A Preview of the Role Health Care May Play in the 2026 Election

Published: Apr 2, 2026

KFF has long examined the role of health care in U.S. elections, tracking how the issue ranks among voters’ top concerns, which political party or candidate voters’ trust, and how health care issues might motivate voter turnout. This issue brief summarizes the role health care has historically played in elections using KFF polls, exit polls, and other data to show how health care, especially the issue of health care costs, may play a role in the upcoming 2026 midterm elections.

Key Takeaways

  • Historically, health care has often been among the most important issues to voters: In most presidential and midterm election year polling since 1992, health care ranked among voters’ top concerns, with “the economy” taking the top spot in most elections. While these polls usually ask voters to choose between health care and the economy as separate issues, KFF polling has long shown how health care costs are an important factor in people’s economic concerns. On its own, health care rose to the top spot in the 2018 midterm exit poll, immediately after the failed attempt to repeal and replace the Affordable Care Act (ACA). In almost all recent elections, Democratic voters have consistently been more likely than Republican voters to say that health care is a top electoral issue.
  • Partisan advantages on health care and the economy: Historically, Democrats have held an advantage over Republicans on who voters trust to handle health care issues, while Republicans have usually been seen as stronger on the economy. Health care costs sit at the intersection of these issues, raising questions about which party voters will trust more to address the affordability of health care. Recent KFF polling data suggests that heading into the 2026 election, the Democratic Party has the advantage on health care costs, but notably, about a quarter of voters, rising to four in ten independent voters, say they trust neither party on this issue.
  • Implications for the 2026 Midterms: Looking ahead to the 2026 midterm elections, the issue of health care affordability may help candidates motivate their bases. As of March 2026, Democrats maintain an advantage over Republicans in voter trust to address the cost of health care and prescription drugs, and majorities say health care costs are important to their vote. Who voters will ultimately trust to handle the affordability of health care, and whether the issue will be enough to translate into turnout and votes, remains an open question.

Health Care Has Been Among the Top Electoral Issues, Especially Following Periods of National Debate

National exit polls from elections over the past several decades show that voters ranked health care among their top concerns, but “the economy” was the number one issue in most elections. While exit polls usually ask voters to choose between health care and the economy as separate issues, KFF polling has long shown that health care costs are a key economic concern for the public. Analysis of exit poll data also show that health care has been more top-of-mind for voters immediately following periods of national debate on health care reform, such as in elections held during President Clinton’s presidency (1992-1998) and later during President Obama’s presidency (2008-2016) and the passage of the Affordable Care Act (ACA) in 2010. In these instances, health care costs were key health care issues, with political debate centering around affordability. But in the past three decades of exit polls, health care itself has only been ranked the number one issue by voters once, during the 2018 midterms after Republican attempts to repeal and replace the ACA failed dramatically in the Senate. Since 2020, health care has remained among the top issues, with the focus in some elections on specific health care issues such as COVID-19 or abortion access.

Figure 1

Democratic Voters Are More Likely to Say Health Care Is Important to Their Vote

Notably, Democratic voters have typically been more likely than Republican voters to cite health care issues as important in pre-election KFF Health Tracking Polls. For example, in 2018, when health care was the number one issue for all voters, about one third (34%) of Democratic voters said it was important for 2018 candidates to talk about health care, compared to one in five (20%) Republicans who said the same. In more recent elections when health care issues focused on specific topics like abortion rights and COVID-19, between a quarter and half of Democratic voters picked these issues, versus about one in ten, or fewer, Republican voters.

Split bar chart showing the share of republican and democratic voters who say each health care issue is important to their vote.

Democrats Have Historically Had Advantage on Health Care, Republicans on the Economy

While “the economy” tends to almost always have the top billing in election poll issue rankings, KFF polls have consistently found that the cost of health care is an important part of people’s economic concerns. Indeed, recent KFF polls have found that health care costs are a top economic worry, with many adults saying they have difficultly affording these costs, they are burdened by health care debt, or that they delay or skip care due to high costs. Given that health care costs sit at the intersection of both health care and the economy, who do voters say they trust on this issue?

When it comes to presidential elections, KFF Health Tracking Polls and other polls have found that voters often say the Democratic candidate is better suited to handle health care, while the Republican candidate is better suited to handle the economy. In the 2012 and 2016 elections, President Obama and Secretary Clinton had more than 10-percentage point leads over Governor Romney and President Trump respectively in the share of voters who said they trusted each on health care. When it comes to the economy, President Obama had a 7-percentage point advantage over Governor Romney in 2012, but in subsequent elections, President Trump has had an advantage over each of his Democratic opponents. These leads were narrow over Secretary Clinton in 2016 and President Biden in 2020, but widened to a 15-percentage point lead over Vice President Harris in 2024.1

Figure 3

In an era of hyper-partisan politics, KFF Health Tracking Polls conducted in the lead up to elections find that most voters tend to trust their own party to handle the direction of key issues. But among voters overall and among independent voters, the Democratic party has typically had an advantage over the Republican party when it comes to health care costs. For example, in surveys conducted in election years from 2012 to 2023, the Democrats had an advantage of thirteen percentage-points or less over Republicans on lowering health care costs. But in 2023, about six in ten voters said they trust the Democrats on the affordability of health care, compared to about four in ten who said they trust the Republicans.

Figure 4

Implications for the 2026 Midterm Elections

While there are many months before the midterm elections and events such as the war in Iran may shift electoral concerns, recent KFF pre-election polls show the public remains concerned about the number one issue of the 2024 election: the economy. But recent polls also suggest that the role of health care costs among voters’ economic concerns appears to be on the rise compared to previous election cycles. In 2024 polling from AP Votecast, when voters were specifically asked about which household costs they were “very concerned” about, the cost of food and groceries took the top spot across partisans (67% of total voters), and health care costs (54% of total voters) ranked second for Democratic and independent voters.

Split bar chart showing the share of partisan voters who say they are very concerned about the cost of essentials.

In more recent KFF polling from January 2026, health care costs are now voters’ top economic concern (31% of total voters say they are “very worried”). This is the case across partisanship, with substantial shares of Democrats (33%), independents (36%) and Republicans (25%) saying they are “very worried” about being able to afford health care for themselves and their families. 

Split bar chart showing the share of partisan voters who say they are very worried about being able to afford essentials for themselves and their families.

In January of this year, about one in four voters also said they feel their health care costs are increasing faster than other household expenses, such as food and utilities, and looking ahead, a majority (58%) said they expect health care costs for them and their families to become less affordable next year. In addition, in March, a majority (59% of the public; 57% of voters) say they are worried about affording prescription drugs for themselves and their families, the largest share since KFF first polled on this question in 2018.

The rising concern about health care costs has occurred at a time when health insurance premiums and cost-sharing for employer-sponsored insurance are on the rise, with the average annual premium for family health coverage rising 6% to nearly $27,000 in 2025. At the same time, the policy debate and government shutdown over the ACA enhanced tax credits have put a spotlight on increasing health care costs for ACA marketplace enrollees.

Amid this environment, there are signs that Democrats may now be viewed as more trustworthy than they were in 2024, when President Trump (the Republican candidate) won more votes than Vice President Harris (the Democratic candidate) among voters who said they were “very concerned” about health care costs (54% vs. 44%). Now, KFF polling from March 2026 finds Democrats have an advantage over Republicans for who voters trust to address the cost of health care (40% vs. 28%) and the cost of prescription drugs (38% vs. 28%), with about one in four voters saying they trust “neither party” on these issues.

Democrats maintain an advantage on health care and prescription drug costs among independent voters as well. But notably, the share saying they trust “neither party” rises to about four in ten among independent voters, larger than the shares who say they trust either the Democrats or the Republicans. The sizeable shares of independent voters, as well as voters overall, who say they trust neither party suggests that both parties may still be able to make inroads with voters on the issue of health care affordability before the midterm elections. But it also illustrates that there might be a lack of enthusiasm for candidates on this issue and may suggest that some voters may choose to stay home if they don’t feel either party can address this core issue.

Stacked bar chart showing share of registered voters who say they trust the Democrats, Republicans, or neither party to do a better job addressing key health care issues.

While voter trust and the perceived importance of health care costs matter for the midterm election, a key factor is how strongly the issue motivates voters to turn out. The 2026 campaigns are just beginning, but health care costs seem to be motivating voters across party lines. As of January 2026,  about two-thirds of Democratic voters and just less than half of independent voters said health care costs will have a “major impact” on both their decision to vote and which party’s candidate they will support. On the other hand, about one in four Republican voters also said health care costs will have a “major impact” on their voting choices, and an additional third said it will have a “minor impact,” suggesting the issue is motivating Republicans as well.

Stacked bar chart showing the shares of adults who say the cost of health care will have a major impact, minor impact, or no impact at all on their decision to vote or which party's candidate they would support in the 2026 midterm elections. Shown among total voters and by party identification.
  1. In 2012, question wording was, “Which presidential candidate, Barack Obama or Mitt Romney, do you trust to do a better job… lowering health costs for people like you?” and “…dealing with the economy and jobs?”
     
    In 2016, question wording was, “Thinking about the candidates for president in 2016, regardless of political party or who you intend to vote for, which candidate do you trust to do a better job dealing with access and affordability of health care, Donald Trump or Hillary Clinton?” and “Regardless of which presidential candidate you support, please tell me if you think Hillary Clinton or Donald Trump would better handle each of the following issues…The Economy.”
     
    In 2020, question wording was, “Thinking about the candidates for president in 2020, regardless of political party or who you intend to vote for, which candidate do you trust to do a better job… dealing with health care, Donald Trump or Joe Biden?” and “…the economy.”
     
    In 2024, question wording was, “Regardless of who you intend to vote for in the upcoming elections, which presidential candidate do you trust to do a better job dealing with each of the following?” “The economy and inflation” and “Health care costs, including prescription drug costs.” ↩︎
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Policy Tracker: Exceptions to State Abortion Bans and Early Gestational Limits 

Last updated on April 1, 2026

20

states have abortion bans or early gestational limits in effect

5

states have no health exception

9

states have no rape or incest exception 

12

states have no fatal fetal anomaly exception 

Abortion is currently banned in 13 states and 7 states have early gestational limits between 6 weeks and 12 weeks in effect. Nearly all of these bans include exceptions, which generally fall into four categories: to prevent the death of the pregnant person, when there is risk to the health of the pregnant person, when the pregnancy is the result of rape or incest, and when there is a lethal fetal anomaly. Almost all states with a health exception limit it to conditions affecting physical health, with some going further by explicitly excluding emotional or psychological conditions. Alabama is currently the only state with an abortion ban or early gestational limit in place that includes an exception for mental health within its broader health exception. Some states have more than one abortion ban or restriction in place. The maps below illustrate the exceptions in each state’s most restrictive gestational limit or total ban. For details hover over each state to read the rollover.  

For more information on the status of state abortion bans, please visit our Abortion in the United States Dashboard. 

Exceptions to State Abortion Bans and Early Gestational Limits in Effect, as of April 1, 2026 (Choropleth map)
Exceptions to State Abortion Bans and Gestational Limits in Effect, as of April 1, 2026 (Table)
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Poll Finding

KFF Health Tracking Poll: The Public’s View of Immigration Enforcement Activities in Health Care Settings

Published: Apr 1, 2026
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Findings

Soon after taking office, President Trump reversed longstanding policy that had protected against immigration enforcement in “sensitive locations” including health care facilities, schools, and places of worship. Following this recission, as well as an overall increase in enforcement activity, there have been reports of Immigration and Customs Enforcement (ICE) agents showing up at hospitals and other health care facilities. ICE presence at and around health care facilities has led to growing concerns among health care providers about the impacts on the health and safety of the community, including adults and children going without care. These actions sit against a backdrop of broad increased enforcement activity and policies restricting access to health coverage and care for immigrant families. Research shows that this environment has negative impacts on the mental and physical health of immigrant families, including the millions of U.S. citizen children living in them, as well as broader economic effects on communities.

KFF has conducted multiple surveys examining immigrants’ health and experiences amid the policy environment as part of its Surveys of Immigrants conducted since 2023. New data from the KFF Health Tracking Poll provides insights into how the general public views the Trump administration’s immigration enforcement polices in health care settings. Overall, it shows the public is split along partisan lines on the administration’s approach to immigration enforcement in health care facilities. Democrats and independents express concern over the administration’s tactics, whereas Republicans are largely not concerned. Majorities of Democrats and independents say they do not think ICE or Customs and Border Control (CBP) should be allowed to arrest or detain people in and around health care facilities, whereas a majority of Republicans say they should be allowed. On each of these measures, Republicans and Republican-leaning independents who support President Trump’s MAGA movement are much more likely to support these tactics or say they are not concerned than non-MAGA supporters.

A majority of the public say they are concerned about the Trump administration’s tactics and immigration enforcement activities in or around health care settings. This includes majorities of the public who say they are “very” or “somewhat” concerned about people who have been hospitalized after being detained by federal immigration officials not being allowed to contact their families (69%), ICE or CBP arresting or detaining people in health care settings (63%), and health care providers and officials sharing patients’ immigration status with ICE or CBP (59%).

While majorities of the public are concerned about each of these tactics, there are big differences by partisanship, with Democrats and independents more likely than Republicans, especially MAGA Republicans, to say they are concerned about these. For example, about nine in ten Democrats and three-quarters of independents say they are concerned about people who have been hospitalized after detainment not being allowed to contact their families, whereas four in ten Republicans express concern. There are larger divides by partisanship on the two other tactics asked about, with Democrats about three times as likely as Republicans to say they are concerned about ICE or CBP detaining people in or around hospitals, clinics, or other health care facilities (92% vs. 28%) and health officials, hospitals, or health care providers sharing patients’ immigration status with ICE or CBP (86% vs. 24%). For each of these immigration enforcement tactics, two-thirds or more of independents say they are “very” or “somewhat” concerned about them. There are also differences among Republicans and Republican-leaning independents who support MAGA versus those who do not support the MAGA movement, with non-MAGA supporters at least twice as likely to say they are concerned about these tactics than MAGA supporters.

Split bar chart showing percent who say they are very or somewhat concerned about immigration enforcement actions in health care settings. Results shown by total adults, party identification, and MAGA support.

A majority of the public (56%) says ICE and CBP should not be allowed to arrest and detain people in or around hospitals, doctors’ offices or health clinics where they are seeking care, while about three in ten (28%) say they should be allowed, and one in six (16%) are “not sure.” There are stark divides by partisanship on this tactic. Nearly nine in ten (86%) Democrats and about six in ten (59%) independents say immigration enforcement activity should not be allowed in or around health care facilities, whereas six in ten Republicans say it should be allowed. But again among Republicans on this question, MAGA supporters are much more likely than non-MAGA supporters to say this tactic should be allowed (71% vs. 32%), and four in ten (41%) non-MAGA Republicans say it should not be allowed.

Stacked bar chart showing whether adults believe immigration enforcement in health care settings should be allowed or not. Results by total adults, party identification, and MAGA support.

Two-thirds (65%) of adults say they are concerned that immigration enforcement activities in or around health care facilities may discourage some people from seeking needed medical care, while a third (34%) say they are not concerned. There are large differences by party identification on this topic, with about nine in ten Democrats (91%) and about seven in ten (69%) independents saying they are concerned about this, including three-quarters (76%) of Democrats who say they are “very concerned.” In contrast, most (65%) Republican say they are not concerned about this, including four in ten (41%) who say they are “not at all concerned.” However, there are stark divides by MAGA support among Republicans, with a majority of MAGA Republicans (76%) saying they are not concerned and a majority of non-MAGA Republicans (58%) saying they are concerned. Since the rescission of the “sensitive areas” policy and ramp up of ICE activity across the country, there have been reports of immigrants avoiding seeking medical care, which can lead to negative and costly health outcomes. Even prior to the recent uptick in public enforcement activity in areas such as Minneapolis and other parts of the country, the 2025 KFF/New York Times Survey of Immigrants found that many immigrants said they were avoiding seeking medical care due to concerns about drawing attention to someone’s immigration status. As of Fall 2025, 14% of immigrants overall said they have avoided seeking medical care since January 2025, rising to nearly half (48%) of likely undocumented immigrants.

Stacked bar chart showing how concerned adults are about immigration enforcement in health care settings discouraging people from seeking medical care. Results by total adults, party identification, and MAGA support.

Methodology

This KFF Health Tracking Poll/KFF Tracking Poll on Health Information and Trust was designed and analyzed by public opinion researchers at KFF. The survey was conducted February 24 – March 2, 2026, online and by telephone among a nationally representative sample of 1,343 U.S. adults in English (n=1,268) and in Spanish (n=75). The sample includes 1,019 adults (n=62 in Spanish) reached through the SSRS Opinion Panel either online (n=995) or over the phone (n=24). The SSRS Opinion Panel is a nationally representative probability-based panel where panel members are recruited randomly in one of two ways: (a) Through invitations mailed to respondents randomly sampled from an Address-Based Sample (ABS) provided by Marketing Systems Groups (MSG) through the U.S. Postal Service’s Computerized Delivery Sequence (CDS); (b) from a dual-frame random digit dial (RDD) sample provided by MSG. For the online panel component, invitations were sent to panel members by email followed by up to three reminder emails.

Another 324 (n=13 in Spanish) adults were reached through random digit dial telephone sample of prepaid cell phone numbers obtained through MSG. Phone numbers used for the prepaid cell phone component were randomly generated from a cell phone sampling frame with disproportionate stratification aimed at reaching Hispanic and non-Hispanic Black respondents. Stratification was based on incidence of the race/ethnicity groups within each frame. Among this prepaid cell phone component, 142 were interviewed by phone and 182 were invited to the web survey via short message service (SMS).

Respondents in the prepaid cell phone sample who were interviewed by phone received a $15 incentive via a check received by mail or an electronic gift card incentive. Respondents in the prepaid cell phone sample reached via SMS received a $10 electronic gift card incentive. SSRS Opinion Panel respondents received a $5 electronic gift card incentive (some harder-to-reach groups received a $10 electronic gift card). In order to ensure data quality, cases were removed if they failed two or more quality checks: (1) attention check questions in the online version of the questionnaire, (2) had over 30% item non-response, or (3) had a length less than one quarter of the mean length by mode. Based on this criterion, 1 case was removed.

The combined cell phone and panel samples were weighted to match the sample’s demographics to the national U.S. adult population using data from the Census Bureau’s 2024 Current Population Survey (CPS), September 2023 Volunteering and Civic Life Supplement data from the CPS, and the 2025 KFF Benchmarking Survey with ABS and prepaid cell phone samples. The demographic variables included in weighting for the general population sample are gender, age, education, race/ethnicity, region, civic engagement, frequency of internet use and political party identification. The weights account for differences in the probability of selection for each sample type (prepaid cell phone and panel). This includes adjustment for the sample design and geographic stratification of the cell phone sample, within household probability of selection, and the design of the panel-recruitment procedure.

The margin of sampling error including the design effect for the full sample is plus or minus 3 percentage points. Numbers of respondents and margins of sampling error for key subgroups are shown in the table below. For results based on other subgroups, the margin of sampling error may be higher. Sample sizes and margins of sampling error for other subgroups are available on request. Sampling error is only one of many potential sources of error and there may be other unmeasured error in this or any other public opinion poll. KFF public opinion and survey research is a charter member of the Transparency Initiative of the American Association for Public Opinion Research.

GroupN (unweighted)M.O.S.E.
Total1,343± 3 percentage points
   
Party ID  
Democrats449± 6 percentage points
Independents449± 6 percentage points
Republicans373± 6 percentage points
   
MAGA Republicans/Republican leaning independents334± 6 percentage points
   
Used AI for health information or advice in the past year458± 6 percentage points
Used for physical health information407± 6 percentage points
Used for mental health information234± 8 percentage points

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Global COVID-19 Tracker

Published: Mar 31, 2026

Editorial Note: The Policy Actions tracker will no longer be updated as the data source has ceased tracking government responses to COVID-19. For more information, please visit the Oxford Covid-19 Government Response Tracker.

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Cases and Deaths

This tracker provides the cumulative number of confirmed COVID-19 cases and deaths, as well as the rate of daily COVID-19 cases and deaths by country, income, region, and globally. It will be updated weekly, as new data are released. As of March 7, 2023, all data on COVID-19 cases and deaths are drawn from the World Health Organization’s (WHO) Coronavirus (COVID-19) Dashboard. Prior to March 7, 2023, this tracker relied on data provided by the Johns Hopkins University (JHU) Coronavirus Resource Center’s COVID-19 Map, which ended on March 10, 2023. Please see the Methods tab for more detailed information on data sources and notes. To prevent slow load times, the tracker only contains data from the last 200 days. However, the full data set can be downloaded from our GitHub page. While the tracker provides the most recent data available, there is a two-week lag in the data reporting.

Note: The data in this tool were corrected on March 18, 2024, to clarify that they represent new cases and deaths over a full week rather than the average per day over a seven-day period.

Policy Actions

This tracker contains information on policy measures currently in place to address the COVID-19 pandemic. Policy categories currently being tracked include social distancing & closure measures, economic measures, and health systems measures. Policies are tracked at the country-, income-, and region-level. Please see the Methods tab for more detailed information on data sources and notes.

Social Distancing and Closure Measures

As countries continue to implement policies to prevent the transmission of SARS-CoV-2, the virus that causes COVID-19, these tables and charts show which social distancing and closure measures are currently in place by country.

Global COVID-19 Policy Actions

Economic Measures

The COVID-19 pandemic has placed an unprecedented strain on country economies. These tables and charts show which economic-related measures, namely income support and debt relief, are currently in place by country.

Global COVID-19 Policy Actions

Health Systems Measures

The COVID-19 pandemic continues to strain and disrupt global health systems. These tables and charts show which health systems measures are currently in place by country.

Global COVID-19 Policy Actions

Methods

Cases and Deaths

SOURCES

As of March 7, 2023, all data on COVID-19 cases and deaths are drawn from the World Health Organization’s (WHO) Coronavirus (COVID-19) Dashboard. Prior to March 7, 2023, this tracker relied on data provided by the Johns Hopkins University (JHU) Coronavirus Resource Center’s COVID-19 Map, which ends on March 10, 2023. Population data are obtained from the United Nations World Population Prospects using 2021 total population estimates. Income-level classifications are obtained from the latest World Bank Country and Lending Groups. Regional classifications are obtained from the World Health Organization.

Policy Actions

NOTES

Policy actions data include the measure that was in place for each indicator at the country-level as of the end of 2022. Policy actions data will no longer be updated as the data source has ceased tracking government responses to COVID-19. For more information, please visit the Oxford Covid-19 Government Response Tracker.

Social Distancing and Closure Measures

Under ‘Stay At Home Requirements’, exceptions for leaving the house may include anything from being able to leave for daily exercise, grocery shopping, and essential trips, to only being allowed to leave once a week, or one person may leave at a time, etc. Under ‘Workplace Closing’, partial closing includes instances in which a country recommends closing the workplace (or working from home); businesses are open but with significant COVID-19-related operational adjustments; or when workplaces require closing for only some, but not all, sectors or categories of workers. Under ‘School Closing’, partial closing includes instances in which a country has recommended school closures; all schools are open but with significant COVID-19-related operational adjustments; or some schools, but not all, are closed; full closing includes schools that are in session but operating virtually. Under ‘Restrictions On Gatherings’, partial restrictions include restrictions on gatherings of more than 10 people; full restrictions include restrictions on gatherings of 10 people or less. Under ‘International Travel Controls’, partial restrictions include screening and quarantine requirements for those entering the country. Values for ‘Cancel Public Events’ were not recodified.

Economic Measures

Under ‘Income Support’, narrow support includes instances in which a country’s government is replacing less than 50% of lost salary (or if a flat sum, it is less than 50% median salary); broad support includes instances in which a country’s government is replacing 50% or more of lost salary (or if a flat sum, it is greater than 50% median salary). Under ‘Debt/Contract Relief’, narrow support includes instances in which a country’s government is providing narrow relief, such as relief specific to one kind of contract.

Health Systems Measures

Under ‘Vaccine Eligibility’, partial availability includes availability for some or all of the following groups: key workers, non-elderly clinically vulnerable groups, and elderly groups, or for select broad groups/ages. Under ‘Facial Coverings’, recommend/partial requirement includes instances in which a country’s government recommends wearing facial coverings, requires facial coverings in some situations, and requires facial coverings when social distancing is not possible. 

SOURCES

Data on and descriptions of government measures related to COVID-19 provided by the Oxford Covid-19 Government Response Tracker (OxCGRT). For more detailed information on their data collection and methodology, please see their codebook and interpretation guide.

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Overview of President Trump’s Executive Actions on Global Health

Published: Mar 31, 2026

Note: Originally published on Jan. 28, 2025, this resource is updated as needed, most recently on March 31, 2026, to reflect additional developments. 

Starting on the first day of his second term, President Trump began to issue numerous executive actions, several of which directly address or affect U.S. global health efforts.* This guide provides an overview of these actions, in the order in which they were issued. The “date issued” is date the action was first taken; subsequent actions are listed under “What Happens/Implications.” See an accompanying timeline of events specific to the foreign aid review and USAID dissolution.

President Trump’s Executive Actions on Global Health

Initial Rescissions Of Harmful Executive Orders And Actions, January 20, 2025
PURPOSE: Initial rescissions of Executive Orders and Actions issued by President Biden.

Among these orders are several that addressed the COVID-19 pandemic and global health security, such as Executive Order 13987 (Organizing and Mobilizing the United States Government To Provide a Unified and Effective Response To Combat COVID-19 and To Provide United States Leadership on Global Health and Security),  which among other things established the National Security Council Directorate on Global Health Security and Biodefense and a Senior Director position to oversee it.		What Happens Next/Implications: Given that most of the provisions in the COVID-19 and Global Health Security actions issued by President Biden are no longer current or relevant, the rescissions of these actions are likely to have minimal effect on government policies. One exception may be the elimination of the Directorate of Global Health Security and Biodefense and its Senior Director at the National Security Council, which were responsible for interagency coordination on global health security matters during the Biden Administration. The elimination of this office echoes a similar move made during the first Trump Administration to eliminate an NSC Directorate for Global Health Security, and raises questions about who and which offices at NSC (and across the government) will fill this coordination role in the new Administration. More rescissions of other Biden administration Executive Actions may be issued at a later date.
Withdrawing The United States From The World Health Organization, January 20, 2025
PURPOSE: To withdraw from the World Health Organization (WHO).
“The United States noticed its withdrawal from the World Health Organization (WHO) in 2020 due to the organization’s mishandling of the COVID-19 pandemic that arose out of Wuhan, China, and other global health crises, its failure to adopt urgently needed reforms, and its inability to demonstrate independence from the inappropriate political influence of WHO member states.  In addition, the WHO continues to demand unfairly onerous payments from the United States, far out of proportion with other countries’ assessed payments. China, with a population of 1.4 billion, has 300 percent of the population of the United States, yet contributes nearly 90 percent less to the WHO.”

ACTIONS: The United States intends to withdraw from the WHO. 
• The Presidential Letter to the Secretary-General of the United Nations signed on January 20, 2021, that retracted the United States’ July 6, 2020, notification of withdrawal is revoked.
• Executive Order 13987 (Organizing and Mobilizing the United States Government to Provide a Unified and Effective Response to Combat COVID–19 and To Provide United States Leadership on Global Health and Security), which, among other things, called for “engaging with and strengthening the World Health Organization” is revoked.
• Assistant to the President for National Security Affairs shall establish directorates and coordinating mechanisms within the National Security Council apparatus as necessary and appropriate to safeguard public health and fortify biosecurity.
• The Secretary of State and Director of the Office of Management and Budget shall take actions to pause future transfer of any U.S. funds, support, or resources to WHO; recall and reassign U.S. government personnel or contractors working in any capacity with WHO; and identify credible and transparent U.S. and international partners to assume necessary activities previously undertaken by WHO.
• The Director of the White House Office of Pandemic Preparedness and Response Policy shall review, rescind, and replace the 2024 U.S. Global Health Security Strategy.
• The Secretary of State shall immediately inform the Secretary-General of the United Nations, any other applicable depositary, and the leadership of the WHO of the withdrawal.
• While the withdrawal is in progress, Secretary of State will cease negotiations on the WHO Pandemic Agreement and the amendments to the International Health Regulations, and states that “actions taken to effectuate such agreement and amendments will have no binding force on the United States.”		What Happens Next/Implications: President Trump initiated a process to withdraw from the WHO during his first term in office, a process that takes a year to finalize, and halted funding. This time period was not met when President Biden took office and he reversed this decision and restored funding. Now, after issuance of a formal letter of withdrawal United Nations and WHO, the process will be initiated once again. Such a letter has been issued, indicating that membership will end as of January 22, 2026.Per the Executive Order, U.S. government representatives may not work with WHO. While U.S. representatives attended the Executive Board meeting in February (the U.S. previously held a seat on the Executive Board), no representatives attended the World Health Assembly in May, where world leaders adopted the Pandemic Agreement. On May 30, the White House released details on the President’s Budget Request for FY 2026, requesting eliminated funding for WHO. Further, on June 3, the administration asked Congress to rescind funds previously appropriated for fiscal years 2024 and 2025, including contributions to WHO. However, for both the FY 2026 appropriations and FY2024-25 rescissions, Congress will determine the final funding levels. As the largest donor to WHO providing approximately 16%-18% of the organization’s revenue, the absence of U.S. funding will have an impact WHO’s operations, as will the loss of U.S. technical expertise. See: KFF Fact Sheet and Quick Take

Update: The formal withdrawal of the U.S. government from the WHO became effective on January 22, 2026.
Reevaluating And Realigning United States Foreign Aid, January 20, 2025
PURPOSE: To pause funding and review all U.S. foreign assistance to assess alignment with American values.

The U.S. “foreign aid industry and bureaucracy are not aligned with American interests and in many cases antithetical to American values. They serve to destabilize world peace by promoting ideas in foreign countries that are directly inverse to harmonious and stable relations internal to and among countries.”

“It is the policy of United States that no further United States foreign assistance shall be disbursed in a manner that is not fully aligned with the foreign policy of the President of the United States.”

Calls for:

• 90-day pause in U.S. foreign development assistance (new obligations or disbursements) to assess programmatic efficiencies and consistency with U.S. foreign policy.
• Review of U.S. foreign assistance programs by the responsible department and agency heads under guidelines provided by the Secretary of State, in consultation with the Director of OMB.
• Responsible department and agency heads, in consultation with the Director of OMB, will make determinations within 90 days of this order on whether to continue, modify, or cease each foreign assistance program based upon the review recommendations, with the concurrence of the Secretary of State.
• New obligations and disbursements may resume for a program prior to the end of the 90-day period if a review is conducted, and the Secretary of State or his designee, in consultation with the Director of OMB, decide to continue the program in the same or modified form.  Additionally, any other new foreign assistance programs and obligations must be approved by the Secretary of State or his designee, in consultation with the Director of OMB.
• The Secretary of State may waive the pause for specific programs.		What Happens Next/Implications: Almost all global health programs are funded through foreign aid appropriations and are therefore subject to this order. The order temporarily freezes any new U.S. government spending (obligations or disbursements) through these programs, which could interrupt implementation of programs for which funds have not yet been obligated. It also calls for a 90-day review of all foreign aid programs. Key developments are as follows:
• On January 24, 2025, A Notice on Implementation of the Executive Order was issued by USAID which, among other things, calls for stop-work orders to be issued for all existing foreign assistance awards (not just new obligations and disbursements). It notes that waivers have been granted for: foreign military financing for Israel and Egypt and emergency food assistance (and related expenses) and, on a temporary basis, salaries and related administrative expenses, including travel, for U.S. direct hire employees, personal services contractors, and locally employed staff. The stop-work order on existing awards halted U.S. global health (and other foreign assistance) programs that were already underway, placing key programs at risk of not being able to provide critical services, and affecting access for individuals on the ground, unless a waiver was received.
• On January 28, the Secretary of State  issued a blanket waiver for life-saving humanitarian assistance programs, which also lays out a process for requesting additional waivers (more information is here). This guidance also states that the waiver does not apply to “activities that involve abortions, family planning, conferences, administrative costs [unless associated with waived activities], gender or DEI ideology programs, transgender surgeries, or other non-life saving assistance.”
• On February 1, PEPFAR, the global HIV/AIDS program, was granted a limited waiver enabling it to resume or continue “urgent life-saving HIV treatment  services”, defined as a set of care and treatment services and prevention of mother-to-child transmission services.
• On February 4, some additional services for other global health programs  – tuberculosis; malaria; acute risks of maternal and child mortality, including severe acute malnutrition; and other life-threatening diseases and health conditions – deemed to be “lifesaving” were also granted a limited waiver to allow them to resume or continue.
• On February 6, a lawsuit was filed by Democracy Forward and Public Citizen Litigation Group, on behalf of the American Foreign Service Association and American Federation of Government Employees, challenging the foreign aid funding freeze, the plan to put most staff on leave, and the fact that staff had already been placed on leave; on February 7, they filed a temporary restraining order (TRO). That same day, a temporary restraining order was issued by the U.S. District Court in the District of Columbia preventing the government from placing additional staff on leave or evacuating staff back to the U.S., and requiring reinstatement of all staff already placed on leave, until February 14. The court did not grant a TRO on the funding freeze, on the grounds that the plaintiffs in this case did not demonstrate that the freeze caused them irreparable harm. On February 13, the court extended the TRO through February 21 (further actions are described below, as this case was combined with another for purposes of the court’s consideration).
• On February 10, a lawsuit was filed in the U.S. District Court for the District of Columbia on behalf of two U.S. organizations seeking emergency relief from the freeze on funding for foreign assistance (AVAC v. United States Department of State).
• On February 11, a lawsuit was filed in the U.S. District Court for the District of Columbia on behalf of several U.S. organizations challenging the executive order and subsequent actions freezing foreign aid and dissolving USAID, and asking the court to temporarily restrain and preliminarily and permanently enjoin Defendants from implementing these actions (Global Health Council v. Trump).
• On February 13, the court, in a ruling pertaining to the February 10 and February 11 lawsuits brought by numerous U.S. organizations, issued a TRO preventing the Trump administration from “suspending, pausing, or otherwise preventing the obligation or disbursement of appropriated foreign-assistance funds in connection with any contracts, grants, cooperative agreements, loans, or other federal foreign assistance award that was in existence as of January 19, 2025; or issuing, implementing, enforcing”, or “otherwise giving effect to terminations, suspensions, or stop-work orders in connection with any contracts, grants, cooperative agreements, loans, or other federal foreign assistance award that was in existence as of January 19, 2025.”
• On February 14, the parties filed a joint status report proposing an expedited preliminary injunction briefing schedule.
• On February 18, the government filed a required status report stating that, despite the TRO, it had the authority to cancel contracts and suspend grant awards.
• This was followed by a February 19 request by the February 10 plaintiffs (AVAC v. Department of State) for an emergency motion to enforce the TRO and to hold the defendants in civil contempt.
• The defendants filed a required response on February 20, stating that they have not violated the TRO and should not be held in contempt, which was again opposed by the plaintiffs. Also on February 20, the February 11 plaintiffs (Global Health Council v. Trump) filed a response to the defendant’s status report with a motion to enforce the TRO.  The court reaffirmed the TRO on February 20 (but did not hold the defendants in contempt), stating it was prepared to hold a hearing on the preliminary injunction motions in both cases by March 4, 2025 and that the TRO would be in place through March 10, 2025, or the date the Court resolves the preliminary injunction motions, whichever is sooner.
• The plaintiffs filed an emergency order to enforce the TRO on February 24, due to continued lack of payment, and the court issued a motion to enforce on February 25. The government appealed, (asking for a stay pending appeal) but this was denied by the court. The government then appealed to the Supreme Court and was granted a stay until February 28 while the case was considered.
• On March 5, the Supreme Court denied the government’s request to vacate the federal district court’s TRO, sending the order back to the district court to clarify the government’s obligations for ensuring compliance with the TRO.
• On March 6, the federal district court judge ordered the government to release all payments that were due to plaintiffs as of February 13, by Monday, March 10 at 6pm, and on March 10, the federal district court judge preliminarily enjoined the government from taking certain actions related to the foreign aid freeze.
• On March 10, Secretary Rubio announced that a six-week review had been completed and that 83% of programs at USAID (5,200 contracts) had been cancelled. That same day, the court  preliminarily enjoined the government from enforcing actions taken to implement the foreign aid freeze (requiring it to reverse any terminations, suspensions, and stop-work orders and to pay for any work completed by February 13). The court stated that the government was “enjoined from unlawfully impounding congressionally appropriated foreign aid funds and shall make available for obligation the full amount of funds that Congress appropriated for foreign assistance programs in the Further Consolidated Appropriations Act of 2024.”
• On April 1, the government filed an appeal with the U.S. Court of Appeals for the District of Columbia challenging the preliminary injunction issued on March 10.
• On April 17, the administration extended the foreign aid review for another 30 days from the original deadline of April 20, 2025.
•On May 2 and May 30, the White House released information on its budget request for FY 2026, proposing significant decreases, and in some cases eliminations, of funding for global health activities. However, Congress will determine the final funding levels.
• On June 3, the administration asked Congress to rescind previously appropriated funds for fiscal years 2024 and 2025, including $8.3 billion in foreign assistance, of which at least $1.2 billion was designated for global health. However, Congress will need to approve any potential rescissions.
• On August 13, the U.S. District Court of Appeals for the District of Columbia Circuit partially vacated the March 10 preliminary injunction in the cases GHC v. Trump and AVAC v. State Department which required the government to make congressionally appropriated foreign assistance funds available for obligation. The appeals court ruled that the plaintiffs did not have the authority to challenge the President’s impoundment of funds. Instead, the court ruled that challenges of impoundment should be brought forward by the Comptroller General.
• On August 28, the U.S. District Court of Appeals for the District of Columbia Circuit amended its opinion, clarifying that while plaintiffs did not have the authority to challenge impoundment of foreign assistance funds through the Impoundment Control Act, they could seek relief through the Administrative Procedures Act. Following this amended opinion, plaintiffs in GHC v. Trump and AVAC v. State Department cases motioned for a preliminary injunction in the U.S. district court on September 1. On September 3, the U.S. district court granted the preliminary injunction, ordering defendants to obligate expiring foreign assistance funds before the end of the fiscal year on September 30. On September 4, defendants appealed this preliminary injunction and requested a stay on the preliminary injunction pending the resolution of the appeals case, from both the district court and appeals court. These requests were both denied on September 5. On September 8, defendants requested a stay of the preliminary injunction as it pertained to funds included in the President’s proposed rescissions package from the U.S Supreme Court. On September 9, the Chief Justice of the Supreme Court granted a partial administrative stay of the preliminary injunction, and on September 26, the court granted the partial stay, allowing the administration to rescind the $4 billion that was in rescission package. Further legal proceedings in the case are currently stayed as the parties await the outcome of a separate legal case.

The 90-day review of foreign assistance was initially supposed to go through April 19, 2025, however, has been granted a 30-day extension. No formal results of the review have been announced.
America First Policy Directive To The Secretary Of State, January 20, 2025
PURPOSE: To put core American interests first in foreign policy.

The foreign policy of the United States “shall champion core American interests and always put America and American citizens first.”

“As soon as practicable, the Secretary of State shall issue guidance bringing the Department of State’s policies, programs, personnel, and operations in line with an America First foreign policy, which puts America and its interests first.”		What Happens Next/Implications: The State Department is responsible for the supervision and overall strategic direction of foreign assistance programs administered by the State Department and USAID, which includes the vast majority of global health assistance. It also directly oversees PEPFAR, the global HIV/AIDS program, and many aspects of global health diplomacy for the U.S. Priorities and approaches for these and other global health programs are likely to be shaped by how the White House and State Department leadership define “America First” foreign policy and American interests, and how that definition is implemented in practice.

Update: On September 18, the State Department released the America First Global Health Strategy, its new vision for U.S. global health engagement. The strategy is built around three pillars — “making America safer, stronger, and more prosperous” — and prioritizes funding for direct service support, such as commodities and health workers, includes plans for country co-investment, and seeks to transition program management operations from U.S. leadership to country ownership. The State Department is entering into multi-year bilateral agreements with recipient countries and implementation of these new agreements will begin sometime in 2026.
Defending Women From Gender Ideology Extremism And Restoring Biological Truth To The Federal Government, January 20, 2025
PURPOSE: To define sex as an immutable binary biological classification and remove recognition of the concept of gender identity.

• The order states that “It is the policy of the United States to recognize two sexes, male and female” and directs the Executive Branch to “enforce all sex-protective laws to promote this reality”. Elements of the order that may affect global health programs are as follows:
• Defines sex as “an individual’s immutable biological classification as either male or female”.  States that “sex” is not a synonym for and does not include the concept of “gender identity” and that gender identity “does not provide a meaningful basis for identification and cannot be recognized as a replacement for sex.”
• Directs the Secretary of Health and Human Services to provide the U.S. Government, external partners, and the public clear guidance expanding on the sex-based definitions set forth in the order within 30 days.
• Directs each agency and all Federal employees to “enforce laws governing sex-based rights, protections, opportunities, and accommodations to protect men and women as biologically distinct sexes, including when interpreting or applying statutes, regulations, or guidance and in all other official agency business, documents, and communications.
• Directs each agency and all Federal employees, when administering or enforcing sex-based distinctions, to use the term “sex” and not “gender” in all applicable Federal policies and documents.
• Directs agencies to remove all statements, policies, regulations, forms, communications, or other internal and external messages “that promote or otherwise inculcate gender ideology”, and shall cease issuing such statements, policies, regulations, forms, communications or other messages. Directs agencies to take all necessary steps, as permitted by law, to end the Federal funding of gender ideology.
• Requires that Federal funds shall not be used to promote gender ideology and directs agencies to ensure grant funds do not promote gender ideology.
• Rescinds multiple executive orders issued by President Biden, including: “Preventing and Combating Discrimination on the Basis of Gender Identity or Sexual Orientation” (13988) and “Advancing Equality for Lesbian, Gay, Bisexual, Transgender, Queer, and Intersex Individuals” (14075).		What Happens Next/Implications: This order is broad, directed to all federal agencies and programs. Because PEPFAR, and some other U.S. global health programs, serve people who are members of the LGBTQ community, guidance and implementation could affect the ability of these programs to reach individuals and organizations and provide them with services. In addition, the order will likely result in the removal of existing protections based on sexual orientation and gender identity, which had been provided in agency guidance for global health and development programs. Implementation guidance has been issued and all federal agencies must comply.

Update: On January 27, 2026, citing this order (among others) the Trump administration released details of the “Promoting Human Flourishing in Foreign Assistance (PHFFA)” policy which significantly expands the Mexico City Policy (see below) to also prohibit the promotion of “gender ideology” and to apply to significantly more funding and organizations.
Memorandum For The Secretary Of State, The Secretary Of Defense, The Secretary Of Health And Human Services, The Administrator Of The United States Agency For International Development, January 24, 2025
PURPOSE: To reinstate Mexico City Policy and direct review of programs per the Kemp-Kasten Amendment.

• Revokes President Biden’s Presidential Memorandum of January 28, 2021 for the Secretary of State, the Secretary of Defense, the Secretary of Health and Human Services, and the Administrator of the United States Agency for International Development (Protecting Women’s Health at Home and Abroad).
• Reinstates President Trump’s Presidential Memorandum of January 23, 2017 for the Secretary of State, the Secretary of Health and Human Services, and the Administrator of the United States Agency for International Development (The Mexico City Policy).
• Directs the Secretary of State, in coordination with the Secretary of Health and Human Services, to the extent allowable by law, to implement a plan to extend the requirements of the reinstated Memorandum to global health assistance furnished by all departments or agencies.
• Directs the Secretary of State to take all necessary actions, to the extent permitted by law, to ensure that U.S. taxpayer dollars do not fund organizations or programs that support or participate in the management of a program of coercive abortion or involuntary sterilization.		What Happens Next/Implications: The Mexico City Policy is a U.S. government policy that – when in effect – has required foreign NGOs to certify that they will not “perform or actively promote abortion as a method of family planning” using funds from any source (including non-U.S. funds) as a condition of receiving U.S. global family planning assistance and, when in place under the Trump administration, most other U.S. global health assistance. First announced in 1984 by the Reagan administration, the policy has been rescinded and reinstated by subsequent administrations along party lines since, and expanded over time, including a significant expansion during the first Trump administration; it was widely expected that the President Trump would reinstate it in his second term and expand it further. The memorandum calls for the implementation of a plan to extend the requirements to global health assistance furnished by all departments or agencies; until the plan is ready, the scope of the new memorandum is unknown.

The memorandum also directs the Secretary of State to review programs under the Kemp-Kasten amendment, a provision of U.S. law that states that no U.S. funds may be made available to “any organization or program which, as determined by the [p]resident of the United States, supports or participates in the management of a program of coercive abortion or involuntary sterilization.” It has been used in the past to prevent funding from going to UNFPA. See: KFF Mexico City Policy explainer and related resources and Kemp-Kasten explainer.

Update: On January 7, 2026, the Trump administration announced that it had formally withdrawn from membership and participation in UNFPA, also citing the Executive Order on “Withdrawing the United States from and Ending Funding to Certain United Nations Organizations and Reviewing United States Support to All International Organizations.”

Update: Three interim final rules expanding and implementing the Mexico City Policy, now called the Promoting Human Flourishing in Foreign Assistance (PHFFA) Policy, were issued on January 27, 2026:
– Protecting Life in Foreign Assistance
– Combating Gender Ideology in Foreign Assistance
– Combating Discriminatory Equity Ideology in Foreign Assistance Rules
This latest expansion now includes most non-military foreign assistance and applies to U.S. NGOs, international organizations, and foreign governments, as well as foreign NGOs. In addition to abortion, it also now prohibits the promotion of “discriminatory equity ideology” and “gender ideology.”

Renewed Membership in the Geneva Consensus Declaration on Promoting Women’s Health and Strengthening the Family, January 24, 2025
PURPOSE: To rejoin the Geneva Consensus Declaration.

The United States informed signatories of the Geneva Consensus Declaration of its intent to rejoin immediately. Established in 2020, the declaration, led by the United States, has the following objectives: “to secure meaningful health and development gains for women; to protect life at all stages; to defend the family as the fundamental unit of society; and to work together across the UN system to realize these values.”		What Happens Next/Implications: The Geneva Consensus Declaration, initially crafted and signed by the U.S. – along with 31 other countries at the time – was meant to enshrine certain values and principles related to women’s health and family, including a rejection of the “international right to abortion.”  The Biden administration withdrew from the Consensus in 2021.
Review of and Changes to USAID, January 27, 2025
Reorganization of the Department of State, April 22, 2025
PURPOSE: To review and potentially reorganize USAID “to maximize efficiency and align operations with the national interest,” which may include the suspension or elimination of programs, projects, or activities; closing or suspending missions or posts; closing, reorganizing, downsizing, or renaming establishments, organizations, bureaus, centers, or offices; reducing the size of the workforce at such entities; and contracting out or privatizing functions or activities performed by federal employees.What Happens Next/Implications: Related to but separate from the Executive Order on reevaluating and realigning foreign aid and on the America first policy directive to the Secretary of State, the administration has made changes to and begun a review of USAID, the U.S. government’s international development agency which oversees and/or implements most U.S. global health programs (see, The U.S. Government and Global Health). Key developments are as follows:
• On January 27, senior USAID career staff were placed on leave and hundreds of other staff were let go.
• On February 2, the USAID website was taken down.
• On February 3, the USAID building in DC was closed, which has prevented other staff from accessing it.
• The President appointed Secretary of State Rubio as Acting USAID Administrator on February 3. Secretary Rubio has said that the agency has “conflicting, overlapping, and duplicative functions that it shares with the Department of State” and that its systems and processes are not “well synthesized, integrated, or coordinated, and often result in discord in the foreign policy and foreign relations of the United States.” President Trump and other administration officials have called for dissolving the agency altogether. Formal notification of the intent to review the agency was sent by Secretary Rubio to Congress on February 3.
• On February 4, a notice was posted on the USAID website stating that on February 7, all USAID direct hire personnel would be placed on administrative leave globally, with the exception of “designated personnel responsible for mission­ critical functions, core leadership and specially designated programs.” The notice also said that staff posted outside the United States would need to return to the U.S. within 30 days.
• On February 6, a lawsuit was filed by Democracy Forward and Public Citizen Litigation Group, on behalf of the American Foreign Service Association and American Federation of Government Employees, challenging the foreign aid funding freeze, the plan to put most staff on leave, and the fact that staff had already been placed on leave; on February 7, they filed for a temporary restraining order (TRO). That same day, a temporary restraining order was issued by the U.S. District Court in the District of Columbia preventing the government from placing additional staff on leave or evacuating staff back to the U.S., and requiring reinstatement of all staff already placed on leave, until February 14. The court did not grant a TRO on the funding freeze, on the grounds that the plaintiffs in this case did not demonstrate that the freeze caused them irreparable harm. On February 13, the court extended the TRO through February 21, at which time, the court determined that further preliminary injunctive relief was not warranted and the TRO was ended, allowing the government to dismiss USAID staff.
• On February 11, a lawsuit was filed in the U.S. District Court for the District of Columbia on behalf of several U.S. organizations challenging the executive order pausing foreign aid, and subsequent actions freezing foreign aid and dissolving USAID, and asking the court to temporarily restrain and preliminarily and permanently enjoin Defendants from implementing these actions. In a February 13 ruling, a federal court issued a TRO preventing the Trump administration from freezing foreign aid assistance but stated that the proposed injunctions related to USAID were overbroad (in a separate case, the district court ended the TRO on dismissing USAID staff – see above).
• On February 13, a lawsuit was filed in the U.S. District Court for the District of Maryland by 26 former and current employees of USAID, suing Elon Musk and DOGE for taking actions to control and dissolve the agency. On February 18, the plaintiffs filed a motion for preliminary injunction. The defendants responded on February 24 and the plaintiffs replied on February 26. On March 18, the court granted a preliminary injunction, requiring the defendants to reverse many of the actions taken to dissolve USAID, and on March 21, the defendants filed an appeal on the preliminary injunction. On March 25, the U.S. 4th Circuit Court of Appeals granted the defendants’ motion for a temporary stay on the preliminary injunction, allowing DOGE to resume its efforts to dissolve USAID, until March 27. The following day on March 28, the court granted defendants’ motion for a stay, clearing the path for DOGE to continue its work dissolving USAID.
• On February 18, a lawsuit was filed in the U.S. District Court for the District of Columbia on behalf of the Personal Services Contractor Association (representing USAID personal service contractors) challenging the suspension of foreign assistance and the actions related to USAID, including “steps to dismantle USAID, cripple its operations, or transfer its functions to the State Department without Congressional authorization”. On February 19, the plaintiffs filed a motion for a temporary restraining order. On March 6, the court denied the TRO request.
• On March 28, Secretary Rubio announced that the Department of State and USAID have notified Congress on their intent to “undertake a reorganization that would involve realigning certain USAID functions to the Department by July 1, 2025, and discontinuing the remaining USAID functions that do not align with Administration priorities.” Additionally, nearly all the remaining USAID staff received notice that they would be subject to a final reduction-in-force.
• On April 22, Secretary Rubio announced the Department of State’s reorganization plan and new organization chart. The plan states that it would consolidate functions and remove non-statutory programs that are “misaligned with America’s core national interests.”
• On April 28, a lawsuit was filed by a group of labor unions, non-profits, and local governments challenging the administration’s moves to drastically reshape several federal agencies without congressional approval (American Federation of Government Employees v. Trump). The district court issued a TRO on May 9 and preliminary injunction on May 22 ordering the administration to pause large-scale reductions in force, program eliminations, and other actions related to federal agency restructuring. An emergency motion by the government for a stay pending appeal of the district court’s preliminary injunction was denied on May 30.
• On May 2 and May 30, the White House released information on its budget request for FY 2026, noting the reorganization of USAID into the Department of State.
• On May 29, the Department of State notified Congress of its reorganization plans, including absorbing USAID’s continued functions.
• On June 13, the district court in American Federation of Government Employees v. Trump ruled that the actions of the Department of State, including the reorganization announcement and notification to Congress, were in violation of the preliminary injunction.
• On July 8, the U.S. Supreme Court granted the government’s request for a stay of the preliminary injunction pending resolution of the appeals case in American Federation of Government Employees v. Trump, allowing the government to move forward with large-scale reductions to federal agency operations and workforces, including at the State Department.

While initially created through Executive Order in 1961 as part of the State Department, the Foreign Affairs Reform and Restructuring Act of 1998 established it as an independent agency within the executive branch. As such, the Executive branch does not have authority to dissolve it without Congress, and Congress also requires notification first as well as consultation on any proposed changes.

Update: On July 1, 2025, USAID was dissolved (with most employees being separated from the agency; any remaining personnel were separated by September 2, 2025). Remaining functions/activities were transferred to the State Department.
Withdrawing the United States From and Ending Funding to Certain United Nations Organizations and Reviewing United States Support to All International Organizations, February 4, 2025
PURPOSE: To review United States participation in all international intergovernmental organizations, conventions, and treaties and to withdraw from and end funding to certain United Nations (U.N.) organizations.

• The U.S. “helped found” the U.N. “after World War II to prevent future global conflicts and promote international peace and security.  But some of [its] agencies and bodies have drifted from this mission and instead act contrary to the interests of the United States while attacking our allies and propagating anti-Semitism.”
• States that the U.S. “will reevaluate our commitment to these institutions,” including three organizations that “deserve renewed scrutiny”:
a) the U.N. Human Rights Council (UNHRC; the U.S. will not participate in and withhold its contribution to the budget of the body),
b) the U.N. Educational, Scientific, and Cultural Organization (UNESCO; the U.S. will conduct a review of its membership in the body within 90 days), and
c) the U.N. Relief and Works Agency for Palestine Refugees in the Near East (UNRWA; reiterates that the U.S. will not contribute to the body).
• Requires that within 180 days:
a) the Secretary of State, with the U.S. Ambassador to the U.N., conduct a review of all international intergovernmental organizations of which the U.S. is a member and provides any type of funding or other support, and all conventions and treaties to which the United States is a party, to determine which organizations, conventions, and treaties are contrary to the interests of the United States and whether such organizations, conventions, or treaties can be reformed; and
b) the Secretary of State to report the findings of the review to the President, through the National Security Advisor, and provide recommendations as to whether the U.S. should withdraw from any such organizations, conventions, or treaties.		What Happens Next/Implications: With a long history of multilateral global health engagement, the U.S. is often the largest or one of the largest donors to multilateral health efforts (i.e., multi-country, pooled support often directed through an international organization). It provided $2.4 billion in assessed or core contributions in FY 2024 – 19% of overall U.S. global health funding – as well as more funding in voluntary or non-core contributions.

The U.S. is also a signatory or party to numerous global health-related international conventions, treaties, and agreements; these include those that played a role in the global COVID-19 response (such as the International Health Regulations). It often has participated in negotiations for new international instruments, although the Trump administration indicated in a Jan. 20, 2025, Executive Order, listed above, that the U.S. would no longer engage in the Pandemic Agreement (sometimes called the “Pandemic Treaty”) negotiations.

This Executive Order will have immediate impacts via the ordered actions related to the three U.N. organizations specified, much as the impacts of the Jan. 20, 2025, Executive Order on the World Health Organization (WHO, which initiated U.S. withdrawal from membership and halted U.S. funding) are already being seen. Beyond these, additional impacts of this Executive Order will be determined by the findings and recommendations of the international organizations and conventions review, particularly if U.S. support for or membership in some international organizations is recommended to be reduced or eliminated and if it recommends the U.S. withdraw from any international agreements.

The 180 day review of all international intergovernmental organizations goes through August 3, 2025.

Update: On January 7, 2026, the Trump administration announced that it had formally withdrawn from 66 international organizations, including United Nations entities and non-UN entities.  
Memorandum For The Heads Of Executive Departments And Agencies, February 6, 2025
PURPOSE: The memorandum seeks to “stop funding Nongovernmental Organizations that undermine the national interest and administration priorities”.

The memorandum:
• States: it is Administration policy “to stop funding NGOs [Nongovernmental Organizations] that undermine the national interest.”
• Directs heads of executive departments and agencies to review all funding that agencies provide to NGOs and “to align future funding decisions with the interests of the United States and with the goals and priorities of my Administration, as expressed in executive action; as otherwise determined in the judgment of the heads of agencies; and on the basis of applicable authorizing statues, regulations, and terms.”		What Happens Next/Implications: This memo aligns with other Executive actions that target federal funding for global health and foreign assistance programs. Implementation of this memo could result in the Administration halting funding to global health NGOs they determine “do not align with administration priorities.” No criteria for how this determination will be made has been provided.

The majority of U.S. global health assistance is channeled through NGOs. In FY22, for example, 62% of U.S. global health funding was provided to NGOs as prime partners (45% to U.S.-based NGOs and 17% to foreign-based NGOs) and others are likely sub-recipients of U.S. assistance.* As such, this Order could have a significant impact on NGOs if it is determined that they do not align with administration policies. *Source: KFF analysis of data from www.foreignassistance.gov.
Addressing Egregious Actions of The Republic of South Africa, February 7, 2025
PURPOSE: To stop U.S. support for South Africa due to its “commission of rights violations in its country or its ‘undermining United States foreign policy, which poses national security threats to our Nation, our allies, our African partners, and our interests.”

“It is the policy of the United States that, as long as South Africa continues these unjust and immoral practices that harm our Nation:
(a)  the United States shall not provide aid or assistance to South Africa; and
(b)  the United States shall promote the resettlement of Afrikaner refugees escaping government-sponsored race-based discrimination, including racially discriminatory property confiscation.”

ACTIONS:
• All executive departments and agencies, including USAID, shall, to the maximum extent allowed by law, halt foreign aid or assistance delivered or provided to South Africa, and shall promptly exercise all available authorities and discretion to halt such aid or assistance.
• The head of each agency may permit the provision of any such foreign aid or assistance that, in the discretion of the relevant agency head, is necessary or appropriate.
• The Secretary of State and the Secretary of Homeland Security shall take appropriate steps, consistent with law, to prioritize humanitarian relief, including admission and resettlement through the United States Refugee Admissions Program, for Afrikaners in South Africa. A plan shall be submitted to the President through the Assistant to the President and Homeland Security Advisor.		What Happens Next/Implications: South Africa receives a significant amount of global health assistance, particularly for HIV/AIDS, from the United States government. The executive order allows the heads of U.S. agencies to permit the provision of foreign aid or assistance under this order at their discretion. On February 10, the U.S. Embassy and Consulates in South Africa announced that PEPFAR would not be impacted by this Executive Order and could continue under the limited waiver already granted to the foreign aid funding freeze. No other exceptions have yet been announced.

The Government of South Africa has issued a statement in response to the Executive Order that, among other things, expresses concern “by what seems to be a campaign of misinformation and propaganda aimed at misrepresenting our great nation.”

Notes and Sources:

*There are several other Executive Actions issued by the President that instruct all government agencies on a variety of topics and as such broadly affect global health program operations but are not specific to global health. These include, for example, Executive Actions withdrawing from the Paris Agreement under the United Nations Framework Convention on Climate Change and ending DEI programs. These are not included in this resource.

Sources: White House, https://www.whitehouse.gov/presidential-actions/; State Department, www.state.gov.

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Global Health Policy LGBTQ Gender Identity Global Health Aid Cuts International Cooperation PEPFAR U.S. Government Programs

How Does U.S. Life Expectancy Compare to Other Countries?

Published: Mar 31, 2026

Life expectancy at birth in the U.S. increased 0.6 years from 78.4 years in 2023 to 79.0 years in 2024, its highest-ever level. However, the average life expectancy in comparable countries was 82.7 years, about 3.7 years longer than in the U.S., reflecting a persistently wide difference in life expectancy between the U.S. and comparable countries.

This chart collection examines how life expectancy in the U.S. compares to that of other similarly large and wealthy countries in the Organisation for Economic Co-operation and Development (OECD). The countries included in the comparison are Australia, Austria, Belgium, Canada, France, Germany, Japan, Netherlands, Sweden, Switzerland, and the United Kingdom.

The analysis is available through the Peterson-KFF Health System Tracker, an information hub dedicated to monitoring and assessing the performance of the U.S. health system.

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Health Costs Health System Performance International Comparisons Mortality

Also of Interest

Poll Finding

Public Opinion on Prescription Drugs and Their Prices

Published: Mar 31, 2026

Editorial Note: This data note was updated on March 31, 2026, to reflect updated poll findings.

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Key Takeaways

This data note summarizes KFF polling on the U.S. public’s experiences with prescription drug costs, use of GLP-1 medications, and support for policy solutions. Key takeaways include:

  • Most U.S. adults take at least one prescription drug, and many struggle or worry about affording their prescription medications. Six in ten adults say they are worried about being able to afford their prescription drug costs, a new high since KFF began asking in 2018. Four in ten say they have had to take cost-saving measures, such as skipping doses, not filling prescriptions, or taking other measures due to costs.
  • Increasing use of GLP-1 medications raises particular cost concerns. About one in five adults have ever taken a GLP-1 medication, and most users – including those with health insurance – say these drugs are difficult to afford. KFF will continue to monitor the public’s experiences with GLP-1 medications as use, regulation, and new formulations – including oral versions – continue to evolve.
  • Large majorities across party lines want the government to do more to regulate drug prices, and many support a range of policies. At least two-thirds of Democrats, independents, and Republicans say there is not enough regulation of prescription drug prices. Most support a range of policies to address costs, such as two provisions of the 2022 Inflation Reduction Act (IRA): allowing Medicare to negotiate prices and limiting how much drug companies can increase the price of drugs based on annual inflation rates.
  • The Trump administration has taken several steps to try to lower prescription drug costs in its second term, but these initiatives have limited public visibility so far. Few adults have heard much about the administration’s drug pricing deals with manufacturers or TrumpRx, the federal website that provides discount coupons for certain drugs, launched in early 2026. KFF polling from 2019 found broad support for a related approach – lowering what Medicare pays for some drugs based on amounts in other countries – suggesting the idea has public appeal even if awareness of the current initiatives and the debates around them remain low.

The Public’s Experiences with and Views of Prescription Drugs

Prescription drugs touch the lives of most people in the U.S. in some way, and the public broadly recognizes their benefits. About two-thirds (66%) of adults say they are currently taking at least one prescription drug, and three in ten (31%) say they currently take four or more prescription medications. While many adults across age groups take prescription medications, older adults are much more likely to report taking 4 or more medications.

Six in ten adults ages 65 and older report taking four or more prescription medications, compared to fewer than half of younger adults.

Bar chart showing the percent who take any number of prescription medicine, 1 prescription medicine, 2 prescription medicines, 3 prescription medicines, or 4 or more prescription medicines.

The public generally sees the benefits of these medicines. About six in ten (63%) adults believe prescription drugs developed over the past 20 years have generally made the lives of people in the U.S. better, while much smaller shares (21%) say they’ve made them worse or have not made a difference (15%).

Six in Ten Say That Prescription Drugs Developed Over the Past 20 Years Have Made the Lives of People in the U.S. Better (Stacked Bars)

Despite seeing their general benefits to society, about eight in ten adults (82%) say the cost of prescription drugs is unreasonable, and the public sees profits made by pharmaceutical companies as the largest factor contributing to these prices. More than three-quarters of adults across partisanship say profits made by pharmaceutical companies are a “major factor” in the price of prescription drugs. This is followed by more than half who say the cost of research and development is a “major factor” contributing to the price, and 45% saying the same about the cost of marketing and advertising.

Split bar chart by total and party identification, showing the percent who say each of the following is a major factor contributing to the price of prescription drugs: profits made by pharmaceutical companies, the cost of research and development, and the cost of marketing and advertising.

Struggles Affording Prescription Drugs

Many Americans face significant challenges affording their medications, including adults who take more medications or have lower incomes. KFF polling shows these challenges have grown more acute over the years. While about two-thirds (65%) of adults overall say it is “very” or “somewhat” easy to afford their prescription drug costs, affordability is a bigger issue for those who are currently taking four or more prescription medicines. Nearly four in ten (37%) of those taking four or more prescription drugs say they have difficulty affording their prescriptions, compared with one in five (18%) adults who currently take three or fewer prescription medications. Adults with an annual household income of less than $40,000 are also more likely than adults with higher incomes to report difficulty affording their prescription medications.

Bar chart showing percent who say it is difficult to afford the cost of their prescription medicine, by total, number of medications taken, age, and household income.

Overall, about six in ten adults say they are worried about being able to afford prescription drug costs for themselves or their families (59%), including about one in five (22%) who are “very worried.” Worry varies by insurance status, household income, race, and ethnicity. Substantial shares of uninsured adults under age 65 (32%), Hispanic adults (30%), Black adults (26%), and adults in households with annual incomes less than $40,000 (27%) say they are “very worried” about affording their prescription drug costs.

Among adults who take four or more prescription medications, about two-thirds (64%) report worrying about affording their medications, including about three in ten (29%) who are “very worried.” However, worry is not limited to those who take at least four medications. Most adults who take fewer prescriptions (1 to 3) worry about being able to afford their medications (56%). Even among adults who do not currently take any prescriptions themselves, a majority (57%) are “very” or “somewhat worried” about affording prescription medications, perhaps reflecting concerns about future needs or the prescription drug costs of family members.

Notably, about one in five (19%) Medicare enrollees say they are “very worried” about affording their prescription drug costs. Although older adults are more likely to take more prescription medications than younger adults, the vast majority of Medicare beneficiaries are enrolled in Medicare Part D plans, giving them prescription drug coverage that has improved with recent policies in the Inflation Reduction Act of 2022.

About one in four (24%) Medicaid enrollees under age 65 say they are “very worried” about affording their prescription drug costs. Medicaid provides comprehensive access to prescription drugs for eligible adults, with out-of-pocket costs limited to nominal amounts, which helps adults avoid cost-related prescription medication rationing or delays. However, while prescription out-of-pocket costs in Medicaid are limited, even low amounts may still be prohibitive for low-income families with Medicaid.

Majorities Are Worried About Affording Prescription Drugs for Themselves or Their Family (Stacked Bars)

Since KFF first asked about worries affording prescription drug costs in 2018, the share of adults reporting worries has increased steadily, to a new high of six in ten (59%) in 2026.

Bar chart showing the share of adults who are very or somewhat worried about being able to afford prescription drugs from August 2018 to March 2026.

About four in ten (43%) adults report that they have not taken their medication as prescribed at some point in the past year because of the cost. This includes three in ten who have taken an over-the-counter drug instead (31%), a quarter who have not filled a prescription (27%), and about one in five (19%) who have cut pills in half or skipped doses of medicine because of the cost.

The share who reports not filling a prescription, taking an over-the-counter drug instead, or cutting pills in half or skipping doses increases to about half among adults with annual household incomes less than $40,000 (52%).

About Four in Ten Adults Say, in the Past Year, They Did Not Take Their Medicine as Prescribed Due to Costs (Split Bars)

GLP-1 Use and Affordability

In recent years, KFF has been tracking the public’s use and experiences with GLP-1 medications. These medications, such as semaglutide or tirzepatide, are used for weight loss or managing chronic health conditions. As GLP-1 medications have expanded beyond their original use for treating Type 2 diabetes, their popularity, combined with their high cost and need for long-term use, poses a potential cost burden on consumers, employers, and insurers. In response, some employers have restricted or dropped coverage for weight loss in 2026. Medicare Part D currently covers GLP-1 drugs only when prescribed to treat chronic illnesses such as diabetes and sleep apnea but prohibits the coverage for weight loss alone under federal law. Under the Medicaid Drug Rebate Program (MDRP), state Medicaid programs must cover GLP-1s for conditions like diabetes, but coverage for obesity is optional under federal law.

As of March 2026, KFF Health Tracking Polls show about one in five adults have ever taken a GLP-1 medication (18%), including 12% who currently take this class of medication (an increase of 6 percentage points from May 2024).

While most GLP-1 users get their medications from a primary care doctor and have them at least partially covered by insurance, a majority, including 55% of those who have health insurance, say it is difficult to afford these drugs. KFF will continue to monitor the public’s experiences with GLP-1 medications as use, regulation, and new formulations – including oral versions – continue to evolve.

Stacked bar chart showing how easy or difficult paying for GLP-1 drugs is for adults who have ever used GLP-1 drugs.

Public Support for Drug Pricing Policies

There is broad, bipartisan agreement that there should be more government regulation when it comes to prescription drug costs. The March 2026 KFF Health Tracking Poll finds about seven in ten adults (72%) say there is “not as much regulation as there should be” when it comes to limiting the price of prescription drugs, including at least two-thirds of Democrats (77%), Republicans (68%), and independents (72%).

Notably, larger shares of adults now say there is not enough regulation than five years ago, though KFF has found bipartisan agreement on this attitude since 2015.

Split bar chart by total and party identification showing percent of adults who say that there is not as much regulation as there should be when it comes to making sure prescription drugs are safe for people to use and limiting the price of prescription drugs.

For decades, lawmakers have debated and passed drug pricing legislation. For example, in 2022 the Inflation Reduction Act, or IRA, included several provisions aimed at lowering prescription drug costs. The public largely supports many of these provisions, including limiting how much drug companies can increase the price of drugs based on annual inflation rates (88%) and allowing the federal government to negotiate with drug companies to get a lower price on medications for people with Medicare (85%).

KFF polling shows the public – across partisans – is also supportive of other policy proposals that have been debated but not been put into law, such as increasing taxes on drug companies that refuse to negotiate the price of their drugs with the government, allowing Americans to buy drugs imported from Canada, making it easier for generic drugs to come to market, and expanding the IRA’s annual out-of-pocket maximum and monthly cap on insulin prices beyond people with Medicare.

Bar chart showing percent who favor specific actions to keep prescription drug costs down.

It is also notable that bipartisan support for the IRA provisions has held since its passage, and majorities across partisan lines support expanding what the law currently does. KFF polling from 2024, during the Biden administration, showed that at least eight in ten (85%) U.S. adults supported authorizing the federal government to negotiate drug prices for people with Medicare as the IRA does. This provision was supported by 90% of Democrats, 87% of independents, and 79% of Republicans.

In 2024, majorities across partisanship also supported expanding two IRA provisions beyond those covered by Medicare. Three in four adults supported a proposal to expand the $35 cap on out-of-pocket costs for insulin beyond those with Medicare, including majorities of Democrats (82%), independents (78%), and Republicans (67%). About two-thirds supported a proposal to expand the $2,000 annual limit on out-of-pocket prescription drug costs beyond those with Medicare, including 78% of Democrats, 69% of independents, and 57% of Republicans.

Bar chart showing shares of total voters, democratic voters, Independent voters, and Republican voters who say they support proposals to expand IRA provisions beyond those with Medicare.

Trump Administration Policy Actions on Prescription Drug Prices, TrumpRx and Direct Purchasing Options

President Trump first pushed to lower prescription drug costs in the U.S. to match prices in other developed nations, during his first term in 2018, an approach that later became formally known as “most-favored-nation” (MFN) pricing. While this was not put into effect during Trump’s first term, KFF polling from 2019 found broad public support for the approach, with about two-thirds (65%) of adults supporting lowering what Medicare pays for some drugs based on amounts in other countries where governments more closely control prices. This includes most Democrats (74%), independents (62%), and Republicans (54%).

Bar chart showing shares of total voters, democratic voters, Independent voters, and Republican voters who say they support proposals to expand IRA provisions beyond those with Medicare.

In the Trump administration’s second term, there have been more efforts to reduce the cost of prescription drugs. Though the details of the deals are confidential and not available to the public, the administration announced several prescription drug pricing deals with drugmakers related to what they charge state Medicaid programs for some of their drugs, and a subsequent deal with a maker of in vitro fertilization (IVF) drugs aimed at lowering the cost of these treatments. As of November 2025, awareness of these deals was limited, with three in ten adults saying they had heard a lot (6%) or some (25%) about them. Later in 2025, the president announced further developments in the MFN pricing, including deals to sell certain products directly to consumers at discounted rates.

In February 2026, amid the Trump administration’s focus on lowering prescription drug costs, the administration officially launched TrumpRx, the federal government-run website where people can get discounts to buy prescription drugs directly from some manufacturers or pharmacies, without using their health insurance. As of early March 2026, few U.S. adults overall, including those who take prescription drugs, have heard much about or visited the website.

While few prescription drug users (7%) say they have visited the TrumpRx site to shop for or compare prescription prices in the month following the TrumpRx launch, this rises to about one in six (16%) among those who currently take or have ever taken a GLP-1 medication for weight loss or certain chronic conditions. The TrumpRx website features at least four major GLP-1 medications among its initial 43 listed drugs.

Split bar chart showing shares of adults who say they have heard about TrumpRx and share who say they have visited the TrumpRx website. Results shown by adults who take prescription drugs and GLP-1 use.

Prior to the launch of TrumpRx, drug discounts have been available through third-party platforms and directly from drug manufacturers. About four in ten adults who take prescription drugs say that in the past year, they have used a discount card or coupon to reduce their prescription drug costs (42%) or compared prescription drug prices online to find the lowest cost option (39%). Fewer say they have purchased a lower-cost drug from an online pharmacy without their insurance (15%) or directly from a drug manufacturer’s website (8%). 

Bar chart showing shares of adults who currently take prescription drugs and who say they have not taken their medication as prescribed because of the costs.
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Also of Interest

Tracking Implementation of the 2025 Reconciliation Law Medicaid Work Requirements

Published:

Overview
State/National Data & Policies
Guidance & Implementation Questions
Implementation/Waiver Status
Related Resources
Previous: Overview
Next: Implementation Questions
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Medicaid Medicaid Work Requirements

Medicaid Enrollment and Unwinding Tracker

Published: Mar 27, 2026
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Enrollment Data

Note: The data presented below are updated monthly as new Medicaid/CHIP enrollment data become available.

The Medicaid Enrollment and Unwinding Tracker presents the most recent data on monthly Medicaid/CHIP enrollment reported by the Centers for Medicare & Medicaid Services (CMS) as part of the Performance Indicator Project as well as archived data on renewal outcomes reported by states during the unwinding of the Medicaid continuous enrollment provision. The unwinding data were pulled from state websites, where available, and from CMS.

Medicaid/CHIP enrollment trends generally use February 2020 as the baseline month because it was the month prior to the start of the COVID-19 pandemic and implementation of the continuous enrollment provision. During continuous enrollment, which was in place during the three years of the pandemic, states paused Medicaid disenrollments. As a result, when the continuous enrollment provision ended in March 2023, national Medicaid/CHIP enrollment had increased to a record high of 94 million enrollees. Beginning April 1, 2023, states could resume disenrolling people after conducting renewals to verify eligibility for the program, though some states delayed the start of their unwinding periods until May, June, or July 2023. Most states took 12 months to complete unwinding renewals and nearly all states completed renewals by August 2024.

The figures below show Medicaid and CHIP enrollment from February 2020 through the most current month of available data. Some figures also include enrollment for adults and children in Medicaid/CHIP. Key enrollment trends as of December 2025 include:

  • There are 75.7 million people enrolled in Medicaid/CHIP nationally (Figure 1). This represents an 20% decline from total Medicaid/CHIP enrollment in March 2023, but is still 6% higher than Medicaid/CHIP enrollment in February 2020, prior to the pandemic (Figure 2 and Table 1).
  • Several factors likely explain why national Medicaid/CHIP enrollment is higher than pre-pandemic enrollment. The pandemic may have encouraged some people who were previously eligible for Medicaid but not enrolled to newly enroll in the program. During the unwinding, many states took steps to improve their renewal processes, which reduced the number of people who were disenrolled despite remaining eligible. In addition, some states expanded eligibility for certain groups since the start of the pandemic, such as the Affordable Care Act’s (ACA) Medicaid expansion.
  • Medicaid/CHIP enrollment is higher than pre-pandemic levels in all but seventeen states (AK, AR, AZ, CO, FL, ID, IA, LA, MI, MT, NH, NM, SC, TN, TX, VT and WV). Enrollment changes from pre-pandemic baseline vary from a 17% decrease in Montana to a 54% increase in North Carolina (Figure 2). Many of the states with the largest increases in enrollment expanded eligibility since the start of the pandemic. For example, five states (NE, OK, MO, SD, and NC) implemented the Medicaid expansion between October 2020 and December 2023 and Maine increased the income limit for children to qualify for Medicaid.
  • In the 49 states and DC with complete enrollment data by age, there are 35.3 million children (48%) and 38.7 million adults (52%) enrolled, a change from pre-pandemic (February 2020) enrollment patterns when children made up a slight majority (51%) of Medicaid/CHIP enrollees (Figure 1).
  • Child enrollment in Medicaid/CHIP is below pre-pandemic enrollment in 23 states, while adult enrollment is below pre-pandemic levels in 15 states (Figure 2).
  • There are 68.5 million people enrolled in Medicaid and 7.2 million people enrolled in CHIP (Figure 1). More states report CHIP enrollment above their pre-pandemic baselines compared to the number reporting Medicaid enrollment above the baseline (Figure 2).
National Enrollment in Medicaid/CHIP, February 2020 to December 2025 (Line chart)
Cumulative Percent Changes in Enrollment from February 2020 December 2025 (Column Chart)
Total Medicaid/CHIP Enrollment, Selected Time Periods (Table)

Unwinding Data – Archived

Note: The data on unwinding renewal outcomes presented below were last updated on September 12, 2024; since most states have now completed the Medicaid unwinding, the information will not be updated again.

As of September 12, 2024 and with nearly complete unwinding data for most states: 

  • Over 25 million people were disenrolled (31% of completed renewals) and over 56 million people had their coverage renewed (69% of completed renewals).  
  • Disenrollment rates varied across states from 57% in Montana to 12% in North Carolina, driven by a variety of factors including differences in renewal policies and procedures as well as eligibility expansions in some states.  
  • Among those who were disenrolled, nearly seven in ten (69%) were disenrolled for paperwork or procedural reasons while three in ten (31%) were determined ineligible.  
  • Among those whose coverage was renewed during the unwinding, 61% were renewed on an ex parte, or automated, basis, meaning the individual did not have to take any action to maintain coverage. 

State Data on Renewal Outcomes

The data on unwinding-related renewal outcomes presented in this section rely primarily on monthly reports that states were required to submit to the Centers for Medicare & Medicaid Services (CMS) during the unwinding period. The data also reflect updates to the monthly reports that states submit three months after the original report submission to account for the resolution of pending cases and any other changes in renewal metrics. For 13 states, data were pulled from dashboards or reports published on state websites that provide more complete information, and for a few additional states, updated monthly reports were pulled from state websites because they were more timely than what is reported on the CMS website. 

To view archived data for specific states, click on the State Data – Archived tab.

 

As of September 12, 2024, States Have Reported Renewal Outcomes for Nearly Nine Out of Ten People Who Were Enrolled in Medicaid/CHIP Prior to the Start of the Unwinding (Donut Chart)

  

Medicaid Disenrollments

  • As of September 12, 2024, at least 25,198,000 Medicaid enrollees had been disenrolled during the unwinding of the continuous enrollment provision. Overall, 31% of people with a completed renewal were disenrolled in reporting states while 69%, or 56.4 million enrollees, had their coverage renewed.
  • There is wide variation in disenrollment rates across reporting states, ranging from 57% in Montana to 12% in North Carolina. A variety of factors contribute to these differences, including differences in renewal policies and system capacity. Some states adopted policies that promote continued coverage among those who remain eligible and/or have automated eligibility systems that can more easily and accurately process renewals while other states have adopted fewer of these policies and have more manually-driven systems. In addition, North Carolina and South Dakota adopted Medicaid expansion and other states increased eligibility levels for certain populations (e.g., children, parents, etc.) during the unwinding, which may have lowered disenrollment rates in these states.

At Least 25,198,000 Medicaid Enrollees Have Been Disenrolled and 56,378,000 Have Had Their Coverage Renewed, as of September 12, 2024 (Stacked Bars)

 

  • Across all states with available data, 69% of all people disenrolled had their coverage terminated for procedural reasons. However, these rates vary based on how they are calculated (see note below). Procedural disenrollments are cases where people are disenrolled because they did not complete the renewal process and can occur when the state has outdated contact information or because the enrollee does not understand or otherwise does not complete renewal packets within a specific timeframe. High procedural disenrollment rates are concerning because many people who are disenrolled for these paperwork reasons may still be eligible for Medicaid coverage. 

(Note: The first tab in the figure below calculates procedural disenrollment rates using total disenrollments as the denominator. The second tab shows these rates using total completed renewals, which include people whose coverage was terminated as well as those whose coverage was renewed, as the denominator. And finally, the third tab calculates the rates as a share of all renewals due, which include completed renewals and pending cases.)

Of All People Who Were Disenrolled, 69% Were Terminated for Procedural Reasons, as of September 12, 2024 (Stacked Bars)

Medicaid Renewals

  • Of the people whose coverage has been renewed as of September 12, 2024, 61% were renewed on an ex parte basis while 39% were renewed through a renewal form, though rates vary across states. Under federal rules, states are required to first try to complete administrative (or “ex parte”) renewals by verifying ongoing eligibility through available data sources, such as state wage databases, before sending a renewal form or requesting documentation from an enrollee. Ex parte renewal rates varied across states from 90% or more in Arizona, North Carolina, and Rhode Island to less than 20% in Pennsylvania and Texas. 

Overall, 61% of People who Retained Medicaid Coverage Were Renewed Through Ex Parte Processes, as of September 12, 2024 (Stacked Bars)

Federal Data on Renewal Outcomes

The data presented here are cumulative unwinding metrics published by CMS. These counts and percentages may differ from the above data, which present renewal metrics reported on state websites when state-reported data are more complete.  

Figure 1 below shows cumulative renewal data reported by CMS during states’ unwinding periods. Renewal data for the months after the end of states’ unwinding period are excluded. The data reflect updated unwinding data reported by states three months after the original monthly reports as they become available.   

Cumulative Medicaid Renewal Outcomes for Reporting States Through August 2024 (Stacked Bars)

For questions about this tracker, please contact KFFTracker@kff.org

State Data – Archived

Note: The state data presented below were last updated on September 12, 2024; since most states have now completed the Medicaid unwinding, the information will not be updated again. 

The data presented here provide state-level data on enrollment trends and renewal outcomes during the unwinding period. Figure 1 shows total Medicaid enrollment by month starting in January 2023 and, once disenrollments resumed in a state, the cumulative percent change in Medicaid enrollment relative to the month before Medicaid disenrollments started (this baseline month will differ across states). Figure 2 shows renewal metrics for each month of a state’s unwinding period (or cumulative data for the unwinding period for some states). 

For total national Medicaid enrollment, click on the Enrollment Data tab.

Related Resources

Resources on unwinding data

Resources on state policies and preparations for the unwinding

Resources on pre-pandemic enrollment patterns and coverage transitions

KFF’s unwinding explainer

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Medicaid State Health Policy and Data Uninsured Access to Care Children's Health Insurance Program (CHIP) Enrollment

Also of Interest

U.S. Global Health Country-Level Funding Tracker

Published: Mar 27, 2026

This tracker provides U.S. global health funding data by program area and country. It includes Congressionally appropriated (planned) funding amounts from FY 2006 – FY 2023, as well as obligations and disbursements from FY 2006 – FY 2025 (FY 2025 data are partially reported). Data were obtained from ForeignAssistance.gov (see About This Tracker below for more details). For examples of analyses that can be done using this tracker, please expand the section below.

Tracker

About This Tracker

The U.S. is the largest donor to global health in the world, providing bilateral (direct country-to-country) support for U.S. global health programs in over 75 countries in FY 2023 (through appropriated/planned funding), with additional countries reached through U.S. regional efforts and U.S. contributions to multilateral organizations. This tracker provides historical data on bilateral U.S. government funding for global health by country, region, and income-level. It presents data on country-specific global health funding channeled through the Department of State (State) and U.S. Agency for International Development (USAID); these agencies account for approximately 85% of all U.S. funding for global health. Funding channeled through other agencies – the National Institutes of Health (NIH), Centers for Disease Control and Prevention (CDC), and Department of Defense (DoD) – is not included, as these data are not available at the country-level. Funding directed to “regional” or “worldwide” programs, which may reach additional countries, is also not included. See our companion resource, KFF U.S. Global Health Budget Tracker, to view data on U.S. funding for global health overall, including funding channeled through these other agencies. Data in this tracker present three transaction types:

  1. Appropriated: funding amounts based on Congressional appropriations for a given fiscal year which may be obligated and disbursed over a multi-year period;
  2. Obligations: binding agreements that will result in disbursements (or outlays), immediately or in the future, and
  3. Disbursements: actual paid amounts (an outlay of funds) to a recipient in a given year.

These amounts will be updated as new data become available. Queried data can be downloaded using the button within the interactive, and the full data can be downloaded here. For questions related to this resource, or for inquiries on further analyses on U.S. global health funding, please contact globalhealthbudget@kff.org.

Sources

KFF analysis of data from the U.S. Foreign Assistance Dashboard, U.S. State Department regional classifications, and World Bank income classifications.

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