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Catherine Rayner came to the House chamber as a character in President Donald Trump’s favorite kind of story. In his State of the Union address, Trump said Rayner had been paying $4,000 for an IVF drug but, after visiting the new website TrumpRx.gov, got that same drug for under $500. He told her "we are all praying for you," and added that the site showcased price differences of "300, 400, 500, 600 percent and more."
Trump’s broader health pitch followed the same logic. He described "the crushing costs of health care," blamed "the unaffordable care act, sometimes referred to as Obamacare," and said his "Great Healthcare Plan" would stop payments to "big insurance companies" and "give that money directly to the people."
The following day, another health pitch was being given in a Senate hearing. Dr. Casey Means, Trump’s nominee for surgeon general, was pressed on whether she would advise Americans to vaccinate against "flu and measles amid outbreaks across the U.S." She didn’t commit, stressing "informed consent," and when asked whether she accepts evidence that vaccines don’t cause autism, she said: "I do accept that evidence…I also think that science is never settled."
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As of February 19, the CDC reported 982 confirmed measles cases in 2026. Science may never be settled, but pricing won't solve this problem. Words, however, may matter.
Common Knowledge
Critics saw the Means hearing as a test of the Trump health agenda. Senator Bernie Sanders put it bluntly: "I have very serious questions about the ability of Dr. Means to be the kind of surgeon general this country needs."
Senator Bill Cassidy (a Republican physician) said America’s top doctor must fight "vaccine skepticism…at a time when so many, for whatever reason, sow distrust and confusion."
That anxiety is amplified by what happened to the CDC’s own messaging on autism and vaccines. The CDC’s "Autism and Vaccines" page now says it was updated under the Data Quality Act because the statement "Vaccines do not cause autism" is "not an evidence-based claim," and it says HHS has launched "a comprehensive assessment of the causes of autism," including investigation of "potential causal links."
The populist 'Make America Healthy Again' (MAHA) wing sees Means as the antidote to a health establishment that obfuscated during the pandemic. Means was explicitly cultural: "Our nation is angry, exhausted and hurting," she told senators, arguing that focusing on "shared root causes" can stop "the whack-a-mole medicine that’s not working for us."
However, previously Dr. Mehmet Oz—now running CMS—urged vaccination in unusually direct terms for this administration: "Take the vaccine, please. We have a solution for our problem."
Uncommon Knowledge
In Trump’s 2026 State of the Union, there was no mention of "vaccine," "autism," "measles," or "MMR." That absence matters because measles numbers are large enough to be an alarming national indicator.
The CDC says the 982 confirmed measles cases so far this year included cases reported by 26 jurisdictions, plus 6 cases among international visitors. It also reports 7 separate outbreaks in 2026 and says 89 percent of this year's cases are outbreak-associated. In 2024, there were only 285 cases.
Meanwhile, the CDC says kindergarten MMR coverage fell from 95.2 percent in the 2019–2020 school year to 92.5 percent in 2024–2025, leaving approximately 286,000 kindergartners at risk. The 95 percent is vital because that is when most people become protected through herd immunity.
This is where "informed consent" runs into the math. The CDC explicitly warns that "pockets of unvaccinated people can exist" even in states with high overall coverage, and that when measles enters those communities, outbreaks can occur.
The global outlook adds to those concerns. The World Health Organization reported in late 2025 that measles deaths fell 88 percent from 2000 to 2024 and that nearly 59 million lives have been saved by measles vaccine since 2000, but it also estimated 95,000 measles deaths in 2024 and said that cases are surging again. The CDC points to "global measles activity" increasing as one reason there is "more measles activity" domestically.
So measles is up. Coverage is down. Importation risk is up.
Hepatitis B is another case in point. In December 2025, the CDC’s Advisory Committee on Immunization Practices voted 8–3 to recommend "individual-based decision-making" for whether infants born to hepatitis B–negative mothers should receive the HepB vaccine birth dose. The CDC later adopted that policy, suggesting that for infants not receiving the birth dose, the initial dose be administered "no earlier than two months of age."
That's where it does, in fact, align with Trump’s SOTU health care pitch. Cut out "big insurance," send money "directly to the people," publish prices. Means, in the hearing, built her defense around "informed consent," with patients and doctors deciding together, while declining to make a simple recommendation about measles vaccination during outbreaks.
The MAHA coalition is not wrong that chronic disease is a massive national problem, nor that many Americans feel they were bullied rather than persuaded in recent years. The problem is that measles and other diseases do not behave like a consumer product.
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