President Donald Trump’s age, public behavior and recurring health questions could eventually produce an extraordinary power shift inside the White House—but not necessarily toward Vice President JD Vance.
Global affairs analyst David Rothkopf has floated a far more surprising possibility: Deputy White House Chief of Staff Stephen Miller could become the administration’s most influential figure behind the scenes if Trump becomes less capable of managing his presidential duties.
Rothkopf emphasized that he was offering a prediction, not reporting that a transfer of authority had already occurred. Nevertheless, he argued that the people controlling a president’s schedule, access and public communications can accumulate enormous practical power without ever assuming the presidency formally.
“Power flows from the president, from the people closest to the president, from the people who control his schedule, from the people who send out his statements,” Rothkopf said during an appearance on “The Daily Beast Podcast.”
That description places Miller in a potentially commanding position.
As deputy chief of staff and one of Trump’s longest-serving ideological advisers, Miller has become deeply involved in the administration’s policies, messaging and executive actions. He frequently appears beside Trump at high-profile White House events and has helped shape some of the president’s most controversial immigration and citizenship initiatives.
Vance, by contrast, has been less visible at several of those events, Rothkopf observed.
The argument does not mean Miller could legally replace Trump or Vance. The Constitution and the 25th Amendment establish formal procedures for presidential succession and the temporary transfer of presidential authority. Unelected White House aides cannot constitutionally become president simply because they control access or influence decisions.
But informal authority is different from legal authority.
History has repeatedly shown that close advisers, spouses and senior staff members can become exceptionally powerful when a president is ill, distracted or increasingly dependent on those around him. They may determine which information reaches the Oval Office, which meetings appear on the schedule and which decisions receive immediate attention.
Rothkopf suggested Trump could be approaching such a period.
“And I’ve got to tell you, you look at Donald Trump, you look at the bruises, you look at his behavior, you look at his age, you look at his family history, and we could be heading for one of these periods where somebody other than Trump is actually, behind the scenes, the acting president,” he said.
Questions surrounding Trump’s health have intensified during his second administration. Photographs have repeatedly shown bruising on his hands, while other images have drawn attention to swelling around his ankles.
The White House and Trump have previously attributed the bruising to frequent handshaking and the president’s use of aspirin. Reports have also said he has been diagnosed with chronic venous insufficiency, a condition affecting blood flow in the legs.
None of those publicly discussed symptoms, however, independently proves that Trump is unable to perform his duties. Photographs cannot provide a reliable medical diagnosis, and outside observers do not have access to his complete health records.
Claims about cognitive deterioration require similar caution. Trump’s speeches, social media activity and admission that he has taken multiple cognitive assessments have fueled speculation among political critics. But only qualified clinicians who have examined him and reviewed his medical history could responsibly diagnose a neurological or psychiatric condition.
Rothkopf’s argument is therefore fundamentally political rather than medical.
His concern is that a gradual decline—whether caused by age, illness, exhaustion or reduced engagement—would not necessarily produce a dramatic public announcement. It could instead trigger a quiet redistribution of authority among the officials closest to Trump.
He pointed to periods involving Presidents Dwight Eisenhower and Franklin D. Roosevelt as reminders that presidential illness can reshape how an administration functions. Eisenhower experienced serious health problems while in office, including a heart attack and stroke. Roosevelt’s deteriorating condition during his final years also raised lasting questions about how much the public and other officials understood about his health.
Modern succession rules are clearer than they were during those presidencies. The 25th Amendment, ratified in 1967, allows a president to transfer authority temporarily to the vice president. It also provides a mechanism for the vice president and a majority of the Cabinet to declare a president unable to discharge the office’s duties, although that procedure could provoke an enormous constitutional confrontation if contested.
If Trump voluntarily transferred power or became unable to serve, Vance—not Miller—would formally become acting president.
Yet Rothkopf’s warning focuses on what might happen before any official process begins. An aide who controls information, drafts statements and shapes access could exert tremendous influence while decisions continue to be issued in the president’s name.
That possibility becomes especially consequential when the aide is as ideologically driven as Miller, whose hardline positions on immigration and executive authority have profoundly shaped Trump’s agenda.
There is currently no public proof that Miller is secretly performing presidential duties or that Trump has relinquished control of the administration. Rothkopf’s scenario remains speculation based on White House power dynamics and visible questions surrounding an 80-year-old president.
But it identifies an issue larger than any one diagnosis: If Trump’s ability to govern declines gradually, Americans may not immediately see power move through the constitutional line of succession.
It could first migrate quietly—to the person standing closest to his desk.
