Life, Liberty, Property #142: Trump Administration Appoints Health Care Affordability Czar
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- Trump Administration Appoints Health Care Affordability Czar
- Video of the Week: Lee Zeldin defends ‘controversial’ record as head of EPA at Heartland Institute Climate Conference
- States’ Legislative Pushback Against ESG Has Been Slow
- States Look to Limit Access to Courts
Trump Administration Appoints Health Care Affordability Czar
The U.S. Department of Health and Human Services is appointing first-term Trump administration Council of Economic Advisers member Casey Mulligan to a newly created position of chief economist and chief regulatory officer.
In an exclusive report on the decision, Axios states the obvious, saying, “The personnel move suggests the administration is attempting to respond to voters’ concerns about health care costs ahead of the midterm elections.” The article continues,
Health care affordability is emerging as a key political issue as health care costs continue to rise.
- Policymakers and think tanks on both sides of the aisle have been responding with aggressive policy ideas, though tackling underlying health costs would be an enormously difficult political endeavor.
Tellingly, the exclusive Axios story appeared early on Thursday morning, promoted at X at 6:00 a.m. Eastern time, shortly before HHS Secretary Robert Kennedy Jr. was to testify before the House Appropriations Committee to discuss the department’s proposed 2027 budget. The Washington Post described the hearing accurately as “contentious.” Democrat representatives had their knives out for Kennedy, having sharpened them for the past seven months, in which they have not had a chance to go at him in person:
Kennedy’s health department has recently undergone a major leadership shake-up, and he’s leaned into his messaging around food and nutrition as GOP pollsters warn of the political risks of vaccine skepticism ahead of the midterms. But for hours on Thursday, lawmakers quizzed him on vaccines, fraud in federal government programs and the budget request for his department.
Along with the increasingly popular issue of nutrition, Kennedy emphasized affordability in his comments, the Post story notes:
Kennedy is known for speaking off the cuff, sharing conspiracy theories and anti-vaccine claims. But in recent months, he has adopted administration talking points around affordability and nutrition as the upcoming midterm elections loom.
Kennedy largely stayed on message Thursday.
Committee Democrats kept the spotlight on vaccines, an issue on which Kennedy is vulnerable, the Post noted:
Rep. Madeleine Dean (D-Pennsylvania) … said she was “deeply troubled” that vaccine rates are declining. The exchange became feisty as Kennedy accused Dean of not having the “courage” to let him reply to her questions and argued vaccination rates dropped after the coronavirus pandemic due to mismanagement and not because of his leadership.
The timing of the decline is a fact, not an argument, it is worth noting.
Another Democrat representative suggested that the HHS decision not to recommend the hepatitis B vaccine for all newborns somehow caused an adult to die, the Post reports:
The Centers for Disease Control and Prevention moved to eliminate a long-standing recommendation for all newborns to receive a hepatitis B vaccine shortly after birth, which public health experts have credited with dramatically reducing infections. The move is on hold by a federal judge.
Rep. Judy Chu (D-California) criticized the decision, telling a story of a friend and city council member in her district who died of liver cancer. Kennedy, who has repeatedly questioned why newborns should receive the shot, called hepatitis B a “terrible disease,” but said the vaccine has not been safety tested and parents should be allowed to question its risk profile. Health authorities say the shot is safe.
The Post’s addendum that “the shot is safe” is a classic example of sneaky editorialization in news stories. In addition, the Post story does not acknowledge that the overwhelming majority of infants do not need the vaccine: the major risk of exposure to the disease is in the womb of the mother. Health care providers routinely test expectant mothers for infection.
Despite their objections to Kennedy’s policies, House Democrats expressed eagerness to give him more money to waste spend. The Post reports:
The White House’s fiscal 2027 budget somewhat mirrors the cuts that Trump proposed last year, as well as seeking to consolidate several agencies into the Administration for a Healthy America.Kennedy defended the proposed cuts, although at one point he noted if given money, he would spend it. Lawmakers last year mostly snubbed the health department’s budget request.
“It’s easy to demonize OMB and Russ Vought,” Kennedy said, referring to Trump’s budget chief. “But Russ Vought is looking out for our country. We have a $39 trillion debt.”
In a notable exchange with Rep. Gwen Moore (D-Wisconsin), who pushed him on how the Trump administration could cut programs meant to help children’s nutrition, Kennedy said he wasn’t happy about the cuts.
“Nobody wants to make the cuts,” he said, but pointed to the nation’s debt as a necessary reason to do so.
The Mulligan appointment and the House hearings display the incoherence of federal health care policy, which combines enormous spending and harsh regulation. For decades, Congress has been increasing costs, reducing access to services, introducing enormous inefficiencies, suppressing innovation, expanding bureaucracy and regulation, and making people’s engagement with the system increasingly miserable, expensive, exasperating, and humiliating.
Congress and presidents have continually “solved” this problem by imposing more of what caused it in the first place: more taxpayer dollars and tighter regulation.
That policy approach has corrupted the nation’s entire health care system. Appointing an official to focus on making the system more affordable is a good move, though the nation’s health care sector is now so distorted and irrational that there seems to be little such tinkering can accomplish.
What the nation needs is an entirely new approach to health care. Ideally, the national government would not spend anything at all on health care, leaving that to the states and the people, as the Constitution requires. That is not going to happen without a fiscal collapse, of course.
Meanwhile, we at the Heartland Institute have published two thorough proposals for comprehensive reform: “The American Health Care Plan” (2021) and “The 2024 American Health Care Plan: State Solutions.” These two documents explain how to fix the current system by unleashing consumer power over spending decisions and encouraging the states to reform their federally mandated heath care programs while awaiting long-needed action on the federal level.
Until Congress and the president step in to make fundamental changes along the lines we propose, the system will only deteriorate further.
Sources: Axios; The Washington Post
Video of the Week
EPA Administrator Lee Zeldin on April 8, 2026 was the opening keynote speaker at the 16th International Conference on Climate Change in Washington, DC. He said climate “realism” is “rising, which is what the American people voted for in 2024.”
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States’ Legislative Pushback Against ESG Has Been Slow
State legislators across the nation are pushing back against the widespread use of environment, social, and governance (ESG) scores by government agencies and private sector businesses to punish politically or socially disfavored activities. The West Virginia Legislature, for example, is considering a bill that would require stockholder proxy advisors to disclose whether their recommendations to investors use environment, social, and governance (ESG) scores instead of solely being “based on financial analysis of what actions would enhance investment value,” as the bill text states.
It’s an excellent bill. Unfortunately, it has been sitting in the state Senate’s Banking and Insurance Committee for three months. Similar bills in Iowa, Minnesota, Missouri, and several other states are also awaiting action. In many cases, such legislation has been filed for multiple years without receiving a full legislative vote.
These bills would prohibit each state government from entering into contracts with businesses that boycott companies in the fossil fuel, agriculture, or other such industries based on ESG criteria, and they would ban the use of ESG scores in awarding public contracts. Some of the bills also tackle ESG in the private sector. Legislation in Missouri, for example, would provide a sanction against financial institutions that use such systems, without banning them entirely from mutual private-sector agreements.
West Virginia’s Senate Bill 417 emphasizes transparency in ESG use. The bill would require proxy advisors to inform shareholders, corporate boards, and the public about whether they have used ESG in their recommendations, and to make their written financial analyses available to clients and to the companies affected. Violations would be classified as deceptive trade practices under state law. The legislation would allow for private lawsuits by proxy advice service clients, companies, and shareholders.
A growing number of investment decisions and corporate governance actions in recent years have been determined not by the financial interests of the shareholders but by ideological ESG goals of asset managers and proxy advisors promoting “stakeholder capitalism.” The “Big Three” asset managers—BlackRock, Vanguard, and State Street—were at the center of this movement, collectively managing approximately $24.5 trillion in assets as of the end of 2025.
ESG-driven financial discrimination against industries, companies, and individuals has been prolific. In 2018, for example, large U.S. banks such as Citibank and Bank of America implemented restrictions on gun manufacturers and retailers. Banks were “restricting their credit card and banking services to gun retailers and halting lending to gun makers that do not comply with age limits and background check rules determined by the banks,” in addition to other companies, The New York Times reported at the time (approvingly, of course).
By 2021, more than 450 banks, investors, and insurance companies, whose members controlled $130 trillion in assets, were in the United Nations-led Glasgow Financial Alliance for NetZero (GFANZ). GFANZ imposed emission targets through the Net-Zero Asset Managers Initiative and the Net-Zero Banking Alliance, which controlled 41 percent of global banking assets in 2021.
These powerful investment firms and financial institutions have increasingly used ESG scores as a risk assessment mechanism to force companies, entire industries such as agriculture, and society at large to advance the companies’ politically motivated, subjective goals. These requirements often directly contravene the interests of companies, shareholders, and customers while degrading overall prosperity, markets, social institutions, and individual liberty.
Most major banks screen their lending portfolios in line with ESG plans such as the Due Diligence guidelines of the international Organisation for Economic Co-operation and Development, weeding out many potential corporate-lending or project-finance transactions. These financial institutions use the predetermined ESG criteria to rule companies in or out of eligibility for financing.
Dozens of the world’s most powerful banks have weaponized ESG to varying degrees to screen out businesses and even some individuals who refuse to comply with those companies’ preferred social justice or environmental policies. Virtually every large bank in the United States has committed to forcing the businesses they work with to phase out their use of fossil fuels, for example, even if it causes economic harm to customers and businesses. Financial institutions such as JP Morgan Chase, Bank of America, Wells Fargo, and U.S. Bank and credit card processors such as PayPal have also discriminated against faith-based organizations.
Discrimination has also been endemic among major insurance companies. Many across the globe refuse to underwrite fossil fuel projects, including Allianz, AXA, Swiss RE, Munich RE, Zurich Insurance Group, The Hartford, Chubb, and AIG. A recent example: Zurich announced in 2024 it would cease underwriting new oil and gas exploration and development projects, as well as metallurgical coal mining. Zurich requires its highest-emitting corporate clients to adopt measures to reach net-zero emissions by 2050, stating it may terminate relationships with those that fail to show sufficient progress.
Chubb updated its policies in 2025, announcing it may “decline coverage if a potential
policyholder cannot meet our methane performance expectations” of progress toward near-zero emissions. That August, Chubb withdrew its insurance coverage for the Rio Grande liquefied natural gas project in Brownville, Texas, one of the largest proposed fossil fuel infrastructure investments in the state.
Anti-ESG bills are popping up in states with a large farming sector, such as Iowa and Missouri. Activists and financial institutions have been increasingly pushing ESG on agriculture and food production, to deny loans and financing for farmers who choose the most efficient production methods.
Examples from the “Global Sector Strategies: Recommended Investor Expectations for Food and Beverage” distributed by the globalist NGO Climate 100+ include “Paris-aligned GHG emissions targets,” “Impact of GHG [greenhouse gas] emissions,” “Land use and ecological sensitivity,” “Impact of air pollution,” “Impact of freshwater consumption and withdrawal,” “Impact of solid waste disposal,” and “Nutrients,” which monitors the “metric tonnes of nitrogen, phosphorous, and potassium in fertilizer consumed.”
ESG mandates can directly harm the economy and the public. The world has already experienced adverse food supply shocks caused directly or indirectly by ESG mandates. The most shocking instance occurred in Sri Lanka, where a regulatory ban on chemical fertilizers in 2019 cut crop production nearly in half and resulted in societal upheaval that toppled the nation’s government. Other ESG-related disruptions in food supply have occurred throughout Europe—especially in the Netherlands—and in Canada and the United States.
Perversely hoping to spread the policies that have consistently caused disaster in Sri Lanka and elsewhere, activists are targeting nitrogen-based fertilizer use in the United States, trying to force farmers to curtail meat and dairy production and use only electric equipment, all to lower their carbon-dioxide footprints. The plan is to force farmers to undertake these “voluntary” changes or risk being frozen out of bank financing.
A 2024 report by the Buckeye Institute found an ESG reporting system would increase farmers’ operating expenses by 34 percent, raising the price of groceries. Consumer prices of items such as American cheese (79 percent), beef (70 percent), strawberries (47 percent), and chicken (39 percent), to name just a few examples, would increase significantly. The report estimates household grocery bills will increase by 15 percent under ESG scoring.
ESG advocates have consistently ignored such chilling forecasts. By 2021, more than 450 banks, investors, and insurance companies, whose members controlled $130 trillion in assets, were in the United Nations-led Glasgow Financial Alliance for NetZero (GFANZ). GFANZ imposed emission targets through the Net-Zero Asset Managers Initiative and the Net-Zero Banking Alliance, which controlled 41 percent of global banking assets in 2021.
The latter two initiatives have folded since then. The NetZero Banking Alliance folded in 2025 “after many big banks left” in a “mass exodus,” Reuters reported. In addition, some U.S. firms, such as Bank of America, Citi, Goldman Sachs, JP Morgan, and Wells Fargo, are reducing their ESG commitments, having read the tea leaves from the last presidential election: President Donald Trump has gone on record as a firm opponent of the practice. Preventing future administrations from pushing these financial giants back into ESG schemes, however, will require legislation from the federal and state governments.
ESG-driven financial discrimination imposes political goals on private-sector businesses at the expense of sound risk assessment, consumer choice, and economic vitality. The commonsense provisions in West Virginia’s SB 417 would protect residents and businesses from this global scheme of discrimination and denial of basic financial services through which radical activists, many from outside the state and even outside this country, try to control the means of production and curtail the freedoms of each and every West Virginian.
The more-limited bills in other states would at least disassociate these states and their residents from complicity in these schemes. Those who believe in freedom should monitor their states’ policies on this important issue.
Sources: West Virginia Senate Bill 417 (2026); Missouri Senate Bill 1302 (2026), “Prohibits Giving Preferential Treatment or Discrimination Based Upon ESG Scores”; Minnesota House File 2806 (2026), “The Stop Environmental Social Governance (ESG) and Social Credit Score Discrimination Act”; Iowa House Bill 922 (91st General Assembly, 2025-2026)
States Look to Limit Access to Courts
Like the U.S. Congress and several states across the country, the Iowa Legislature is considering a bill that would limit people’s access to civil courts by imposing new restrictions on plaintiffs in civil lawsuits.
I wrote about the congressional legislation in Life, Liberty, Property 132, and the principles I outlined there apply to these state-level bills as well. Iowa’s Senate File 54 would require plaintiffs in civil actions to disclose the identity of anyone who would benefit financially from the case, limit how much funders of the lawsuit could receive from any award of damages, and ban those participants from influencing the lawyers’ decisions or receiving referral fees.
As I noted in regard to the federal legislation, third-party litigation funding involves an individual, company, or other organization giving a plaintiff or a law firm money to cover the costs of a proposed lawsuit. In turn, the third-party funder receives a share of any judgment or settlement the court may award. If the plaintiff loses the case, the funder gets nothing.
While presented as consumer protection, SF 54 would increase the power of big businesses and large institutions at the expense of the public. Requiring a plaintiff to identify financial backers to the defendants as well as the court creates the obvious possibility that the information could be leaked to the public, with funders to be subjected to harassment, boycotts, character assassination, public bullying, and worse.
Third-party litigation funding is not burdening the courts: the annual number of civil lawsuits in the United States has declined by about one-third since 2012, Consumer Shield reports, while third-party litigation funding has been rising. In addition, less than 1 percent of state-level lawsuits go to trial, the others being settled or dismissed for other reasons.
As I mentioned in the article about the proposed federal legislation, the goal of a trial is to determine whether a defendant has done what the plaintiff claims, what the damages were, if any, and what remuneration the defendant should make. Who pays the plaintiff’s lawyers has no relevance to any of that. In fact, the protection of a funder’s identity makes a trial fairer by removing a potential distraction from the jury’s attention: defense lawyers cannot paint the plaintiff as the pawn of a lawsuit abuser. That argument does not merit protection.
The Iowa bill’s imitations on fee sharing and interest rates are likewise unnecessary and unfair. SF 54 would deny this class of plaintiffs the right to spend the award however they choose, though other litigants retain that right. Meanwhile, the proposed restrictions do not affect the wealthy defendants in these cases: they can hire all the high-end lawyers they want.
Far from being an instrument of lawsuit abuse, third-party financial support of civil litigation makes access to the courts more equal. By threatening people who want to bring lawsuits, SF 54 would decrease access to civil justice and transfer more power from the people of Iowa to big corporations and the ultra-wealthy.
Sources: Iowa Senate File 54: Litigation Financing Transparency and Consumer Protection Act (2026); Consumer Shield
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S. T. Karnick is a senior fellow and director of publications for The Heartland Institute.
