In this edition of AcademyHealth’s Situation Report, we examine ongoing challenges to public health infrastructure and scientific integrity. As the government shutdown nears its second week, former top health officials are highlighting concerns over shifts in vaccine policies and cuts to federal health agencies, while rural hospitals and local health departments are already feeling the effects of diminished Medicaid funding and public health support. At the same time, the Supreme Court is weighing a case that could erode protections for LGBTQ+ youth by striking down state bans on conversion therapy. These developments underscore the critical role of health services research in guiding evidence-based policy—an issue explored in depth in the latest episode of Tradeoffs, where AcademyHealth President and CEO Aaron Carroll discusses how research informs decisions that protect communities and strengthen public health systems.
In today’s issue:
- Former U.S. Surgeons General Raise Alarm Over Shift in Vaccine Policies, Distrust in Public Health
- The Hill's Health Next Summit Highlights Public Health Priorities and Federal Budget Impacts
- Indian Health Service Adjustments and Their Effects on Other Agencies
- Supreme Court's Deliberations on Conversion Therapy Ban
- Government Shutdown Approaches Day 9 with No Clear Path Forward
- Raising the Banner for Health Services Research: Dr. Carroll Featured on Tradeoffs
Former U.S. Surgeons General Raise Alarm Over Shift in Vaccine Policies, Distrust in Public Health
Six former U.S. surgeons general, who served in both Republican and Democratic administrations, wrote an op-ed in the Washington Post raising alarm about the actions of Health and Human Services Secretary Kennedy. The surgeons general noted that the Secretary is “endangering the health of the nation,” and pointed to the Secretary deemphasizing the value of vaccines during a measles outbreak and replacing key Advisory Committee on Immunization Practices (ACIP) members with those who are vaccine skeptics. Nine former directors and acting directors from the Centers for Disease Control and Prevention (CDC) shared a similar critique last month, citing the undermining of vaccines and dismantling of public health expertise within federal agencies as developments that could weaken public trust in immunization programs.
The surgeons general letter comes on the heels of Secretary Kennedy firing a fourth National Institute of Health (NIH) director, Dr. Jeanna Marrazo, a top NIH scientist appointed to succeed Dr. Anthony Fauci as director of the National Institute of Allergy and Infectious Diseases. Dr. Marazzo had recently filed a complaint against the Trump administration for silencing and demoting her due to her public comments against the administration’s policies that she argued undermined vaccine research, went against court orders, and cancelled important clinical trials. She stated that her termination, “shows that the leaders of HHS and the National Institutes of Health do not share my commitment to scientific integrity and public health,” a sentiment shared by the more than 20 medical organizations and over 1,000 current and former HHS employees who signed respective letters calling for Secretary Kennedy’s resignation. Health services researchers can help policymakers and the public understand how deviations from evidence-based approaches affect population health and health system performance.
The Hill's Health Next Summit Highlights Public Health Priorities and Federal Budget Impacts
The Hill’s “Health Next Summit” on Tuesday featured health policy experts, industry leaders, and lawmakers who shared their perspectives on the future of U.S. public health, outlining both opportunities and challenges. Just one week into the government shutdown, health policy experts shared fears regarding the impact of policy changes under the current administration on health care, citing the firing of the CDC’s ACIP and Secretary Kennedy’s leadership.
According to the Robert Wood Johnson Foundation president and former director of the CDC Richard Besser, the CDC is no longer the revered public health agency it once was, threatening the United States’ once strategic global leadership in science and technology. Brown also cited the “devastating” $18 billion in cuts to the NIH under the proposed budget, which was rejected by the Senate Appropriations committee, who then advanced a bill that proposed increasing funding to NIH. The destruction of scientific infrastructure and research will have a disastrous impact on the future of health care and for individuals, according to Besser.
The impacts of proposed reductions in federal Medicaid funding outlined in the budget reconciliation bill, which will cut over $1 trillion of federal Medicaid spending in the next decade, are already being felt by health care providers, even though the majority of these provisions aren’t scheduled to go into effect until after 2026 midterms. Indeed, many rural hospitals are already discussing terminating and/or not expanding important services. A rural hospital in Georgia, for example, announced that it would be shutting down its labor and delivery unit, citing cuts from the budget reconciliation bill as a contributing factor in the decision.
At the same time, mass firings have resulted in states losing access to federal resources when dealing with public health emergencies. The Milwaukee public health department, for instance, attempted to secure aid from the CDC to deal with lead poisoning in the water, preventing the city from accessing safe drinkable water. They were informed, however, that the department that dealt with lead poisoning had been terminated. Moreover, officials from the National Center for Environmental Health similarly responded to Milwaukee’s public health department stating that they would be unable to respond to the request for support, citing “the complete loss of our Lead Program.”
The destruction of federal health infrastructure poses great threats to the field of health services research as states and hospitals become increasingly alienated from federal aid to deal with public health crises in their respective communities. To combat the already felt and looming cuts to federal health agencies and Medicaid, health services researchers can work with state and local agencies to develop plans for emergency crises that are not reliant on the federal government. Importantly, health services researchers can also emphasize the importance of such infrastructure, and the impact of further cuts, to policy makers during the shutdown. Understanding how health policy works isn’t optional—it’s essential. Decisions made in a few congressional committee rooms can determine whether hospitals stay open, researchers get paid, and public health data remain available. Join us in person at AcademyHealth’s Health Policy Orientation for a three-day deep dive offering essential knowledge and skills to engage in today’s complex policy environment and contribute to meaningful change.
Indian Health Service Adjustments and Their Effects on Other Agencies
Amid nationwide staffing shortages at Indian Health Service centers, Secretary Kennedy is dispatching over 70 public health corps officers for several month assignments at centers around the country. While the clinics may welcome the assistance, officials are concerned with the gaps that public health corps will leave at their current posts. While tens of thousands of their peers are furloughed due to the government shutdown, public health corps officers are legally allowed to work. The Indian Health Service assignments in addition to an already strained staffing circumstance due to furloughs and on top of the demands of the approaching fall and winter disease outbreak seasons are causing concern, with some health officials fearing these changes are meant to pressure federal workers to resign from their positions.
Health services researchers have the opportunity to monitor how workforce disruptions will impact disease spread and other health risks such as overdose in the coming months as top health officials are furloughed or moved to alternate posts.
Supreme Court's Deliberations on Conversion Therapy Ban
On October 8th, the United States Supreme Court heard arguments challenging Colorado’s ban on conversion therapy for minors, with several justices appearing open to the claim the law infringes on First Amendment rights. The case, brought by Christian counselor Kaley Chiles, represented by the group Alliance Defending Freedom, argues that the state’s restrictions on conversion therapy unconstitutionally limit free speech. Chiles contends that Colorado failed to consider less-restrictive alternatives to a ban on conversion therapy and cannot prove that the practice causes harm. The state, however, maintains that the law regulates professional conduct, not speech, and applies only to state-licensed health care professionals.
Several conservative justices questioned whether the law imposes undue restrictions on speech, and whether professional speech is fully protected under the First Amendment. A ruling in favor of Chiles could have broad implications, potentially prompting more than 20 states to revisit their bans on conversion therapy--a practice that has been widely discredited by major medical organizations. The case reflects ongoing tensions between free speech protections and state authority to regulate health care, especially following recent Supreme Court decisions upholding bans on gender-affirming care.
Striking down state bans on conversion therapy could weaken protections for LGBTQ+ individuals and legitimize harmful practices, further sidelining science and marginalized voices in policymaking. To combat practices like conversion therapy, evidence-based regulation grounded in inclusive data is essential. Health Data for Action (HD4A), a Robert Wood Johnson Foundation signature research program managed by AcademyHealth, provides researchers with access to rich data sets to study health disparities to improve health, well-being, and equity. In a recent interview, HD4A grantee Dr. Carl Streed Jr., a clinician-researcher who specializes in health disparities affecting sexual and gender minority (SGM) populations, discussed the impact of discrimination and minority stress on physical health. He noted that SGM individuals experience higher rates of cardiovascular risk due to the isolation and discrimination they face from society at large. As the Supreme Court weighs free speech against evidence-based health regulation, the HD4A program reinforces the critical role of data and evidence in shaping policies that protect public health.
Government Shutdown Approaches Day 9 with No Clear Path Forward
Today marks the eighth full day of the government shutdown, and there are no signs that either party is budging. On Monday, October 6, President Trump stated he was in conversation with Democrats about the health care subsidies set to expire at the end of this year. The subsidies—and therefore the future of health care access—remain at the center of the government shutdown. Senate Minority Leader Chuck Schumer denied that the administration was in conversation with Democrats. While President Trump initially expressed an interest in reaching a deal that would protect the health care subsidies, he later walked back his remarks about being open to negotiations. Republicans, including President Trump and House Speaker Mike Johnson, are still pushing for the government to reopen without a deal and for negotiations to occur after Congress passes a budget. Meanwhile, 750,000 federal workers continue to work without pay and with the possibility that the administration may disregard a federal law requiring the government to provide furloughed and essential workers with back pay after the shutdown ends. The continuation of a government shutdown and the possibility of federal employees working without pay will affect agencies’ ability to carry out statutory responsibilities. For example, the National Institutes of Health (NIH) and the Agency for Healthcare Research and Quality (AHRQ) are unable to review and award grants, often bringing research across the country to a halt.
Raising the Banner for Health Services Research: Dr. Carroll Featured on Tradeoffs
Amid uncertainty surrounding federal research budgets, AcademyHealth continues to highlight the essential role of health services research in connecting science, practice, and policy. In a new episode of Tradeoffs, AcademyHealth President and CEO Aaron Carroll spotlights how HSR connects science, practice, and policy and what’s at stake if that bridge collapses. His message is one of resolve: we’re not only defending the field, but leading efforts to strengthen it, rebuild trust in science, and ensure evidence continues to drive better care and smarter policy. Listen to the interview here.
Previous Editions
This is the latest in a series of Situation Report updates from AcademyHealth. You can find prior issues here.
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