Health policy effects of budgetary actions under the second Trump administration

The Lancet Regional Health – Americas

The researchers analyzed the impact of the second Trump administration's budgetary actions on policies affecting health. Using the Social Determinants of Health framework, we review executive actions, including funding freezes and rescissions, and the One Big Beautiful Bill Act. They concluded that these measures weakened federal capacity, public health infrastructure, education, scientific research, global health programs, and environmental protections. Medicaid, Affordable Care Act policies, family planning, and food assistance face reduced eligibility, greater administrative burdens, and substantial funding cuts, while funding grows for immigration and carceral policies that damage health. Noncitizens, low-income communities, racial and ethnic minorities, disabled people, and rural populations will bear disproportionate harms. State and local governments may mitigate some effects, but fiscal, legal, political, and institutional constraints limit them. Rebuilding federal health policy will require more than restoring previous funding; policymakers must design stronger, resilient institutions suited to damaged institutions.