Nobody Could Have Predicted

Trump transition nearly a month behind on key policy prep https://t.co/Uu4h6u3ypK

— POLITICO (@politico) December 7, 2024

That puts Trump officials nearly a month behind their recent predecessors, who began what is known as the “agency review” process — meeting with existing agency staff and getting briefed on major policy issues and challenges — right after the election, to ensure their incoming administrations would be up to speed. Trump, however, delayed for months in signing an agreement with the Biden administration to authorize those teams, before finally reaching a deal just before Thanksgiving. 

Amid other transition delays — including in processing security clearances — former officials in both parties say this lag in beginning the usual crash course in agency operations only adds to the obstacles Trump will face as he looks to rapidly implement his sweeping policy agenda. That’s particularly true in areas like health policy, where few of the president-elect’s picks to lead the agencies have any experience in government or in managing such large and complex bureaucracies. 

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“They’re really operating, I would say, at a severe disadvantage,” said Kathleen Sebelius, the secretary of Health and Human Services under President Barack Obama. “It has been decades and decades since somebody has been in these Cabinet offices without any sort of expertise or experience. And there are lots of barriers built into the structure of a huge agency like HHS, where you really can’t just come in and wave a magic wand and say, ‘You used to do things this way, and now we’re going to do it differently.’”

But her email servers!

Even after Trump’s landing teams begin arriving at their assigned agencies for meetings and briefings this year, they are likely to be hampered by Trump’s refusal to sign a separate transition agreement with the General Services Administration and instead run the transition on private funds out of private facilities using private email servers with federal cybersecurity support. 

“Agencies would normally be prepared to start sharing unclassified information now,” said Valerie Smith Boyd, the director of the Center for Presidential Transition at the nonpartisan nonprofit Partnership for Public Service, which assists all parties with transition planning. “But in the absence of a GSA-secure network, individual agencies will need to rely on their best practices for sharing controlled but unclassified information — anything that might be kind of more sensitive than the norm, like law enforcement information.” 

Rather than swiftly sharing data over email, she added, “That type of information they might choose to share only on paper or standalone terminals,” within the agency buildings, “but they may not feel comfortable transmitting that over a non-government provided network.”

And past is prologue:

“The most dangerous implications are for national security, and that includes health security,” stressed Democratic health care strategist Chris Jennings, who has served on both sides of several presidential transitions, including Biden’s transition in 2020. “They need to be briefed up and prepared to quickly act on viral, microbial, and chemical warfare threats. You can’t afford to play around with those. They are predictably unpredictable risks that can’t wait for officials to be briefed up on ramifications and needed remedies months into an administration.” 

Trump is poised to enter office in January amid a troubling outbreak of bird flu that public health experts worry could quickly balloon into a threat to the food supply or the general population, as well as a resurgence of once-rare childhood illnesses like whooping cough and measles. Health officials and outside experts who recall Trump’s chaotic Covid-19 response during his first term now fear the combination of his current nominees’ disdain for mainstream science, their expressed desire to move away from funding infectious disease research, and their failure to use the transition period to properly prepare could mean a slow or inadequate response to future health crises that put the general public in danger. 

Trump’s surgeon general in his first term, Jerome Adams, warned in a post on X that the new administration runs the risk of being “distracted with outbreaks for 4 years this time instead of 1.” 

Trump’s penchant for bucking the usual transition processes isn’t new. When preparing to enter the White House in 2017, he threw out months of work prepared by then-transition chair Chris Christie in a shakeup of his transition leadership, was slow to put together agency review teams, and ignored briefing materials compiled by the outgoing Obama administration — including a nearly 70-page “pandemic playbook” that they were given years before Covid-19 struck.

Suddenly I’m not that worried about Trump forcing the Senate into recess or deporting millions on Day One. 🎅 Not that I’m feeling particularly comfortable with four more years of incompetence.

But Leslie Dach, a former senior counselor at HHS during the Obama administration who now works for the health advocacy group Protect Our Care, cautioned that Trump’s officials could still accomplish a lot through inaction, particularly with the Affordable Care Act’s enhanced tax credits set to expire in 2025. 

“They just have to sit on their hands and 5 million people will lose their insurance and you more than 15 million others would be bankrupt, possibly, by their health insurance premiums,” he said, adding that there were many other low-effort ways they could undermine Obamacare. “You can shorten open enrollment, eliminate the special enrollment period, shut down the call centers over the weekends, like they’ve done before, and all of a sudden you would lower the number of people with health insurance dramatically. You can show up to work late, leave early, and take health care away from millions of people.”

Yeah, it’s not all sunshine and lollipops.🍭