The second Trump presidency: Health care themes, policies, and impacts in his first year back in office

President Trump came into office with an agenda to rein in government programs and regulations. The Trump administration has focused on making government smaller and nearly eliminating humanitarian foreign health aid, while eschewing conclusions drawn by the mainstream scientific community, particularly regarding vaccination policy.

Specific actions have included cuts to both health personnel and budgets, efforts to remove vaccine mandates, attempts to end diversity efforts, and the essentially shuttering of the United States Agency for International Development program. Reforms also include allowing the expiration of enhanced federal premium subsidies for the individual insurance marketplaces beginning in 2026 and a substantial reduction in federal payments to state Medicaid programs beginning in 2027.

Downstream impacts will include collecting less health data, moving away from research on communicable diseases, promoting vaccine hesitancy, and reducing access to, and possibly the quality of, care. Cutting humanitarian foreign health aid may have an even larger impact, as access to vaccinations and medications has already been curtailed, especially in Africa. Cuts to global health have endangered lives in many of the world's poorest countries, while the destabilization of global trade has limited the scope for European countries to fill the gap.

Millions of Americans will lose their health insurance coverage, while people in many countries - especially Africa - will have their lives endangered. Vaccination rates, particularly among young children, will decline, exposing more Americans to communicable diseases. Scientific research output is likely to decline as universities face increasing financial pressures.