NY Times Guest Opinion writer Robert Rubin stated, “If You’re Worried About the Future of Our Country, Do Something About It.” Civic engagement in issues beyond the immediate scope of one’s professional and personal life for the greater good is more critical than ever. Further, Rubin noted that widespread engagement is especially needed when democracies like America face threats from autocracies abroad and intense social and political strain at home.

Sipping my coffee for a few minutes and gazing toward the horizon, “Bullshit. Not happening: been there, done that.”

Of course, Rubin was referencing the younger generation. In tactical terms, I am an old geezer, one nearing 65 and one who should be dead but somehow manages to keep rising. Tactically, I could still fight, but I did my part, and American voters symbolically said, “Yeah, thanks,” but “Fuck you.” This is an America I no longer care about. I gave a lot, but I never thought America would vote for an authoritarian.

In the military in southwest Asia, I rescued many poor people who went fishing in poorly crafted boats. The boats sunk. I went out and saved them. During my first real job after college, my three years at the Better Business Bureau, saw me helping thousands of poor families ripped off by unscrupulous business owners. In twelve years at an automotive manufacturer, I helped thousands of buyers by protecting them from dealerships who intentionally frauded them. During my twenty years in the medical field, I assisted hospitals by helping them to protect healthcare data. I sat with dying patients who took their final breath and was there on the front lines of the coronavirus pandemic with clinicians who fought every day against their arch enemy: death. Most of those taking their breaths’ were the poor and elderly. The ones most of the youth shuttled off to nursing homes to get rid of them.

Rubin believes engagement with the world makes life more interesting, meaningful, and enjoyable. Bullshit. I contributed to the greater good. I sought opportunities for all people, regardless of background or resources, and engaged them. I advocated for the poor and combated poverty. “Yeah, so what?” said one young voter (CNN interview). “I can’t buy a new car.” “Can’t afford a new iPhone.” said another. What struck me was the fact that two young voters on national television prioritized argument for voting GOP was not being able to buy a new car or new iPhone.

Tufts’ Tisch College reported that young voters supported Kamala Harris by a 4-point margin, but it was a smaller margin than the 25-point support young voters gave President Biden in 2020. Much of that shift appears to be driven by young men, who voted for Biden in 2020 but for Trump in 2024, and especially by young white men. The shift was driven mainly by young white men, who voted for Trump by a 28-point margin. Young Latino men also preferred Trump by a 2-point margin, though that is well within the margin of error. Young Black and Asian women had the highest level of support for Harris. Young people named immigration, crime, and the economy propelled them to vote for the GOP. Youth who chose immigration as their top issue in 2024 voted for Trump by a nearly 70-point margin.

So what’s likely to happen under Trump 2.0?

  • Current operational Marketplace enrollment standards and may narrow enrollment opportunities.
  • Encourage state flexibility in implementing ACA private coverage reforms, primarily by approving reinsurance waivers. If enhanced subsidies in the Inflation Reduction Act expire, leading to a return of the “subsidy cliff,” there may be a renewed desire for reinsurance waivers or other state-specific changes to the ACA markets.
  • Further attempts to kill the Affordable Care Act.
  • Reinstate the standards for short-term limited duration (STLD) health plans. STLDs offer fewer covered benefits and consumer protections compared to plans that meet ACA standards and, as a result, typically have lower premiums but increased financial risk for enrollees.
  • Revert to older restrictions on mifepristone and other abortion medications. President-elect Trump recently indicated he will probably not restrict access to medication abortion but left room to change his position.
  • Enforce the 1873 Comstock Act, which prohibits the mailing of medications used for abortion.
  • Stop enforcing the Emergency Medical Treatment and Labor Act (EMTALA) for emergency abortion care.
  • Rescind HIPAA regulations that safeguard abortion privacy. In April 2024, HHS finalized a regulation adding a new protection category to HIPAA privacy regulations for the use and disclosure of reproductive health information in certain circumstances. The rule prohibits health care providers, health plans, and others from disclosing, for example, information about reproductive health care, such as abortion or contraception counseling obtained legally, to a law enforcement agency seeking to investigate or impose legal liability related to that care.
    • A federal judge in Texas recently ruled that President Joe Biden’s administration likely exceeded its authority by issuing a rule strengthening privacy protections for women seeking abortions and for patients who receive gender transition treatments.
  • Approve waivers that include work requirements as a condition of Medicaid eligibility, premiums, and other eligibility restrictions. 
  • End the Deferred Action for Childhood Arrivals (DACA) program and associated ACA Marketplace coverage expansion.
  • Carry out mass detentions and deportations of millions of immigrants.
  • Revise guidance implementing section 1557 of the Affordable Care Act (ACA), removing LGBTQ protections.
  • Issue executive orders limiting LGBTQ protections, including in health care.
  • Questioned vaccine mandates, threatened to withdraw education funding from schools that require vaccines, and showed support for the false link between vaccination and autism. In addition, President-elect Trump has announced his intention to nominate Robert F. Kennedy Jr. as Secretary of Health and Human Services and Tom Weldon as the Director of the Centers for Disease Control and Prevention, each of whom has expressed concerns about vaccine safety and promoted the false claim that childhood vaccinations are linked to autism.
  • Halt funding for and withdraw from the World Health Organization (WHO). President-elect Trump has stated his intention to halt U.S. funding for and withdraw the U.S. from membership in WHO. 
  • Rejoin the Geneva Consensus Declaration, an October 2020 statement that was initially crafted and signed by the U.S. – along with 31 other countries – and meant to enshrine specific values and principles related to women’s health and family, including a rejection of the “international right to abortion.”
  • Undo regulations issued by the Biden administration that established the first-ever requirements for minimum staffing levels for nursing facilities. The incoming Trump administration could also choose not to defend the rule from legal challenges or support litigation opposing the rule.

As mentioned in E-Day +2, I likely won’t be here in four years. The world will keep spinning, indifferent to my frustration, to my years of service, to the ideals I fought for. Americans traded the principles for which so many bled and died for a flirtation with fascism (or fascism itself). I’m done. I will not turn against anyone who voted for Trump—but I will not fight to save them, either.

But hey all you GOP-aligned voters, I hope you get your car and new iPhone.