What Donald Trump's Second Presidency Has Meant for Health

We have just come through one of the most significant years in the history of American health policy. The first year of the second Trump administration saw enormous changes that will shape every element of health for years to come—from whether future clinicians have professional degrees to whether a particular hospital survives, and from whether we monitor diseases to whether we continue Meals on Wheels.

President Trump only received 49.8 percent of the vote in November 2024,¹ but he pretends to have a mandate from an overwhelming majority of the country, and his administration has been forceful and creative in reshaping healthcare. Its ability to swiftly enact sweeping change has been enabled by unified Republican control of Congress, which has chosen not to check the administration’s actions. Shortly after Trump’s inauguration, the Senate voted to confirm his nominees to lead the federal public health bureaucracy—most notably, Robert F. Kennedy Jr. as secretary of Health and Human Services (HHS), despite his long record of disseminating disinformation and pseudoscience on issues ranging from vaccines to fluoride to AIDS.

Under the leadership of Secretary Kennedy, as well as the administrators of the National Institutes of Health (NIH), the Centers for Medicare and Medicaid Services (CMS), and the Food and Drug Administration (FDA), this administration has wrought profound transformations throughout healthcare and public health. It has unleashed damage that will take decades to rectify. This article synthesizes the damage and outlines what can and must be done to protect our health and our democracy.

Dramatic Cuts to Health Spending

The biggest target in 2025 for the administration and Republican lawmakers was healthcare. They called their signature legislation, signed into law on July 4, the One Big Beautiful Bill Act (OBBBA). The OBBBA extended the enormous tax cuts for the rich passed in Trump’s first term while massively increasing spending on the Department of Homeland Security (DHS) and especially immigration enforcement (with ruinous results that are outside the scope of this article). Under Senate rules, that loss of tax revenue and increase in DHS spending had to be offset by large spending cuts elsewhere. Republicans went straight to healthcare to find those cuts. The healthcare cuts fall into two major buckets: Medicaid and the Affordable Care Act (ACA); there were also huge cuts in areas that affect health, such as the Supplemental Nutrition Assistance Program (SNAP), which supplements grocery budgets for lower-income families.

Cutting Medicaid

In Medicaid, the big policy changes include an intensive sequence of eligibility checks, eventually mandating state verification of enrollees against federal databases every month, new cost-sharing requirements for Medicaid expansion enrollees, and work requirements for Medicaid. The work requirements are a Medicaid cut disguised as a means of reducing “fraud.” They mandate fussy bureaucratic documentation and count on people who are, in fact, eligible for Medicaid being too tired, confused, or sick to complete it correctly, on time, over and over again.

Although work requirements poll well and fit within a familiar “personal responsibility” narrative, they do not produce employment gains and have little to do with the actual Medicaid population, most of whom are already working or are obviously unable to work.² In reality, work requirements weaponize administrative burden, an old tactic that has been given new life by this administration; it has the effect of depriving people of benefits to which they are entitled by tying them up in paperwork and reporting requirements.³ Politically afraid of cutting Medicaid even more, Republicans ordered states to adopt subtle but effective ways to make Medicaid harder to use. And while these burdensome requirements have already been enacted in a small number of states (namely, Arkansas attempted it on a temporary basis in 2018⁴ and Georgia on an ongoing basis in 2023⁵), the OBBBA upends state control of Medicaid by compelling states to impose these constraints. Given the unpopularity of many of the reforms enacted through the OBBBA, it is little wonder that congressional Republicans deferred most of the provisions’ implementation until after the 2026 midterm elections—when voters might hold them accountable.

The OBBBA also makes changes to Medicaid that target specific groups, especially immigrants.⁶ The bill is filled with restrictions on the services that immigrants can receive, and, as with the work requirements, the burden of constantly proving citizenship will reduce their access to care. However, in addition to having lower healthcare usage and costs compared with US-born citizens,⁷ documented and undocumented immigrants pay more in taxes than they receive in services overall. They pay a range of taxes, from sales and gas taxes to income tax and the taxes withheld from paychecks to fund Social Security and Medicare. Undocumented immigrants in particular get far less for their taxes than documented immigrants and citizens, since they are ineligible for many programs. An average undocumented immigrant with less than a high school education who arrives at age 25 will pay about $200,000 more in taxes than they receive in services over their life⁸—so 100 undocumented immigrants could easily mean $20 million in additional tax revenue over their lifetimes.

The OBBBA’s focus on making people constantly prove citizenship to participate in programs makes it less likely that undocumented immigrants will acquire the paperwork needed to contribute through payroll taxes. As a result, there is a decent chance that these changes actually harm the Medicaid budget by making it harder for immigrants to pay into the system.⁹ The care that they do receive in the United States, when they become too sick to avoid it, will often be uncompensated care for hospitals, further straining providers’ finances. In general, of course, these Republican policies are intended to induce immigrants to “self-deport” (and to dissuade potential immigrants from coming to the United States at all).

Finally, the OBBBA makes cuts to Medicaid provider taxes, the state-imposed taxes on healthcare organizations and on facilities for which at least 85 percent of the tax burden is applied to healthcare items, services, or entities that provide or pay for healthcare items or services.¹⁰ Though provider taxes may seem obscure, all states except Alaska use them to help finance the state’s share of responsibility for Medicaid funding. These taxes are a jerry-rigged way to prop up inadequately funded Medicaid programs, but cutting them isn’t a fix. As in most other areas of health policy, Republicans don’t have a plan for improving or reforming Medicaid. They simply want to pull out the props without any intent to replace them with something better.

Undermining the Affordable Care Act

Under the Affordable Care Act, the marketplaces that enable working-class people to buy insurance combine regulation (the policies have to meet certain standards, including the provision of a comprehensive set of benefits) with subsidies to make the policies more affordable for those with qualifying incomes. The OBBBA drastically cuts the subsidies,¹¹ leading to the sticker shock roughly 24 million marketplace enrollees faced during the 2025 open enrollment period for insurance in 2026; by January 15, 1.2 million fewer people had selected (or continued) insurance plans compared to the previous year (and more reductions are expected in the coming months as people receive their new bills).¹² Over a year or two, the higher costs will filter through to other parts of the healthcare system. Insurers will withdraw options or raise prices to compensate for the loss of marketplace business, health systems will see uncompensated care costs rise, people will get sicker as they forgo preventive care and treatment of chronic issues, and smaller and rural hospitals will lose crucial revenue.

Republicans’ commitment to undermining the ACA was so absolute that they refused to end the October–November 2025 shutdown of the federal government by restoring ACA subsidies, despite the popularity of the ACA as a whole and of the subsidies in particular.¹³ Restoring the subsidies would have mostly benefited their voters in time to help Republicans keep their seats in the November 2025 elections, or in the coming 2026 elections, as more than half of all ACA marketplace subsidy recipients live in red states.¹⁴ But all Republican leaders would promise was a Senate vote sometime later in January 2026. This deadline ultimately came and went without a vote to extend the enhanced subsidies.¹⁵ Absent this assistance with plan premiums, America will experience increases in uninsurance as well as underinsurance, compromising hospitals’ financial security and patients’ health security.

Though the ACA has long been ensnared in partisan politics, it has been a lifesaver for the tens of millions of Americans with preexisting medical conditions such as previous cancer treatment or a chronic disease. Prior to the ACA’s implementation, preexisting conditions could lead one to be denied coverage outright or else charged prohibitively expensive premiums. Though some Americans may not really remember what healthcare was like before the ACA, many will soon find out just how far-reaching its impact is—and after years of not being fearful of documenting medical concerns, many more people could be in trouble.

Some will find out because they work for healthcare facilities that depend on the ACA and Medicaid. The impact on healthcare facilities and jobs will be mediated through all sorts of capital market and corporate decisions, but we can identify the facilities at most risk. A high share of Medicaid and ACA marketplace patients—common for hospitals and clinics that serve rural areas¹⁶—is a very bad sign for healthcare providers post-OBBBA. In that vulnerable group, we should worry most about rural providers (many of which were already facing budget crises¹⁷), more remote facilities attached to larger systems, and for-profit providers with margin-minded owners who might reevaluate the viability of the business once the cuts take hold.¹⁸

Aware of the threat to rural healthcare, Republicans stuck a $50 billion Rural Health Transformation Program into the OBBBA, with the first funds to be distributed in 2026. While $50 billion sounds like a lot of money, it’s much less when divided among 50 states—with the average grant amounting to $200 million¹⁹—and this initiative is a drop in the bucket compared to the Medicaid cuts and other cuts to programs, including SNAP,²⁰ that help sustain rural healthcare. Don’t bank on this $50 billion saving your local hospital. As more of the draconian Medicaid cuts go into effect, the broader constellation of rural healthcare providers, from hospitals to federally qualified health centers to community mental health centers, will continue to be strained—shrinking services, driving facility closures, and increasing the risk of adverse patient outcomes and death.²¹

Destroying American Science

Evidence-based practice is hard and can be imperfect in execution, but at its core it requires evidence. The development of new treatments, born from insights about topics from gene splicing to the bacterial origins of ulcers, requires science. The US federal government has been, by a wide margin, the world’s largest funder of research into basic biomedical science, new treatments, and evidence on the effectiveness of treatments. This has been primarily through its huge National Institutes of Health (NIH)²² and the National Science Foundation (NSF), but also through smaller agencies like the Agency for Healthcare Research and Quality (AHRQ) and those that conducted healthcare research as part of other agendas, like the US Agency for International Development (USAID).

The payoffs of federal research are enormous. One study of 356 drugs approved between 2010 and 2019 found that all but two clearly involved NIH research.²³ If you were to look at those two, we bet you’d find people trained on NIH grants, educated by scholars supported by NIH, and using experimental techniques NIH helped develop. In other words, essentially every FDA-approved medication that came on the market in the last decade received NIH support.

Think of any medicine that you were able to start using in patient care between 2010 and 2020. That medication is the result of NIH research. The study ended in 2019, but it’s highly unlikely that anything has changed. The federal government, not pharmaceutical companies, funds the basic research upon which medicines are developed. And that’s just medicines. NIH also funds research into vaccines, medical devices and procedures, and population health—even complementary medicine that supplements standard biomedical care.

The National Science Foundation, meanwhile, might be better known for particle accelerators and the US Antarctica research station, but it’s also been crucial to healthcare. In theory, NSF doesn’t directly fund health research, but if you look into it, technologies as important as MRIs, mRNA, and the internet itself were actually born of its science grants.²⁴

That world-leading science machine is a target of the Trump administration. The White House and the Department of Government Efficiency (DOGE), initiated by Elon Musk at the beginning of Trump’s second term, went after the science agencies with big efforts to lay off staff, redirect priorities, and end research programs that the White House found objectionable.²⁵ Their primary target was “woke” research; grant programs and grants were blocked on the basis of broad searches for terms like gender, bias (even in the context of statistical analysis), diversity (even in the context of biological species), or women. Their dragnet approach to identifying “woke” grants fit with an overall attack on diversity, equity, and inclusion (DEI) initiatives that attempted to compel universities to cut programs.*

The result was chaos in science, as patients had treatments cut off because trials were ended, stop-work orders led to sudden layoffs, university programs cut admissions because their graduate study grants were not funded, and government officials went silent.²⁶ It’s not hard to find medical researchers who haven’t heard from their government sponsors or received promised funding in months and have had to shut down their studies.

The Republican-led House of Representatives’ and White House’s proposed fiscal year 2026 budgets both call for drastic cuts to AHRQ ($369 million and $129 million in cuts respectively), and these cuts do not just imperil health systems research. AHRQ has been the core source of funding for numerous predoctoral and postdoctoral training programs in health services research,²⁷ which now face existential threats. The result is that even with the restoration of many grants, there will be delays in training the next generation of health researchers who help us work out which treatments are effective and safe.

Republicans don’t agree among themselves about this agenda, as evidenced by some stark differences in Congress’s and the White House’s spending proposals for the 2026 fiscal year (which started on October 1, 2025). Trump’s budget proposal included enormous cuts to NIH and NSF, and in fact to most science spending. The House left most funding flat, while the Senate’s budget negotiations stalled for months;²⁸ Congress has since passed “minibus” legislation to fund most agencies, including federal science agencies.²⁹ However, the protracted negotiations fueled prolonged uncertainty about the continued functioning, and even survival, of key agencies that support health-related research, training, and services to communities throughout the nation.

Undermining Regulation

The US federal government also has historically regulated health treatments, separating effective treatments from the sorts of products health grifters sell on the internet. That has long made government regulation and the agencies that carry it out an enemy of businesses that sell “health” products, some of them actively engaged in misinformation with products or treatments that can be dangerous to individual and public health.³⁰ With the arrival of Secretary Kennedy and his colleagues in high office, opponents of science-based regulation are now in charge of science-based regulation.

It’s very easy to get lost in the weeds with all the committees and processes that make up federal healthcare regulation. But what is happening is simple. The federal system for regulating and recommending healthcare, such as determining the preventive services and vaccines that insurers must cover, was designed on the assumption that impartial and highly skilled civil servants would support committees of experts who would bring together the best evidence to make recommendations that would influence standards of care and insurance coverage. That system is being pulled inside out, with political appointees running committees of people with limited expertise and deep connections to anti-vaccination movements and other purveyors of health misinformation.^†

Hollowing Out Vaccine Recommendations

These political appointments, combined with other cuts to health agencies and spending, are already resulting in consequential decisions, especially in vaccine policy and communication. On January 5, 2026, the Centers for Disease Control and Prevention (CDC) changed the childhood vaccination schedule, limiting the number of vaccinations recommended to all children to 11 from a previous 17. Instead, the CDC recommended “shared decision-making” for vaccinations for rotavirus, COVID-19, influenza, meningococcal disease, and hepatitis A and B, meaning that they are offered for those at high risk or in consultation with a physician.³¹ While CDC and HHS leadership have claimed that these decisions will build public trust in science, experts from academics and clinicians to the former chief scientist at the FDA and former members of the Advisory Committee on Immunization Practices agree that they will instead erode trust, decreasing vaccine uptake and increasing childhood disease.³²

Further eroding this trust is the current CDC position on the MMR vaccine. At the top of the CDC’s “Autism and Vaccines” webpage is this false assertion: “The claim ‘vaccines do not cause autism’ is not an evidence-based claim because studies have not ruled out the possibility that infant vaccines cause autism. Studies supporting a link have been ignored by health authorities.” The bottom of the page then delivers a sucker-punch to Republican Senator Bill Cassidy from Louisiana, a physician who forced Kennedy into one paltry commitment to secure his confirmation vote³³ for HHS secretary: “The header ‘Vaccines do not cause autism’ has not been removed due to an agreement with the chair of the US Senate Health, Education, Labor, and Pensions Committee that it would remain on the CDC website.”³⁴ Under Kennedy, the CDC is showing only grudging compliance with the demands of a single Republican senator who required that it stand up for the science that should define it.

Perhaps the best evidence of the health consequences of the institutionalization of the anti-vaccination movement is in the handling of measles. The United States is currently having a multistate measles outbreak, with cases from New Mexico to South Carolina to Michigan, and case numbers for this extremely infectious disease are rising. Measles had been eliminated in the United States until anti-vaccination activism managed to push down vaccination rates; now, the country is on pace to lose its measles elimination status.³⁵ Instead of evidence-based promotions of measles vaccinations, HHS under Kennedy called for research into treatments, recommending strange or untested alternatives, including vitamin A and cod liver oil.³⁶ Instead of stopping measles, they are pushing measles patients onto healthcare systems. Few healthcare workers in the United States have ever seen measles, but more will soon.

Sowing Confusion About Nutrition

Kennedy and the MAHA movement are no better for chronic diseases. Consider our new dietary pyramid. The new federal dietary guidelines claim to attack processed food in the name of addressing chronic diseases, but they diverge by a lot from decades of nutrition science.³⁷ They explicitly “prioritize … healthy fats from whole foods such as eggs, seafood, meats, [and] full-fat dairy” and literally flip the food pyramid that the government long used.³⁸ In the new pyramid, a bowl of oatmeal and a few nuts sit at the narrow bottom while what appears to be a roasted chicken, a marbled steak, and a piece of cheese share the wide top next to some broccoli, peas, and carrots. The dietary guidelines retain previous recommendations to keep saturated fats below 10 percent of daily caloric consumption;³⁹ how people are supposed to do that while eating such foods is not explained. Additionally, while nutritionists caution against eating lots of processed food like packaged sweets or corn chips,⁴⁰ few would dream of suggesting the antidote is full-fat milk and a steak. This new approach turns a reasonable idea (“eat real food”) into something with little scientific backing.

Cutting Critical Agencies

The federal government has many agencies that are mostly known to those who work directly with them, from the Administration for Community Living (ACL) to the Health Resources and Services Administration (HRSA). Of them, perhaps only the Federal Emergency Management Agency, CDC, and FDA have much public visibility, but all of their work is important.

These agencies have been hit very hard by DOGE’s questionably legal cuts, sometimes retroactively made legal in a process called “rescission.”⁴¹ Their workforces are down by huge percentages, though the chaos of DOGE, layoffs, and early retirements make it really hard to figure out headcount or who is actually still employed and working. (ProPublica had to investigate, while websites like the CDC Data Project, cdcdataproject.org/units-rifs, are crowdsourcing the cuts because the official federal communications are rare and not helpful.⁴²) The White House’s 2026 budget proposal would have cut them extensively,⁴³ and Kennedy has proposed to reorganize most of them in a new “Administration for a Healthy America.”⁴⁴

Imperiling Care for Seniors and Communities

Sooner or later, these agency cuts will have indelible impacts on the federal government. Just consider a couple of these little-known agencies. HRSA is responsible for improving healthcare access in underserved areas and to underserved populations, with its grants often a lifeline for those providers; it also runs nationwide databases that track malpractice and the nationwide organ transplant networks that match kidneys or livers with recipients.⁴⁵ Kennedy and the HHS administration have cut its workforce and are attempting to abolish it entirely, moving bits of it around within the agency.⁴⁶ Over time, the impact on healthcare access, malpractice, and organ transplants, among other things, could be huge. Or look at the ACL, which among other activities funds Meals on Wheels, supports programs that allow people with illness or disability to live independently (e.g., providing transport to healthcare appointments), and plays a critical role in oversight of nursing homes.⁴⁷ As cuts overtake the agency, it will imperil seniors’ and disabled individuals’ abilities to live in their communities. What’s more, in December 2025 CMS repealed the minimum staffing requirements for skilled nursing and long-term care facilities, such that these facilities will no longer be required to provide at least 3.48 hours of nursing care per resident per day, with additional rescission of the requirement of 24/7 on-site RN services in nursing homes,⁴⁸ undercutting the health and safety of those dependent on this level of care.

Hobbling the US Public Health Response

Let’s hope that there is no global pandemic like COVID-19 anytime soon because no matter how skeptical you might have been of the US response, it relied on better science, preparedness, stockpiling, surveillance, and willingness to support vaccination than we have now. Cuts to NIH are directing research away from mRNA technology in particular and are undermining the base of scientists and labs that work on vaccines, treatments, and diseases. Cutting training programs for scientists means fewer people can staff testing or research into treatments and vaccines. And the FDA has been wracked by decimation of staff and instability; 3,500 personnel responsible for food testing and inspection, among other functions, were laid off in April 2025, with 20 percent or less reinstated months later, compromising the safety of the nation’s food and drug supplies and defense response.⁴⁹

COVID-19 showed us how quickly scientific capacity can pivot, which is how we went from the first identification of the virus to a tested vaccine in almost exactly a year. There was a vaccine available before the virus was even present in every country in the world. (Tonga didn’t have its first case until fall 2021.⁵⁰) For comparison, it took three years from the first documentation of AIDS to identification of the underlying human immunodeficiency virus.⁵¹ We should not celebrate the stunning achievement of identifying powerful vaccines against COVID-19 by cutting the scientific capacity that made those vaccines possible and destroying the public health infrastructure that made the vaccination campaigns happen.

Public health and emergency management workers—and really anybody who tries to prevent bad things—like to say that they do their best work when nobody notices their work. We are about to find out what they were preventing, from bedsores in substandard nursing homes and understaffing and closure of rural healthcare facilities to the mismanagement of massive natural disasters. We’ll miss them when emergencies arise that force us to notice they are gone.

Defining Professionals

The US Department of Education is being dismantled, but it still retains the legal authority to determine the list of professional degrees that are eligible for the highest caps on federal student loans; the department was mandated in the OBBBA to use that authority to cut student loans. In November 2025, the department proposed rules changes through its advisory committee that would remove many healthcare professional degrees from the list, lowering the caps for student loans from $200,000 to $100,000⁵²—and telling healthcare professionals that they aren’t professionals after all.

Degrees that they propose to cut from the list include, remarkably, nursing, physician assistant, and physical and occupational therapy. In fact, if the profession requires fewer than two years of graduate study (e.g., nursing) or requires no credential (e.g., most master of public health degrees), it is likely out. This reduction in student loan caps could decrease the supply of health professionals, leading to workforce shortages, and decrease the number of people from working- and middle-class backgrounds in these fields. This proposal was put forth by the department as a proposed regulation for public comment,⁵³ and it tells us a lot about how this administration regards healthcare workers. This action comes in tandem with others that imperil the healthcare workforce, including anti-immigration actions (over one million noncitizens are employed in healthcare), cuts to Medicaid, and the reorganization of HRSA.⁵⁴

Fighting for Our Health and Our Democracy

What can be done for American health and the health of our democracy?

One thing we can do stems from a worrisome research finding, which is that poorer health makes people more likely to support authoritarian leaders like Trump.⁵⁵ We know that counties with worsening health, greater inequality, more extensive illegal drug problems, and economic decline are more likely to vote for Trump. That is true even if some of the reasons their health is worsening are attributable to Republican policies that close hospitals, minimize access to healthcare, or undermine drug treatment programs.⁵⁶ One study found that rural voters blamed former President Barack Obama for hospital closures that had been caused by states’ refusal to expand Medicaid.⁵⁷

Why does poor health make people more likely to vote for radical right candidates like Trump?⁵⁸ The answer seems to be trust. Poorer self-reported health means more time spent navigating the healthcare system (as well as human resources departments and social assistance programs). Patients aren’t just dealing with their new and old health issues, whatever they are. They aren’t just learning to live differently or cope with pain or secure help to care for others in their lives. They are also getting to know the healthcare system better—not just care professionals but also telephone trees, insurance companies, puzzling invoices, long waits for appointments, difficult provider websites, incompatible health records, and all the other things that can make healthcare intensely frustrating.

No wonder many people have lost faith in the healthcare system and in our broader society. More exposure to a difficult-to-navigate healthcare system means more opportunities to feel disrespected, more hours spent in an urgent care or emergency department waiting room or on the phone with insurance companies, and more inexplicable and unaffordable medical bills. All of these interactions with the US healthcare system diminish trust—and, in the United States and elsewhere, lower trust makes people more likely to support authoritarians who exude strength (even when they offer false promises).⁵⁹

That might actually be more positive for healthcare workers than it sounds. Reforming society is the hard work of many, but perhaps making healthcare more trustworthy is something that can be done one day at a time, one patient at a time. Building trust among your fellow clinicians, and building patients’ trust in you, isn’t just good practice to get through the day; it’s a service to democracy in dark times.

Unions are one of the best ways to build that trust.⁶⁰ They bring workers together, with the goals of enhancing patient care and making workers’ lives better so that patients are seeing less-stressed professionals, and professionals have more scope to do their jobs well. Unions build solidarity rather than sow division and allow workers to bargain for the common good, supporting their communities as part of supporting themselves. The Trump administration has actively worked to strip workers’ protections and ability to organize.⁶¹ But collective action by clinicians and healthcare professionals, such as fighting facility downsizing or increased reliance on private equity prompted by Medicaid cuts and bargaining for contract provisions that mandate safe staffing and reduce unsafe workloads, can improve the quality of patient care⁶²—and it can help restore trust and the sense that clinicians have the power to positively affect the problems we all face.

Equally, highlighting and explaining the impact of the Trump presidency on healthcare matters a lot, both to our health and to the well-being of our country. The Trump administration has been trying to command the political stage with a “shock and awe” campaign, overwhelming everyone from reporters to legislators to doomscrollers with the speed and fury of their cuts and actions on everything from science and medicine to immigration and international policy. That is not a bad strategy for a party led by a historically unpopular president with a historically thin victory in November 2024⁶³ whose party holds the House and Senate by tiny margins⁶⁴ and suffered a massive rebuke in the November 2025 elections.⁶⁵

Ultimately, we the people will decide whether the Trump administration’s agenda will be implemented and survive in health, immigration, taxes, or trade. Health is one of the weakest points for Republicans in general, and the Trump administration’s healthcare, science, and public health policies are very unpopular⁶⁶—but more communication and engagement are needed to draw public attention to this administration’s harmful health actions.⁶⁷ The more people are aware of the hospital closures, union-busting, rate increases, shuttered labs, and anti-vaccination propaganda championed by Trump and his allies, the less popular Trump becomes, and the less he can do in the future. Raising the profile of healthcare and public health cuts and their deadly consequences is not just a service to health: It’s a service to democracy.

Scott L. Greer, PhD, is a professor of health management and policy, global public health, and political science (by courtesy) at the University of Michigan. Holly Jarman, PhD, is an associate professor of health management and policy at the University of Michigan and a senior scientist with the US Army Corps of Engineers at the Engineer Research and Development Center. Rachel Kulikoff, MPH, is a joint PhD candidate in the University of Michigan’s School of Public Health and Department of Political Science. Miranda Yaver, PhD, is an assistant professor of health policy and management at the University of Pittsburgh.

*For details on these attacks on higher education, see “A Better Future for All: How Our Public Colleges and Universities Save Lives, Power the Economy, and Strengthen Democracy.” (return to article)

^†To hear from one former federal employee, see “Why I Resigned: A Reflection on Public Health, Scientific Integrity, and Moral Courage.” (return to article)

Endnotes

1. J. Lindsay, “The 2024 Election by the Numbers,” Council on Foreign Relations, December 18, 2024, cfr.org/article/2024-election-numbers.

2. E. Hinton and R. Rudowitz, “5 Key Facts About Medicaid Work Requirements,” KFF, February 18, 2025, kff.org/medicaid/5-key-facts-about-medicaid-work-requirements.

3. P. Herd and D. Moynihan, “Herd and Moynihan: A Framework to Reduce Administrative Burdens in the Social Safety Net,” Gerald R. Ford School of Public Policy, University of Michigan, March 20, 2025, fordschool.umich.edu/news/2025/
herd-and-moynihan-framework-reduce-administrative-burdens-social-safety-net.

4. L. Harker, Pain but No Gain: Arkansas’ Failed Medicaid Work-Reporting Requirements Should Not Be a Model (Center on Budget and Policy Priorities, August 8, 2023), cbpp.org/research/health/pain-but-no-gain-arkansas-failed-medicaid-work-
reporting-requirements-should-not-be.

5. Hinton and Rudowitz, “5 Key Facts.”

6. KFF, “Health Provisions in the 2025 Federal Budget Reconciliation Law; Medicaid: Eligibility and Cost Sharing Practices: Section 71119: Work Requirements,” August 22, 2025, kff.org/medicaid/health-provisions-in-the-2025-federal-budget-
reconciliation-law/#2ca666ac-5d15-4454-8973-241566e22bb5.

7. S. Artiga et al., “5 Key Facts About Immigrants and Medicaid,” KFF, February 19, 2025, kff.org/racial-equity-and-health-policy/5-key-facts-about-immigrants-and-
medicaid.

8. Tax Policy Center, “Yes, Undocumented Immigrants Pay Taxes—and Receive Few Tax Benefits,” Urban Institute and Brookings Institution, December 17, 2024, taxpolicycenter.org/fiscal-facts/yes-undocumented-immigrants-pay-taxes-and-
receive-few-tax-benefits.

9. Tax Policy Center, “Yes, Undocumented Immigrants Pay Taxes.”

10. KFF, “States and Medicaid Provider Taxes or Fees,” June 27, 2017, kff.org/
medicaid/states-and-medicaid-provider-taxes-or-fees.

11. J. Ortaliza et al., “How Will the One Big Beautiful Bill Act Affect the ACA, Medicaid, and the Uninsured Rate?,” KFF, June 18, 2025, kff.org/affordable-care-act/
how-will-the-2025-budget-reconciliation-affect-the-aca-medicaid-and-the-uninsured-rate.

12. J. Ortaliza, “ACA Sign-Ups Are Down by Over a Million People, but It’s Still an Incomplete Picture,” KFF, January 29, 2026, kff.org/quick-take/aca-signups-are-down-but-still-an-incomplete-picture.

13. KFF, “Poll: Support for Extending the Expiring Enhanced ACA Tax Credits Remains High, but Dips Among Republicans and MAGA Supporters as Shutdown Continues and Partisanship Takes Hold,” November 6, 2025, kff.org/affordable-care-act/poll-support-
for-extending-the-expiring-enhanced-aca-tax-credits-remains-high-but-dips-among-
republicans-and-maga-supporters-as-shutdown-continues-and-partisanship-takes-
hold.

14. J. Ortaliza, “More Than Half of ACA Marketplace Enrollees Live in Republican Congressional Districts,” KFF, October 6, 2025, kff.org/quick-take/more-than-half-of-
aca-marketplace-enrollees-live-in-republican-congressional-districts.

15. R. King and S. Levien, “Why Congress Failed to Reach an Obamacare Deal,” Politico, February 17, 2026, politico.com/news/2026/02/17/inside-congress-failed-
battle-to-keep-obamacare-premiums-from-skyrocketing-00781825.

16. A. Ellison, “When the Hospital Leaves Town,” Fierce Healthcare, November 24, 2025, fiercehealthcare.com/hospitals/when-hospital-leaves-town.

17. Center for Healthcare Quality & Payment Reform, “Rural Hospitals at Risk of Closing,” January 2026, chqpr.org/downloads/
Rural_Hospitals_at_Risk_of_Closing.pdf.

18. Within the for-profit space, private equity is a particular concern. For more information, see “How Private Equity Has Looted Our Hospitals” in the Fall 2024 issue of AFT Health Care: go.aft.org/q19.

19. Centers for Medicare and Medicaid Services, “CMS Announces $50 Billion in Awards to Strengthen Rural Health in All 50 States,” December 29, 2025, cms.gov/
newsroom/press-releases/cms-announces-50-billion-awards-strengthen-rural-health-all-50-states.

20. L. Harnack, S. Valluri, and S. French, “Importance of the Supplemental Nutrition Assistance Program in Rural America,” American Journal of Public Health 109, no. 12 (December 2019): 1641–45.

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[Illustrations by Brian Stauffer]