A Clarion Call for Public Health: Sustain Non-Partisan Federal Service

My fourth guide dog, Izzie, was the final dog partner in my particular federal agency’s building when I recently retired from service as a health care lawyer with expertise in public health.

As I review my career, from my start as a Presidential Management Fellow (PMF) at the U.S. Centers for Medicare and Medicaid Services (CMS), to what I have observed since the winter of 2025, including the termination of the PMF program, I am deeply troubled. As a lawyer and law professor with a disability, I regrettably have qualms about the President’s “Make American Healthy Again” (MAHA) Commission and the future of our republic and its health.

A society may be healthy or unhealthy depending on the motives of public officials and the law and policy they advance. The Administration’s concerning attitudes and legal language related to diversity connect to how the Administration has deleteriously affected our public health infrastructure. Eliminating the Presidential Management Fellowship removes opportunities for young lawyers with disabilities like me, and these actions will harm our future public health.

Specifically, the recently passed “Big Beautiful Bill” will worsen both the fiscal crisis of these United States and the public health of Americans. Changes to Medicaid — one of our important safety net programs — will cause harm and cost lives. Compare this legislative “achievement” with the many positive law measures of past Democratic and Republican Administrations, including affirmative hiring of people with disabilities. Let us recall what seem like halcyon times: When President George H.W. Bush signed the Americans with Disabilities Act into law or when President Biden issued an Executive Order in 2021 titled “Diversity, Equity, Inclusion, and Accessibility in the Federal Workforce” elevating the contextual factor of disability and promotion of inclusion within public service.

The “soft law” tool of DEIA can, if well implemented, add significant wealth by bringing a new class of contributors to our social fabric and our public health infrastructure: people and policy professionals with disabilities. Pipeline programs, such as the Presidential Management Fellowship, have been key to this effort.

I celebrated the 25^th anniversary of the ADA by serving as a Visiting Fellow at the nonpartisan Robert J. Dole Institute for Politics, considering health care law and policy among other issues. For example, America suffers from an ever-increasing burden of chronic illness. Many of these illnesses may rise to the level of legally defined disability, expanding the number of Americans who might request care and accommodations from the U.S. health care system.

The “A” for Accessibility in the DEIA acronym reflects the reality that people with disabilities, as the world’s largest minority population, require affirmative measures to address their health and wellness disparities and to meet their goals.

Despite this bipartisan understanding of the issues, I am skeptical about the motives of the Trump Administration and its officials, including the MAHA Commission and how it will affect public health and people with disabilities, a medically underserved community.

The 2025 Executive Order “Ending Radical and Wasteful DEI Programs and Preferencing” targets DEI and DEIA and is a troubling example why the Trump Administration’s goals may harm health care equity. The “A” for Accessibility in the DEIA acronym reflects the reality that people with disabilities, as the world’s largest minority population, require affirmative measures to address their health and wellness disparities and to meet their goals.

Until 2025, I worked with incredible “able-bodied” and disabled federal public servants, including other high-performing former Presidential Management Fellows, on health care equity. I attended a reception in 2024 with many people with disabilities working within the Presidential Management Fellowship program. Fellows, with and without disabilities, highly educated and remarkably talented, worked within health agencies until late winter or early spring 2025 when workforce reductions began.

The administration also disbanded a health equity committee examining access to Medicaid and Medicare. And, apparently because the word “minority” was in the title, the Trump Administration abolished the Office of Minority Health at CMS without regard to its actual functions. Meanwhile, the Center for Medicare and Medicaid Innovation stopped, as of late winter 2025, collecting data on most factors including race and gender. It is reportedly “considering” continuing to collect self-reported disability status information. Other workforce actions under the Trump Administration have specifically targeted offices addressing the public health of older adults and people with disabilities.

Many so-called “diversity hires” may have been, like me, lifelong libertarians, who chose a life of public service instead of more lucrative endeavors to pad our pockets. Contextual factors of person and place are not immoral but critical to public health research.

The Trump Administration saddens me in many ways. In Shakespeare’s Julius Caesar, it is said “I know he would not be a wolf, But that he sees the Romans are but sheep.” Americans must not be sheep to Trump’s wolf. I hope that halcyon days will occur once again, and we can witness another young lawyer with a guide dog serving within public service and within the public health infrastructure. Until then, Izzie and I must chart our next chapter.