Inside the ‘Make America Healthy Again’ push that’s perplexing health leaders

Welcome to the start of another October weekend — or as I think of it, another perfect weekend to rewatch "The Hunt for Red October." (And if it's one of your favorite movies too, might I suggest this retrospective on Tom Clancy , written by a familiar health reporter?) Send your tips and own weekend rewatchables to .

Today's edition: Texas is suing a doctor for allegedly providing gender-affirming care to minors in violation of state law. Tobacco use among U.S. youths hit a 25-year low. But first ...

The MAHA moment

Donald Trump-Robert F. Kennedy Jr. political alliance has an official brand: MAHA.

"Don't you want a president that's going to make America healthy again?" Kennedy said to Trump supporters at an Arizona rally two months ago, winning cheers as he officially endorsed his onetime rival. The slogan riffs off Trump's own "Make America Great Again" pledge, or MAGA.

Expect to hear more about MAHA as the Trump campaign tries to make it part of their closing message, hoping to win over voters who are skeptical about Trump but are worried about childhood obesity, chronic disease and other bipartisan problems. Kennedy, Trump and several health experts are set to hold a virtual town hall on Tuesday, further focusing attention on their still-developing plan.

In The Washington Post today , Rachel RoubeinLauren Weber and I delve into the mechanics of MAHA — where it came from, how it emerged and the skepticism, even among former Trump officials, that Trump and Kennedy can deliver on what they're promising.

There's widespread consensus: We're too sick. Experts have long complained that the U.S. health system is skewed toward treating illnesses rather than addressing its root causes. A Post series last year found that too many Americans were dying too soon .

But there's also little political will to make transformative changes around diet, fitness and other factors contributing to America's poor health, because it would involve fighting industry and making long-term investments that might not pay off for years, as The Post detailed.

"We're paying for the cost of inaction on issues such as chronic disease prevention," said J. Nadine Gracia, the president of Trust for America's Health, a nonpartisan public health policy, research and advocacy organization.

MAHA represents a political shift.

While some politicians like Sens. Elizabeth Warren (D-Mass.) and Bernie Sanders (I-Vt.) have demanded big government actions on chronic disease, Republicans hadn't really elevated it as a national issue. Until now.

"This traditionally has been much more a concern on the left," said Helena Bottemiller Evich, a journalist who writes Food Fix and has covered the politics of food policy for 15 years. "What I think we're seeing now is a real realignment, and it's happened really fast."

Kennedy, who initially ran for president as a Democrat before pivoting to an independent run, has long been fixated on the risks of chemicals in the environment. When he threw his support to Trump, he received assurances from Trump that he'd play a role shaping personnel and policy in the next administration, Kennedy has said.

Now the two men are trying to rebrand themselves as champions of public health. Experts are happy that chronic disease has suddenly become a presidential campaign priority — but not sure how to feel about the message coming from Trump and Kennedy.

Kennedy gained national attention as an anti-vaccine activist, alarming the public health community for years. And as president, Trump oversaw a rollback of environmental protections — which Kennedy himself repeatedly criticized as a public health threat and called "despicable" as it was happening.

The MAHA ambitions are big — and may not be feasible.

The movement is calling for changes that are far more aggressive than policymakers typically propose.

For instance, Trust for America's Health released a blueprint this month that lays out recommendations for the next administration, whether Democrat or Republican. It's a collection of ideas that are generally endorsed by prominent health leaders on both sides of the aisle, such as calling on the next administration to invest in the nation's public health agencies as part of a plan to combat chronic disease.

Compare that to an op-ed by Kennedy that lays out the MAHA agenda, which calls for gutting those agencies and transforming how the Food and Drug Administration is funded.

Even some former Trump officials predict that MAHA would run into roadblocks, given the workings of Washington and Trump's history of making sweeping promises, like his 2016 campaign vow to repeal the Affordable Care Act, and his failure to fulfill them.

One more takeaway from our : There's agreement that dramatic action is needed but little confidence that Trump and Kennedy are the right people to lead it.

State scanPaxton accuses doctor of providing gender-affirming care unlawfully

Texas Attorney General Ken Paxton (R) is suing a Dallas pediatrician, alleging she provided hormone replacement therapy to 21 minors in violation of the state's gender-affirming care ban.

The lawsuit , which appears to be the first of its kind, accuses May C. Lau of misleading pharmacies, insurance providers and patients by falsifying records to indicate that her testosterone prescriptions were for purposes other than gender transition. Lau is an adolescent medicine physician at Children's Health Center Dallas and an associate professor at the University of Texas Southwestern Medical Center.

"Our top priority is the health and well being of our patients," Children's Health said in a statement, emphasizing that the health-care system "adheres to all state health care laws." Neither Lau nor UT Southwestern responded to a request for comment.

Next steps: Paxton is asking the Collin County district court for a temporary injunction against Lau and is pushing for fines of $10,000 for each alleged violation. If found guilty of violating the state's ban, she could also lose her medical license.

Meanwhile ...

A federal judge ordered Florida to stop threatening television stations with criminal charges if they run a political ad calling for the repeal of the state's six-week abortion ban, The Post's Lori Rozsa reports.

Key context: Proponents of Amendment 4, which would enshrine abortion rights in the state's constitution, filed a lawsuit on Wednesday after the Florida Department of Health sent cease-and-desist letters to stations demanding they pull the advertisement .

Chief U.S. District Judge Mark Walker called the demand "unconstitutional coercion" by the state, which he said violates the First Amendment. He issued a temporary injunction against the state, which lasts until Oct. 29 — a week before the Nov. 5 election.

The view from abortion rights advocates: "This critical initial victory is a triumph for every Floridian who believes in democracy and the sanctity of the First Amendment," said Lauren Brenzel, campaign director of Yes on 4.

The view from the state: "The ads are unequivocally false and put the lives and health of pregnant women at risk," said Julia Friedland, deputy press secretary for Gov. Ron DeSantis (R), who criticized the decision as "another order that excites the press."

Agency alertSurvey: Tobacco use among young people hits lowest level in 25 years

In 2024, U.S. middle and high school students reported using a tobacco product in the past month, down from in 2023, according to the National Youth Tobacco Survey by the FDA and the Centers for Disease Control and Prevention.

Federal health officials said the decline is mainly due to a notable drop in e-cigarette use , which fell from in 2023 to in 2024. Cigarette smoking also hit a record low, with just of students reporting current use.

Yes, but: Despite the overall decline, e-cigarettes remain the most commonly used tobacco product among youths for the consecutive year. This comes as the federal government has tightened its regulation of the vaping industry and ramped up its efforts to crack down on illegal distribution and sales.

From our notebookScott Gottlieb calls for a 'refocus' of CDC role

Dan also sent this update: Writing in JAMA Health Forum , the Trump-era FDA commissioner concludes that the CDC's "sprawling mandate" is creating bureaucratic inefficiency, slowing down public health responses and harming the agency's image.

Gottlieb cites an example from his time trying to crack down on e-cigarettes, when he says FDA's enforcement efforts were delayed by CDC dawdling on data collection. "Allowing certain activities to be transferred to other agencies in exchange for a strengthened infectious-disease control budget could set the stage for a revitalization of CDC," Gottlieb argues.

The piece got some attention on CDC's Atlanta campus, where Gottlieb is not universally popular after criticizing elements of the agency's covid-19 response. But some CDC officials conceded he had a point about the value of streamlining the agency's bureaucracy, even if they were skeptical about winning budget increases for infectious-disease control.

Industry RxThe big business that opposes wiping medical debt from credit reports

The booming medical debt collection industry is warning that a proposal championed by Vice President Kamala Harris would threaten their work, The Post's Peter Whoriskey reports .

Key context: Private equity firms and others have poured millions into debt collection companies, which chase payments from insurers and patients on behalf of doctors and hospitals, taking a cut of what they recover.

The Harris-led initiative , currently undergoing review by the Consumer Financial Protection Bureau, would remove medical debt from credit reports used for mortgages, car loans and credit cards — a key pillar of her presidential campaign's economic agenda .

The response: Supporters say the new rules would help people facing unexpected medical bills, but the nation's debt collectors argue it would make it too easy for patients to shirk their financial responsibilities. Bankers, who rely on the credit reports to make decisions on loans and other transactions, are also opposed.

If finalized, collections industry executives predict that more debt collectors would file lawsuits against patients and lenders would reduce offerings due to a lack of information. They also warn the move could hurt the finances of struggling hospitals and medical practices.

Health-care providers appear split on the topic. Some favor the proposal, saying the burden of the debts prevents the sick from seeking necessary treatment; while others worry it could shrink their revenue.

Quote of the week Health reads Legal marijuana contains dangerous mold. States approve it anyway. (By Ben Warren and Julie Wernau | The Wall Street Journal)

'Unlimited dollars': how an Indiana hospital chain took over a region and jacked up prices (By George Joseph, Will Craft and Jessica Glenza | The Guardian)

Opponents of Missouri Abortion Rights Amendment Turn to Anti-Trans Messaging and Misinformation (By Jeremy Kohler | ProPublica)

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