How Trump’s transition could end up hamstringing his agenda

President-elect Donald Trump’s transition team still has not sent policy advisers to coordinate with the federal agencies he is preparing to take over, delaying preparations that could be key to executing his ambitious agenda.

The Trump transition signed an agreement Nov. 26 paving the way for those “landing teams” to begin work in the agencies. But before they can do that, the transition has to submit its lists of people who will serve on the teams to the Biden administration — and they just began sending over those names late this week, the White House confirmed Friday.

That puts Trump officials nearly a month behind their recent predecessors, who began what is known as the “agency review” process — meeting with existing agency staff and getting briefed on major policy issues and challenges — right after the election, to ensure their incoming administrations would be up to speed. Trump, however, delayed for months in signing an agreement with the Biden administration to authorize those teams, before finally reaching a deal just before Thanksgiving.

Amid other transition delays — including in processing security clearances — former officials in both parties say this lag in beginning the usual crash course in agency operations only adds to the obstacles Trump will face as he looks to rapidly implement his sweeping policy agenda. That’s particularly true in areas like health policy, where few of the president-elect’s picks to lead the agencies have any experience in government or in managing such large and complex bureaucracies.

Trump’s health nominees include television personalities Dr. Mehmet Oz to lead the Centers for Medicare and Medicaid Services and Dr. Janette Nesheiwat to be surgeon general; Florida Rep. Dave Weldon to lead the Centers for Disease Control; surgeon Marty Makary to lead the Food and Drug Administration; and anti-vaccine activist Robert F. Kennedy Jr. as secretary for Health and Human Services. None have any history working for the executive branch or leading an organization on this scale.

And, thanks to the holdup in putting together landing teams, they have only a few weeks before Trump takes power to meet the career workforce, walk through the budget, get to know how various offices interact, and familiarize themselves with what pitfalls may await them after Inauguration Day.

“They’re really operating, I would say, at a severe disadvantage,” said Kathleen Sebelius, the secretary of Health and Human Services under President Barack Obama. “It has been decades and decades since somebody has been in these Cabinet offices without any sort of expertise or experience. And there are lots of barriers built into the structure of a huge agency like HHS, where you really can’t just come in and wave a magic wand and say, ‘You used to do things this way, and now we’re going to do it differently.’”

While the Trump transition declined to comment on the status of their landing teams, incoming White House Press Secretary Karoline Leavitt praised the president-elect’s nominees in a statement, calling them “highly-qualified men and women who have the talent, experience, and necessary skill sets to Make America Great Again.”

The agency review process typically begins by mid-November. Trump’s team began submitting the names of some of their landing team members to the White House on Thursday, but has not yet completed the process. In comparison, President Joe Biden unveiled his landing teams on Nov. 10 — though their work was delayed for weeks after that by Trump’s refusal to concede the election. And when Trump first won in 2016, his transition began launching its landing teams on Nov. 18.

Even after Trump’s landing teams begin arriving at their assigned agencies for meetings and briefings this year, they are likely to be hampered by Trump’s refusal to sign a separate transition agreement with the General Services Administration and instead run the transition on private funds out of private facilities using private email servers with federal cybersecurity support.

“Agencies would normally be prepared to start sharing unclassified information now,” said Valerie Smith Boyd, the director of the Center for Presidential Transition at the nonpartisan nonprofit Partnership for Public Service, which assists all parties with transition planning. “But in the absence of a GSA-secure network, individual agencies will need to rely on their best practices for sharing controlled but unclassified information — anything that might be kind of more sensitive than the norm, like law enforcement information.”

Rather than swiftly sharing data over email, she added, “That type of information they might choose to share only on paper or standalone terminals,” within the agency buildings, “but they may not feel comfortable transmitting that over a non-government provided network.”

People in both parties who have previously held these roles tell POLITICO that those kinds of slow downs in the less-than-three-month transition could stall or even scuttle the new administration’s ambitions on everything from revamping vaccine safety data collection to tackling chronic diseases, and leave them unprepared to confront emerging threats like avian flu.

“The most dangerous implications are for national security, and that includes health security,” stressed Democratic health care strategist Chris Jennings, who has served on both sides of several presidential transitions, including Biden’s transition in 2020. “They need to be briefed up and prepared to quickly act on viral, microbial, and chemical warfare threats. You can’t afford to play around with those. They are predictably unpredictable risks that can’t wait for officials to be briefed up on ramifications and needed remedies months into an administration.”

Trump is poised to enter office in January amid a troubling outbreak of bird flu that public health experts worry could quickly balloon into a threat to the food supply or the general population, as well as a resurgence of once-rare childhood illnesses like whooping cough and measles. Health officials and outside experts who recall Trump’s chaotic Covid-19 response during his first term now fear the combination of his current nominees’ disdain for mainstream science, their expressed desire to move away from funding infectious disease research, and their failure to use the transition period to properly prepare could mean a slow or inadequate response to future health crises that put the general public in danger.

Trump’s surgeon general in his first term, Jerome Adams, warned in a post on X that the new administration runs the risk of being “distracted with outbreaks for 4 years this time instead of 1.”

Trump’s penchant for bucking the usual transition processes isn’t new. When preparing to enter the White House in 2017, he threw out months of work prepared by then-transition chair Chris Christie in a shakeup of his transition leadership, was slow to put together agency review teams, and ignored briefing materials compiled by the outgoing Obama administration — including a nearly 70-page “pandemic playbook” that they were given years before Covid-19 struck.

On health policy, the impact of those choices was mitigated, in part, by a team of Cabinet members that included state health commissioners, former HHS officials, and others with years of experience working with federal health programs.

Tom Scully, who ran the Centers for Medicare and Medicaid Services under Republican President George W. Bush, said transition coordination was less important for him because he already had extensive federal government experience and a personal relationship with the official he replaced. But for Trump’s incoming health officials who lack those connections, it’s another story.

Scully said it’s “critical” for those Trump nominees to “get in there and start working with the departments to see what’s going on.”

“I don’t know Dr. Oz, and I’m sure he’s a highly capable guy, but he should probably call up [CMS Administrator] Chiquita Brooks-LaSure, who’s a lovely person, and spend some time with her, figuring out what her biggest issues are and where she agrees with him,” he continued. “It’s just the rational thing to do to figure out what’s on their agenda, what they think has been left undone, whether you agree with them politically or not.”

The managerial inexperience of Trump’s recent picks to run these agencies — which collectively have tens of thousands of employees and a budget of over a trillion dollars per year — also raises the pressure on the incoming administration to appoint people familiar with their inner workings to deputy positions.

Trump, for example, has tapped Jim O’Neill, a veteran of George W. Bush’s HHS, to serve as deputy secretary of the agency.

But RFK Jr.’s lack of policymaking experience is still worrying some key conservative allies.

“While RFK Jr. at HHS has the skills to end weaponized agency policy and evaluate the environmental harms of abortion, the Trump team needs to balance the HHS ticket by being sure that pro-life voices are heard and experienced experts added to RFK Jr’s team,” said Kristan Hawkins, the president of Students for Life of America. She added that reports that the Heritage Foundation’s Roger Severino, a senior HHS official in Trump’s first term, has been passed over this time “represent the wrong direction.”

The next Trump administration, Hawkins argued, needs “experienced hands” who know how to undo all of the Biden policies that have expanded access to abortion over the last four years.

Some former Democratic officials who spoke to POLITICO — including Sebelius — expressed hope the Trump health team’s inexperience and lack of preparation stymies their plans to put a conservative stamp on the system.

But Leslie Dach, a former senior counselor at HHS during the Obama administration who now works for the health advocacy group Protect Our Care, cautioned that Trump’s officials could still accomplish a lot through inaction, particularly with the Affordable Care Act’s enhanced tax credits set to expire in 2025.

“They just have to sit on their hands and 5 million people will lose their insurance and you more than 15 million others would be bankrupt, possibly, by their health insurance premiums,” he said, adding that there were many other low-effort ways they could undermine Obamacare. “You can shorten open enrollment, eliminate the special enrollment period, shut down the call centers over the weekends, like they’ve done before, and all of a sudden you would lower the number of people with health insurance dramatically. You can show up to work late, leave early, and take health care away from millions of people.”