Category: Blog

The Beginning of the End for Vaccine Mandates?: What Happens When Ideological Opposition to Vaccination Invades Public Health Policy

“We did it everybody!” exclaimed Leslie Manookian, “We passed the first true medical freedom bill in the nation!” Ms. Manookian and other members of the anti-vaccine group Health Freedom Idaho were celebrating the Idaho Medical Freedom Act being signed into Idaho state law on April 4, 2025, which protects those who refuse to take medical interventions like vaccines from being excluded from activities of daily life such as obtaining a service from a business or attending school.

Idaho is the first state in the country to enact a law protecting personal medical freedom which includes these types of protections for people who are against getting vaccinated, but other states may attempt to implement similar laws and public health policy changes due to vaccine skepticism present throughout the nation. For example, Florida’s current Surgeon General Joseph Ladapo has expressed a desire to eliminate vaccine mandates throughout the state of Florida despite broad medical and religious exemptions. Mr. Ladapo’s rhetoric regarding eliminating vaccine mandates seems less based on science and more based on morals and principle. When describing vaccine mandates Mr. Ladapo stated, “every last one of them is wrong and drips with disdain and slavery,” he added that forcing vaccine mandates “immoral” and “wrong”, and he proclaimed “Your body is a gift from God.” Similarly, when asked about her motivations to help codify the Idaho Medical Freedom Act, Ms. Manookian stated that she and others pushing for freedom from vaccine mandates believe that “our immune systems, given to us by God, are perfect as long as they’re well nourished.” Ms. Manookian also insisted that it was “not accurate” that the implementation of the measles vaccine was what led to the eradication of measles, instead citing improvements in clean drinking water and waste management which helped quell spread of the disease. These types of moral statements regarding vaccine use reflect a growing population of people who see public health interventions such as vaccines more as an issue of personal freedom rather than an issue of safety. These statements made by Mr. Ladapo and Ms. Manookian highlight a crucial ideological issue that public health officials must learn to address more effectively to reduce vaccine skepticism. Global health organizations are beginning to provide targeted guidance to assist healthcare professionals in combating vaccine skepticism not just by providing accurate information but by building trust and a deeper understanding of community perceptions, social norms, and potential logistical barriers to vaccination.

So far in 2025 the United States had had over 1,600 measles infections, which is the most measles infections in the country since 1992, and in 92% of cases the patients are either unvaccinated people or their vaccine status is unknown. Prior case law on the issue of vaccine mandates in the United States, such as the landmark Supreme Court case Jacobson v. Massachusetts, have allowed state public health departments to compel their citizens to be vaccinated despite ideological opposition to the vaccine, but if the legislatures and health departments themselves buy into ideological opposition to vaccines then a key safeguard against disease transmission will be dismantled. It may not be enough to simply combat vaccine misinformation with accurate science, as surveys have shown that false or unproven claims about vaccines are more widely accepted today than two to three years ago despite concerted efforts to combat misinformation with accurate science. The American College of Allergy, Asthma, and Immunology has urged policymakers to weigh the unintended public health implications if vaccine mandates were to be eliminated, but public health officials and medical professionals should be prepared going forward to find new ways to address skepticism to vaccines once a major legal enforcement tool is eroded.

The MIND Act: Congress’s Attempt to Protect Americans’ Brain Data

Neurotechnologies are devices that have been used in the clinical context for decades to collect data about brain or nervous system activity. Examples include the use of magnetic resonance imaging (MRI) to diagnose brain tumors, electroencephalograms (EEG) to predict strokes, and deep brain stimulation (DBS) to treat symptoms of Parkinson’s disease.

In addition to the clinical context, the consumer market now accounts for 60% of the global neurotechnology landscape. By 2034, the global neurotechnology market size is predicted to reach around $52.86 billion. Neuralink, a company founded by Elon Musk, creates implantable brain-computer interfaces (BCIs), which are used to restore personal control over limbs, prosthetics, and communication devices. Other consumer neurotechnologies include EEG headsets that produce real-time brain data and earbuds that measure brain activity from the ear canal.

Several issues are raised by the use of neural data in both the clinical and consumer sectors. The production, distribution, and use of these neurotechnologies creates unique privacy, discrimination, and security concerns. There have even been efforts in the criminal justice system to identify deception from brain activity. Scholars have proposed and debated the necessity of a new category of rights called “neurorights,” which include mental privacy, mental integrity, and cognitive liberty.

In response to these growing concerns, Democratic Senators Chuck Schumer (D-NY), Maria Cantwell (D-WA) and Ed Markey (D-MA) recently introduced the Management of Individuals’ Neural Data Act of 2025 (the MIND Act). This bill aims to protect Americans’ brain data from exploitation and was referred to the Committee on Commerce, Science, and Transportation.

The MIND Act defines neural data as “information obtained by measuring the activity of an individual’s central or peripheral nervous system through the use of neurotechnology.” It also provides an expansive definition of neurotechnology as any “device, system, or procedure that assesses, monitors, records, analyzes, predicts, stimulates or alters the nervous system of an individual to understand, influence, restore, or anticipate the structure, activity, or function of the nervous system.” This definition encompasses basic tools like MRI and EEG, but also covers BCIs and consumer products like smart glasses and smart watches.

The proposed legislation directs the Federal Trade Commission (FTC) to study how neural data and other related data, which can infer psychological states or neurological conditions, are currently governed. It also compels the FTC to identify gaps in current governing frameworks, including the Health Insurance Portability and Accountability Act (HIPAA). At the federal level, HIPAA defines health information expansively, but likely fails to protect neural data in several clinical contexts.

At the state level, neural data is not clearly included in most consumer privacy laws. In response to this, Colorado, California, Montana, and Connecticut have led the way by passing privacy laws that categorize neural data as highly sensitive information. If passed, the MIND Act would establish a federal standard that follows in these states’ footsteps.

While it does not go so far as to create a new private right of action, the MIND Act does create a roadmap for future FTC rulemaking or broader privacy legislation. It may also play an important role in healthcare product development as neurotechnology and AI are integrated and developed in tandem. Perhaps more importantly, it is a clear message from Congress about the importance of privacy protections in an ever-changing technological landscape.

Acetaminophen, Pregnancy, and Neurodevelopment: What the Science Really Says

Acetaminophen, more commonly recognized by the brand name Tylenol, has been recommended by physicians to pregnant women as a safe fever-reducer and effective pain-reliever for decades. However, in September of this year, President Donald Trump and U.S. Health and Human Services Secretary Robert F. Kennedy Jr. issued a warning regarding a supposed link between Tylenol use during pregnancy and an increased risk of autism in children. These warnings have received massive media attention and spread rapidly across social media platforms, but the scientific evidence behind these claims remains far from conclusive.

The warnings and statements presented by President Trump and Secretary Kennedy risk confusing the public by blurring the crucial distinction between correlation and causation. Correlation merely suggests that two variables are related in some way, while causation indicates that a change in one variable directly causes a change in the other. The difference may sound subtle, but in science and law it is fundamental. Correlation alone is insufficient to prove a cause-and-effect relationship, as other confounding variables may be present. The studies cited by President Trump and Secretary Kennedy merely demonstrate correlation; none provide credible evidence that Tylenol use during pregnancy causes autism in children.

A comprehensive review of 46 studies investigating the relationship between Tylenol use during pregnancy and neurodevelopmental disorders found that more than half showed only minimal associations, while the remainder showed no evidence of increased risk whatsoever. In another large-scale Swedish study involving 2,480,797 children born from 1995 to 2019,  researchers found no statistically significant link between prenatal Tylenol use and autism in children. Additionally, the U.S. Food and Drug Administration (FDA) has reiterated that no causal relationship has been established between Tylenol and neurodevelopmental disorders.

Despite this, President Trump has gone so far as to advise pregnant women to “tough it out” and avoid Tylenol entirely. Yet Tylenol is commonly taken for fever and pain, both of which can pose serious health risks if left untreated. In fact, research suggests that untreated fever during pregnancy may increase the risk for autism in the child as much as forty percent in the second trimester, and more than 300 percent for pregnant women who reported three or more fevers after the twelfth week of pregnancy.

Discouraging pregnant women from using Tylenol, the only over-the-counter pain-reliever approved to use while pregnant, could increase health risks for both mothers and their unborn children. Without access to safe fever and pain management, women may turn to unsafe alternatives or endure conditions that themselves elevate the risk of poor health and pregnancy outcomes.

From a legal perspective, the warnings presented by President Trump and Secretary Kennedy raise significant concerns. The FDA has initiated a process to update the labeling of products containing Tylenol in response to the claims of a potential association between pregnancy use and neurodevelopmental disorders, despite the lack of evidence establishing causation. Manufacturers of Tylenol could be exposed to product-liability litigation because the label change process shifts the standard of care and opens the door to claims of inadequate warnings or information. Additionally, when a highly influential public figure advises pregnant women to “tough it out” and avoid the only approved over-the-counter pain-reliever for use in pregnancy, healthcare providers could face increased exposure to malpractice claims if fever or pain in pregnancy is left untreated and injury results. The discourse created by the warnings from President Trump risks generating confusion among pregnant women about safe Tylenol use, which may lead to under-treatment of fever or pain or even to the substitution of Tylenol with less safe alternatives, increasing potential legal exposure across providers, insurers, and manufacturers.

As of now, both the FDA and the Centers for Disease Control (CDC) continue to advise that acetaminophen remains the safest and most effective over-the-counter pain relief option for pregnant women.

Florida Lawmakers Hope to Close Medical Malpractice Loophole with House Bill 6003

Earlier this month, Florida lawmakers introduced House Bill 6003 to close the “deadly legal loophole” for the current medical malpractice law. Under current Florida medical malpractice law, people who are 25 years old or older cannot collect “non-economic” damages for the wrongful death of a family member who is also 25 years or older. House Bill 6003 would “restore the rights  of certain adults and adult children to recover non-economic damages in wrongful death cases tied to medical negligence.” The Republican lawmaker who introduced House Bill 6003, Dana Trabulsy, asked, “How is it just for a family to be able to recover non-economic damages when their loved one died from a car accident, but not for a death related to medical malpractice?”      

     

As of 2024, Florida is currently ranked number two for having the most medical malpractice suits and payouts in the country. Despite this high number, there has been an uproar among families who have lost a loved one and were prevented from seeking justice for their family member’s wrongful death. Florida Governor Ron DeSantis, vetoed a previous version of House Bill 6003 in May 2025. DeSantis sided with opponents concerned that physicians would be reluctant to move to Florida, and practicing physicians would move away from Florida due to the fear of being sued for medical negligence. One orthopedic surgeon from Tallahassee was quoted saying, “if you actually want physicians who are well trained, well-experienced, to stay here in Florida and take care of you and your patients, you need to reconsider this.” However, doctors should not fear if they are “well-trained and well-experienced,” because the probability of committing medical negligence would be low.

Misdiagnosis, delay of diagnosis, and surgical errors are among the biggest causes of medical negligence. As of now, in Florida, patients who are 25 years and older may not be receiving the best possible care due to the lack of accountability placed on physicians if their actions result in medical negligence. If House Bill 6003 is passed and repeals the current Florida law, then the effect of House Bill 6003 would indirectly impose stricter health compliance and standards upon physicians to provide the best care and exercise the utmost caution to avoid committing medical negligence. Those physicians who may take shortcuts or minimize patients’ voices and concerns are more likely to be affected by House Bill 6003 because their actions are the ones that are more likely to result in medical negligence to the extent that it results in a wrongful death. So, would the implications of House Bill 6003 really be that detrimental to the healthcare field in Florida? 

As of October 15, 2025, House Bill 6003 is currently being reviewed by the judiciary committee in the House. House Bill 6003 bill has the potential to decrease medical negligence cases overall by holding physicians more accountable and elevating patients’ voices to ensure the best care and utmost caution are being provided and exercised. Florida’s lawmakers are commendably taking a step towards reshaping justice and restoring health rights for many of its residents.

Detaining Medical Information: The Growing Threat to Immigrants’ Health Care Access

Emboldened by President Trump, armed and masked immigration enforcement agents are increasingly threatening the public and conducting raids to detain people whom they suspect are undocumented immigrants. Attention, both in popular and social media, has primarily focused on immigration enforcement in areas once considered safe, including raids occurring in schools, public parks, and grocery stores. However, these highly publicized incidents overshadow an alarming immigration enforcement and detention strategy—confiscating immigrants’ medical information. 

This past June, the Trump Administration granted Immigration and Customs Enforcement (ICE) officials access to the personal information of millions of Medicaid enrollees. This information included home addresses, ethnicities, social security numbers, and even immigration status. Initially, U.S. Department of Health and Human Services (HHS) officials stated that the goal of the transfer was to disqualify those improperly enrolled in Medicaid. The Associated Press, however, obtained a copy of the agreement between the Centers for Medicare & Medicaid Services and the Department of Homeland Security, which indicates that the purpose of the data is to allow ICE to “find the location of aliens.” It seems that it is no coincidence that the states targeted in the data transfer—California, New York, Washington, Oregon, Illinois, Minnesota, and Colorado—all have programs that allow non-citizens to enroll in Medicaid. 

In response, 20 states sued the federal government, arguing that the data release violated federal health privacy laws, including the Health Insurance Portability and Accountability Act (HIPAA). In August, a federal judge issued a partial preliminary injunction precluding ICE from using the accessed data. Citing key cases such as FCC v. Prometheus Radio Project and FCC v. Fox Television Stations, Inc., Judge Vince Chhabria found that the government’s decision was arbitrary and capricious. As the case continues to play out in the courts, it is imperative to discuss its implications for privacy concerns and, more importantly, the intense chilling effect it will create, both in the present day and potentially for decades to come.

Now that such medical information, which includes citizenship status, is in the possession of ICE, there is certainly a fear that this information will be used to track down and detain immigrants (or those who may appear as undocumented immigrants to authorities). But beyond the looming threat of ICE using the data to detain people, there is also a harmful chilling effect: immigrants are reporting that they are avoiding health care facilities entirely. 

The relationship between immigrants and the United States health care system was already precarious. Examples of systematic, repeated racism in the health care system have already strained migrants’ trust. Furthermore, there are several documented cases in which doctors have engaged in medical care without informed consent or conducted unethical research on immigrants. These stories and incidents have created enduring narratives that understandably engender distrust in the American health system. As a result of these deeply embedded fears, immigrant communities are more likely to attempt to avoid the health care system altogether until their health situation becomes dire. 

ICE’s entanglement in our health care system is a moral and economic injury. Managing an effective health care system needs more than just surgical kits, prescriptions, and check-ins. It requires fostering a safe environment where people, regardless of their citizenship status, can receive the care they need. Furthermore, it is commonly cited that immigrants invest more in American health care than they deduct. Several health policy scholars have demonstrated that ensuring communities have access to preventative health care is cost-saving for the country’s overall economy.

Freely handing sensitive Medicaid data to ICE is a betrayal of the core values of health care: autonomy, trust, and privacy. The fear of detention since Trump’s first presidency already loomed over immigrant communities. However, this distrust and fear are now magnitudes worse due to the cruel and novel tactics now being employed by ICE. Embedding immigration enforcement within health care is harmful; some may even argue that the goals of the two institutions are inherently at odds. As ICE raids increase in intensity across the country and immigrants become increasingly aware that their data is now in possession of ICE, this fear––and resulting harm––will grow. 

Mental Health Parity: A Question of Agency Authority

A recent legal challenge to a key mental health parity law sparks conversations about federal agencies’ power to interpret and enforce statutes. Earlier this year, the Employee Retirement Income Security Act Industry Committee (ERIC) filed a lawsuit against the Department of Health and Human Services (HHS), the Department of Labor (DOL), and the Treasury, regarding the enforcement of the updated 2024 Mental Health Parity and Addiction Equity Act (MHPAEA).

MHPAEA was enacted in 2008 to address disparities in benefits between mental health or substance use disorder (MH/SUD) treatment and medical/surgical (M/S) services. Under MHPAEA, MH/SUD treatment and financial limits must not be more restrictive than those for M/S services, and MH/SUD benefits cannot have separate limits that are not also applied to M/S benefits. In practice, the law required health plans and healthcare facilities to cover MH/SUD services in the same way as M/S services. 

A 2013 Rule updated MHPAEA, clarifying ambiguity about parity for non-quantitative treatment limits (NQTLs), such as prior authorizations, network adequacy, medical necessity standards, and step therapies. This Rule also confirms that parity applies across all care levels, including outpatient, inpatient, and “intermediate” behavioral health settings. 

Enforcing compliance with insurance plans under MHPAEA was difficult because the Act did not require strong proof of adherence. The 2021 Consolidated Appropriations Act (CAA) addressed this issue by requiring a comparative analysis of health plans to demonstrate parity between MH/SUD and M/S services, specifically NQTLs, and by allowing federal agency audits and on-demand submissions from health plans. 

The 2024 Final Rule aimed to improve enforceability further and reduce ambiguity across employer plans (ERISA), ACA marketplace plans, and Managed Care plans through several new standards: requirements to report NQTL comparative analysis data to federal agencies and beneficiaries with clear explanations, fiduciary certification for ERISA plans, a more detailed NQTL collection and reporting process, and a standard that ensures plans offering any MH/SUD benefits provide meaningful material benefits in every classification that the plan also offers M/S benefits. 

ERIC filed a lawsuit on January 17, 2025, with several allegations against the implementation of the 2024 Final Rule. First, ERIC argued that the Final Rule is too vague in guiding the collection and reporting of NQTL outcome measures and in addressing and fixing material differences in MH/SUD and M/S benefits. ERIC also claimed that many of these measures, now required for collection, could be affected by external factors that might hinder payers’ ability to remain compliant.

Additionally, ERIC questioned the scope of the Final Rule, arguing that the 1:1 requirement for MH/SUD and M/S benefits across all classifications exceeds the Act’s scope and intent. Finally, ERIC challenged the applicability date of January 1, 2025, claiming that it offers too little time for employers/agencies to make the necessary adjustments to comply. Throughout their complaint, ERIC argued that HHS, DOL, and the Treasury violated the Administrative Procedure Act by creating and enforcing what they describe as a vague and overbroad regulation. 

On May 12, 2025, the U.S. District Court for the District of Columbia agreed to stay ERIC’s lawsuit after the Tri-Agencies made a motion for abeyance to consider rescinding or modifying the 2024 Rule. The agencies also issued a non-enforcement policy for the components of the Rule that took effect in January 2025 or were set to take effect in 2026.

Several advocacy organizations and provider-focused trade associations have criticized the decision not to enforce, claiming that it harms agencies’ ability to implement and enforce aspects of the 2021 additions to MHPAEA, while also inhibiting critical steps to ensure more detailed analysis of parity and leaving room for health insurers to take advantage of potential loopholes.

Following the Supreme Court’s decision in Loper Bright v. Raimando, debates over federal agency authority and explicit statutory authorization requirements have become more common. ERIC’s complaint, in large part, focuses on concerns regarding agency overreach in interpreting and enforcing statutes. Lawsuits like this are likely to play a part in setting a precedent for what constitutes an acceptable scope for federal agency interpretation and enforcement of statutes governing their authority.