What The Hell America!

President Donald Trump late Wednesday directed the Centers for Medicare and Medicaid Services (CMS) to disband a committee to identify and reduce systemic barriers that people of color, LGBTQ+ people and rural Americans encounter when trying to access government health care programs.

The directive came as part of an executive order on “commencing the reduction of the federal bureaucracy.”

Trump directed the heads of relevant agencies to disband within two weeks entities that include the Health Equity Advisory Committee at CMS, the Advisory Committee on Voluntary Foreign Aid at the U.S. Agency for International Development, the Community Bank Advisory Council at the Federal Deposit Insurance Corporation, and Secretary’s Advisory Committee on Long COVID at the Department of Health and Human Services.  

“It is the policy of my Administration to dramatically reduce the size of the Federal Government,” Trump wrote in the order. “This order commences a reduction in the elements of the Federal bureaucracy that the President has determined are unnecessary.”

The establishment of the CMS Health Equity Advisory Committee was prompted by an executive order “On Advancing Racial Equity and Support for Underserved Communities Through the Federal Government” that Democratic President Joe Biden signed on his first day in office.

Xavier Becerra, the head of the Department of Health and Human Services under Biden, published the committee’s charter in July 2024, with the stated goal of making “recommendations on the identification and resolution of systemic barriers in the CMS programs that hinder access and quality for beneficiaries and consumers.” 

The committee’s purview included Medicare, the government health insurance program for the elderly and disabled; Medicaid, the government health insurance program for lower-income Americans; the Children’s Health Insurance Program (CHIP) for children from low-income families; and the marketplace of health insurance programs established by the Affordable Care Act. Its mandate included addressing systemic barriers to access that included structural racism, which Trump labeled a “divisive concept” during his first administration.

A December 2024 notice in the Federal Register soliciting nominations for committee members said that the panel would, “focus on health disparities in underserved communities … such as but not limited to Black, Latino, and Indigenous and Native American persons, Asian Americans and Pacific Islanders and other persons of color; members of religious minorities; lesbian, gay, bisexual, transgender, and queer persons; persons with disabilities; persons who live in rural areas; and persons otherwise adversely affected by persistent poverty or inequality.”

Health disparities in underserved communities are well documented, as are disparities in accessing medical care. 

Research shows that Type 2 diabetes, a condition that often worsens with age and requires frequent doctor’s visits, impacts Black and Latinx Americans at higher rates than White Americans. Rates are also higher in rural areas, with Alabama, Kentucky, Georgia and West Virginia reporting some of the highest. An April 2024 CMS report showed that Indigenous and Black Americans in particular faced barriers to accessing care for diabetes and related conditions.  

Non-White Americans with kidney failure are referred for transplants at lower rates and wait longer for them when they are. A November 2024 CMS report showed that rural patients were at a particular disadvantage when trying to access medical care for kidney disease. 

In the first month of his second presidency, Trump has focused on reducing the size of the federal government and dismantling diversity, equity and inclusion (DEI) and accessibility (DEIA) efforts within federal agencies. Civil rights groups on Wednesday sued the Trump administration over a series of DEI-related executive orders, arguing they were unconstitutional because Trump both exceeded his presidential authority and because the orders discriminated against Black and transgender Americans. 

Researchers have warned that the DEI orders are so broad that they could hamper efforts to study race- and gender-identity-related disparities across a variety of subjects, including health care.

A list of diversity-related words that are allegedly banned from being used by federal agencies has been circulating in Washington. Reuters reported Thursday that some scientists at the Food and Drug Administration (FDA) had been told to stop using the words “woman,” “disabled” and “elderly” in external communications. The White House told the newswire that the agency had misinterpreted Trump’s executive orders.

Trump said in an interview with Fox News this week that “Medicare, Medicaid, none of that stuff is going to be touched.” Hours later, he endorsed a GOP budget proposal in the House of Representatives that would gut Medicaid funding. A White House spokesperson told Politico that “the Trump administration is committed to protecting Medicare and Medicaid while slashing the waste, fraud, and abuse within those programs.”