In a little more than 100 days, the Trump administration has upended the U.S. health care system Americans love to hate, sparking turmoil and confusion. The Trump administration calls its sweeping changes a "critical course correction" to the way the nation delivers health care.
"This is not just policy ‒ it's a revolution in public health," HHS Secretary Robert F. Kennedy Jr. said in an April 29 statement touting the administration's accomplishments.
On the administration's list of accomplishments: a new commission to end childhood chronic diseases, a review of infant formula safety, an investigation into the causes of autism and an effort to reduce animal testing. HHS also plans to review whether fluoride is safe to add to drinking water, despite decades of evidence that it supports dental health and poses no substantial risks.
But some people on the frontlines of the health care system - doctors and nurses, researchers, advocates and local officials - criticize the rapid-fire overhaul as "reckless" and say it will cost dollars and lives.
More than 70% of Americans say the health care system isn't meeting their needs in some way, according to a recent poll.
Yet it can still get worse. Millions of people are likely to lose health insurance under policy changes and expected cuts to Medicaid and other programs. Tariffs are expected to push up drug prices. A healthy school lunch program was terminated. Critical research trials have already been canceled midstream. Although states will continue to address childhood lead poisoning, the federal workers they counted on for expertise have all been fired. And Trump's proposed fiscal year 2026 budget calls for a 37% cut to the National Institutes of Health, which includes the National Cancer Institute.
Already announced cuts to the country's research infrastructure will trigger roughly $16 billion in economic losses and 68,000 jobs nationwide, according to the Science & Community Impacts Mapping Project (SCIMaP), which has mapped the economic impact of the cuts on every county in America. And Trump is proposing to chop the National Institutes of Health budget by 40% next year.
Among its other actions, the administration has suspended testing of milk quality (saying that states can adequately perform this function) as well as cancer research funding, support for LGBTQ youth considering suicide and money to investigate child sexual abuse and internet crimes against children.
"These are reckless, thoughtless cuts that will only make American communities less healthy and less safe," Dr. Richard Besser, president and CEO of the nonprofit Robert Wood Johnson Foundation, said in a statement. "They are systematically and cruelly dismantling our nation's public health system and workforce, which threatens the health and wellbeing of everyone in America."
Trump has criticized President Joe Biden's plan for slowly lowering the price of select, popular medications. On April 15, he announced his own drug price reduction proposal in an executive order.
Medical experts say it's not yet clear how Trump's plan will work in practice.
"Some of these proposed reforms could assist patients struggling with high drug prices; others would face significant legal and practical obstacles; and still others might even increase drug prices,' Rachel Sachs, a former senior advisor at the Department of Health and Human Services, wrote in a recent article in Health Affairs.
While Trump's initial round of tariffs left pharmaceuticals exempt, many of the raw materials that go into drug-making are expected to increase in price, making it harder and more expensive to get these ingredients.
"There are clearly going to be tariffs that impact pharmaceutical supply chains," Tom Kraus, of the American Society of Health-System Pharmacists, which represents hospital pharmacists, previously told USA TODAY. Generic drugs − which account for the vast majority of prescriptions − have small profit margins and are more likely to feel the financial squeeze from tariffs, he said.
A number of major drug companies have forecast hundreds of millions of dollars in extra costs from the tariffs, which could end up being passed on to consumers.
In a win for the administration, which aims to bring manufacturing back to the United States, drugmaker Roche announced on April 21 that it would invest $50 billion in building new manufacturing capacity, creating 12,000 jobs across five states.
Across the country local officials and low-income Americans are preparing for dramatic cuts to Medicaid, which serves 78 million low-income and disabled Americans and is funded with a combination of federal and state dollars.
Any cuts will have a ripple effect across the country, public health experts and health care advocates said, and even conservative activists like Laura Loomer have advised against chopping Medicaid because of the expected political fallout from Trump supporters.
Trump has repeatedly promised he wouldn't touch Social Security or Medicare, but cutting Medicaid will harm the same people who receive those programs, Amber Christ, a managing director at the advocacy group Justice in Aging, said in a recent webinar. Roughly 30% of Medicaid spending supports Medicare enrollees, she said.
"Without Medicaid financial assistance, seniors could not afford Medicare," she said.
In Omaha, Nebraska, more than one-third of all children and nearly 1 in 5 of all residents receive Medicaid funding, according to the advocacy group FamiliesUSA. Medicaid also covers 5 in 9 nursing home residents in Nebraska.
Families in the Omaha metro area are already struggling to pay for their health care bills, FamiliesUSA found, with 18% saying they have trouble paying medical bills.
A coalition of disability rights activists, unions and caregiving organizations planned a 24-hour rally in D.C. from 1 p.m. May 7 to noon May 8 to protest the cuts.
In a little-noticed move, the federal workers who determine eligibility limits for Medicaid have all been laid off, said Manat Singh, executive director of the Colorado Consumer Health Initiative, an advocacy group.
"Everything that makes all of the work we do function is getting cut, dismantled, gutted, defunded, moved around, and it's hard enough for those of us who work on this every day to figure out what's going on," she said in a recent webinar.
If hospitals are forced to close because of these cuts ‒ a distinct possibility, especially in small, rural areas and big cities, she and other public health experts said ‒ then many more than just Medicaid recipients will lose access to care.
All of the CDC's staff involved in testing for lead poisoning in children have been eliminated, as have many grants for that purpose.
The city of Milwaukee, for example, was relying on expertise from the federal Centers for Disease Control and Prevention to help it address a growing problem of older elementary school students with lead poisoning, said Dr. Michael Totoraitis, the city's health commissioner.
Milwaukee has lost $5 million in federal health care funding so far, including a grant to reduce health care disparities, wastewater testing for infectious diseases and support in addressing childhood lead poisoning.
Totoraitis' staff was working with CDC officials to develop a long-term plan for helping older children with lead poisoning. But the entire childhood lead team at CDC was cut on April 3, and his city's request for help addressing lead poisoning was denied, he said in a Big Cities Health Coalition webinar.
"Children are getting hurt, life expectancy is declining," he said. "We are handcuffed in our ability to help our own residents because the federal government had been helping us for decades with all these fights and currently is unresponsive to our needs."
"It's a pretty humbling moment working in public health not knowing where to go (for expertise)," Totoraitis said.
Kennedy has said he wants to put more public emphasis on addressing chronic diseases, particularly those in childhood.
Marlene Schwartz, who directs the Rudd Center for Food Policy & Health at the University of Connecticut, said she's thrilled the administration is interested in trying to prevent diet-related chronic diseases.
Kennedy has promised a complete overhaul of the school lunch program, but so far, the only concrete change has been to cut a $1 billion Biden plan to buy local fresh foods for schools, child care centers and food banks.
Kids typically eat healthier at school than at home, Schwartz said. Research has shown school meals are helping to reduce childhood obesity, and the Biden plan also would have benefited local farmers, she said.
"I hope that the administration reconsiders