Trump’s Attack on the American Health System

More than 185 lawsuits have been filed against the Trump oligarchy for their blatantly illegal actions to remake the U.S. into a fascist nation.  You can find them all in the Litigation Tracker.

Some law firms have caved and kissed the ring, but 504 signed an amicus brief in the Perkins Coie case, 300 professors signed an open letter defying the administration, and the American Bar Association is hosting a national DEI training. Lawyers are one of the active arms fighting fascism today. Lower courts are mostly holding but the Supreme Court is a big problem.  

In Arizona, our Attorney General Kris Mayes has signed on to at least three lawsuits about attacks on public health. While things change daily, and it’s impossible to keep up, this is what was accurate on April 10, 2025.  

The First Shot: Health Research

The first lawsuit was filed by 22 state governments against the National Institute of Health (NIH) on February 10, challenging the administration’s attempt to cut $12 billion from health research. This Rate Change Notice for Arizona would be $239 million and hit tribes and rural communities the hardest. The lawsuit is Commonwealth of Massachusetts et al. v. National Institutes of Health et al., Case 1:25-cv-10338, filed in Massachusetts and asked for declaratory (say the law is wrong) and injunctive (stop them from doing it) relief.  

The issue is that the “indirect cost rates” that had been previously negotiated for each grant were reduced across the board to 15%. The “indirect cost rates” are the funds necessary to do the research, e.g., buildings, equipment, utilities, clerical and IT support. 

The Rate Change Notice will slash research grants for: 

• Gene editing
• Vaccines such as flu vaccines
• Vures for diseases like cancer, infectious diseases, and addiction
• Alzheimer’s and Parkinson’s disease research
• Pediatric and human development (including autism)
• Obstetrics, gynecology and reproductive health
• Cancer and stroke
• Kidney disease
• Diabetes
• Treatments for Duchenne muscular dystrophy
• Pain management for traumatic brain injury patients
• A cure for chronic HIV infection
• Stem-cell based therapy used to repair damaged heart muscle

Biomedical advancements that have resulted from earlier research include the first radiation treatment for cancer, research contributing to the first flu vaccine, the discovery of the role of LDL and HDL cholesterol in heart disease, and the invention of modern gene editing. The funding cut would stop the Human Genome Project and the MRI, as well as other treatments for cancers.  Dozens of NIH-supported scientists have earned Nobel Prizes for their groundbreaking scientific work.

Critical research and real-time data that these facilities provide, such as the regular testing of eggs, poultry, and milk for diseases (including avian influenza) and the emerging avian influenza pandemic, are also included. 

Felon47 tried this in his first term, and Congress responded by passing a law prohibiting it – a law this cut directly violates. The administration order applies retroactively, so money already spent will not be reimbursed. This is a typical practice by the oligarchy not to pay for work already done.   

The states argued that the Rate Change Notice violates the Administrative Procedure Act (APA) because it:

• Is arbitrary and capricious
• Fails to state the reasons for the categorical rate cap of 15%
• Fails to consider the grant recipients’ reliance on their negotiated rates
• Disregards the factual findings that formed the basis for the current negotiated indirect cost rates.
• Violates the law in the appropriation acts governing the NIH. When Trump issued the Rate Change Notice, he did not use the required notice and comment requirement of rulemaking.  

A blanket reduction to 15% would be fatal. In Arizona specifically, the University of Arizona had over $170 million in NIH funding in FY 2024. Arizona State University’s Tempe Campus was awarded over $65 million in NIH funding in FY 2024. 

►The lawsuit charges that the funding cut violates the APA because it is arbitrary, capricious, and an abuse of discretion. These grants are already awarded and incorporated into budgets. The cuts failed to consider the recipients’ interests, which is a required factor. These indirect rates were negotiated with each institution based on local facts. No justification was given for this reduction in this one-day notice of the reduction.

►The second cause of action is that it violated the Appropriations Act passed by Congress.

►The third cause of action is that the cuts violated the code of federal regulations that implement the appropriations law passed by Congress.  A different rate than that agreed to by the law can be used only after having notice and a hearing – not fiat from the administration.  

►The fourth cause of action is that the cuts were made without any authority. The Rate Change Notice was retroactive and such rate cannot be changed retroactively.

►The fifth cause of action was procedural violations of the APA, i.e., the administration did not follow the required procedures of notice, publication, and comment.

Based on these five reasons, the states asked the court to set aside the rule and issue a TRO, a preliminary injunction, and a permanent injunction prohibiting the implementation of the law. The states also asked the court to order the government to file a status report within 24 hours of the TRO and at regular intervals confirming that the funds were delivered.  

Within six hours of the suit being filed, the judge issued a Temporary Restraining Order (TRO) against it, barring the cuts. On March 5, the court extended the TRO to a nationwide preliminary injunction prohibiting the implementation of this guidance in any form. 

The Second Shot: Public Health Funding

On March 24, 2025, the USDHHS suddenly terminated $11 billion of public health funding. In response, the second lawsuit, State of Colorado et al. v. U.S. Department of Health and Human Services (USDHHS) et al., Case 1:25-cv-00121, was filed on April 1, 2025, in Rhode Island. The states allege terminating this funding violates the Administrative Procedure Act and have asked the court to vacate and enjoin the funding terminations.

The plaintiffs are 20 states, including Arizona, and two Democratic governors of Kentucky and Pennsylvania. This funding paid for:

• Identifying, tracking, and addressing infectious diseases
• Ensuring access to immunizations
• Fortifying emergency preparedness
• Providing mental health and substance abuse services
• Modernizing critical public health infrastructure.

To clarify, this suit calls this funding halt “Public Health Terminations.” The only reason given for the action was because the grants were related to COVID-19 laws, and the pandemic is over. This is demonstrably false. The law specifically says that such grants can be terminated “for cause” only on the “material failure” of the grant recipient. In fact, Congress did terminate some funding after the pandemic was declared over – so they do know how so.  If they had wished to terminate these grants, they could have. They didn’t and, in fact, specifically renewed them.  

The causes of action in this case echo the last – violations of the APA because of being arbitrary and capricious, ignoring the plaintiff’s reliance, and harmful impact.  

During the COVID-19 pandemic, Congress appropriated substantial funds to strengthen public health programs that were not tied to the duration of the COVID-19 pandemic. The goal was to respond to the devastation and place the nation on a path to recovery once the pandemic had ended, and ensure that the nation was better prepared for future public health threats. 

The funds attacked by the administration were for:

• Genome sequencing and surveillance
• Data modernization and forecasting
• Public health workforce development
• Public health investments in community health centers, teaching health centers, family planning, and nurses surveillance, epidemiology, laboratory capacity, infection control, mitigation, communications
• Preparedness and response activities
• Strengthening vaccine confidence and improve rates of vaccination throughout the United States.

In the notice, the termination was immediate and, in some cases, retroactive. The same termination notice was then sent about substance abuse funding (SAMHSA) so there are two different notices being addressed in the suit.  The SAMHSA notice involved block grants that are given to a state, not a university or individual.  The law specifically says that before taking action against a state, the federal government must give prior notice and opportunity for a hearing. They also must find material non-compliance with the terms and conditions to cancel.  The reason was to not allow the procedure to be used politically as it is here, by see-sawing between administrations with different political ideologies.

The causes of action here will sound familiar. First, SAMHSA violated the APA because it failed to issue termination notices, conduct an investigation or hold a hearing according to law, failed to find “for cause,” and failed to find material noncompliance.  

The second cause is the same violation by the CDC termination notices that do not find cause but simply state that the pandemic is over.  A “for cause” termination is allowed, but they must have a hearing and findings.  A simple declaration that the pandemic is over is not enough. 

The plaintiffs note that some paragraphs cite HHS regulations and some cite nothing.  It is clear the federal government is just throwing spaghetti on the wall and seeing if anything will stick.

The third cause of action is the violation of the APA for being arbitrary and capricious for all the terminations.  The administration is  (1) assuming, with no legal or factual support, that all appropriations in COVID-19-related laws were only intended for use during the pandemic, when the relevant statutes indicate the opposite; (2) failing to undertake any individualized assessments of the grants or cooperative agreements, including any analysis of the benefits of this public health funding or the dire consequences of termination; (3) ignoring the substantial reliance interests of Plaintiff States (and their local health jurisdictions) and the tremendously harmful impact of immediately terminating, without any advance warning, billions of dollars in congressionally appropriated funds midstream; (4) asserting that this public health funding was suddenly unnecessary due to the “end of the pandemic”—an event that occurred almost two years ago; (5)failing to explain HHS’s sudden change in position regarding availability of funds; and (6) arbitrarily misapplying a “for cause” termination provision.

One of the arguments made by the NY Attorney General Letticia James, was that the “power of the purse” belongs to Congress under Article I of the Constitution. The power of the president in Article II is to enforce the laws passed by Congress, not to change them. 

For the remedy, the states ask that the court set aside the terminations, declare them unlawful acts, enjoin (stop) the federal government from implementing any of them, award fees and costs, including attorney fees, and do anything else the judge likes. On April 1, the states filed a motion for a TRO to block any implementation or enforcement of the terminations.

The Third Shot: Terminating DEI Health Programs

Sixteen states brought the third lawsuit, the Commonwealth of Massachusetts et al v. Robert F. Kennedy et al. Case 1:25-cv-10814, filed in Massachusetts on April 4, 2025. The states argue the administration violated the Administrative Procedure Act, the U.S. Constitution’s separation of powers, and the Spending Clause.

The National Institutes of Health (NIH) started in 1887 and now consists of 27 institutes around the U.S. NIH scientists pioneered the rubella vaccine, eradicating a disease that, in the 1960s, killed thousands of babies and left thousands more with lifelong disabilities. I’m sure we are aware that this is recurring in Texas now and spreading among unvaccinated children and adults. For us boomers, be sure to get your measles booster if you have not.

NIH studies led to the discovery of the BRCA mutation, helping countless Americans reduce their risk of breast and ovarian cancer.  NIH research fueled the development of treatments for HIV and AIDS, transforming what used to be a fatal disease into one with a nearly normal life expectancy. Other issues studied include COVID-19, Ebola virus disease (EVD), and influenza (flu).”  A Notice is required in the federal register. I know most of us don’t read the federal register with our morning coffee but those in the field do read it. It is hard to find a medical breakthrough in recent years that has not been assisted—whether directly or indirectly—by NIH’s pioneering work.

The other benefit of the grants is training the next generation of doctors, researchers, and biomedical entrepreneurs. They have ensured that crucial innovations take place in American institutions—allowing the United States to reap the economic benefits of those discoveries. In Fiscal Year 2024 alone, NIH’s more than $36 billion in awards spurred more than $94 billion in new economic activity—a return of $2.56 for every $1 invested. These investments supported more than 407,000 jobs across every State and the District of Columbia. Thus, the intent of this cut is not to reduce costs, waste or fraud. 

The administration has used the delay in the review and approval of applications and terminations of already-issued grants. Plaintiffs challenge both actions. The delay violates the APA and violates separation of powers required by the Constitution. The grants were terminated because of “DEI,” “transgender issues,” or for investigating “vaccine hesitancy.”  

However, Congress has specifically ordered that the NIH increase women and vulnerable individuals in biomedical and behavioral research; improve research related to the health of sexual and gender minority populations; improve women’s health, including reproductive health and the prevalence of certain heart conditions in women, “including African-American women and other women who are members of racial or ethnic minority groups.”  

Congress has established a National Institute on Minority Health and Health Disparities to support research and training “with respect to minority health conditions and other populations with health disparities. Congress has established an Office of Research on Women’s Health within NIH to “determine the extent to which women are represented among senior physicians and scientists of the national research institutes and among physicians and scientists conducting research with funds provided by such institutes, and as appropriate, carry out activities to increase the extent of such representation.”  

Congress has instructed the Secretary of Health and Human Services to award Ruth L. Kirschstein National Research Service Awards “in a manner that will result in the recruitment of women, and individuals from disadvantaged backgrounds (including racial and ethnic minorities), into fields of biomedical or behavioral research and in the provision of research training to women and such individuals.” The president cannot unliterally change or suspend the laws passed by Congress.  

These grants are also not issued as lump sums but pay-as-you-go with reimbursement so the recipient must be stable enough to do that. The recipient can also obtain a line of credit based on the award to sustain themselves.  

Some projects axed include “Elucidation of the mechanisms by which Ms4a genes regulate neurodegeneration in Alzheimer’s Disease and related disorders,” and work on HIV and COVID as well as including diseases of emerging concern such as Dengue, Chikungunya, and Zika, as well as women experiencing domestic violence, children at risk of suicide, and minorities at a higher risk of chronic or infectious diseases.

The studies were terminated without any bridge money to assist patients in finding other services. This can be extremely dangerous for both physical and psychological issues. The termination of the grants often means that researchers cannot fully evaluate whether an intervention is statistically effective—essentially wasting the valuable resources already expended and delaying scientific progress, stifling innovation, and impeding the development of new medical treatments, technologies, and public health initiatives.

One of UMCP’s stalled submissions is the Bucharest Early Intervention Project, a landmark child development study that has followed a group of individuals, some of whom were raised in institutions for more than 20 years. Another terminated grant funded a study at UMB involving more than 1000 people who underwent diagnostic tests as part of the funded study. The people consented to the study based on the understanding that they would be provided with test results that could be important to their health. The abrupt termination of the grant takes away federal funding for providing subjects with those test results.

The work being done by these centers is longitudinal and the lapse in funding will mean loss of critical cohorts that have been studied in some cases up to 40 years in one Alzheimer’s study. This is the waste going on. Other studies focused on trauma research for victims of sexual assault, prevention of chlamydia infections, and the impact of air pollution on Alzheimer’s disease and related dementias, among other topics. These grants are to fund research on infectious disease, vaccine development, minority health disparities, and child health and human development. 

In Arizona, multiple of Arizona State University’s NIH-funded projects have been paused or terminated. Northern Arizona University received a termination notification of an award, “Bridging Arizona Native American Students to Bachelor Degrees,” that funds a transfer program of students from two-year associate degree programs at Coconino Community College to four-year baccalaureate degree programs at Northern Arizona University. This program will cease for current students, jeopardizing the likelihood that they transfer to Northern Arizona University and complete a baccalaureate degree. Northern Arizona University has 34 proposals, representing approximately $47 million, submitted to NIH for which it has not received a response. Arizona State University, Northern Arizona University, and the University of Arizona in Fiscal Year 2024, managed approximately 425 NIH awards totaling over $229 million.

Once interrupted, these studies cannot be simply restarted. In many cases, there is no way to recover the lost time, research continuity, or training value for graduate students and postdoctoral researchers. Promising discoveries may be delayed indefinitely and, in some cases, entirely lost.

The plaintiff states argue that this action traces back to Executive Order (EO) 14151 entitled “Ending Radical Government DEI Programs and Preferencing” (DEI Order), EO14168, entitled “Defending Women from Gender Ideology Extremism and Restoring Biological Truth to the Federal Government” (Gender Ideology Order) and EO 14173, entitled “Ending Illegal Discrimination and Restoring Merit-Based Opportunity” (Discrimination Order). 

Because of those EOs, on February 10, Acting Secretary of Health and Human Services Dorothy Fink issued a memorandum implementing the EO related to DEI. That memorandum “DIRECT[ED]” all HHS personnel, including NIH, to “pause all payments made to . . . grantees related to DEI and similar programs for internal review for payment integrity. . . . [I]f after review, the Department has determined that a contract is inconsistent with Department priorities and no longer in the interest of government . . . grants may be terminated in accordance with federal law.”

The same day Fink then issued a “Secretarial Directive on DEI-Related Funding,”  to pause all payments for internal review after which the Department would determine whether to continue or terminate the grant “in accordance with federal law.” Federal law requires notice, hearing, and a fact finding of cause i.e. a violation by the recipient – none of which occurred.  

In a nod to earlier federal rulings, on February 12, Mike Lauer, then NIH’s Deputy Director for Extramural Research, sent a memo directing that “given recent court orders” in federal court actions related to funding freezes, NIH institutes and centers were “authorized, along with their respective grant management staff, to proceed with issuing awards for all competing, non-competing continuation, and administrative supplements . . . grants.”

But the next day, Mr. Lauer instructed Chief Grants Management Officers that “[i]f the sole purpose of the grant . . . supports DEI activities, then the award must be fully restricted.” It also called for “hard funding restrictions” where the program promotes initiatives that “discriminate” on the basis of race, sex, or other protected characteristics.  Lauer was allegedly forced out because of his Feb. 12 memo in which he attempted to follow the law. To cover what they were doing (acting on the EOs) the staff was directed to only refer to NIH and HHS priorities.  

The “diversity supplements” were cancelled that were meant to increase diversity in the scientific profession by providing training, mentorship and career development opportunities to individuals from underrepresented populations including “[i]ndividuals with disabilities,” and “[i]ndividuals from disadvantaged backgrounds,” including those who have experienced homelessness, who were in foster care, who experienced poverty, or who are from rural areas. So this would hit poor whites too.

The administration also deleted grants for studies that were to ascertain why vaccine hesitancy was growing in the U.S.  and how to improve levels. I could answer that – lies told by the administration and conspiracy theorists magnified in social media has resulted in low coverage. I think we all know how to improve it.  COVID-19 was then added to the “cut” list which is a blow to those suffering from long-haul COVID.

The administration also tried to hide what it was doing by delay and then cancellation of the meetings of the advisory council or study section meetings so grants could not be discussed or approved. When they began holding them again after 2 months, it was basically half of what had been done before. Of course hundreds of workers were laid off making it impossible to resume the workload. In addition, they have been systematically delaying and withholding final decisions on applications that have already been vetted and were recommended. The administration consulted with none of the NIH program officers working on these specific grants which is not surprising since this administration knows nothing about how a government works and doesn’t want to.

You will recognize again the Causes of Action. The first cause is a violation of the APA because of the unlawful withholding and unreasonable delay of action. The APA uses the language of “shall” in its directions to agencies.  “Shall” in legalese means they are obligated to do it.  It is not discretionary.  

The second cause is the APA unlawful withholding and unreasonable delay of agency action on the applications for the same reason. The third cause is the APA unlawful withholding and unreasonable delay of agency action as to the delayed renewals for the same reason. The fourth violation is APA termination of the grants without cause and without proper procedure under the regulation. The fifth violation is APA termination of the grants without cause and without proper procedure under the statute. These are also beyond statutory authority because the administration cannot override a Congressional statute.

The sixth violation of APA is because the action was arbitrary and capricious for the terminated grants because it was not done based on any of the possible reasons in the authorizing statute.  Defendants also did not consider the plaintiffs reliance interests in the projects, and other potential resolutions as required by the statute but relied on factors Congress did not authorize such as the EO.

The seventh reason is a violation of the separation of powers i.e. Congress controls the purse strings and the legislative power. The administration has no power to repeal or amend laws. Rather it is the duty of the executive to “take Care that the Laws be faithfully executed.” U.S. Const. Art. II, Sec. 3. The administration is violating this all over the place. If the executive dislikes a law or funding, there is a way to protest it by going to Congress. But he cannot unilaterally by EOs change the law or refuse to implement it.  

The eighth and final cause of action is the spending clause violation. The Spending Clause of the U.S. Constitution, art. I, §8, cl. 1, provides that Congress—not the Executive—“shall have Power to lay and collect Taxes, Duties, Imposts and Excises, to pay the Debts and provide for the common Defence and general Welfare of the United States.”  Note this would apply to tariffs also.

This clause requires States to have fair notice of the terms that apply to the disbursement of funds to them. The funding conditions must be set out “unambiguously.” And the federal statute must be viewed “from the perspective of a state official who is engaged in the process of deciding whether the State should accept [federal statute] funds and the obligations that go with those funds.” Thus the delays and terminations violate the principle that funding restrictions can only impose conditions that are reasonably related to the federal interest in the project and the project’s objectives. 

In their prayer for relief, they asked for an injunction, start up and speed up the advisory councils and study sections,  to issue the final decisions on the delayed applications and renewals, to grant a preliminary and permanent injunction barring the NIH from withholding funds or terminating grants, to declare that the actions were unconstitutional, and to award other relief as justice requires.

When I checked the tracker on this one, it had not yet been entered as the tracker was only accurate up to April 2. By looking on PACER (a federal court information service), I found that the states withdrew their motion for a TRO and instead moved for a preliminary injunction for which a briefing schedule was set.

Conclusion

Is there bias in our scientific and medical studies, of course there is. We live in a society born of racism and sexism so there will be bias. A scalpel is needed not a chainsaw. The actions of the administration are designed to make it worse not better.  

Is there waste and corruption? I’m sure there is. But the actions of the administration, from day one, illustrate corruption on a level we have never seen since the Tea Pot Dome in the 1920s in which administration officials went to prison.  

These actions will have long term negative consequences. Several countries have already set up programs to entice fired American researchers, scientists, doctors, and graduate students. These countries include France, Germany, Spain, Belgium, the Netherlands, Austria, Bulgaria, Czech Republic, Estonia, Greece, Latvia, Romania, Slovakia, and Slovenia.  Students can go to college and graduate school free in Slovenia. In Canada, Manitoba and other provinces have rolled out the welcome mat. Two law professors specializing in studying fascism have already rolled up their mats and fled to Canada to avoid potential abduction by masked government agents.    

This brain drain will assure that the United States will no longer be the leader in scientific or medical research and we all will be the poorer for that.