income or political party."

Republicans have floated cutting Medicaid, which provides health care for more than 10 million children and adults with disabilities — nearly 15% of the program's beneficiaries.

• Medicaid covers services that allow people with disabilities to live and work in their own communities rather in institutions or medical facilities. But waiting lists for those services are long.
• Medicaid-provided home and community services have been vital to Sean Pevsner, a Texas-based civil rights attorney with cerebral palsy. Their support has allowed him to attend college and law school, practice law, and lobby for disability rights, he said.

Threat level: A Republican-led lawsuit challenging a Biden-era policy to treat gender dysphoria as a protected disability has the potential to undermine a 1973 civil rights law that prohibits discrimination based on disability, advocates warn.

• Republican attorneys general leading the lawsuit told the court they don't want the entire section of the law overturned, only the provisions on transgender care.
• However, advocates remain concerned and say LGBTQ support programs frequently overlap with the disabilities community.
• According to the Human Rights Campaign, 1 in 3 LGBTQ adults report having a disability — including more than half of transgender adults.
• "Not only is disability on the chopping block," said Lizzy Graham, an autistic transgender woman with ADHD. "We have the entire LGBTQ community on the chopping block."

Beyond policies, advocates say Trump and those in his orbit routinely denigrate people with disabilities, giving supporters license to use the same rhetoric online.

• For example Trump incorrectly blamed DEI hires and people with intellectual and developmental disabilities at the Federal Aviation Administration for a fatal plane crash outside of Washington, D.C.
• Elon Musk, who heads Trump's Department of Government Efficiency, also regularly uses ableist slurs in his social media posts.
• This tone is "very hurtful, because people with disabilities have a right to work, and they get their jobs because they're qualified," said Sydney Badeau, a neurodivergent self-advocate in Wisconsin.

The other side: The Trump administration takes issue with lowering standards to achieve diversity, equity, inclusion and accessibility goals — not DEIA itself, the White House told Axios.

• "President Trump is a leader for all Americans. The Trump-Vance administration values the contributions of government employees with disabilities and believes they should be recognized and rewarded based on the merit of the work," a White House official said in an email.

Yes, but: Trump administration officials such as Health and Human Services Secretary Robert F. Kennedy Jr. have stigmatized disabilities by falsely linking vaccines to conditions such as autism, advocates say.

• That medicalizes disabilities, treating them as impairments that need to be fixed, Graham said. She prefers a "social model" that emphasizes societal barriers that create challenges for people with disabilities.
• Eroding support for disabled people "harkens back to the time when people with disabilities were put behind closed doors and not talked about instead of being celebrated and supported," said Nicole Jorwic, advocacy chief at Caring Across Generations, a coalition of caregivers and care recipients.

What's next: Ray Hemachandra, whose son Nicholas is autistic and medically fragile, said he wants more Republican families to join and be welcomed into disability advocacy circles.

• "I'm hopeful that we recognize, and that politicians recognize and legislators recognize, that Republicans are as likely to have a family member with intellectual and developmental disabilities as Democrats do," Hemachandran said.

Go deeper:

• Trump's DEI orders may halt progress for disabled workers
• Mapped: Medicaid recipients across the U.S.

The Department of Health and Human Services will define sex as an "immutable biological classification" and only recognize males and females, officials said on Wednesday.

Why it matters: HHS Secretary Robert F. Kennedy Jr. on his first full day on the job released guidance building on on President Trump's executive order seeking to stop recognizing the concept of gender identity.

State of play: The guidance included definitions HHS will use, including defining "father" as a male parent and "mother" as a female parent.

• The definition of female is "a person of the sex characterized by a reproductive system with the biological function of producing eggs (ova)," while a male is "a person of the sex characterized by a reproductive system with the biological function of producing sperm."
• A woman is "an adult human female," and a man is "an adult human male."

Reality check: There are about 1.6 million people older than age 13 that identify as transgender in the United States.

• An estimated 1.7% of the world population are born with biological traits that don't fit the binary of male and female sexes.

Zoom out: HHS also published a new webpage titled "Protecting women and children," which links to Trump's executive orders on gender ideology and calling for the end of gender-affirming care for minors.

Go deeper: Trump's road map for defunding gender-affirming care

Elon Musk's Department of Government Efficiency has gained access to the inner workings of Health and Human Services, including data systems of the agency that manages a nearly $2 trillion budget, handles Medicare and Medicaid benefits and runs the National Institutes of Health, the world's biggest biomedical research institution.

Why it matters: As they march through the federal bureaucracy, Musk and his team now have a seemingly unfiltered view of the sensitive inner workings of much of U.S. health care.

• DOGE is looking for examples of waste, fraud and abuse as it pursues "opportunities for more effective and efficient use of resources" at the Centers for Medicare and Medicaid Services, an agency spokesperson said.
• But it's not clear how wide a net it's casting or how it's defining those words.

State of play: Two senior agency staff, one focused on policy and one focused on operations, are leading collaborative efforts with DOGE and "ensuring appropriate access to CMS systems and technology," a CMS spokesperson said Wednesday.

• DOGE team members have also visited the Atlanta offices of the Centers for Disease Control and Prevention and asked for sensitive information from the agencies, the Washington Post reported.
• DOGE staff have been given read-only access to a database including information on contracts the agency maintains, according the Wall Street Journal, which first reported on DOGE entering CMS.
• WSJ reported that DOGE is also looking at the technology used by CMS and its organizational structure.
• CMS did not respond to questions on specific systems DOGE staff have access to, or how long the review is expected to last.

What they're saying: "Yeah, this is where the big money fraud is happening," Musk wrote on X Wednesday, referring to DOGE going into Medicare systems.

The definition of abuse or waste "is really in the eye of the beholder," Chris Meekins, managing director at Raymond James, wrote in a client note.

• For example, Medicare advisers to Congress argue the government is overpaying privately administrated Medicare Advantage plans that now cover more than half of the country's seniors. But insurers and other policymakers and advisers disagree that the government is wasting money in that space.
• DOGE has said it wants to save $2 trillion in government spending, which is virtually impossible to do without making cuts to health spending. But President Trump told reporters last week that his administration won't touch Social Security, Medicare or Medicaid unless it finds abuse or waste.
• "The people won't be affected," Trump said.

Reality check: The federal government has long-established channels for rooting out overspending and wrongdoing in health programs. They recoup billions of taxpayer dollars each year.

• HHS inspectors recovered $7.13 billion for the federal government in misspent taxpayer funds during fiscal year 2024. The Justice Department brought in another $1.7 billion in settlements and judgements from health care-related litigation on false claims.
• Trump fired HHS inspector general Christi Grimm last week.

Yes, but: The Government Accountability Office said in an April report that the federal government can do more to stop improper payments in Medicare and Medicaid.

• The two programs accounted for 43% of improper payments made throughout federal agencies in 2023, according to GAO.
• Conservative health wonks are optimistic that DOGE can bring positive change to government-run health programs.
• "It is a no-brainer for DOGE to focus on problems in this area and it's long overdue," Brian Blase, president of health policy think tank Paragon Health Institute, told Axios.

Medical costs and access still top Americans' health concerns by a wide margin, ahead of food and water safety or reducing chronic diseases, according to a new poll from Gallup and Emory University.

Why it matters: Despite talk in Congress about bringing down drug and other costs, the results show a disconnect with some of the current hot-button debates around childhood vaccines, access to reproductive health and even maternal mortality.

• The sensitivity over costs and coverage could help explain the mounting public anger over health insurance and some state efforts to crank up oversight of carriers.

Zoom in: More than half (52%) of Americans ranked better health care access and affordability as one of their top three priorities when presented with a list of 15 options.

• 37% of those surveyed included ensuring safe food and water in their top three, while 32% picked reducing chronic disease.
• In contrast, 13% included ensuring access to comprehensive reproductive care, 11% listed ensuring childhood vaccination against preventable diseases. The same percentage listed ensuring adequate care for a mother and infant after birth.
• "People are still struggling to pay health health bills," said Stephen Patrick, chair of health policy and management at Emory University.
• "Even though we've made progress over the last 10 years in reducing the rates of uninsurance, we still have challenges in many communities in just getting in to see somebody."

Most respondents said the federal government could better address their top three issues than the states.

• Americans with higher incomes also were likelier to list access as a priority than those with lower incomes.

The results show agreement among Democrats and Republicans that improving access and affordability and ensuring food and water safety should be top priorities for officials.

• But more Democratic voters (32%) rated improved access and affordability as their top priority, while food safety came in at No. 1 for more Republican voters (24%).

Between the lines: Health and Human Services Secretary-designate Robert F. Kennedy Jr. told a Senate confirmation hearing last week that he sees ending chronic disease as the key to fixing all issues facing the United States health care system.

• "If we don't solve that problem ... all of the other disputes we have about who's paying and whether it's insurance companies, whether it's providers, whether it's HMOs, whether it's patients or families, all of those are moving deck chairs around on the Titanic," Kennedy said.

The intrigue: Just 2% of survey respondents rated preparing for future pandemics as their top public health priority, and only 12% rated it in their top three issues.

• "As we see the U.S. beginning to deal with bird flu, I worry about that," Patrick said.
• 6% listed addressing the health effects of climate change and extreme weather.

The poll surveyed 2,121 adults between Dec. 2-15.

A national physicians group sued the Trump administration Tuesday for removing thousands of pages of health data and information from federal websites.

The big picture: Doctors for America claims that in taking public health data offline without advance notice, agencies including the Centers for Disease Control and Prevention and Food and Drug Administration abused their discretion and arbitrarily deprived clinicians and researchers of tools necessary to treat patients.

State of play: The complaint in U.S. District Court for the District of Columbia also named Health and Human Services and the White House Office of Personnel Management, which directed agencies to remove or modify websites in accordance with executive orders from President Trump.

• The White House and HHS did not immediately respond to a request for comment.

Zoom in: The lawsuit seeks to compel the CDC, the FDA and HHS to restore webpages and datasets and to stop the agencies from further removing or substantially modifying significant health information, when doing so would prevent timely public access to the information.

• The physicians group, which claims 27,000 members, is represented by lawyers from Public Citizen, a left-leaning consumer advocacy organization.

Context: Federal agencies on Friday started removing swaths of webpages, including CDC information on topics including contraception, HIV and vaccine guidelines.

• Some pages have come back online without clarity on what's been changed or removed, and with disclaimers noting that the pages may be further modified.

Fewer than half of U.S. adults in a new poll trust health recommendations from President Trump and his picks to lead federal health policy, but Republicans are about as likely to trust them as they are their own doctors.

Why it matters: Democrats, independents and Republicans have all lost trust in medical professionals and government health agencies over the past 18 months.

• But there is still a deep partisan divide over how Americans view health information and the people and institutions who share health-related messages.
• The split emerged during the pandemic and has become more entrenched in the almost five years since.

By the numbers: Less than half of the respondents surveyed this month trust President Trump (42%) and Health and Human Services Secretary-designate Robert F. Kennedy Jr. (43%) at least a fair amount to make the right recommendations on health issues.

• But among Republicans, similar shares say they trust Trump (84%) and Kennedy (81%) as say they trust their own doctors (84%).
• 85% of respondents said they trust their doctor at least a fair amount to make the right health recommendations. That's still the vast majority, but it's down from 93% in KFF's June 2023 poll.
• 61% of adults in the poll, released by KFF on Tuesday, said they trust the Centers for Disease Control and Prevention to make good health suggestions, and 53% said they trust the Food and Drug Administration. That's down from 66% and 65%, respectively, in 2023.

Zoom in: Public sentiments toward vaccines also appear to be shifting, especially among Republican parents, the KFF poll shows.

• 82% of parents with kids under age 18 said they typically keep their child up to date with recommended vaccines. The figure, while still high, is down eight percentage points from 2023, KFF noted.
• Among Republican parents, about one-quarter (26%) say they have skipped or delayed some vaccines for their kids, compared with 13% of Republican parents in 2023.

Reality check: There's still broad support for public school vaccine requirements that allow for religious and health exceptions: 83% of the public overall agree with such requirements, and three-quarters of Republicans do, too.

President Trump's orders to freeze some work and communications at government health agencies and begin a U.S. pullout from the World Health Organization are rattling clinicians and researchers, who fear they're the leading edge of a broad anti-science agenda.

Why it matters: Policy experts and researchers are mobilizing for a fight over the politicization of science that stems from — and could rival — the clashes over the COVID-19 response.

State of play: Health and Human Services this week halted most outgoing communications, travel and grant reviews among its agencies — a directive that even prevented National Institute of Health researchers from purchasing supplies for clinical trials.

• Trump also blocked the disbursement of funds for global HIV work through the President's Emergency Plan for AIDS Relief, or PEPFAR.
• The administration called for the exit from WHO, directing staff to stop working with the global health agency.
• A purge of diversity, equity, inclusion and accessibility programs is expected to sweep up efforts aimed at narrowing health disparities and improving diversity in clinical trials.

The tensions are likely to intensify this week as vaccine critic Robert F. Kennedy Jr. faces confirmation hearings to be the nation's top health official.

What they're saying: "Right now, it sort of feels like we are drinking from a fire hose, and I know that a lot of that is the intention of the administration," said Darya Minovi, a senior analyst at the Union of Concerned Scientists.

• "We have just seen a complete rejection of science," she said.
• The organization is mobilizing its network of roughly 20,000 members and maintaining a database of attacks on science.

An ad-hoc coalition of public health workers, researchers and patient advocates called Defending Public Health has circulated a letter with more than 700 signatures calling on senators to vote down Kennedy's nomination.

• The all-volunteer group is still sizing up where to best focus its efforts, said Gregg Gonsalves, an associate professor at the Yale School of Public Health.
• Liberal-leaning advocacy groups like Protect Our Care are also activating to oppose the Kennedy nomination.

Between the lines: Some scientists see Trump's early moves as payback to experts inside and outside the government who criticized his first administration's response to the COVID-19 pandemic.

• They're particularly concerned about an envisioned overhaul of NIH, a frequent target of conservatives, which funds tens of billions of dollars of work at universities. The agency saw its grant review "study sections" frozen last week, and had to pull job ads and rescind offers, per Science.
• "This is just vengeance, as far as I'm concerned," said Jim Alwine, an emeritus professor of cancer biology at the University of Pennsylvania and a member of Defending Public Health. "I think Trump … saw the whole pandemic as a personal affront to him, and I think he's out to hurt science."

Mainstream research groups and universities so far are holding their fire.

• The Association of American Medical Colleges is reviewing the Trump orders and assessing which weigh heaviest on its members, chief public policy officer Danielle Turnipseed said in a statement.
• "I think academic research centers will speak out, but also with hesitation, because they know that their funding comes from the federal government," Lawrence Gostin, a global health law expert at Georgetown University, told Axios. "Even industry wants to be on the good side of the president."
• For his part, Gostin said he's doing what he can to foster connections between WHO leadership and members of the administration like Secretary of State Marco Rubio and RFK Jr. "How can we get a win-win?" Gostin said. "There's a deal to be made here."

To be sure, every new administration needs time to get settled, and communications pauses and policy reviews following an inauguration aren't unprecedented.

• HHS did not respond to Axios' request for comment.
• "The people voted for a different direction, so it is wise for the incoming Trump team to review and reconsider all decisions that don't reflect the incoming president's agenda," David Mansdoerfer, former deputy assistant secretary for health during the first Trump administration, told Axios.

Yes, but: Putting the brakes on NIH's work, even in the short-term, "can have a devastating effect on our nation's longer term research productivity and success," Monica Bertagnolli, NIH director under the Biden administration, wrote on LinkedIn.

• The actual impact of the freeze will depend on how long it continues, but the freeze itself may still erode researchers' trust in the administration, said Elizabeth Jacobs, a professor emeritus at the University of Arizona.

Science and civil rights groups anticipate possible legal challenges to future administration rules in the same vein, experts say.

• They'll also seek to spell out the ripple effects while clarifying how they affect medical providers, to avoid unnecessary self-censorship of research topics and medical care.

Friction point: It's notable that Trump hasn't trained his sights on the Affordable Care Act, drug prices or Medicaid, opting instead to focus on cultural flashpoints, said Larry Levitt, executive vice president for health policy at KFF.

• "Rolling behind the scenes is this potential tsunami of cuts to Medicaid, which would have big implications for the entire health care system," Levitt said.

President Trump will reinstate a policy cutting off U.S. global health funding to international organizations that provide legal abortion information, referrals or services, the White House wrote in a memo released on Friday.

Why it matters: Trump will expand the so-called Mexico City policy, which critics refer to as a global gag rule.

• Former President Ronald Reagan first enacted the policy in 1984. Each Democratic president has rescinded the rule upon entering office, and each Republican president has reinstated it.

The gag rule has negatively affected global health care systems beyond family planning, according to a 2019 review of existing research on the policy.

• Only a handful of studies actually examined the rule's impact on abortion rates, and those three papers concluded that the policy does not decrease abortion rates, per the scope review.

A Louisiana resident has died after being hospitalized for a severe case of H5N1 bird flu, the state's health department said Monday.

The big picture: This marks the first bird flu-related human death in the U.S. Louisiana's health department has not identified any additional cases of the illness or evidence of human transmission, the department said in a news release.

Zoom in: The patient, who became the first person hospitalized with severe bird flu in the country last month, was over the age of 65 and reportedly had underlying medical conditions, according to Louisiana officials.

• The person was exposed to sick and dead birds in a non-commercial backyard flock, as well as wild birds.

By the numbers: 66 cases of bird flu in humans have been reported so far, according to the Centers for Disease Control and Prevention.

State of play: To avoid contracting bird flu, people should not touch sick or dead animals or eat uncooked poultry, eggs and other animal products, including unpasteurized milk, the release said.

• "While the current public health risk for the general public remains low, people who work with birds, poultry or cows, or have recreational exposure to them, are at higher risk," the Louisiana Department of Health wrote.

President Biden is making a final push to build on the Affordable Care Act, extending the enrollment period for marketplace coverage that kicks in Jan. 1 as sign-ups lag.

Why it matters: ACA enrollment has hit new record highs each year of the Biden administration. But those gains are on shaky ground as the Trump administration prepares to take over in January.

• "It's clearly something that the president sees as one of his major accomplishments of his administration," said Sabrina Corlette, co-director of Georgetown University's Center on Health Insurance Reforms.
• "I think we'll continue to see until the very last minute that they're going to be beating the drum to encourage people to get the coverage that they're eligible for."

Where it stands: The Centers for Medicare and Medicaid Services said on Monday that consumers can get health coverage for all of 2025 on the federal marketplace through Dec. 18, extending the deadline from Sunday. Enrollment customarily surges in the last few days of the sign-up period.

• Enrollment for coverage that begins in February will continue through Jan. 15. Current marketplace enrollees who don't change their coverage will be re-enrolled in the same plan, or the most similar one still on the market.

Biden has prioritized growing marketplace enrollment since he hit the presidential campaign trail in 2019.

• 21.3 million people selected an ACA plan for 2024, either through the federal HealthCare.gov site or a state-based marketplace. That beat the previous enrollment record, set the year before, by nearly 5 million, according to Health and Human Services.
• Consumers, on average, will have more choice of insurers for their 2025 coverage, according to KFF. Nearly all HealthCare.gov enrollees will have three or more insurers to choose from for ACA coverage, up from 78% of enrollees with at least three insurer options in 2021.

But the incoming Trump administration is less convinced of the benefits of ACA enrollment.

• While it's still unclear what changes are in store, Trump in his first term slashed funding for the navigators who help people sign up for coverage and made it easier to buy alternate health insurance that doesn't comply with ACA standards. Insurer participation in marketplaces hit an all-time low in 2018, during Trump's tenure.
• The Republican Congress could also decide not to renew enhanced subsidies for marketplace coverage, which have driven enrollment growth over the past few years.

Between the lines: New enrollments in the federal insurance exchange, HealthCare.gov, are trending lower than this time last year, according to the most recent available data from CMS.

• The introduction of enhanced subsidies and then the end of pandemic-era expanded Medicaid coverage boosted marketplace enrollment in recent years. There isn't a precipitating factor for huge enrollment gains this year, said Cynthia Cox, vice president and director of the ACA program at KFF.
• The presidential election also swamped airwaves that might otherwise have been used to remind people about sign-ups. And new federal efforts to crack down on unscrupulous brokers switching consumers' coverage without consent could slow down the process for picking a new plan
• CMS did not respond to questions about why open enrollment was extended. But the agency said earlier this month that it's on track for another record-high number of plan selections during open enrollment this year.

What we're watching: Whether a few extra days makes a difference in how many people sign up for marketplace coverage.

• Stride Health, an online benefits platform for people without employer-sponsored health insurance, was on track to enroll more people on Monday than it did on Sunday, the original final day of the enrollment period, CEO Noah Lang told Axios.
• "Three days might not seem like a long time, but for a lot of folks, it's a game changer," he said

An ally of Robert F. Kennedy Jr. in 2022 petitioned the Food and Drug Administration to revoke approval for the use of a polio vaccine on children on the grounds that the agency didn't do sufficient safety studies, documents show.

The big picture: Aaron Siri, a lawyer who worked for Kennedy during his presidential campaign, has filed more than a dozen petitions on behalf of private citizens requesting the government halt distribution of certain vaccines, also including the one for hepatitis B.

• Siri's national law firm advertises 60-plus years of vaccine injury experience and a 90% success rate for winning exemptions from vaccine requirements for clients.
• He's worked on behalf of the Informed Consent Action Network, an anti-vaccine group founded by Del Bigtree, another close Kennedy ally.
• Siri's efforts on FDA vaccine approvals was first reported by the New York Times.

President-elect Trump said in a TIME magazine interview published Thursday that he plans to have a "big discussion" with Kennedy about potentially ending childhood vaccination programs.

Context: The polio vaccine, which uses inactivated poliovirus strains, has been in use in the United States since 1955 and is deemed safe and effective. It's led to the elimination of natural polio transmission in the U.S. since 1979.

• Siri's 2022 petition specifically targets IPOL, the only stand-alone vaccine used in the U.S. to protect against polio. Several combination vaccines, which are commonly used in the U.S. to protect against polio and other diseases, would not be impacted.
• Siri's petition against the IPOL polio vaccine asks the FDA to suspend the jab's approval for infants, toddlers and children "until a properly controlled and properly powered double-blind trial of sufficient duration is conducted."
• The petition claims that the studies FDA cited in its 1990 approval of updated polio vaccine don't properly investigate the vaccine's long-term safety.

Zoom out: While Kennedy has tried to distance himself from his previous anti-vaccine views, he's reportedly maintained a close relationship with Siri since Trump selected him as his pick for secretary of Health and Human Services.

• Siri has assisted Kennedy with vetting candidates for other health jobs in the Trump administration from transition headquarters in Florida, per the Times.
• Siri posted on his X feed in response to the New York Times' original reporting.
• "The hit piece begins (and ends) with defending a certain polio vaccine, IPOL, which is not the polio vaccine of old, while playing on fear to distract from the clear safety gaps in licensing this particular product," Siri wrote, noting that the petition was filed on behalf of the Informed Consent Action Network and not himself.
• "The petition, if granted by the FDA, would not leave adults or children without a polio vaccine," Siri later told Axios.
• The Trump transition team did not respond to a request for comment.

Where it stands: The FDA sent Siri an interim response in February 2023, noting that it had not yet made a decision on his request.

• The request requires "further review and analysis by agency officials," said the letter, signed by Peter Marks, director of the Center for Biologics Evaluation and Research.

Reality check: Before a vaccine was developed, polio killed thousands of people and paralyzed another 15,000 annually, according to HHS.

• Children typically get the first of four doses of the polio vaccine at two months old.
• Senate Republican Leader Mitch McConnell, who had polio as a child, said in a statement Friday that efforts to undermine the vaccine's safety are dangerous and uninformed.
• "Anyone seeking the Senate's consent to serve in the incoming Administration would do well to steer clear of even the appearance of association with such efforts," he said.

Editor's note: The story has been corrected to reflect that Aaron Siri's petition on behalf of the Informed Consent Action Network only targets the use of IPOL, a stand-alone version of the polio vaccine, on children. It has also been updated with comment from Siri.

The vitriol directed at health insurers following the killing of UnitedHealthcare CEO Brian Thompson could prompt more scrutiny of an industry thought to be facing a favorable regulatory outlook in the second Trump administration.

The big picture: Parent UnitedHealth Group's plummeting market value this week suggests investors fear a regulatory crackdown in response to the public outcry over coverage denials and corporate indifference.

• Lawmakers have focused recently on the prior authorization process and instances in which insurers used AI to deny coverage. But a large-scale push to change the industry's business practices seems far-fetched.

Where it stands: Shares of parent UnitedHealth Group have declined more than 12% in the last five days.

• Shares of other carriers including Cigna and Humana also fell this week.
• "[W]ith public sentiment apparently so low, it is possible that regulators may feel emboldened to make bigger changes than they would have prior to this event," Julie Utterback, senior equity analyst at Morningstar, said in an email to Axios.
• "Obviously, there's a lot of uncertainty around that, especially given the partisanship that typically rules in Washington," she added.

Flash back: UnitedHealth Group's stock surged in the days following President-elect Trump's re-election.

• Republicans have historically favored privately run health insurance and lighter regulation, to the benefit of health insurers operating in the commercial market and Medicare Advantage.

But the public fury directed at health insurance companies in the wake of Thompson's killing, combined with a growing populist wing of the Republican party, could shift the tenor.

• Members of Congress have condemned Thompson's killing and reactions valorizing Luigi Mangione, who has been charged with the murder. However, some have also acknowledged Americans' frustration with their insurers.
• Sens. Josh Hawley (R-Mo.) and Richard Blumenthal (D-Conn.) sent a letter Tuesday to Elevance, the parent company of Anthem, asking for an explanation of a widely panned and now reversed policy to place time caps on reimbursement for surgical anesthesia services.

The insurance industry has condemned the outcry against it and portrayed its mission as making coverage more affordable while helping people navigate the health system.

• And surveys have shown many Americans are satisfied with their own coverage but harbor suspicion and resentment toward the insurance industry as a whole. Satisfaction is lower among people with worse health.

Between the lines: The health insurance industry isn't the only sector contributing to the complexity and cost of the U.S. health care system, said Howard Forman, director of Yale School of Medicine's MD/MBA program.

• "There's no free lunch here," he said. "If we got rid of plan denials, costs would go up. If we really want to do anything, it requires nationalizing everything, and you can sort of guarantee the political will is not there to do that."
• Trump also knows firsthand the difficulty of changing the health care system, after a failed effort to repeal the Affordable Care Act during his first term.
• Trump continues to bash ACA coverage, but his comments suggest major reform isn't a priority. He repeated on Sunday that he has "concepts of a plan" for how to improve coverage.

The bottom line: "At the very least, it has been enlightening to see the public's view of the industry, and there may need to be a bigger focus by industry players on how end users are treated" in the U.S. health care system, Morningstar's Utterback said, adding that change could come through regulation or companies' internal initiatives.

• A 2010 book criticizing the health insurance industry has shot up to No. 2 on Amazon's nonfiction bestseller list, Axios' Sareen Habeshian reported.

Wednesday's shocking murder of UnitedHealthcare CEO Brian Thompson unleashed a wave of social media-fueled rage against health insurers, with posters lashing out over coverage denials and other business practices.

Why it matters: Experts say the lack of sympathy may reflect an inherent truth about Americans and their health plans: People tend to like their own insurer but distrust the industry — and indeed, the health system at large.

• UnitedHealthcare is the country's largest private health insurer by market share and, like other big carriers, has been targeted with lawsuits and criticism from regulators and lawmakers over allegedly denying claims to maximize profits.
• Thompson's wife told NBC News he had been receiving threats, possibly related to health care coverage, but investigators haven't identified a motive for the murder.

Context: Thompson, a 50-year-old father of two based in Minnesota, was shot and killed in what police say was a targeted attack early Wednesday morning in Manhattan while walking to an investor conference.

• He joined the parent UnitedHealth Group in 2004 and climbed the ranks, becoming CEO of UnitedHealthcare in April 2021, according to his LinkedIn account.

Driving the news: As the news broke Wednesday morning, a vocal subset of social media users unleashed raw emotions about the industry.

• "When you shoot one man in the street it's murder. When you kill thousands of people in hospitals by taking away their ability to get treatment you're an entrepreneur," an X user wrote.
• "Saw mainstream news coverage about the killing of the CEO of United Healthcare on TikTok and I think political and industry leaders might want to read the comments and think hard about them," activist Tobita Chow wrote on X.

Where it stands: Americans tend to give their health insurance positive reviews — unless they're sick and actually need to use it, according to a KFF survey of more than 3,600 insured adults conducted last year.

• 81% of insured U.S. adults in the survey gave their health insurance a rating of good or excellent. But that figure dropped to 68% for people with fair or poor health.

Zoom in: Even though Americans largely rate their own health insurance positively, public opinion polls show people dislike the insurance industry overall, said Liz Hamel, vice president and director of public opinion and survey research at KFF.

• In a 2018 survey from KFF, 90% of adults with employer-sponsored coverage who thought health spending was too high said health insurance companies bear at least a fair amount of blame for the problem.
• Data collected by Gallup last year found that 36% of Americans rated the services health insurance companies provide as only fair, and another 32% rated them as poor.
• "People who are healthy and don't have to use their coverage a lot, they see how much it can cost if you don't have insurance," Hamel said. "There's a phenomenon of people feeling grateful that they have coverage" at all.

The other side: Insurance leaders cautioned against drawing broad conclusions from some inflammatory posts.

• "People choosing to say and do deeply unkind things on the internet is unfortunately nothing new and is not unique to today's tragic events," said one industry official, speaking on the condition he not be identified because of the sensitivity of the matter.
• Mike Tuffin, CEO of AHIP, the trade group for health insurers, on Thursday condemned suggestions that threats against industry officials are acceptable.
• "The people in our industry are mission-driven professionals working to make coverage and care as affordable as possible and to help people navigate the complex medical system," he said in a statement to Axios.
• UnitedHealth did not respond to a request for comment.

Still, Americans' frustration with health insurance companies is based on real events that can have serious medical and financial consequences.

• Nearly 60% of those surveyed by KFF last year said they'd experienced problems with their health insurance, such as denied claims or difficulties with provider networks.
• Among insured adults who saw a doctor more than 10 times in the previous year, nearly one-third experienced problems with requirements that the health insurer sign off on an item or service before it's covered, the KFF survey found.

Health insurers maintain that these policies prevent fraud and stop unneeded or inappropriate medical care. But other data shows the requirements can lead to patients abandoning or delaying care.

• Policymakers have sought to crack down on prior authorization overuse in recent years.

Case in point: Anthem Blue Cross Blue Shield plans in Connecticut, New York and Missouri decided last month to only cover anesthesia services for a certain number of minutes per procedure starting next year.

• "This is just the latest in a long line of appalling behavior by commercial health insurers looking to drive their profits up at the expense of patients and physicians providing essential care," Donald Arnold, president of the American Society of Anesthesiologists, said in a news release.

Axios' Nathan Bomey contributed.

Editor's note: The story has been updated with comment from AHIP.

Between Robert F. Kennedy Jr. and Vivek Ramaswamy, the incoming Trump administration has divergent views on regulating the pharmaceutical industry.

Why it matters: Both influential MAGA allies say there are deep problems with America's drug development system. But RFK Jr., the Health and Human Services secretary designee, is calling for more oversight of drugs and vaccines and diminished federal funding for R&D.

• Ramaswamy, a biotech entrepreneur who will lead a new "Department of Government Efficiency" with Elon Musk, is a small government aficionado who's called for fewer barriers to bringing drugs to market.

Their differences add another layer of uncertainty for pharmaceutical companies trying to navigate what could be dizzying changes in the new administration.

Where it stands: Kennedy's priorities include a crackdown on direct-to-consumer drug ads and diverting half of the National Institutes of Health's research budget from infectious diseases to alternative cures and preventive health.

• The vaccine critic wants to see more safety data on shots already on the market. And before Trump selected him for the top health care post, Kennedy also pledged to end the Food and Drug Administration's "war" on "anything that can't be patented by Pharma."

Ramaswamy, in contrast, wrote on social media last week that his biggest problem with the FDA is the agency's layers of bureaucracy, which he said stifle innovation.

• "This stops patients from accessing promising therapies & raises prescription drug costs by impeding competition. The agency's staff have callous disregard for the impact of their daily decisions on the cost of developing new therapies, which inevitably gets passed on to the healthcare system," Ramaswamy posted on X.

Zoom out: The differences between Ramaswamy and Kennedy create more confusion for the pharmaceutical industry, said Dave Latshaw, CEO of BioPhy, which analyzes clinical trial data and helps companies with drug development.

• Prior to Trump's selection of Kennedy to lead HHS, life sciences companies were focused on how the next administration's economic policy, including tariffs, would affect their business.
• But the nearly simultaneous selections of Kennedy and Ramaswamy last week created "so many unknown variables in there that you can't really solve for them all at the same time," Latshaw told Axios.
• "The default for most people — the vast majority of companies and operators — is going to be, well, we have to plan for the worst," he said, adding that he thinks the risk to companies is overstated.
• For example, companies might end some high-risk research programs. And there's already speculation that venture capital will stop funding new biotechs because of the uncertainty.

The pharmaceutical industry has been tight-lipped in its public statements about what it's expecting from the Trump administration.

• "This industry is a crown jewel of the American economy. ... We want to work with the Trump administration to further strengthen our innovation ecosystem and improve health care for patients," PhRMA CEO Steve Ubl said in a statement last week.

Yes, but: Ramaswamy and Kennedy are aligned on some issues. Both have said they want to root out corruption in the FDA. They've also both advocated for restructuring federal departments and firing career civil service employees.

• Ramaswamy said last year that he regrets getting vaccinated against COVID. He also praised Kennedy and elements of his health care agenda on Fox News in August. "I think RFK Jr. has been thoughtful on a number of issues, particularly on COVID policies," he said.
• They spoke together in September at a Tucker Carlson live tour stop, and this past weekend they attended an Ultimate Fighting Championship card with Trump and other influential Republican figures.

President-elect Trump doesn't see an inherent contradiction in his personnel choices.

• "President Trump has chosen highly-respected and accomplished individuals to serve in his Administration, including RFK Jr., Elon Musk, and Vivek Ramaswamy, all of whom are brilliant minds with bold ideas to Make America Great and Healthy Again," Brian Hughes, spokesperson for the administration's transition team, said in an email to Axios.
• Kennedy's and Ramaswamy's representatives didn't respond to requests for comment.

Reality check: There are still a lot of unknowns that could color the Trump administration's views on drug policy or tip it in a specific direction.

• For instance, the Senate could decide not to confirm Kennedy as HHS secretary.
• The Department of Government Efficiency is an advisory body. Its recommendations will need to be adopted and implemented by the White House or Congress, and its mission of slashing federal spending is much easier said than done.

A sprawling movement built around concerns over the food supply and drug industry profiteering is poised to shake up health policy in the new Trump administration — and is already stoking disinformation concerns.

Why it matters: Trump has now picked the leader of the "Make America Healthy Again" campaign, Robert F. Kennedy Jr., as his nominee for health secretary — meaning he could soon have the power to implement some of the MAHA agenda.

The big picture: The MAHA campaign blends generally mainstream views on policing food additives or expanding health savings accounts with more conspiracy-tinged ideas about corruption within the Food and Drug Administration, fluoride in water and vaccine recommendations.

• While President-elect Trump only embraced its tenets late in his campaign, Kennedy and other movement leaders are now in a position to influence federal health policy.
• Trump's other picks to lead health agencies — or, as Kennedy has suggested, purge swaths of their workforce — could be announced within days.
• That's sending shivers through segments of the public health community, with Centers for Disease Control and Prevention director Mandy Cohen publicly warning on Wednesday about the threat of curtailing vaccination efforts, per Bloomberg News.
• FDA commissioner Robert Califf likewise sounded alarms at a cancer conference, Stat reported.

The big picture: The movement taps into frustration with corporate influences in the U.S. medical system and what it claims is an overriding public health focus on infectious diseases.

• The United States spends more on health care than any other country, but our life expectancy is significantly lower than in peer countries like Australia, Japan and the U.K.
• Kennedy and a cadre of influencers, entrepreneurs and others behind the movement propose addressing that contradiction in a variety of ways.
• Kennedy has called for outlawing food dyes and additives that aren't allowed abroad. He wants to devote half of the National Institutes of Health budget to researching alternative health care. And he's pressing for more transparency and data on vaccines while pledging not to take any away.

Zoom in: The movement has two central goals, said health care entrepreneur Calley Means, who with his physician sister, Casey, are leading proponents.

• The first is to change the focus of health care research. More federal funding should be directed to determining why people get sick, he told Axios.
• The second is to adjust federal health policies to give patients more options. Americans can still get medications if they want, but Medicare and Medicaid should also cover alternatives like visits to functional medicine doctors, who focus on nutrition and exercise over pharmaceuticals, Means said.

Yes, but: Certain shifts run counter to some conservatives' past calls for a federal health bureaucracy that's more focused on infectious diseases.

• Project 2025's rollbacks to dietary guidelines would make it harder to fight ultra-processed foods, experts said.

And some of the MAHA movement's ideas veer into the conspiratorial. Kennedy has said he wants to end "the FDA's war on public health" and stop the agency's "aggressive suppression" of raw milk, ivermectin, sunshine and other things.

• He told MSNBC last week that current vaccine safety science "has huge deficits in it." (Vaccines approved by the FDA currently must go through rigorous clinical trials and are subject to real-time quality testing.)
• "One of the more concerning things that could happen is just the perpetuation of misinformation and disinformation," said Richard Hughes, a health care lawyer at Epstein Becker Green. "In RFK Jr., you have someone that does not follow mainstream science."

Reality check: Even with Trump's focus on government efficiency, political appointees may find that rules around the federal bureaucracy complicate major policy change, said Chris Meekins, an analyst at Raymond James who worked at Health and Human Services in the first Trump administration.

• "I think it's much more likely for the career staff in the bureaucracy to support what [RFK Jr. is] attempting to do on the healthy food side than he is on the drug side," Meekins added.
• That said, spreading fears of a voluntary exodus of staff at the FDA and other divisions of HHS could make that less of a factor.

Between the lines: The idea of big changes to the food and pharmaceutical industries have captured Americans' interest, especially mothers concerned about their children's health.

• RFK Jr.-aligned influencers such as Jessica Reed Kraus, who has more than 1.3 million Instagram followers, boosted Trump's popularity online. They helped the campaign grow its base of women and mothers, a social media executive who worked on the campaign told Axios' Sara Fischer.

But the lasting political momentum of these broader health reforms is uncertain.

• Public health and chronic illness weren't the major motivators that propelled voters toward Trump, according to Robert Blendon, a polling expert and professor emeritus of health policy and political analysis at Harvard.
• Outside of vaccines, which fire up public sentiment in different ways, public health isn't a very politically visible topic right now, he said. It may not get much attention from the White House.
• "When you look at the exit polls, health care is not in the top five for people who voted for Trump. It just didn't play a role," he said.

Editor's note: This story was updated after Trump announced RFK Jr. as his HHS pick.