THE gathering threat to Donald Trump of the imminent likely release of the Epstein files comes at a time when the Republican Party, and Trump’s far-right, authoritarian agenda are increasingly unpopular on almost every major issue.

The various elections in New York and across the US on November 4 showed a comprehensive rejection of Republicans and their supporters, even in areas where Trump won strongly a year ago.

A few weeks earlier an extraordinary series of 2,700 anti-Trump “No Kings” demonstrations mobilised an estimated seven million Americans across all 50 US states on October 18, significantly more than the initial June protest. There are signs, too, that Trump’s “Make America Great Again” base is beginning to fracture, with some Republican politicians breaking ranks.

Even on the populist issue of immigration, a Gallup poll in June found support for the idea that immigration is a “good thing” for the US had risen from 64 per cent in 2024 to 79 per cent, while the proportion of voters who see it as a “bad thing” had fallen from 32 per cent to just 20 per cent.

And amid a torrent of social media clips showing the brutal actions of the masked, warrantless thugs employed by US Immigration and Customs Enforcement (Ice), and the increasing evidence that their targets have been harmless, hard-working mums, dads and children (and significant numbers of US citizens) rather than Trump’s claim that they would be targeting illegal aliens, rapists, paedophiles and criminal gangs, a YouGov-Yahoo! poll found the net favourability rating of Ice had plummeted from 15 per cent in February to -13 per cent in June.

But Trump’s policies on health and healthcare are also seriously unpopular, and the end to the prolonged eight-week government shutdown now brings the US closer to a reckoning with the consequences of some of the most heavy-handed cuts — with much worse to come as the so-called “One Big Beautiful Bill” takes effect.

While some of the biggest cuts — over $1 trillion over 10 years from spending on Medicaid, the federal and state-funded healthcare for low-income families, and a likely resultant closure of up to 300 rural hospitals — are postponed in the OBBB until after the mid-term elections next November, other measures are due to take effect almost immediately.

Tax credits that help people on lower and middle incomes afford health insurance under Barack Obama’s Affordable Care Act will be allowed to expire at the end of this year. This change is expected to cause a massive, unpayable increase in premiums that will result in five million individuals losing what limited health insurance they had, and joining the 27 million already uninsured — in a country where over 60 per cent of bankruptcies (well over 500,000 per year) are due to medical bills.

MSNBC TV presenter Rachel Maddow highlighted the scale of the premium increases that are a key issue at the centre of the government shutdown, because Democrats were refusing to agree a budget unless it extended the ACA tax credits.

Maddow pointed out that without a change of line subsidies would disappear entirely for individuals and families with household incomes above 400 per cent of the ($16,000) federal poverty level (FPL). A 63-year-old couple in West Virginia earning $85,000 could see the monthly premium for their lowest-cost “gold” plan soar from $300 to over $4,700.

A September 2025 analysis by KFF (an independent source for health policy research, polling, and journalism) found that if the enhanced subsidies expire, average premiums for ACA plans could more than double for the 22 million Americans who currently receive the credits, with some families facing thousands, or tens of thousands of dollars in extra health insurance costs.

The shock of the ending of the subsidies will still be having an impact on millions of Americans when the proposed cuts in Medicaid are rolled out in 2027. Medicaid cuts are extremely unpopular across the political spectrum: a KFF poll in May reported that 75 per cent of the public, including 95 per cent of Democrats, 79 per cent of independents, and 55 per cent of Republicans, opposed major federal funding cuts to Medicaid. Even among supporters of Trump’s “Make America Great Again” (Maga) movement, only 51 per cent supported Medicaid cuts.

Trump proposals already passed also include a $12 billion (17 per cent) cut next year in the Veterans Administration (VA) budget for medical services, resulting in protests by veterans — who had voted 61 per cent Trump to 37 per cent Harris in the 2024 election.

Trump’s cuts to VA health provision include a net loss of thousands of healthcare positions (the only net loss in the last five years). Jobs axed include 688 doctors, 1,882 registered nurses, 365 licensed practical nurses, 316 nurse assistants, 511 social workers, 201 psychologists, and 766 medical support assistants. Trump’s administration is also seeking to privatise more and more of the VA health provision — which threatens the quality and local accessibility of VA service, which are tailored to the needs of veterans.

The government department that governs the payments for Medicare (publicly funded health care for seniors) Medicaid and the Veterans Health Administration is Health and Human Services (HHS). Trump installed anti-vax crank Robert F Kennedy Jnr as its secretary, encouraging him to “go wild on health.”

He has definitely done that, sacking an entire committee in charge of vaccine policies and replacing them with anti-vax extremists, cutting a quarter of HHS staff, among them:

• 3,500 at the Food and Drug Administration (FDA), which ensures the safety and effectiveness of medicines and medical devices and regulates food, cosmetics, and tobacco products.
• 2,400 at Centres for Disease Control and Prevention (CDC), charged with protecting the US people from health threats including infectious diseases like measles and bird flu, with mass “reductions in force” across most CDC offices, including domestic violence prevention; Smoking and Health; HIV prevention, Tuberculosis elimination and asthma control.
• Two-thirds (nearly 900 people) from the CDC’s National Institute for Occupational Safety and Health (NIOSH) who are experts in workers’ health and safety on the job, particularly in mining, the maritime industry and firefighting.
• RFK also halved the staff of the Substance Abuse and Mental Health Services Administration (SAMHSA) responsible for services and support to people for mental health. The agency plays a leading role in tackling the fentanyl and opioid crisis, and it oversees the 988 Suicide and Crisis Lifeline.
• 1,100 staff at the National Institutes of Health (NIH) the nation’s premier biomedical research agency were fired, before Trump nominee Jay Bhattacharya took over as head of the NIH, and sacked another 1,300 NIH scientists and staff, including the country’s top infectious diseases official.
• In late April all 28 members of the Board of Scientific Advisers to the National Cancer Institute (NCI) were fired by the NIH.

As this chaos indicates, the US population is facing an all-round Trump-instigated and RFK-fuelled onslaught on health insurance, health services and health science. But each of these attacks are further radicalising the voting public, and undermining Trump’s populist Maga base which is set to suffer the brunt of the cutbacks.

The challenge now is to develop a genuine alternative that will take up the fight for a national health programme that is collectively funded, rather than the disastrous insurance-based system, and for rational, science-based and evidence-based policies in place of Kennedy’s nonsense.

Wealth versus Health – Trump’s Global War on Health and Science by John Lister is available now as paperback or ebook from Amazon or from keepournhspublic.com.