Opinion: The Trump administration is burying science and health care in paperwork

If you have ever interacted with the federal government, it’s probably involved a lot of paperwork. According to the federal government’s own estimate, in 2023, 10,503 million hours were spent filling out paperwork across federal agencies. The amount of time that people spend trying to navigate government bureaucracy to get benefits, services, or funding has been coined the “time tax” by journalist Annie Lowrey. This wasted time takes away from time that could otherwise be spent productively on work or leisure and worse, can discourage people from accessing benefits they are entitled to. The government estimates that, each year, about $140 billion in benefits goes unclaimed because of this time tax. This was the situation before the Trump administration, and it’s likely become much worse. Despite a stated focus on “finding efficiencies,” the administration has significantly increased the bureaucracy Americans — from scientists seeking grants to Medicaid beneficiaries — have to navigate, especially at the Department of Health and Human Services. All of this will have a dramatic effect on America’s health care system and its biomedical research industry. We’ll start with the scientists. Perhaps no federal agency has been slowed down by administrative burden this past year like the National Institutes of Health (NIH). Before 2025, scientists spent about 40% of their time on administrative-related tasks. That percentage has surely increased. To make sure that grants are in line with new presidential priorities, the agency has been using a computer tool to scan grants for prohibited terms. Grantees are asked to make revisions — sometimes in the middle of the grant lifespan. These changes can be merely language related, but other times they require significant changes to the aims and protocols. This puts a huge burden on research teams and administrative staff at universities, who not only have to deal with regular grant compliance but now have to contend with surprise requests and additional “DEI”-related screening. All of this also results in delays in grants being awarded — as of the end of June, NIH has spent 25% less on grants compared to 2021-2024. All told, the chances of being awarded a new NIH grant has dropped to 13%. Now, the Office of Management and Budget (OMB) has proposed making this process permanent and potentially worse by having a political appointee review all grants before they are awarded, superseding the peer review process. This rule (which would impact all grantees across the federal government, not just academic institutions) was proposed to go into effect Oct. 1, though a Senate bill has prohibited OMB from doing that until at least Dec. 11. Scientists now are spending an increasing amount of time worrying about keeping the lights on and people employed, which ultimately distracts from time spent doing research. These changes to NIH will certainly discourage young scientists from pursuing a career in research, and push people to look abroad for opportunities. As a matter of survival, universities will continue to navigate administrative hurdles. But what about the average person who doesn’t have an army of staff? This is what Medicaid recipients will be facing come Jan. 1. Thanks to the One Big Beautiful Bill Act (OBBA), a number of changes coming to Medicaid are poised to kick millions off of their health care. These changes include: increasing renewals to twice a year (rather than annually), introducing “community engagement” requirements (defined as working, volunteering, or going to school at least 80 hours per month) for most people (apart from the elderly, children, people who are “medically frail,” and pregnant women), and kicking off certain groups of immigrants from Medicaid altogether. The vast majority of current recipients (92%) should continue to qualify for Medicaid under these new rules, but many are expected to fall off due to the complex bureaucracy that has to be navigated. A renewal process happening twice a year instead of yearly automatically increases the administrative load for the state, the individual, and medical providers. Case managers for people who are unhoused will now have to double their workload to ensure their clients stay enrolled in Medicaid. Then there are the community engagement (i.e., “work”) requirements, which themselves have to be documented. States can use what existing data they have to automate these processes and reduce the burden on the individual. But that requires incredible amounts of investment and government staff time. That’s why implementing work requirements is likely to cost states millions of dollars. When Georgia implemented work requirements in 2023, the state spent $40 million on implementing work requirements, and 80% of that cost was administrative. In 2019, the Government Accountability Office modeled the cost of work requirements for a number of states and found that Kentucky would have to spend an additional $271 million on administrative costs implementing the new policies. Adding to this burden is the process of getting an exemption from the work requirements, specifically for having a condition that makes you “medically frail” and therefore unable to work. The process now laid out by the Centers for Medicare and Medicaid Services demands that states verify how severe a diagnosis is — this requires an extra visit and paperwork from the doctor. Conditions such as depression, asthma, and chronic pain may not qualify someone from Medicaid automatically, but experts point out that these conditions can be debilitating on some days, even if people can function on others. This process is so burdensome that it is currently subject to litigation from a number of states. For those not on Medicaid, this process may seem like a slight headache. But in practice, it is a nightmare scenario for millions of Americans. Let’s say you are undergoing cancer treatment, but you don’t have the right paperwork for your renewal. As a result, you’re disenrolled from Medicaid. You desperately try to fix the mistake, but you are faced with long wait times and no answers, so you cease treatment altogether. Across the country, others might be meeting the work requirements but miss the notice to renew in the mail and as a result, experience an interruption in coverage. Paperwork here is not merely an annoyance, it is a matter of life or death for millions with Medicaid coverage. Then there’s the matter of literacy. Forms can be hard to follow and confusing, and with a third of the country reading at a sixth-grade level, there’s a real risk that people may not be able to understand the forms they are filling out. A 2012 analysis found that most states’ Medicaid renewal applications fail readability tests, and there’s not much indication things have improved. Studies have also investigated a similar concept of “health insurance literacy” and found that clients generally have low literacy especially as changes to forms and text occur. The OBBA also put into place dramatic changes to the Supplemental Nutrition Assistance Program (SNAP) that similarly increased the burden of paperwork to verify that someone qualifies for the program. In Arizona, this has resulted in more than 440,000 people being dropped from the program even though most still qualify for assistance. People are stuck in procedural limbo waiting for months. The point of these bureaucratic hurdles is to keep people from accessing federal benefits, whether it’s Medicaid or scientific funding. All of these have impacts beyond the people who directly benefit; every $1 cut to SNAP costs families $14-$20, Medicaid cuts will reduce the GDP by $154 billion in 2029, and cuts to research could cost the country billions if not trillions. Perhaps more than in any other time in recent history, Americans are severely burdened by paperwork. Time and money are being lost to needless bureaucracy, and people are going hungry and losing health care as a result. Labs are being shuttered and scientific innovation is being interrupted. In its myopic focus to pay for tax cuts, the federal government is ignoring these great costs. But beyond that, government should serve to make your life easier, not harder. Abdullah Shihipar directs narrative projects and policy impact initiatives at the People, Place, and Health Collective at the Brown University School of Public Health. Brandon Marshall is a professor of epidemiology at the Brown University School of Public Health, and director of the People, Place, and Health Collective at Brown.