In a recent live poll conducted during a WTW webinar, attendees revealed their most significant worries as a new federal administration begins to take shape. Healthcare costs emerged as the clear top concern, highlighting the critical importance of this area in the coming months. Courtney Stubblefield, the managing director at WTW, shared valuable insights with the audience during the webinar.

Unraveling the Potential Shifts in Healthcare Under a New Administration

Attendees' Biggest Concerns in the New Administration Era

During the live poll, it became evident that healthcare costs were at the forefront of attendees' minds. This is not surprising given the potential for significant changes under the incoming Trump administration. As Stubblefield pointed out, "There will be a lot to monitor, watch and pay attention to over the coming months." The nominations of key health-related Cabinet positions, such as Robert F. Kennedy, Jr. as U.S. Health Secretary, Dr. Mehmet Oz to lead the Centers for Medicare and Medicaid Services, and Dr. Jay Bhattacharya as director of the National Institutes of Health, are setting the stage for potential policy shifts.The narrative from these proposed leaders around health and safety is markedly different from the current Biden administration. Stubblefield emphasized, "This is a team of people who have a change agenda. A lot remains to be seen, but [if confirmed] they could shape the national narrative around health."

The Rhetoric of Trump's Health Picks and Its Implications

The rhetoric of Trump's health picks suggests an administration that is willing to step away from the standard. For example, Kennedy is a vocal vaccine skeptic. Stubblefield noted that there has been commentary about wanting to move away from the suppression of information and allow for open, scientific debate. This could potentially lead to new scrutiny of vaccine and medication safety standards.This approach may ultimately fuel the move towards more flexibility in benefits coverage provisions, fewer mandates, and more deference to healthcare providers in decision-making. As Stubblefield explained, "There is a potential for a shift in priorities that could have a significant impact on the healthcare landscape."

Shifting Priorities on Health in the New Administration

Some of Trump's Cabinet picks were critics of Dr. Anthony Fauci's strategy during the COVID-19 pandemic. Stubblefield stated that their nominations indicate an administration that may de-emphasize the federal focus on infectious diseases and pivot more investment towards chronic diseases. At the same time, a federal emphasis on disease prevention for chronic diseases may shift attention to the inclusion of more holistic treatments.She added, "Hopefully, there will be a balanced dialogue there, but there's a lot to watch and wait for to see how this shapes up." This highlights the uncertainty and the need for careful observation as the new administration takes shape.

Revisiting Healthcare Insurance Standards

One of the most hotly debated healthcare-related issues under the incoming administration is the Affordable Care Act. Stubblefield cautioned that while Trump has a stated goal of "improving and optimizing" the ACA rather than repealing and replacing it, making the program more affordable is a challenging task.Some pundits have proposed that the administration may move to lower costs for younger populations, which could have implications for older Americans insured through the ACA. At the same time, many of Trump's Cabinet picks support Medicare privatization and could push for the continued expansion of Medicare Advantage plans.Stubblefield emphasized, "We've reached a state where it's almost 50/50 between enrollment in traditional and Advantage programs, and it's not faring well financially. How will that trickle into commercial coverage? Nothing exists in isolation in healthcare."

For Saja, two years ago when women were banned from universities in Afghanistan, studying nursing at a healthcare institute in Kabul became her last hope to achieve something. But now, the Taliban government's order to exclude Afghan women from medical training has dashed this ambition, causing panic across institutions. When she heard the news, it was as if she was "reliving the same nightmare."

Afghan Women's Nursing Dreams Crushed by Taliban's Decision

The Ban and Its Aftermath

After women were barred from universities, many like Saja turned to healthcare institutes. However, the Taliban government's order to expel women students from medical training has led to a chaotic situation. Multiple directors and employees of health training centres have been informed of this order, which was issued by the Taliban supreme leader and passed down verbally by the health ministry. Institutes across the country were given a few days to over a week to organise final exams, but without clear announcements or documents, confusion reigns. Some institutes are operating as normal until they receive written orders, while others have closed immediately or are scrambling to hold exams before shutting down. Some even refused to comment, fearing consequences.

Saja, who was in her first year at a private institute, said, "Everyone is confused, and no one is sharing what is really happening." She added that they were given two or three exams each day even though they had already finished their exams a few months back and had to pay fees to sit for these exams.

The director of a Kabul private institute with 1,100 students, 700 of whom were women, said, "No one is happy." He told AFP from his office steps away from women's classrooms where the last lesson on the board advised on how to manage stress and depression in patients.

The Number of Affected Women Students

According to a source within the health ministry, 35,000 women are currently students in some 10 public and more than 150 private institutes offering two-year diplomas in subjects like nursing, midwifery, dentistry and laboratory work. The Norwegian Afghanistan Committee (NAC), which trains 588 women in institutes managed in collaboration with the health ministry, was verbally informed that classes were "temporarily suspended." NAC country director Terje Magnusson Watterdal said this has to be taken "equally seriously as a written document" and that there are many people within the current government who are opposed to this decision. He hopes at least public institutes will be reopened to women.

The Impact on Midwifery Students

Midwifery students are particularly passionate about their studies. As Magnusson Watterdal said, "So many of these young women have been motivated to become a midwife because they have lost a mother or an aunt or a sister in childbirth. It's not just a profession; it's a vocation. So, of course, there's great desperation among students and staff."

Small protests have been held in various parts of the country as shown by sources and images circulated on social media. Another student, Assal, using a pseudonym, received an expedited diploma last week but still has little hope of finding a job in a country with widespread unemployment and limited opportunities for women. She said, "They had already taken everything from us. Next thing we won't even be allowed to breathe."