In recent months, the U.S. healthcare system has experienced significant administrative changes. President Trump’s reelection led to the appointment of Robert F. Kennedy Jr. as Secretary of Health and Human Services (HHS). Under Kennedy’s leadership, the HHS underwent a substantial downsizing, with approximately 20,000 employees leaving due to layoffs and resignations; this restructuring has sparked polarized reactions 1.

The downsizing extended to key public health agencies, including the National Institutes of Health (NIH) and the Centers for Disease Control and Prevention (CDC). Major health research grants were abruptly canceled, raising concerns about the future of medical research and public health preparedness 2–4. Proponents of these decisions highlighted cost savings and a smaller burden on the federal budget.

Simultaneously, legislative proposals have emerged with significant implications for seniors and Medicaid recipients. Senate Republicans have proposed $880 billion in Medicaid cuts, which could put long-term care services for over six million Americans at risk. Additionally, the Administration for Community Living (ACL), the federal agency dedicated to supporting seniors and people with disabilities, faces potential dismantling. These developments have led critics to raise alarms about the future of elder care and disability services in the U.S. 5,6.

In response to these changes to U.S. healthcare, some policymakers and advocates have renewed calls for a Medicare for All system in recent months. For example, Senator Bernie Sanders argues that the current U.S. healthcare system is exorbitantly expensive and inequitable, leaving over 85 million Americans uninsured or underinsured. He emphasizes that a universal healthcare system would not only provide comprehensive, cost-free care but also reduce administrative expenses and improve health outcomes 7,8.

The healthcare landscape is also being reshaped by technological advancements. Hospitals are increasingly advocating for a shift from in-hospital care to remote care at patients’ homes, a movement fueled by innovations from the COVID-19 pandemic and backed by legislation from Congress. This transition aims to make healthcare more efficient and cost-effective while expanding access to treatments 9,10.

Economic factors continue to influence the healthcare system. Healthcare spending in the U.S. grew by 7.5% in 2023, reaching $4.9 trillion, or $14,570 per person. This growth reflects ongoing challenges such as labor shortages, inflation, and the enduring impact of the COVID-19 pandemic. Providers face constrained reimbursement growth and a shifting payer mix, with increased enrollment in Medicaid and Medicare programs 11.

The U.S. healthcare system is undergoing a period of significant change, marked by recent administrative overhauls, legislative proposals, technological advancements, and economic pressures. These changes have far-reaching implications for healthcare access, quality, and affordability. As the nation navigates this evolving landscape, stakeholders across the spectrum, including patients, providers, policymakers, and advocates, must engage in informed dialogue to shape a healthcare system that meets the needs of all Americans.

References

1.Affairs (ASPA), A. S. for P. Robert F. Kennedy, Jr. https://www.hhs.gov/about/leadership/robert-kennedy.html (2025).
2.Kozlov, M. Exclusive: NIH to cut grants for COVID research, documents reveal. Nature 640, 17–18 (2025). DOI: 10.1038/d41586-025-00954-y
3.Wadman, M. Trump proposes massive NIH budget cut and reorganization. Science (2025). DOI: 10.1126/science.zaomfqe
4.Abrupt layoffs at CDC, other HHS agencies endanger public health. https://www.apha.org/publications/public-health-newswire/articles/(clone)-firing-of-hhs-workers.
5.Office, A. P. HHS Announces Transformation to Make America Healthy Again. https://www.hhs.gov/press-room/hhs-restructuring-doge.html (2025).
6.Executive Directive 2025-3: Impact of Federal Medicaid Cuts. https://www.michigan.gov/whitmer/news/state-orders-and-directives/2025/04/17/executive-directive-2025-3-impact-of-federal-medicaid-cuts.
7.Bernie Sanders describes ‘dysfunctional’ U.S. health care system—and how to fix it | Harvard T.H. Chan School of Public Health. https://hsph.harvard.edu/news/bernie-sanders-describes-dysfunctional-u-s-health-care-system-and-how-to-fix-it/ (2024).
8.Bernie Sanders Official Website. https://bsanders-astro.pages.dev/.
9.From facility to home: How healthcare could shift by 2025 | McKinsey. https://www.mckinsey.com/industries/healthcare/our-insights/from-facility-to-home-how-healthcare-could-shift-by-2025.
10.Bringing hospital-level care to patients’ homes – The Washington Post. https://www.washingtonpost.com/health/2025/02/25/hospitals-at-home-care/.
11.NHE Fact Sheet | CMS. https://www.cms.gov/data-research/statistics-trends-and-reports/national-health-expenditure-data/nhe-fact-sheet.