This story is part of The Cancer Letter’s ongoing coverage of COVID-19’s impact on oncology. A full list of our coverage is available here.
The future of American health care, pandemic response, and sustained funding for cancer research hangs in the balance as the final votes are being counted and legal challenges launched in the 2020 presidential election.
At this writing, former Vice President Joe R. Biden is projected to win the election, but President Donald J. Trump, claiming election fraud, is unlikely to concede.
Much is at stake in this election, as the United States recorded over 120,000 new coronavirus cases on Nov. 5—the highest number of cases ever reported by a single country in a single day—as surges overwhelm hospitals in the upper Midwest. According to exit polls, most Americans ranked the economy and COVID-19 as top priorities that informed their decisions at the ballot.
Credible public health experts—including many oncologists—have openly criticized Trump’s handling of the COVID-19 pandemic (The Cancer Letter, May 8, 2020, Coronavirus vs. Oncology). The deadly disease, caused by the SARS-CoV-2 virus, has claimed over 234,000 lives in the U.S. since March.
Congressional support for biomedical and cancer research is likely to remain solid no matter who is sworn in as the U.S. president in January. However, a potential second term for Trump may embolden him to act on his feud with NIH and FDA and make another effort to cut research funding.
Also, Trump would be expected to continue to chip away at operational aspects of the Affordable Care Act, even as he pushes for lower drug prices, as well as transparency in hospital billing practices and insurance reimbursement.
A Biden win would defend the ACA, and, possibly, lay down the foundations for a public healthcare framework, as per his campaign promise.
Of particular significance is Biden’s record of securing $1.8 billion in a sweeping bipartisan deal to fund cancer research via the Beau Biden Cancer Moonshot, which was folded into the 21st Century Cures Act of 2016. The Moonshot has enabled the creation of a dedicated cancer center at FDA, led by Richard Pazdur (The Cancer Letter, Dec. 16, 2016, Jan. 20, 2017, To the Moon).
In spite of multiple budget proposals by the White House to slash domestic spending—including funding for biomedical research—over the past five years, Congress delivered some of the largest annual increases to NIH, growing the agency’s budget by $11.6 billion, or 39%.
In 2018 alone, congressional appropriators added $3 billion to NIH, the largest increase in 15 years since the doubling effort led by then Rep. John Porter (R-IL). In that same year, Trump’s budget proposed slashing NIH funding by 27% (The Cancer Letter, July 10, 2020, April 6, 2018, March 16, 2018, March 17, 2017).
Porter, U.S. Congressman from the 10th district in Illinois for 21 years, who served on the U.S. House Committee on Appropriations and chairing the House Appropriations Subcommittee on Labor, Health and Human Services, Education and Related Agencies, had this to say about Trump’s proposed budget cuts in 2018:
“Oh God. It would devastate medical research. Definitely devastate it,” Porter said at the time to The Cancer Letter. “I can’t tell you how they get their numbers. They look at the overall spending rate, and then they determine where they’re going to suggest cuts and the hopeful message is to the people who want to cut down on the size of government and its reach, that they are doing what they were elected to do.”
For many cancer patients, a repeal of the ACA could eliminate access to care—an outcome prevented by the late Sen. John McCain (R-AZ), who cast the deciding vote in July 2017 against a Republican effort to gut the healthcare law. With Democrats retaining control of the House of Representatives in the 2020 elections, another attempt at a repeal is unlikely to succeed over the next four years, even if Trump is re-elected.
To date, it remains unclear whether the White House and congressional Republicans have a replacement plan for the ACA, despite their vows to repeal the healthcare law and preserve subsidized insurance premiums and access to health care for an estimated over 20 million Americans who are covered under ACA provisions (The Cancer Letter, Jan. 20, 2017).
For career scientists at NIH and FDA and civil servants across the federal government, a hypothetical second term for Trump may prove devastating, pursuant to an Oct. 21 executive order that would strip civil service and due process protections for some federal employees.
On Nov. 2, a day before the election, Trump indicated that he may fire Anthony Fauci, the head of the National Institute of Allergy and Infectious Diseases and the face of the federal response to the COVID-19 pandemic. Fauci recently warned that the U.S. is badly positioned to cope with a winter surge, saying, “We’re in for a whole lot of hurt. It’s not a good situation.”
Fauci said he and Deborah Birx, the coronavirus task force coordinator, have not spoken with Trump since early October.
Observers describe the Oct. 21 executive order as an attempt to purge Washington of “disloyal” career employees under the guise of “poor performance”—in a city that consistently and overwhelmingly votes Democratic. According to the latest tally, 92.6% of counted ballots in the District of Columbia favored Biden in the presidential election.
The White House said Trump’s EO would “promote good governance and accountability within the federal workforce” by giving agencies more “flexibility to hire ‘Schedule F’ employees” and “to remove them without going through a lengthy appeals process.”
The same “fact sheet” states that the order prohibits personnel actions against these employees, “including actions on the basis of the employee’s partisan affiliation, other protected characteristics, or because of the employee’s status as a whistleblower.”
Even as a lame duck president, Trump is expected to launch these attacks on what he and his supporters describe as the “Deep State.”
