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AS US President Donald Trump prepares to face the ballot box in the hopes of winning a second term, his handling of the coronavirus pandemic will be at the forefront of voters鈥� minds. But Trump鈥檚 impact on health, space and environment policy during his time in office also warrants examining.

In the past four years, Trump has promised to reverse environmental regulations and climate change policy, to repeal and replace his predecessor Barack Obama鈥檚 landmark healthcare policy and to revive the fortunes of NASA. Has he succeeded?

A green undoing

One promise Trump has kept is the removal of the US from the landmark 2015 Paris Agreement on climate change, in which nearly all nations agreed goals to reduce carbon emissions in an attempt to keep global warming below 2掳C above pre-industrial levels.

During a campaign speech in May 2016, Trump said: 鈥淲e鈥檙e going to cancel the Paris climate agreement and stop all payments of US tax dollars to UN global warming programmes.鈥� He followed through once in office, announcing in June 2017 that the US would exit the agreement, though Congress continued to fund such UN programmes.

Environmental campaigners were dismayed. As the US is the second largest carbon emitter behind China, combating global warming can only be done with it on side. 鈥淭he alternative is the end of the world as we know it,鈥� says Kassie Siegel at the Center for Biological Diversity Action Fund in Washington DC. 鈥淲e鈥檝e known this for a long time, we鈥檝e known what the science demands.鈥�

鈥淭he Paris climate accord shackles economies and has done nothing to reduce greenhouse gas emissions,鈥� says Judd Deere, deputy press secretary for the White House.

The US won鈥檛 officially exit the Paris Agreement until 4 November, the day after the US election, due to the rules of withdrawal in the accord. Siegel thinks rejoining could happen quickly under another president, but other environmental policy changes may be harder to reverse.

The Trump administration has rolled back dozens of regulations, such as endangered species protections, limits on greenhouse gas emissions and emissions standards for power plants and vehicles. 鈥淭here鈥檚 a whole suite of things intended to ram through as much fossil fuel production as possible,鈥� says Siegel.

These include weakening regulations put in place under the Obama administration鈥檚 Clean Power Plan (CPP). Its Trump-era replacement, the Affordable Clean Energy rule, scraps federal emissions standards and gives responsibility for setting those standards to state governments. This effectively takes the legs out from the US Environmental Protection Agency, which is responsible for policing infractions but is now unable to set common standards.

The CPP called for a reduction in greenhouse gas emissions from the power sector by 32 per cent between 2005 and 2030, and would have relied on states moving away from using coal power plants. Its elimination makes it easier to keep coal plants operating for longer.

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Length of wall constructed on the US-Mexico border鈥�

Fossil fuel industries have also benefited from deregulation in other ways. The Trump administration poked holes in a rule that requires coal power plants to . Oil and gas companies, meanwhile, no longer have to report and repair . Methane is a particularly important greenhouse gas in the short term because it has a greater warming effect than carbon dioxide. 鈥淭he oil and gas sector is a massive source of methane, and it鈥檚 technically feasible and extremely cheap and easy to stop those leaks,鈥� says Siegel.

Trump has repeatedly claimed that the US has the cleanest air and water in the world, . In fact, efforts to reduce pollution have been weakened under his leadership. For example, Obama-era emissions standards for vehicles that required a 5 per cent decrease in carbon emissions each year have now been downgraded to 1.5 per cent, while Obama鈥檚 expansion of federal protection for streams and wetlands has been reversed, with long-term consequences.

鈥淭he impact that will occur because headwaters and intermittent streams in the wetlands are going to be less protected will take a while to actually show up,鈥� says Durelle Scott at Virginia Tech. Degraded ecosystems, contaminants in the water and poorer health for people and animals could take five to 10 years to appear, he says.

Trump鈥檚 signature campaign promise to build a border wall between the US and Mexico has also taken a toll on natural resources. 鈥淭he Trump administration is extracting hundreds of millions of gallons of water from desert aquifers to mix concrete for the 10-foot-deep barriers at the border,鈥� says Laiken Jordahl at the Center for Biological Diversity Action Fund, who works in the border region in Arizona.

US Customs and Border Protection says 580 kilometres of border wall have been erected. While the president鈥檚 detractors often point out that much of this is replacement wall, the new, taller barriers have a much greater impact on wildlife, says Jordahl. It has affected that are endangered, threatened or identified as warranting protection, he says.

An obscured crisis

The Obama-era law Trump has targeted most vehemently is the Affordable Care Act (ACA), also known as Obamacare, which resulted in 20 million more people having healthcare insurance. It is still in place, but the president has been chipping away at it bit by bit since the day of his inauguration. On 20 January 2017, he signed an stating his intent to seek its 鈥減rompt repeal鈥� and allowing US agencies to eliminate portions of the law that placed an economic burden on patients, insurers, drug-makers, doctors and states. The resulting slash in funding for programmes helping people get healthcare through the ACA led to getting coverage the following year.

In an effort to make good on the rest of Trump鈥檚 promise, Republicans in the US Congress spent much of 2017 attempting to repeal the law, going on a rollercoaster ride of proposed and ultimately failed bills. By October 2017, Trump had taken matters into his own hands. He signed an to permit less robust health insurance plans under the ACA, such as short-term plans that can expire when someone is in the middle of treatment.

In December 2017, as part of a tax bill signed by Trump, a key part of the ACA was reversed. The individual mandate, which required most people in the US to have health insurance or pay a fine, was revoked. This requirement kept younger, healthy people insured alongside older people and those with health conditions, lowering costs, as younger and healthier people pay in but require less treatment.

In the ensuing years, the number of uninsured people in the US has gone up. According to Census Bureau data, 25.6 million people were uninsured in 2017, a figure that rose to 27.5 million in 2018. More recent figures show that in the first three years of Trump鈥檚 tenure, up to the end of 2019, the number of uninsured people in the US rose 2.3 million.

Because many people in the US have health insurance through their employer, the covid-19 crisis has also led to a marked decrease in healthcare coverage. The months between February and May saw the largest ever increase in the number of uninsured adults 鈥� a jump of 39 per cent, or 5.4 million people 鈥� according to in Washington DC.

Trump has repeatedly promised to produce a healthcare plan that would replace the ACA, but he hasn鈥檛 delivered. In May 2018, he said his plan would come out in four weeks. In June 2019, he said it would be released within two months. During the pandemic, he has mentioned on several occasions that he is on the verge of revealing a new healthcare plan. It has yet to materialise.

The focus on the pandemic has obscured an existing US health crisis: the large number of deaths due to opioid overdoses. When he was campaigning for office in 2016, Trump said he would tackle this, and while his administration has taken steps to do so, it hasn鈥檛 been able to stem the tide.

In the 12 months preceding February 2020, drug overdose deaths in the US hit an all-time high of , with more than two-thirds of that due to opioids. This is an increase from about 65,000 overdose deaths in 2017, according to the US Centers for Disease Control and Prevention. It is also a reversal of a short-term trend that showed drug overdose deaths declining slightly in 2018, mainly due to a reduction in prescription opioid deaths. A rise in overdose deaths from illegal drugs has reversed that progress. In 2020, overdose deaths are spiking again, .

In 2017, the Trump administration declared the opioid crisis a public health emergency, though the US Government Accountability Office found that this . The administration expedited a survey on prescription drug trends and waived some red tape for research on treatment.

In 2019, Trump announced that the federal government would set aside $1.8 billion for treatment and prevention. States have used the money to treat overdoses and fund recovery programmes.

More funding may be needed, especially now. 鈥淭he covid-19 pandemic has exacerbated an already difficult situation by reducing access to life-saving treatment, harm reduction, and recovery support services, while increased stress and isolation might increase the risk of addiction and substance use disorders,鈥� wrote Leana Wen at George Washington University in Washington DC and Nakisa Sadeghi at the University of North Carolina at Chapel Hill in .

Shoot for the moon

Obama鈥檚 space policy was muddled. He cancelled a George W. Bush-era programme to send astronauts to the moon in favour of focusing on Mars, via a human mission to an asteroid that had lukewarm support.

Under Trump, NASA has the moon firmly in its sights. 鈥淭his time, we will not only plant our flag and leave our footprint, we will establish a foundation for an eventual mission to Mars and perhaps, someday, to many worlds beyond,鈥� Trump announced in 2017, on the 45th anniversary of the Apollo 17 lunar landing.

In 2019, vice president Mike Pence set an ambitious timeline, directing NASA to return to the moon by 2024. 鈥淭he goal of 2024 put some energy into the system and it鈥檚 been aggressive and helped things move faster than they would have,鈥� says Mary Lynne Dittmar at the Coalition for Deep Space Exploration.

Whether Trump鈥檚 space policy can actually deliver remains to be seen. NASA鈥檚 Artemis programme aims to put a man and a woman on the moon in four years, and Dittmar says that鈥檚 a challenging goal. 鈥淚鈥檝e never seen human space flight come in on time by anybody, by any nation,鈥� she says.

鈥淣ASA鈥檚 Artemis programme aims to put a man and a woman on the moon in four years鈥�

But NASA is moving forward quickly. 鈥淭his time, we are not going alone, but with commercial and international partners. To meet these goals, this president has called for historic increases in NASA鈥檚 budget,鈥� says Will Boyington of the National Space Council.

On 13 October, eight countries signed up to the US-proposed Artemis Accords, which sets out rules for lunar mining and standards for sending both robots and people to the moon鈥檚 surface. The hope is to avoid potential future disputes over the use of materials extracted from the moon, although China and Russia 鈥� both major players in space flight 鈥� haven鈥檛 signed up.

Beyond NASA, in 2019 Trump directed the creation of the US Space Force, which was touted as a new branch of the military. 鈥淚t鈥檚 like the army and the navy, but for space, because we鈥檙e spending a lot of money on space,鈥� he said. In reality, it is more of a bureaucratic shuffle of existing space command away from the air force, army and navy branches that housed them before.

The Trump administration also set out to develop standards around space traffic management, cybersecurity issues for satellites and launch regulations. 鈥淪ome of these will be implemented by the end of the first presidential term. There鈥檚 been more focus on trying to address some of these structural problems than I remember in the past 20 years,鈥� says Dittmar.

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