As part of their Careers in Bioethics Lecture Series, Columbia University’s School of Professional Studies invited panelists to discuss the implications of the 2024 Election results on healthcare. 

On Monday, November 11, Columbia University’s School of Professional Studies hosted five prominent leaders in health policy and bioethics to discuss the impact that the 2024 Presidential Election might have on healthcare. The event was moderated by Robert Klitzman, the Director of the Masters of Bioethics Program and Professor of Psychiatry at the Columbia University Irving Medical Center. 

Klitzman began the conversation by asking panelists to share why Vice President Kamala Harris and the Democratic Party lost the election by such a steep margin, and what the implications of this election result are on healthcare domestically and globally. Ross Frommer, Vice President for Government and Community Affairs and Associate Dean of the Columbia University Irving Medical Center, began his remarks with data and visual aids provided by CNN’s reporting to explain and contextualize the results. 

Ultimately, he noted that President-Elect Donald Trump won the presidency because he won all seven battleground states: Arizona, Georgia, Michigan, Nevada, North Carolina, Pennsylvania, and Wisconsin. In 2016, Trump won all of these battleground states except for Nevada, and in 2020, President Joe Biden won all but North Carolina, pointing to a rightward shift from 2020 to 2024. Frommer noted the higher voter turnout in these states compared to non-swing states like California or Texas in conjunction with Trump’s ability to turn “royal blue states light blue” earned him the candidacy. 

Concerning the popular vote, which Trump also won, Frommer said that he and other scholars “expected a 2016 situation” where a candidate wins the popular vote but isn’t elected president. As of Monday evening, Harris received 10 million fewer votes than Biden did in 2020, whereas Trump only received about 500 thousand more votes than he did in 2020. 

The Senate race has been called, according to the Associated Press, with the Republican Party holding 53 to Democrat’s 47 seats. The House of Representatives has yet to be called, with 9 seats still undecided. With such a close race, every seat matters for each party, and as Trump begins to decide his cabinet, it becomes even more complicated. Elise Stefanik, Trump’s pick for United Nations Ambassador, currently holds a crucial seat in the House. If she is confirmed to Trump’s cabinet, she will have to step down from her position in the House, creating a vacancy that will require a special election. Although Frommer said this seat would likely remain Republican, anything is possible, and any vacancies created by Trump’s new cabinet will further complicate this race. 

Frommer contextualized Harris’ loss through the key issues of this election cycle, including the economy and immigration, specifically among Trump supporters. Trump, he said, had stronger messaging on these top categories, and although Harris was stronger on topics such as abortion, healthcare, and climate, these issues were not of the same relevance to all voters. 

Next, Basil Smikle, a professor of Practice and the Director of the MS Program in Nonprofit Management at Columbia’s School of Professional Studies and an MSNBC political analyst, highlighted the deeply racial and gendered implications of this election result. Through this election, the “levels of racism and sexism that this country has become accustomed to” have become evident, Smikle said. 

Smikle discussed reproductive health and mentioned New York State’s Proposal 1, which was overwhelmingly passed to enshrine abortion rights in the state’s constitution. Although this legislation, as well as reproductive rights bills passed in other states, is a positive for many voters, Smikle also highlighted the sobering reality for those living in states without these protections. According to Smikle, 60% of Black women live in a state that has abortion bans and/or restrictions, which he stated has an inevitable impact on Black women’s mental health and potentially mortality rates. To further his point on mental health, Smikle noted that statistically, Black men are four times more likely to commit suicide than Black women, which is a major component of an evolving conversation about male isolation as a result of social media. 

The conversation then shifted to the perspectives of Jonathan Engel, Senior Lecturer in Health Policy and Management at the Mailman School of Public Health and Lecturer in Bioethics MS Program at Columbia University, and Sherry Glied, the Dean and Professor of Public Service at New York University. Engel and Glied highlighted the specific implications of the election results on healthcare and where these changes might manifest. 

Engel stated that Trump’s presidency might not have an immense impact on healthcare, since many aspects of healthcare are largely nonpartisan. As an example, Engel cited that Trump’s main healthcare legislation from his first term, which tackled high prescription drug prices, received bipartisan support. He further stressed that public health issues are mostly under state and municipal jurisdiction—for instance, different states tackled quarantine and masking policies independently during the COVID-19 pandemic while the federal government was unable to enact universal legislation.

Glied then discussed some of the changes we might see as a result of a second Trump Administration and where to look for these changes, especially as benefits from past legislation such as the Affordable Care Act (ACA) are set to expire during Trump’s second term. Traditional legislation such as ACA are typically held up and reinforced by partisan differences: they must get past the filibuster, requiring 60 of the 100 Senate votes. Glied predicted that Trump will not achieve this number, which will limit his legislative capabilities. Alternatively, budget reconciliations, or the accelerated process for the passage of bills relevant to the Congressional budget, only require half (50) of the Senate votes. Since the Republican Party will have 53 of these votes, more changes might be seen through this channel. Even still, Trump would need to gain the support of all 53 Republican Senators, which Glied noted will be difficult. 

It is also important to consider administrative actions that don’t rise to the level of regulation, such as executive orders, which Glied described as “smoke rather than fire.” Executive orders, or written directives from the President that do not require Congressional approval, tend to be very ideological and have more limited effects on what will happen on the ground, Glied explained. An example of an executive order could be pardoning an individual or imposing tariffs, two things that Trump has promised to do in the early days of his administration. 

To wrap up the conversation, the panelists answered a few questions from listeners concerning mental health care, gender-affirming care, and abortion. 

Concerning mental health care, Smikle mentioned the potential elimination of the Department of Education, which could result in crucial programs being cut. For example, Title I, which provides financial assistance to low-income school districts, and programs like Head Start that are crucial for early-education support, are at risk. Smikle asked his audience to consider the ripple effect of cutting such programs, like fewer counselors and other mental health support on campuses. 

Glied extended the previous conversation on reproductive rights to discuss the possibility of a federal abortion ban. She noted that abortion bans of any kind will likely go through the Senate’s “filibuster-proof majority” which requires a two-thirds majority vote to pass legislation, making it more difficult for legislation to be passed. Trump has said that restrictions and bans on abortion should be left up to the state’s discretion, so it is unlikely that a national abortion ban will come to pass for this reason also. Frommer argued that despite Trump’s disavowal of a national abortion ban, there will still be one proposed in Congress as soon as the next session begins, reflecting Republican control of both chambers.

Glied was also asked about the potential appointment of Robert F Kennedy, Jr, a former Independent presidential candidate, to a top healthcare office such as the Federal Drug Administration or the National Institutes of Health. Kennedy has been criticized for spreading scientific conspiracy theories, such as false claims that vaccines cause autism and that AIDS may not be caused by HIV. Glied said that while Kennedy might not have sweeping power over health administration, Americans should be concerned with who Trump will appoint to scientific review committees, which have more concrete control over where healthcare funding goes.

Lastly, when asked what people who are concerned or disheartened by the election results should do, Glied emphasized that a lot of health policy happens at the state and local level, so getting involved with organizing at that level is imperative. Additionally, she noted that the regulatory process in the United States has a lot of room for public comment through organizations or local elected officials, which are required to be substantially considered by the administration, so making your voice heard through these channels is especially important.  

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