Author: Sarah Bucic, MSN, RN is a Policy Analyst for the Alliance of Nurses for Healthy Environments
Children in the United States face health problems which have long gone unaddressed. On February 13, 2025, President Trump, through Executive Order 14212, established the Make America Healthy Again Commission which is tasked with studying “the scope of the childhood chronic disease crisis and any potential contributing causes”. The MAHA Commission’s Report, released in May 2025, covers the increase in childhood chronic disease in the United States, the shift over time of the eating of ultra-processed foods, the cumulative load of chemicals in our environment, the crisis of childhood behavior in the digital age, and a summary of, what some perceive as, the overmedicalization of children. Chemical exposures are listed second among the “four potential drivers behind the rise in childhood chronic disease that present the clearest opportunities for progress.”
It is critical to frame the current landscape in which this report is being released. The MAHA Commission Report states plans for all Americans “today and in the future” to “live longer, healthier lives, supported by systems that prioritize prevention, wellbeing, and resilience” (p 5). This laudable goal is in stark contrast to a number of current actions being enacted. The report promotes an emphasis on prevention, mentioned 31 times in the report. Medicaid ensures access to “comprehensive pediatric health services – including preventive care, screenings, and treatment.” Therefore, cuts and limitations to programs such as the Centers for Medicare & Medicaid Services (CMS), which could close the gaps on health-related social needs (HRSNs) are not consistent with prevention research. Removal of Diversity, Equity and Inclusion (DEI) initiatives are also posing very real health threats to racial health equity. The current Congressional Reconciliation package, if passed, will further affect federal and state Medicaid spending impacting children’s access to services and care. Medicaid covers 42% of all children nationwide and 77% of children living in poverty in the U.S. Cuts to Medicaid and programs that support overall child health will limit many of the health promotion strategies noted in this report. The effectiveness of any interventions will be severely limited as children will undoubtedly face increasing barriers to health care services.
Chemicals of Concern and Cumulative Load of Chemicals in the Environment
For those advocating for stronger FDA oversight of potent neurotoxins, such as limiting lead in baby formula and increased transparency and oversight and removal of industry influence in the scientific process, the Make America Healthy Again (MAHA) report could sound incredibly promising. Even the Former Director of the Centers for Disease Control and Prevention (CDC) from 2009-2017 Tom Frieden, noted that the campaign to Make America Healthy Again “gets some things right: Our country is beset by chronic disease, environmental risks, and dangerous and inappropriate corporate influence on health decisions.” The MAHA report outlines a number of very real issues facing U.S. children and nearly thirty years after President Bill Clinton signed Executive Order 13045 in 1997, which directs the EPA to evaluate regulations for their impact on children, U.S. children remain exposed to a growing number of loosely regulated chemicals for which we know that newborns, children and adolescents remain uniquely vulnerable.
“The cumulative load of thousands of synthetic chemicals that our children are exposed to through the food they eat, the water they drink, and the air they breathe may pose risks to their long-term health, including neurodevelopmental and endocrine effects” (p 16) with “no country in the world” having fully accounted children’s exposure to “complex mixtures of chemicals” (p 39). While the report laments cumulative environmental exposures and their potential synergistic health consequences, the actions of the current administration run entirely counter to their stated concerns. The report lists PFAS and lead exposure as concerns to children, yet employees in the U.S. CDC were haphazardly fired as part of a massive reorganization this past April. This firing and hiring included CDC workers performing surveillance of childhood lead exposure and those offering technical assistance to the Milwaukee Health Department after the city discovered dangerous lead levels in some public schools. Employees fired at the CDC were then rehired nearly 2 months later amidst massive confusion by Secretary RFK Jr. regarding if the CDC Childhood Lead Poisoning Prevention Program’s funding, existence and functioning was still intact. PFAS exposure is associated with a variety of health effects, including immune suppression and changes in cholesterol in children, yet the report doesn’t highlight how this same administration is rolling back regulations of the National Public Drinking Water Standards from regulating 6 PFAS to merely 2 of the thousands of PFAS currently in use.. The report also omits that the funding for carrying out regulation of PFAS in drinking water has been dramatically reduced, with EPA canceling at least $3 million in grants aimed at understanding PFAS contamination on farms and rescinding additional grants targeting neonicotinoid pesticides and PFAS impacts from flooding.
It is critical to underscore that the concerns mentioned in this report come at the same time that the current administration has reduced EPA by 733 less employees with future plans to further slash EPA funding. The proposed FY26 request cuts the agency’s total budget by approximately 54 percent, eliminating most grants to state environmental agencies, valued at about $1 billion, along with billions of dollars in water infrastructure loans. Cuts of over 56 percent to EPA’s Sustainable and Healthy Communities Research Program is expected to impede highly contaminated communities from being able to address PFAS public health threats in the absence of state and federal technical assistance.
The MAHA Commission’s report properly calls out the health concerns related to microplastics, phthalates, and bisphenols yet the policies being currently enacted under this administration will undoubtedly increase chemical exposures. On May 22, 2025, Congress passed a joint resolution of disapproval under the Congressional Review Act (CRA) to repeal the Biden rule which would regulate seven particularly hazardous air pollutants including dioxins, mercury, and pollutants that accumulate in soil, dust, and people’s bodies, several of which are known to cause cancer, neurological issues, and birth defects even at very low exposure levels. The MAHA Commission’s concerns about chemical exposures are being poorly received by public health experts who note that the EPA has recently engaged in launching “The Biggest Deregulatory Action in U.S. History” and drastically cut Environmental Justice funding at the Federal level.
The MAHA Commission reports possible links between pesticides, herbicides, and insecticides and adverse health outcomes, especially in children highlighting glyphosate, the key ingredient in the popular Roundup brand with possible health effects, “ranging from reproductive and developmental disorders as well as cancers, liver inflammation and metabolic disturbances” (p 45). The report also highlights the weed killer atrazine, used widely in farming, with research linking atrazine to endocrine disruption and birth defects. While the MAHA Commission has been directed to work with “the involved agencies to work with farmers to ensure that United States food is the healthiest, most abundant, and most affordable in the world” (p 45), in the entire MAHA report of 72 pages, with 12 pages devoted to ultra processed foods, there is no mention of farmworkers, many of whom are children, yet they are being exposed at levels hundreds of times greater than consumers’ exposures to pesticides.
The MAHA Report Does Not Improve Transparency or Corporate Influence
President Donald Trump celebrated MAHA’s release noting “unlike other administrations, we will not be silenced or intimidated by the corporate lobbyists or special interests.” It has long been known that industrial groups affect research and policy. One needs to look no further than the history of per-and polyfluoroalkyl substances (PFAS) to see the wide-ranging significant public health, political, and societal effects that can emanate from “the lack of transparency in industry-driven research on industrial chemicals”. PFAS is not unique, these same trends can be found in almost every environmental toxin from the lead industry and how they aggressively lobbied and influenced decision-makers and targeted scientists to modern industry bias found in health research on sterilization chemicals such as ethylene oxide (EtO).
The MAHA Commission report blames ‘corporate influence’ for lax chemical regulations noting that last year, the chemical-manufacturing lobby spent roughly $77 million on “federal influence activities,” placing the industry among Washington’s top spenders with 60% of chemical-sector lobbyists previously holding federal posts as of 2023 (p 47) but the MAHA report doesn’t mention that such influence is coming from inside the Trump administration, with multiple EPA appointees coming directly from industry. Wittenberg and Borst report in Politico that “In reality, multiple Trump appointees currently at EPA previously worked at the agency during Trump’s first term. And in between his presidencies, those officials represented the chemical industry, often as attorneys, opposing EPA regulations. After just a few months back at the agency, these officials have helped shepherd the regulatory rollbacks they advocated on the outside.”
Additionally, the MAHA Commission notes that Artificial Intelligence (AI) technology “will develop new tools and push the frontiers of science to help us better understand how to measure and reverse chronic disease” (p 8) and that “the rapid progression of AI technology creates new opportunities to develop tools to better evaluate the environmental exposures of chronic diseases in children” (p 39). With such a strong focus on AI, “American technologic innovation” (p 8) and “Unleashing Private Sector Innovation” (p 39) with an invitation to “all of America, especially the private sector and academia, to be part of the solution” (p 72), it is difficult to see how the administration will not be impacted by special interest groups.
Are there any positive takeaways from the MAHA Report?
There are all well-known regulatory actions that impact health and well-being in the United States. The Clean Air Act is a documented success having saved hundreds of thousands of lives. Unfortunately for those waiting for improved regulatory oversight and a more health-based approach to regulating chemicals in our water, food supply and consumer products, they will have to wait. Experts in the field of environmental health such as Dr. Tracey Woodruff, director of the Program on Reproductive Health and the Environment at the University of California San Francisco point out the importance of connecting toxic chemicals with children’s health stating “I don’t think this administration is going to solve these issues and actually regulate toxic chemicals. But now that this has been recognized by this White House, it’s not going to go back in the bottle.” Dr. Philip Landrigan, a leader in Environmental Toxic Chemical exposures in children and a professor of pediatric and public health at Boston College, notes that the authors of the report “make a great diagnosis and they have a very weak treatment plan.”
The MAHA Commission’s specifics on how the administration plans to achieve their goals will come in a later report, Make Our Children Healthy Again Strategy, due in August. EPA Administrator Lee Zeldin, one of the Commission’s 14 members, signaled stricter regulations won’t necessarily be part of the solution. Until then, nurses will continue to advocate for strong health protective regulations and educate one another and our patients. Katie Huffling, DNP, RN, CNM, FAAN stated “The voices of nurses have always been critical. Right now they are absolutely vital to save the health of our patients.”
Sarah Bucic, MSN, RN is a Policy Analyst for the Alliance of Nurses for Healthy Environments
References
Ash, E., Carrington, W., Heller, R. & Hwang, G. (2023, November). Exploring the effects of Medicaid during childhood on the economy and the budget. Congressional Budget Office, U.S. Congressional Budget Office. https://www.cbo.gov/system/files/2023-10/59231-Medicaid.pdf.
Bendix, A. (2025, May 22). CDC’s childhood lead program is still defunct, despite Kennedy’s claims. NBC News. https://www.nbcnews.com/health/kids-health/cdcs-childhood-lead-program-still-defunct-kennedys-claims-rcna208047
Borst, E. & Wittenberg, A. (2025, May 22). MAHA targets environmental chemicals. E & E Politico. https://www.eenews.net/articles/maha-targets-environmental-chemicals/
Borunda, A. (2025, May 22). Congress moves to loosen toxic air pollution rules. All Things Considered, NPR. https://www.npr.org/2025/05/22/nx-s1-5405619/air-pollution-rollback-congress
Bunch, L., Ketema, H., & Keisler-Starkey, K. (2024, September). How age and poverty level impact health insurance coverage. U.S. Census Bureau. https://www.census.gov/library/stories/2024/09/health-insurance-coverage.html.
Centers for Medicare and Medicaid Services. (2024, December). Medicaid and CHIP eligibility operations and enrollment snapshot (2025, April). https://www.medicaid.gov/resources-for-states/downloads/eligib-oper-and-enrol-snap-december2024.pdf.
Centers for Medicaid and Medicare: Center for Medicaid and CHIP services. (2025, March 4). CMCS informational bulletin: Rescission of guidance on health-related social needs. https://www.medicaid.gov/federal-policy-guidance/downloads/cib03042025.pdf
Environmental Protection Agency. (2025, March 12). EPA launches biggest deregulatory action in U.S. history: Administrator Zeldin announces 31 historic actions to power the Great American Comeback. https://www.epa.gov/newsreleases/epa-launches-biggest-deregulatory-action-us-history
Environmental Protection Agency. (2025, May 14). EPA announces it will keep maximum contaminant levels for PFOA, PFOS. https://www.epa.gov/newsreleases/epa-announces-it-will-keep-maximum-contaminant-levels-pfoa-pfos
Environmental Protection Agency. (Last updated May 15, 2025). Benefits and costs of the Clean Air Act 1990-2020, the second prospective study. https://www.epa.gov/clean-air-act-overview/benefits-and-costs-clean-air-act-1990-2020-second-prospective-study
Farmworker Justice. (2013).Exposed and ignored: How pesticides are endangering our nation’s farmworkers. https://kresge.org/sites/default/files/Exposed-and-ignored-Farmworker-Justice-KF.pdf
Federal Register. (2025, February 13). Executive Order 14212—Establishing the President’s Make America Healthy Again Commission. https://www.federalregister.gov/documents/2025/02/19/2025-02871/establishing-the-presidents-make-america-healthy-again-commission
Frazin, R. (2025, June 3). EPA down at least 733 staffers since January. The Hill.
https://thehill.com/policy/energy-environment/5331075-epa-down-staffers-trump-zeldin/
Frieden, T. (2024, October 31). What Trump and RFK Jr.’s ‘Make America Healthy Again’ gets right – and very wrong. https://www.statnews.com/2024/10/31/maha-make-america-healthy-again-trump-rfk-jr/
Gillam, C. (2025, May 22). Health advocates applaud MAHA report for calling out chemical harms, but say it falls short. The New Lede.
Halpern, M. (2017, July 24). Remembering Herb Needleman—The hero who got lead out of gasoline.
Held, L. (2025, May 19). EPA defunds research Into PFAS contamination on farms: University teams studying how ‘forever chemicals’ contaminate soil and groundwater, including projects focused on farms, lose millions in grant funding. https://civileats.com/2025/05/19/epa-defunds-research-into-pfas-contamination-on-farms/
Hill, L., Artiga, S., Pillai, A., & Rao, A. (2025, March 21). Elimination of Federal Diversity Initiatives: Implications for Racial Health Equity. Kaiser Family Foundation. https://www.kff.org/racial-equity-and-health-policy/issue-brief/elimination-of-federal-diversity-initiatives-implications-for-racial-health-equity/
Pelch, K. (2025, May 14). The immense societal burdens of PFAS “Forever Chemicals.” Expert Blog, Natural Resources Defense Council.
https://www.nrdc.org/bio/katie-pelch/immense-societal-burdens-pfas-forever-chemicals
Pelch, K. & Reade, A. (2025, May 14). The social burden of PFAS “Forever Chemicals” in California. Backgrounder: Natural Resources Defense Council.
https://www.nrdc.org/media/social-burden-pfas-forever-chemicals-california
Mann, C., Serafi, K., Eder, J., Polk, E., Tranchina, M.T. (2025, May). No place to hide: Children will be hurt by Medicaid cuts. Mannatt Health, Lucille Packard Foundation. https://assets-us-01.kc-usercontent.com/9fd8e81d-74db-00ef-d0b1-5d17c12fdda9/2c986338-438c-491e-9420-e07c99ead14d/No%20Place%20to%20Hide%20-%20Children%20Will%20Be%20Hurt%20by%20Medicaid%20Cuts%20-%20Brief%20FINAL%2005%2006%202025.pdf
Marquez, E. (2025, May 22). Yes Mr. Secretary, pesticide exposures matter — but there’s more than just herbicides. Blog, Pesticide Action & Agroecology. Network. https://www.panna.org/news/yes-mr-secretary-pesticide-exposures-matter-but-theres-more-than-just-herbicides/
Rushing, K. (2025, March 14). Trump guts environmental justice policies, but the fight for justice continues: The administration is slashing initiatives meant to help communities of color and low-income communities facing high pollution burdens. Earthjustice, Community Partnerships. https://earthjustice.org/article/trump-guts-environmental-justice-policies-but-the-fight-for-justice-continues
Savage, N. (2022, May 31). How the lead industry misled the public about its toxic problem for decades: The lead industry characterized lead poisoning as a problem of poor people and minorities to protect its sales during the 20th century. Missouri Independent. https://missouriindependent.com/2022/05/31/how-the-lead-industry-misled-the-public-about-its-toxic-problem-for-decades/
Stone, W. (2025, June 3). Research cuts conflict with MAHA’s stated goals. All Things Considered, NPR.
https://www.npr.org/2025/06/03/nx-s1-5414544/research-cuts-conflict-with-mahas-stated-goals
The White House. (2025) Make America Healthy Again. https://www.whitehouse.gov/wp-content/uploads/2025/05/WH-The-MAHA-Report-Assessment.pdf
Tirrell, M. & Goodman, B. (2025, June 11). HHS reinstates more than 450 CDC employees fired in April reorganization, including childhood lead poisoning team. CNN. https://www.cnn.com/2025/06/11/health/hhs-cdc-employees-reinstated#:~:text=On%20Wednesday%2C%20the%20entire%20lead,director%2C%20Dr.%20Erik%20Svendsen.
Wittenberg, A. (2025, May 23). MAHA report targets chemical industry revolving door — without mentioning EPA. E & E Politico. https://www.eenews.net/articles/maha-report-targets-chemical-industry-revolving-door-without-mentioning-epa/
Yohannan, S. (2025, June 11). States’ PFAS work likely to suffer under EPA’s FY26 budget cuts.
