How Much and Why Premiums Are Going Up for Small Businesses in 2027

Published: Aug 6, 2026

Small businesses that offer health insurance to their employees could see health costs rise in 2027, according to an analysis of preliminary rate filings from all 50 states and DC. Nearly 300 insurers offering small group coverage reported a median proposed premium increase of 14% for next year.

Small group insurers say rising medical prices, including for hospitalizations, physician care, and prescription drugs, and increased utilization are major drivers of the premium increases. Among the other drivers, insurers point to the continued decline in small group plan enrollment, as more small businesses shift to alternative coverage options like self-insurance or stop offering health coverage altogether to lower costs.

The full analysis and other data on health costs are available on the Peterson-KFF Health System Tracker, an online information hub dedicated to monitoring and assessing the performance of the U.S. health system.

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The Future of CDC HIV Prevention Funding for Community Organizations

Published: Aug 4, 2026

It has been reported that the Centers for Disease Control and Prevention (CDC) will not renew its main, five-year, HIV prevention grant for community-based organizations (CBOs) (grant number PS21-2102). CBOs have long been part of the front-line of the HIV response. As noted in the original CBO grant announcement, “because of their accessibility, history, and credibility in the community, CBOs are recognized and remain important partners in providing comprehensive high-impact HIV prevention services.” Grantees have used these funds to conduct a range of integrated prevention activities, including HIV and other STI testing, linkage-to-care efforts, PrEP navigation, and partner services, among many other efforts.

Separately, CDC has made supplemental funding available to state and local health departments to carry out HIV prevention activities under a separate preexisting grant mechanism (PS24-0047), which health departments can apply for.1 Those health departments receiving supplemental grants under PS24-0047 are encouraged but not required to engage community-based partners, with higher suggested allocations going to those in “Ending the HIV Epidemic (EHE)” jurisdictions.2 These supplements would not replace direct-to-CBO funding (PS21-2102) but could provide some organizations with future resources. Ultimately, different health departments will make different decisions, but the new approach could affect the budgets and sustainability of some community-based organizations, particularly those that are already less well-resourced. More broadly, this would be a marked change in how CDC carries out its HIV prevention work, ending direct funding to CBOs, which it had been doing since the late 1980s.

Advocates and members of Congress have expressed concern about this development, reportedly coming at the direction of the Office of Management and Budget (OMB). It also comes at a time when there are questions about the federal commitment to HIV prevention, with the Trump administration seeking to eliminate CDC HIV prevention funding altogether (although Congress has rejected these requests). The administration has also taken actions aimed at limiting or terminating federal funding or programing, particularly for projects that address LGBTQ+ issues and racial/ethnic health disparities. Per available award information, many of the funded CBOs specifically sought to address HIV in these communities with their grants, especially working to ensure efforts reach Black, Latino, and transgender people, groups disproportionately impacted by HIV.

To better understand the extent of this change, this analysis uses data from USAspending.gov, the federal government’s official source of federal award and spending information, to provide a snapshot of where, to whom, and at what level the CBO (PS21-2102) grants were distributed. Overall, it finds that CBOs stand to lose significant amounts of funding for HIV prevention going forward, with potentially more than $230 million at stake. The largest number of these organizations are located in the South, the region with the greatest number of HIV diagnoses in the U.S.

Findings

  • Including both base and supplemental/continuation amounts, funding for CBOs through PS21-2102 totaled $239.3 million over the grant period, initially five years (2021-2025), with some additional funding distributed in 2026. (See Figure 1, Table 1).
    • Over the entire period, grants ranged from $2.2 million (received by two organizations: Arcare in Woodruff County, AR and Centro De Salud La Comunidad De San Ysidro Inc. in San Diego County, CA) to $3.0 million (received by BEAT AIDS Coalition Trust in Bexar County, TX). The most common funding amount was $2.3 million, received by 46 grantees.
    • On an annual basis, each organization received approximately $442,000. Supplemental or continuation3 funding ranged, depending on the year, between approximately $100,000-$300,000 per grantee.
      • Of the $239.3 million for PS21-2102, $212.8 million was provided through base funding (89%), while the remainder ($26.5 million, 11%) was provided through supplemental funding in various years.
  • Funding was awarded to 96 community organizations across 62 counties/jurisdictions in 31 states, Washington D.C., Puerto Rico, and the U.S. Virgin Islands. The states with the greatest concentration of CBOs receiving funding were California, Florida, and Texas (each with 11 CBOs). CBO funding averaged $7 million per state, ranging from $2.2 million (Arkansas) to $29.2 million (Texas). By county, the average amount allocated to CBOs was $3.9 million, ranging from $2.2 million in Woodruff County, AR, for a single grantee, to $14.5 million in Los Angeles County, CA for six grantees.
  • Half of all funding was channeled to the South. Forty-nine percent (49%) of all funds, or $118 million, was awarded to organizations in the South, a region that accounts for over half of HIV diagnoses. Organizations in the West (18%), Northeast (16%), and Midwest (14%) saw more even award distribution. Organizations in the Caribbean received 3% of award funding.
  • For some CBOs, direct CDC funding represented a significant share of their revenue, and they may be more vulnerable to funding reductions. For example:
    • Community Wellness Project in St. Louis (City), MO, received a base award of $441,625 per year. According to their 990s, in 2024 this represented 20% of the organization’s revenue and in 2021, 45%.4
    • NAESM Inc. in Fulton County, GA also received an award of $441,625 per year. Based on their 2024 990, one year of grant funding would have been equal to 10% of their overall revenue and, 31% of revenue in 2021.5
    • APNH: A Place to Nourish Your Health, Inc. in South Central Connecticut Planning Region, CT also received $441,625 per year. Based on their 990, one year of grant funding would have been equal to 18% of their overall revenue in 2024.6
  • The new supplemental funding provided to health departments (PS24-0047) appears unlikely to be able to replace the resources PS21-2102 provided directly to community organizations. Even if all health departments in jurisdictions with former CBO grantees (36 jurisdictions in total) applied for and were awarded additional PS24-0047 funding at the level described and chose to allocate resources to CBOs at the minimum levels recommended by CDC, local organizations would see a decline in funding compared to what they received under PS21-2102.  
  • Estimated one-year PS24-0047 supplemental funding to CBOs would be 27% to 71% lower than the final year of the PS21-2102 base amount when provided at the minimum recommended levels.7
    • 29 of the 36 health departments (81%) home to former CBO grantees would need to make greater than the highest minimum recommended allocations of PS24-0047 supplemental funding to match prior direct-to-CBO (PS21-2102) funding.
    • To match the level of funding CBOs had been receiving, overall health departments would need to allocate 35% of their awards to CBOs, a share above the minimum recommended by CDC (10% or 25% minimum depending on jurisdiction, see note and methods).2  Some would not be able to match PS21-2102 funding with their award. (See Table 2.)
      • This ranges by jurisdiction, from 13% of the award in two jurisdictions (North Carolina and Ohio) to over 100% of funding in three jurisdictions (Minnesota, Oregon, and the U.S. Virgin Islands)
      • Additionally, Tennessee has rejected CDC HIV prevention funds and therefore is not eligible for supplemental awards and will not have these resources to allocate to CBOs. Similarly, if other health departments do not apply for or are not awarded the PS24-0047 supplemental funds, there will be nothing to allocate to CBOs from this account.

It is not yet known which health departments applied for or will be awarded the supplemental funds, nor what share of funds health departments will ultimately decide to allocate to community groups. However, this analysis finds that even if they choose to fund CBOs at the minimum recommended levels, the level of funding going to CBOs would be reduced in many regions, including some that would see significant drops. Facing fewer resources, organizations may be less equipped to provide or support HIV prevention programs, which could in turn affect the HIV prevention response, increasing the vulnerability of some communities to additional HIV cases.

Methods

PS21-2102 funding totals: PS21-2102 funding levels were obtained from USAspending.gov on July 28, 2026. Funding was examined for the full five-year grant period (2021-2025) and includes base year funding and supplemental or “revision” amounts. Funding was also captured for continuation funding provided in 2026. State and county designations are those assigned in USAspending.gov.

Estimated PS24-0047 CBO supplemental funding and comparison to historic direct-to-CBO PS21-2102: Estimated PS24-0047 supplemental funding levels was obtained from the CDC’s “Updated Supplement Guidance” for Notice of Funding Opportunity Number (NOFO): CDC-RFA-PS-24-0047. In this announcement, 60 health departments are identified as eligible to apply for the new supplemental funding. Among the 96 organizations previously funded by PS21-2102, all but two organizations (located in Tennessee, and discussed in text) were located in these jurisdictions. These organizations are based in 36 of the 60 eligible health department regions.

Assessing how estimated one-year PS24-0047 supplemental funding allocated to CBOs would compare to the final year of the PS21-2102 base funding at minimum recommended levels: CDC encourages grantees “to provide a minimum of 10% of the supplemental funding to support partnerships with community-based organizations (CBOs)…[and for] EHE jurisdictions…to provide a minimum of 25% of funding” to CBOs. CDC has historically expressed specifically what share of health department PS24-0047 funds are for EHE and which are not, but that information is not yet available. Since it is not yet known what share of funds is likely to be treated as EHE, we applied blanket 10% and 25% allocation scenarios to the estimated supplemental award levels to develop a range of minimum anticipated funding. Because the PS24-0047 supplemental amount is for one year, only the final year (FY 2025) base amount of the PS21-2102 awards is used in that part of the analysis.

Over a 5 Year Period Nearly 100 Community Based Organizations Across the Country Received More Than 0 Million in CDC HIV Prevention Funding (Choropleth map)
Organizations Funded Through CDC PS21-2102: Comprehensive High-Impact HIV Prevention Programs for Community Based Organizations (Table)
Share of Anticipated Supplemental Health Department Funding Needed to Equal One-Year of Direct CBO Funding (Table)
  1. The supplement is associated with their primary health department HIV prevention grant, PS24-0047: https://www.cdc.gov/hiv/pdf/funding/announcements/ps24-0047/CDC_HIV_PS24-0047-Funding-Tables_020224.pdf ↩︎
  2. CDC recommends recipients “provide a minimum of 10% of the supplemental funding to support partnerships with community-based organizations (CBOs). EHE jurisdictions are encouraged to provide a minimum of 25% of funding resources that should support community-based organizations (CBOs).” ↩︎
  3. Called “revisions” in USAspending.gov data. ↩︎
  4. No supplemental funding was awarded in these years. ↩︎
  5. Ibid. ↩︎
  6. Ibid. ↩︎
  7. Depending on how CDC’s minimum recommended allocations (10% or 25% for EHE jurisdictions) are ultimately applied. ↩︎
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The Facts About Medicare Spending

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Table of Contents

Introduction

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Medicare, the federal health insurance program for people ages 65 and over and younger people with long-term disabilities, plays a major role in the U.S. health care system.

Medicare provides health insurance coverage for 70 million people, 20% of the U.S. population – a share which will grow larger in the coming decades. Medicare spending comprised 14% of the federal budget in 2025 and 21% of national health care spending in 2024. Given Medicare’s essential role as a source of coverage for an aging population and the importance of sustaining the program for future generations, Medicare is often part of discussions about total federal government spending, health care spending in the U.S., and the affordability of health care costs.

This brief provides key data about Medicare spending to help frame these discussions.

Population Aging and Medicare Enrollment Growth

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An aging population leads to higher enrollment in Medicare. With the aging of the U.S. population, the number of people covered by Medicare has increased over time and will increase further in the coming decades. At the same time, the Medicare population will include a growing number of people ages 80 and older.

Figure 1

Medicare Spending Trends

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Growth in total Medicare spending has been driven in part by an increase in the number of people enrolled in Medicare. Higher total Medicare spending has also been driven by growth in health care spending per Medicare beneficiary, which is influenced by increasing volume and use of services, new technologies, and rising prices. Rising spending on Medicare Advantage has also contributed to growth in total Medicare spending (discussed more below). Looking to the future, these factors will continue to play a role in Medicare spending growth.

Figure 2

Growth in Medicare spending per person over time has historically been on par with or lower than spending per person with private insurance, but may increase in the coming decade. Between 2010 and 2025, growth in spending per person was lower in Medicare than in private health insurance (3.1% vs. 4.3%). In contrast to private insurers, Medicare typically sets payment rates in advance for covered services, including hospitals, physicians, and other services (except prescription drugs). As a result, Medicare payments for these services are generally lower than rates paid by private insurers. For example, private payment rates for all hospital services are about double Medicare rates, on average.

Between 2025 and 2034, growth in spending per person is projected to be higher in Medicare than in private health insurance (6.0% vs. 4.9%), reflecting the aging of the population during this period, among other factors.

Figure 3

Spending on Medicare Benefits and Medicare Advantage

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Spending on physician services and on Medicare Advantage accounts for a growing share of Medicare spending. Medicare now spends more on physician and outpatient services covered under Medicare Part B, including drugs administered by physicians, than hospital services covered under Medicare Part A, or retail prescription drugs covered under Part D. This gap is expected to grow. Spending on Medicare Advantage, the private plan alternative to traditional Medicare, has also grown in recent years and is projected to continue to increase.

Figure 4

This increase in spending on Medicare Advantage in part reflects a rise in Medicare Advantage enrollment over these years. Between 2010 and 2025, the share of Medicare beneficiaries enrolled in Medicare Advantage plans more than doubled, from 25% to 54%.

Additionally, Medicare pays more to private Medicare Advantage plans for enrollees than their costs would be in traditional Medicare due to factors such as higher coding intensity and favorable selection into Medicare Advantage. These higher payments have contributed to growth in spending on Medicare Advantage and overall Medicare spending.

In 2026, payments to Medicare Advantage plans are estimated to be 114% of what traditional Medicare would have spent on the same beneficiary, on average. This amount had been decreasing after Congress made changes to how Medicare Advantage plans are paid in 2010—but it has been trending higher since 2017.

Medicare pays firms offering Medicare Advantage plans a set monthly amount per enrollee. The payment is determined through an annual process in which plans submit “bids” for how much they estimate it will cost to provide benefits covered under Medicare Parts A and B for an average beneficiary. Medicare also adjusts payment to Medicare Advantage plans based on certain factors, such as the health status of enrollees. Read KFF’s explainer to understand the details of how Medicare pays private plans.

Medicare Part A Solvency Challenges

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The Medicare Hospital Insurance (Part A) Trust Fund faces solvency challenges in the near future. Higher Medicare Part A spending, driven by enrollment growth and an increase in spending per beneficiary, coupled with a shortfall in revenues needed to pay for all Part A covered benefits, is projected to deplete the reserves in the Part A Trust Fund within 7 years.

Figure 5

Growth in Out-of-Pocket Spending

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Increases in Medicare spending have led to higher Medicare premiums and deductibles for beneficiaries. Taken together the cost of Medicare Part A and B premiums and cost sharing represents roughly 18% of the average Social Security benefit in 2026, up from 14% in 2000. (Most beneficiaries do not pay a Part A premium. However, beneficiaries ages 65 and older who have paid fewer than 10 years of Medicare payroll taxes and some younger beneficiaries with disabilities are required to pay a premium for Part A coverage.) While most beneficiaries have other sources of income in addition to Social Security to help cover these expenses, there are also other out-of-pocket health care costs that beneficiaries could incur, such as premiums for prescription drug coverage and cost sharing for medications and physician visits, as well as costs for services not covered by Medicare, such as dental care and long-term services and supports.

Figure 6

Conclusion

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Medicare faces spending pressures due to rising enrollment and rising health care costs. Consideration of possible changes to Medicare to sustain the program for the long run—such as changes in payments to providers and Medicare Advantage plans, changes in benefits, or additional revenues—will involve careful deliberation about the effects on federal spending, total health care spending, health care providers, and access to quality care and the affordability of health care for Medicare’s growing number of beneficiaries.

Data Sources

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This resource, originally published on April 26, 2022, was most recently updated with new data in July 2026.

The Boards of Trustees of the Federal Hospital Insurance and Federal Supplementary Medical Insurance Trust Funds, 2026 Annual Report of the Boards of Trustees of the Federal Hospital Insurance and Federal Supplementary Medical Insurance Trust Funds, June 2026.

Centers for Medicare & Medicaid Services, Chronic Conditions Data Warehouse.

Centers for Medicare & Medicaid Services, Office of the Actuary, National Health Statistics Group, National Health Expenditure Data, Table 21 Expenditures, Enrollment and Per Enrollee Estimates of Health Insurance, United States, Calendar Years 1987-2024.

Congressional Budget Office, Analysis of the President’s Budgetary Proposals for Fiscal Year 2001, April 2000.

Congressional Budget Office, Baseline Projections for Medicare, various years.

Congressional Budget Office, The Budget and Economic Outlook: 2026 to 2036, February 2026.

KFF, How Medicare Pays Medicare Advantage Plans: Issues and Policy Options, November 2025.

KFF, Medicare 101: How Does Medicare Pay Hospitals, Physicians, and Other Providers in Traditional Medicare? October, 2025.

Medicare Payment Advisory Commission, March 2026 Report to the Congress: Medicare Payment Policy, March 2026.

Social Security Administration, Office of Retirement and Disability Policy, Annual Statistical Supplement, 2025, March 2026.

Social Security Administration, Office of Retirement and Disability Policy, Monthly Statistical Snapshot, January 2026, February 2025.

U.S. Census Bureau, Population Division, Projected Population by Five-Year Age Group and Sex for the United States, Main Series: 2022-2100.

U.S. Census Bureau, Laura Blakeslee, Zoe Caplan, Julie A. Meyer, Megan A. Rabe, and Andrew W. Roberts, Age and Sex Composition: 2020, C2020BR-06, May 2023.

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How Much and Why ACA Marketplace Premiums Are Going Up in 2027

Authors: Matt McGough, Jared Ortaliza, Ashley Ferguson, Imani Telesford, Shameek Rakshit, Lynne Cotter, and Cynthia Cox
Published: Aug 3, 2026

Note: This brief was originally published on July 8 and updated on August 3, 2026 to include proposed 2027 rates from all 50 states and the District of Columbia.

ACA Marketplaces insurers are proposing a median premium increase of 15% in 2027, according to KFF’s updated analysis of 276 insurers with publicly available filings across all 50 states and the District of Columbia. This is the second consecutive year of double-digit premium hikes. Last year’s median nationwide proposed rate change was 18%, and the median finalized rate change was 20%. While this proposed rate change is lower than last year, it represents the second-highest requested rate change since 2018, as premium growth had been relatively flat in this market for several years.

Based on detailed filings from 16 states and DC, rising healthcare prices—as in prior years—remain the primary driver of 2027 premium increases. Insurers cite higher costs for health services, general economic inflation, and labor shortages. They also point to factors unique to the individual market: the expiration of enhanced premium tax credits at the end of 2025 and a related increase in the risk pool’s morbidity, as contributing to rising rates for 2027.

The full analysis and other data on health costs are available on the Peterson-KFF Health System Tracker, an online information hub dedicated to monitoring and assessing the performance of the U.S. health system.

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Tracking Implementation of the 2025 Reconciliation Law: Medicaid Work Requirements

Updated on:

Overview
State/National Data & Policies
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Implementation/Waiver Status
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The 2025 reconciliation law, once called the “One Big Beautiful Bill,” signed by President Trump on July 4, 2025, requires 44 states (including DC) to condition Medicaid eligibility for adults in the Affordable Care Act (ACA) Medicaid expansion group and certain enrollees in 1115 waiver programs on meeting work requirements starting January 1, 2027. Currently, 41 states (including DC) have expanded their Medicaid programs under the ACA to nearly all adults with income up to 138% FPL ($21,597 for an individual in 2025). In June 2026, CMS released a list of states with 1115 waiver programs that include individuals who will be subject to work requirements. The list identifies waiver programs in three non-expansion states Georgia, Tennessee, and Wisconsin, as well as in five expansion states, Hawaii, Massachusetts, New York, Oregon, and Utah (Figure 1).  

ACA Medicaid Expansion Enrollees and Certain Medicaid Section 1115 Waiver Enrollees Will Be Required to Meet Work Requirements in 44 States. (Choropleth map)

To implement Medicaid work requirements, states will need to make important policy and operational decisions, implement needed system upgrades or changes, develop new outreach and education strategies, and hire and train staff, all within a relatively short timeframe. The information tracked here can serve as a resource to understand Medicaid work requirements and state options, gauge readiness, and track implementation of the requirements, including:

This resource will be updated to include guidance from the Centers for Medicare and Medicaid Services (CMS), information on state policy decisions as they are made, and new data when available.

Continue scrolling to learn more about the Medicaid work requirements in the 2025 reconciliation law.

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Tracking Implementation of the 2025 Reconciliation Law Medicaid Work Requirements

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Medicaid Medicaid Work Requirements

Tracking Implementation of the 2025 Reconciliation Law Medicaid Work Requirements

Updated on:

Overview
State/National Data & Policies
Guidance & Implementation Questions
Implementation/Waiver Status
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The 2025 reconciliation law requires states to condition Medicaid eligibility for adults in the ACA Medicaid expansion group on meeting work requirements starting January 1, 2027; however, states have the option to implement requirements sooner through a state plan amendment (SPA) or through an approved 1115 waiver.

State Plan Amendments (SPAs)

States may choose to implement work requirements prior to the required January 1, 2027 implementation date through a state plan amendment. Nebraska is the first state to announce that it will begin enforcing federal work requirements early through a state plan amendment, starting May 1, 2026. Two other states are also planning to implement before January 2027–Montana on July 1, 2026 and Iowa on December 1, 2026. Arkansas has announced that it plans to launch a soft implementation of work requirements on July 1, 2026 but will not disenroll individuals prior to January 1, 2027.

1115 Waivers

Since the start of the second Trump administration, several states have submitted waivers to implement work requirements. However, states are unlikely to be moving forward with proposed 1115 waivers at this time due to the passage of federal work requirements. States that plan to implement federal work requirements early will do so through a state plan amendment. Currently, Georgia is the only state with a Medicaid work requirement waiver in place following litigation over the Biden administration’s attempt to stop it. Georgia’s waiver will expire December 31, 2026; the state is required to come into compliance with the new federal requirements effective January 1, 2027.

Early Implementation and Waiver Status

The map below identifies states that have indicated they will implement federal work requirements early through a state plan amendment and the one state (Georgia) that has implemented work requirements through an 1115 waiver.

States Implementing Work Requirements Early and/or With Approved Work Requirement Waivers (Choropleth map)
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Tracking Implementation of the 2025 Reconciliation Law Medicaid Work Requirements

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Arkansas work requirement experience:

KFF Polling on Work Requirements:

Beyond the Data by KFF CEO Drew Altman:

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Tracking Implementation of the 2025 Reconciliation Law Medicaid Work Requirements

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Overview of President Trump’s Executive Actions on Global Health

Published: Aug 3, 2026

Note: Originally published on Jan. 28, 2025, this resource is updated as needed, most recently on August 3, 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.
• On July 27, 2026, plaintiffs in the GHC v. Trump case filed a motion requesting a summary judgment which would compel defendants to, among other things, obligate remaining foreign assistance and global health funds set to expire on September 30, 2026.

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.
• On April 20, 2026, a congressional notification was sent to Congress outlining plans for USAID to use remaining funds, including $2 billion in FY25 funding from the Global Health Programs (GHP) account, to close out the agency and terminated awards.

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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