Federal budget cuts, policy changes could leave deep scars on Americans’ health

Changes to federal spending and policies under the second Trump administration are already affecting Americans’ health and could worsen existing health disparities, strain public health infrastructure and have lasting consequences for years to come, according to new research led by the University of Michigan.

The analysis, conducted by researchers from U-M and the University of Pittsburgh, assessed executive orders, legislation, federal budget documents—including the One Big Beautiful Bill—government announcements, policy reports and existing scientific literature to examine how shifts in federal spending affect Americans’ health.

The researchers conclude that the changes are likely to disproportionately affect vulnerable populations, including low-income households, rural communities, people with disabilities, racial and ethnic minorities, and noncitizens—and weaken already strapped public health agencies trying to respond to the growing number of Americans’ struggling to stay healthy, access healthcare and pay for it.

The study, published in The Lancet Regional Health-Americas, comes as the cost of health insurance through the Affordable Care Act marketplace is projected to double in price next year, leaving millions of people with no coverage. In addition, new federal work requirements for SNAP food assistance went into effect this month, and significant cuts and requirements to Medicaid and Medicare are expected to leave people with higher costs, less or no coverage and hurdles to benefits.

“The policy changes are still being implemented and sufficient data are not yet available to measure their full effects on population health,” said Scott Greer, the Richard Carl Jelinek Professor of Health Management and Policy at the U-M School of Public Health.

“Our findings distinguish between consequences already documented, changes to existing programs whose effects we are starting to see now, and longer-term health outcomes projected using established research. Together, we can see that the cumulative effects of federal budget decisions could shape Americans’ health for years to come.”

The analysis, which also examined whether state and local governments could compensate for reductions in federal programs, concluded that restoring federal public health capacity in the future may require more than reinstating previous funding levels.

“Americans are experiencing an uprooting of their healthcare and public health system. Rebuilding programs, staffing, institutional expertise and public trust could require broader structural changes,” said Holly Jarman, associate professor of health management and policy at the U-M School of Public Health.

“States may be able to preserve some services or pursue alternative policies, but there are substantial limitations, including budget pressures, federal funding requirements and limited capacity, to replace national research and public health institutions.”

The researchers used the World Health Organization’s Social Determinants of Health to examine how federal changes to healthcare, food assistance, public health programs, education, employment and environment combine and compound the ability to afford or access healthcare, work and stay healthy.

A growing number of Americans, a number expected to grow as the funding and program losses increase in 2027, are grappling with the closure of hospitals and loss of access to medical services, with being priced out of the health insurance market and losing benefits and programs that were once the safety net.

“We set out to do this study knowing that the policies being adopted would have health effects far beyond the sizable Medicaid and Medicare cuts,” Greer said. “We did not want to look only at isolated individual policies. We wanted to measure potential cumulative effects on public health, and we were honestly surprised by the likely effects.”

Key findings

• Healthcare access: Medicaid and Affordable Care Act changes, including tighter eligibility requirements, additional administrative hurdles and reduced financial assistance, are expected to make health coverage more difficult to obtain or maintain.
• Food assistance: The study identifies $187 billion in reductions to the Supplemental Nutrition Assistance Program, SNAP, which serves approximately 40 million Americans. Researchers cite a decline of 4.5 million SNAP participants between April 2025 and April 2026.
• Public health infrastructure: Federal staffing and funding reductions have weakened agencies and programs responsible for disease prevention, public health services, scientific research and health protections.
• Rural communities: Changes to Medicaid and other federal health programs could further strain rural healthcare providers, potentially threatening access to care in communities already experiencing provider shortages and financial challenges.
• Global health: Reductions in foreign assistance, including funding for USAID and international HIV prevention and treatment programs, have disrupted health services worldwide.
• Education and environmental protections: Federal policy and spending changes affecting education, environmental regulation and scientific research could have longer-term consequences for population health.
• Unequal effects: Researchers conclude that populations already facing barriers to health and economic stability are likely to experience the greatest consequences.

“Federal health policy cannot be evaluated solely through changes to hospitals, insurance coverage or medical services,” Jarman said. “Access to nutritious food, quality education, stable employment and healthy living conditions also shapes individual and community health. When these all are being taken away, it’s not hard to see the pain and suffering that lies ahead.”

Co-authors include Rachel Kulikoff of the U-M School of Public Health and Miranda Yaver of the University of Pittsburgh School of Public Health.