Penn health experts respond to health care rollbacks by the Trump administration.
Credit: Devansh Raniwala
Since returning to the Oval Office in January, 1968 Wharton graduate and President Donald Trump has reshaped and rolled back several aspects of the United States health care system.
The Trump administration’s efforts against health care have included sweeping changes to federal health insurance protections and the withdrawal of funding from public health research initiatives. The Daily Pennsylvanian spoke with University public health experts and legal scholars to understand the impact of recent policies — including the effects of restricted Medicaid eligibility on immigrant populations.
According to University of Pennsylvania Carey Law School professor Allison Hoffman, who specializes in health sciences, the One Big Beautiful Bill Act — signed into law by Trump on July 4 — introduced several provisions that will impact access to Medicaid services nationwide.
“On average, about 30% of state budgets are spent on Medicaid,” Hoffman told the DP. “Of that, half or more comes from the federal government. What this law is doing is pulling money away from the state Medicaid programs in a number of ways.”
Hoffman said the federal government plans to implement “work and community engagement requirements” as a consideration for Medicaid eligibility as part of the act — adding that “people who are able to work have to be working or seeking work or engaged in the community in some other statutorily defined way.”
For renewals scheduled on or after Dec. 31, 2026, Medicaid recipients must reaffirm their eligibility every six months. According to Victor Roy, an assistant professor at the Perelman School of Medicine in the Department of Family Medicine and Community Health, the work requirements “place more administrative burdens on people, which will have the impact of less people getting Medicaid.”
“To see [work requirements] rolled out in such a broad-strokes way through this law is really a fundamental change to how the Medicaid program is going to function,” Hoffman said.
University faculty also said that the new Medicaid restrictions will widely impact immigrants residing in the U.S., especially those who are undocumented.
Hoffman described how previous laws’ definitions of “a qualified immigrant” included “people who have refugee or asylum status, people who are the victims of domestic violence — these kinds of categories.”
“This law narrows the list of who is considered a qualified immigrant to just a few groups,” she said.
Penn Carey Law professor Fernando Chang-Muy, a lecturer on immigration, classified qualification restrictions as “short-sighted.”
“This administration is looking at it [with] very tunnel vision and saying, ‘if you’re not in one of these categories, we’re not going to treat you, you’re not going to get access to health care,’” he said to the DP.
Chang-Muy also criticized hospitals potentially requiring information on a patient’s citizenship status or birthplace when seeking medical care.
“It just doesn’t make sense from a moral perspective, from an economic perspective, and from a public health perspective, not to support and treat people regardless of their immigration status,” he continued.
Penn Carey Law professor and director of the Transnational Legal Clinic, Sarah Paoletti, echoed Chang-Muy’s concern about health care access under Trump-era legislation.
“My understanding is that doctors have an ethical obligation to treat the patient in front of them, and that would also mean treating the patient in front of them regardless of immigration status,” Paoletti wrote to the DP. “It is not legal – under international law – to discriminate in any way on the basis of migration status.”
“We are a nation of immigrants, and we should all be treated with respect and dignity,” Chang-Muy said.
Paoletti noted that “even if the medical care is still being provided, the asking of questions deters someone from seeking help” and may “have longer term public health consequences not just for those afraid of being detained and deported, but for all of us.”
She also emphasized that many concerns surrounding immigrants seeking medical services are rooted in a hospital’s finances — or the question of “who is going to pay the bill?”
“If the person has insurance, then there is no legal basis for which a medical institution can or should be asking about migration status,” Paoletti wrote. “If the person does not have insurance, then that person should legally and ethically be treated like any other patient without medical insurance.”
“I understand that it costs money to run medical facilities and to provide medical care, but everyone should have the same right to access medical care regardless of their migration status, as a matter of fundamental human rights,” she added.
The Trump administration has also attempted to alter the marketplace created by the Affordable Care Act, which was signed into law by former President Barack Obama in 2010.
“The Biden administration had been providing subsidies for certain categories of people at higher levels,” Hoffman said. “The Trump administration has failed to extend the period, resulting in about “5 million people [that] may lose Marketplace coverage.”
Hoffman also pointed to the administration’s efforts to “make it harder to enroll” in insurance programs through new legislation, such as the One Big Beautiful Bill Act and other policies.
“By establishing new requirements for eligibility and restrictions on enrollment periods, less people eligible for insurance will not be able to receive it under the ACA,” she said.
Roy said that many decisions from the federal government are made “to finance tax cuts,” which results in a “redistribution of wealth from the low-income populations to wealthy individuals.”
The rollback of scientific and medical research — which accelerated on Feb. 7, when the National Institutes of Health implemented a funding cut on indirect costs — has also left many questions for the future of health care.
Katherine Milkman, the James G. Dinan Endowed Wharton professor of operations, information and decisions, called the cuts “worrisome” in an interview with the DP, noting the March stop-work orders for research grants received by members of Penn’s faculty.
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“It’s unclear what the implications will be and how dire, but it’s clear that we’re going to have a lot more loss of life that’s unnecessary,” Milkman said.
She also criticized the “cutback in support for communication” for those who were receiving NIH funding.
“People are getting these letters that are crazy,” Milkman said. “They say things in broken English … it says it’s no longer in the U.S. national interest to understand why people might not get vaccinated. How could that not be in the U.S. national interest when it’s this amazing preventative way to save lives?”
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