Overview of President Trump’s Executive Actions on Global Health

Published: Oct 7, 2026

Note: Originally published on Jan. 28, 2025, this resource is updated as needed, most recently on October 7, 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Given that most of the provisions in the COVID-19 and Global Health Security actions issued by President Biden are no longer current or relevant, the rescissions of these actions are likely to have minimal effect on government policies.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. 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. 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. On September 30, the court ordered a suspension of the September 30th expiration date for unobligated funds set to expire then, allowing these funds to remain available for obligation until the suspension is lifted.  
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.

First Look at New Hospital Price Transparency Provisions: Some Factors Complicate Price Comparisons

Published: Oct 7, 2026

This analysis takes a first look at how hospitals are reporting prices under updated federal hospital price transparency requirements that took effect in January 2026. The hospital price transparency (HPT) rule requires most non-federal hospitals to publish their standard charges for each item and service they provide.

The analysis describes several key issues with how hospitals are reporting rates and other required information, which limits the usefulness of the new data for researcher comparing hospital prices. Notably, the negotiated payment arrangements between hospitals and payers are complicated and can take many forms, making it difficult to accurately compare prices across hospitals.

The brief is 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

Which States Will Be Affected by Key Medicaid Provisions in the 2025 Reconciliation Law?

Published: Oct 7, 2026

Amidst challenging fiscal conditions and upcoming national and state elections, states are working to implement major federal changes to Medicaid. The 2025 reconciliation law made major changes to federal revenues and spending. Shortly after enactment, the Congressional Budget Office (CBO) estimated the new law would reduce federal spending on Medicaid by $911 billion over the 2025–2034 period and that the Medicaid changes would increase the number of people without health insurance by 7.5 million in the year 2034. Recognizing the risks such changes posed for rural areas, policy makers added a $50 billion rural health transformation program (referred to here as the “rural health fund”) to the reconciliation law. All 50 states have received first-year allotments from the rural health fund and are implementing new initiatives to support rural health care, although these funds will not offset reductions in federal Medicaid support.

Even before the new restrictions take effect, the landscape is evolving, making it difficult to isolate the effects of the changes in the law. Medicaid enrollment is declining, and states are facing tight fiscal conditions due to slowing revenue growth and increased spending pressures. The forthcoming policy changes from the 2025 reconciliation law are expected to increase coverage loss, decrease provider reimbursement rates, and place new strain on state budgets. Some more recent estimates of the law’s provisions—such as those included in proposed or final regulations—are not comparable to the older CBO estimates because they cover different time periods, use different baseline projections of spending and health coverage, and have different assumptions about how states, providers, and people will respond to the changing Medicaid policies.

Although current estimates of the effect of the law on Medicaid are not available—and are unlikely to be available in the future, this policy watch illuminates how the impacts will vary across states by showing which key eligibility and financing provisions are expected to affect each state and Washington DC (hereafter referred to as a state). Some provisions in the law affect all states, while some provisions only apply to certain states. The effects of many provisions vary by state and states that have adopted the Affordable Care Act (ACA) Medicaid expansion face the most restrictions (Figure 1). In many cases, the full effects of the law are still unknown and will depend on how federal rules are finalized and how states implement the changes. Many of the changes are administratively challenging for states to implement. Those challenges could be amplified in the 36 states with gubernatorial elections in 2026 if the election results in a change of administration. With only 17 incumbent governors currently on the ballot, at least 19 states are expecting some change in leadership.

All States Face Major Changes to Medicaid Stemming from the 2025 Reconciliation Law (Bar Chart)

Which States Will Be Affected by Key Medicaid Eligibility Changes?

The reconciliation law included Medicaid eligibility policies that will lead to fewer people being covered by Medicaid and disproportionately apply to Medicaid expansion states. The most substantial changes include new work requirements, more frequent eligibility redeterminations for expansion adults, and restrictions on Medicaid eligibility for immigrants (Figure 2). The law also reduces the availability of retroactive coverage to pay incurred medical expenses to two months for traditional enrollees and one month for expansion enrollees and imposes new cost-sharing requirements on expansion adults with income 100–138% of the federal poverty level (FPL, Appendix Table 1). While states will face increased administrative costs to implement these changes, lower Medicaid enrollment could reduce state and federal Medicaid costs. However, the drop in Medicaid enrollment over time may shift costs from states to providers as more people become uninsured but still have health care needs. States required to implement key Medicaid eligibility changes include:

  • Forty-four states are required to implement new work requirements on certain adults. These states, including 41 expansion states and 3 non-expansion states, will be required to condition Medicaid eligibility for enrollees with coverage through the ACA Medicaid expansion or under certain waivers on meeting work requirements or qualifying for an exclusion.
  • Forty-one Medicaid expansion states will need to increase the frequency of eligibility redeterminations for expansion adults from annually to every six months. This new 6-month renewal period only applies to expansion adults; states must maintain the 12-month renewal period for other populations eligible on the basis of modified adjusted gross income (MAGI), including most children, pregnant individuals, and parents who are not enrolled in expansion coverage.
  • All states must restrict eligibility for certain lawfully present immigrants. As of October 1, 2026, all states are required to limit Medicaid eligibility to only certain lawfully present immigrants, eliminating eligibility for many other groups of lawfully present immigrants, including refugees and asylees without a green card, among others.
The 2025 Reconciliation Law Requires All States to Make Eligibility Changes (Choropleth map)

Which States Will Be Affected by Key Medicaid Financing Changes?

The reconciliation law makes major changes to Medicaid financing that will affect how states can raise the state share of Medicaid payments and how they can pay providers. Changes to Medicaid financing include new limits on provider taxes that constrain all states in their ability to raise future revenues from provider taxes and further limit the amount of revenues ACA expansion states are permitted to collect. Those new limits are likely to exacerbate states’ current fiscal challenges and may force states to make additional reductions in Medicaid spending. Changes to provider payment rates primarily stem from new limits on state directed payments (SDPs), which cap future payment rates at or near the rates paid by Medicare in all states. Unless states can offset this funding loss, providers are likely to face a significant drop in Medicaid payments at the same time they are experiencing revenue losses resulting from fewer people having health insurance. Although the rural health fund does not offset the loss of federal Medicaid revenues, it may help the 50 states that are receiving funding to adapt their systems to the loss of revenues. However, the extent to which any benefits from these initiatives persist after the time-limited funds are exhausted remains unknown.

Beyond limiting states’ future use of provider taxes, the law may reduce revenues from existing taxes in nearly all states that have adopted the ACA Medicaid expansion. New limits on provider taxes effectively prohibit all states from establishing new provider taxes or increasing the rates of existing taxes, thus limiting one tool states may have used to respond to the 2025 reconciliation law’s reduction in federal funding. For ACA expansion states, the 2025 reconciliation law decreases the percent of net patient revenues (currently 6.0%) that can be collected for all provider taxes except those on nursing facilities and intermediate care facilities. Starting October 1, 2027, the limit will decrease by 0.5 percentage points each year, until it reaches 3.5%. As of 2025, 31 states reported having current taxes that are above 3.5% of net patient revenues and subject to the new limits (Figure 3). A proposed rule to implement the reconciliation law requirements would expand the new limits to include health insurer taxes, likely affecting additional states.

The 2025 Reconciliation Law Limits All States in Their Ability to Collect Provider Taxes (Choropleth map)

At least 41 states have SDPs, which govern the payments managed care organizations make to health care providers and could be affected by new limits in the 2025 reconciliation law. Most SDPs are for hospital services, and most set payment rates at or near rates paid by private health insurance plans. Starting January 1, 2028, payment rates for hospital services will decrease in at least 37 states with directed payments that exceed the new limits. KFF estimates that the federal government spends $93 billion on SDPs each year, $78 billion of which pays for hospital services. Of the $78 billion on hospital services, an estimated $60 billion exceeds the new payment limits and could be reduced as the reconciliation law limits take effect. Some states will be far more affected than others, with over half of the spending above new limits coming from only eight states (California, Illinois, Kentucky, Texas, North Carolina, Louisiana, Arizona, and Michigan).

Provider Payment Rates Could Be Affected by New Limits on SDPs in At Least 41 States (Stacked Bars)

All 50 states (not including Washington DC) are receiving money from the rural health fund, but the amount they are receiving per rural resident ranges from $66 (Texas) to $6,305 (Rhode Island). The rural health fund will provide grant funding to states for a period of five years, with $10 billion awarded across the states each year. First-year awards range from $147 million in New Jersey to $281 million in Texas (Appendix Table 2). Ten states’ awards are less than $100 per rural resident, but eight states’ awards are greater than $500 per rural resident. The range in funding reflects a financing formula that awards 50% of the total amount equally among all states, 25% based on “state need” (which reflects the characteristics of the states’ rural geographies, populations, and providers), and 25% based on states’ proposed initiatives (which reflects states’ plans and their use of initiatives consistent with the priorities of the current administration).

This work was supported in part by Arnold Ventures. KFF maintains full editorial control over all of its policy analysis, polling, and journalism activities.

Appendix

The 2025 Reconciliation Law Requires All States to Make Eligibility Changes (Table)
The 2025 Reconciliation Law Affects Medicaid Financing in All States (Table)

Midterm Election Update: Vaccines

Published: Oct 6, 2026

Federal vaccine policy has shifted toward fewer recommended routine childhood vaccinations, more emphasis on individual decision-making, and greater skepticism about the safety and efficacy of some vaccines. In response, some states are relying less on federal recommendations in setting vaccination requirements. The changes coincide with declining childhood vaccination rates, rising exemptions from school vaccine requirements, and a major measles resurgence. The public’s trust in federal health officials remains low.

Overview

Since January 2025, the Trump administration has made major changes in federal vaccine policy, including which vaccines the federal government recommends, who makes those recommendations, and the kinds of messages that it is providing to the public.  

The changes represent a shift from an expert-driven federal vaccine framework with broad support for routine childhood immunizations toward narrower federal recommendations, fewer recommended childhood vaccinations, greater state variation and greater reliance on individual decision-making. They are unfolding against a backdrop in which childhood vaccination rates were already declining and as vaccine-preventable diseases such as measles are resurging in several states.

Key Developments

Health and Human Services Secretary Robert F. Kennedy Jr., a longtime critic of federal vaccine policy who has questioned the safety and effectiveness of vaccines, has spearheaded the overhaul. Kennedy also is a leading figure in the Make America Healthy Again (MAHA) movement, which has elevated issues such as vaccine safety, the role of corporate interests in federal health agencies, and the presence of chemicals in the food supply.

In June 2025, Kennedy fired and replaced all the members of the Advisory Committee on Immunization Practices (ACIP), the expert panel charged with providing evidence-based recommendations to the Centers for Disease Control and Prevention (CDC).

During 2025, among other policy changes, the CDC revoked its recommendation that healthy children and pregnant women receive routine COVID-19 vaccines and later, in line with guidance from the reconstituted ACIP, revised its immunization schedule to recommend “shared clinical decision-making” for COVID-19 vaccines. In December, ACIP members voted to end the 34-year-old recommendation that all newborns receive the hepatitis B vaccine within 24 hours of birth.

That same month, federal health officials made vaccination reporting measures voluntary rather than mandatory in Medicaid and the Children’s Health Insurance Program, which could make it harder to monitor and understand vaccination trends for children.

The most significant changes came in January 2026, when HHS adopted a substantially revised childhood vaccination schedule. This reduced the number of diseases targeted from 17 to 11 and the number of routine vaccines from 13 to 7, making the U.S. an outlier among peer nations. As a result, six vaccines are no longer recommended for routine use by all children in the U.S.: rotavirus, COVID-19, influenza, hepatitis A, hepatitis B, and meningococcal vaccines. Some of these vaccines are now recommended for a narrower group of children, and all six have been moved from the routine category of vaccination to “shared clinical decision making.” (A federal judge has temporarily blocked the revised HHS recommendations.)

In August, The White House released an executive order reiterating the changes to the childhood vaccination schedule. It also called on the HHS Secretary to offer some childhood vaccines such as measles, mumps, and rubella (MMR) as “single vaccines rather than combination products”, meaning they would be delivered in three separate shots rather than in a single vaccination covering all three.

More generally, President Trump and Secretary Kennedy have repeatedly raised safety concerns about vaccines, including advancing the idea that vaccines cause autism and linking childhood vaccinations with a rise in chronic diseases in children — assertions for which there is no evidence.

At the state level, at least nine states have enacted changes since 2025 that make non-medical exemptions to mandatory school vaccinations more permissive, including by reducing documentation or procedural requirements. Research indicates that easier-to-obtain non-medical exemptions are associated with higher exemption rates and declining childhood vaccination coverage.

Recent Issues and Looking Ahead

In response to the federal changes, a growing number of states has begun to separate their vaccination requirements from federal recommendations. As of August 2026, 30 states and DC had announced they would no longer follow CDC/ACIP recommendations for one or more childhood vaccines, with 27 states delinking from CDC/ACIP recommendations for all childhood vaccines. States are relying instead on prior recommendations, state recommendations, and/or the guidance of external entities such as the American Academy of Pediatrics (AAP) in shaping their state vaccination requirements for children.

The federal changes also have raised concerns about insurance coverage of vaccines. Many private insurers, Medicaid programs, and the federally funded Vaccines for Children program are required to cover ACIP-recommended vaccines without cost-sharing. Changes in recommendations can affect which vaccines insurers must cover at no cost. In practice, the effects vary because states can establish additional requirements, particularly for state-regulated insurance plans and school entry. As a result, vaccine recommendations and potentially the coverage available to families can differ by state. For now, insurers have said they will continue to cover the same vaccinations, and the federal court ruling means the HHS changes to the childhood vaccination schedule remain blocked.

All of this is occurring in a landscape in which childhood vaccination rates were already falling. Data show that 92.4% of kindergarteners had been vaccinated against measles, mumps, rubella (MMR) and polio and 92.0% against DTaP (diphtheria, tetanus, and acellular pertussis) for the 2025-2026 school year. That was down from 95% across all three vaccines for the 2019-2020 (pre-pandemic) school year and below coverage levels of the past decade. At the same time, the share of kindergarteners with exemptions from one or more school vaccination requirements rose to 4.2%, up from 2.5% in 2019-2020.

A vaccination rate of at least 95% is needed to prevent community transmission of measles. Thirty-nine states had MMR coverage below the 95% level, and 18 states were below 90%.

Although measles has been officially “eliminated” from the U.S. since 2000, measles cases have surged over the past two years. In 2026, the U.S. has reported nearly 3,887 confirmed cases of measles as of October 1, more than in any year since 1991, already exceeding the total for all of 2025 and putting the U.S.’s elimination status at risk. Measles cases have been reported in most states, with South Carolina, Utah, Pennsylvania, Texas, and Virginia seeing the largest outbreaks so far in 2026.

The Public’s Views

KFF polling finds that the public’s trust in the CDC remains at its lowest point following the Trump administration’s revisions to the childhood vaccination schedule. Fewer than half (47%) now say that they trust the agency at least “a fair amount” to provide reliable vaccine information, down more than 10 percentage points since the beginning of the second Trump administration, and continuing a downward trend first measured during the COVID-19 pandemic. Views differ along partisan lines, and the recent decline reflects falling confidence in the CDC among Democrats.

About four in ten voters approve of the Trump administration’s handling of vaccine policy (38%) while six in ten disapprove (61%). Democrats hold the advantage over Republicans in whom voters trust to handle vaccine policy (41% vs. 25%), though one quarter trust neither party. While some of the administration’s vaccine policy changes may have been intended to appeal to MAHA voters, among voters who support MAHA, four in ten say lowering health care costs should be the government’s top health care priority, while only one in ten choose reevaluating vaccine safety.

KFF Experts

Jen Kates, a Senior Vice President and Director of the Global and Public Health Policy Program

Josh Michaud, an Associate Director for Global and Public Health Policy

Liz Hamel, a Senior Vice President and Director of Public Opinion and Survey Research 

Journalists with questions about this topic should reach out to KFFMedia@kff.org.

Midterm Election Update: The Affordable Care Act Marketplaces

Published: Oct 6, 2026

More people than ever got coverage through the Affordable Care Act (ACA) Marketplaces in 2025, but the expiration of enhanced premium tax credits has driven up what people pay and contributed to declining enrollment in 2026. Law and regulatory changes also tightened ACA eligibility and enrollment requirements, including for some lawfully present immigrants. Public opinion of the ACA remains generally favorable, although views remain divided along partisan lines.

Overview

The Affordable Care Act (ACA) Marketplaces, sometimes called Obamacare markets, allow individuals and families who don’t get coverage from other sources to buy their own insurance, often with the help of federal tax credits based on income to make comprehensive coverage more affordable.

Effectuated enrollment – that is, the number of people who paid their premiums – climbed to a record 21.8 million in 2025 in large part due to more generous temporary enhanced premium tax credits. These enhanced tax credits reduced premium payments for lower and middle-income Marketplace enrollees and also made some upper-middle class and higher-income enrollees newly eligible for financial assistance. The enhanced tax credits were first passed as part of a relief package during the COVID-19 pandemic and later extended temporarily by the Inflation Reduction Act.

The expiration of those temporary tax credits at the end of 2025 sharply increased what people have to pay out of pocket toward premiums. The total cost of marketplace insurance also is on the rise, with insurers seeking a median premium increase of about 15% for 2027. While the remaining tax credits will protect most enrollees from the full impact of next year’s premium hikes, those with higher incomes who are no longer eligible for financial assistance would have to pay the full costs.

There are also concerns about how shrinking enrollment and rising prices will affect the marketplace’s stability going forward. Some insurers cite a deteriorating risk pool as a factor in rate increases as healthier enrollees drop coverage rather than paying more, and some insurers plan to leave some ACA markets.

Key Developments

As part of the 2025 reconciliation law, sometimes called “the One Big Beautiful Bill,” Congress created new pre-enrollment verification requirements, which could effectively end autorenewals  starting in 2028; required enrollees who underestimated their incomes at the start of the year to fully repay any excess tax credits; and prohibited many lawfully present immigrants from receiving ACA tax credits.

The Trump administration also finalized stricter enrollment and eligibility procedures, including additional verification of income, household information, immigration status, and other eligibility details. Many of these requirements, as well as other changes included in a 2026 regulation, are on hold due to pending litigation but could lead to further enrollment decline if implemented.

The reconciliation law enacted in July 2025 did not address the expiring enhanced premium tax credits. Late last year, Republicans in Congress blocked efforts by Democrats to extend the tax credits before they expired, arguing that they were so generous that they allowed insurers to charge more and encouraged improper or fraudulent enrollment.

The Trump administration also is working to make it easier for consumers to enroll in alternatives to ACA Marketplace coverage, such as short-term limited duration health plans. Unlike Marketplace insurance, short-term plans can reject consumers based on their medical history. Enrollees are also not eligible for any of the ACA’s premium tax credits, meaning they have to pay the full cost themselves regardless of their income.

In September, the Trump administration announced it would send $500 check to nearly 1 million ACA Marketplace enrollees in 30 states – a small share of current enrollees. Enrollees who won’t get rebates include those in mostly blue states that run their own Marketplace and those who receive premium tax credits, even though what they’re paying has gone up. The Administration also announced it would cancel coverage for more than 760,000 people it says were improperly enrolled and did not respond to a request for more information within 30 days. That process likely resulted in some legitimately enrolled consumers losing their coverage.

Recent Issues and Looking Ahead

After the temporary tax credits expired, what people would have to pay in premiums after accounting for tax credits increased by 114% or more than $1,000 annually to stay in the same plan in 2026. Facing higher premium payments, some dropped coverage, while some others switched to lower-premium plans with higher deductibles. On net, premium payments increased 58% on average (as opposed to 114%), but deductibles increased by 37% or about $1,000 more per person due to many people buying down to lower levels of coverage. Eight in ten of those who chose to remain in the marketplace say their health care costs went up, and more than half said they were cutting back on other expenses to afford the increases.

Effectuated enrollment in Marketplace plans fell for the first time in seven years, from 21.8 million last year to 19.2 million in 2026.  Enrollment dropped in every state except New Mexico, which offered state subsidies to replace the expired tax credits. Enrollment is expected to drop further this year, potentially as low as 17.5 million, as consumers wrestle with higher premium payments.

Looking ahead, the Congressional Budget Office projected that the reconciliation law’s ACA provisions alone would increase the number of uninsured by 2.1 million by 2034. Combined with the law’s Medicaid changes and the expiration of the enhanced tax credits, the estimated increase in the uninsured by 2034 topped 14 million people.

The Public’s Views

Most of the public views the ACA favorably as it has since 2017, when congressional Republicans failed to repeal the law during the first Trump administration. As of March, 61% of the public hold favorable views, while 38% hold unfavorable views. Views diverge by political party, with nine in ten Democrats and nearly two thirds of independents (64%) viewing the law favorably, while two thirds of Republicans (67%) hold unfavorable views.

Support for extending the ACA’s enhanced tax credits was also strong throughout 2025. Earlier this year, two thirds of the public (67%), including strong majorities of Democrats and independents, said that Congress did the wrong thing by failing to extend the tax credits. Most Republicans (63%) said Congress did the right thing.

KFF Experts

Larry Levitt, Executive Vice President for Health Policy

Mollyann Brodie, Executive Vice President and Chief Operating Officer, and Executive Director of Public Opinion and Survey Research

Cynthia Cox, Senior Vice President and Director of the Program on the ACA

Liz Hamel, Senior Vice President and Director of Public Opinion and Survey Research

Kaye Pestaina, Vice President and Director of the Program on Patient and Consumer Protection

Journalists with questions about this topic should reach out to KFFMedia@kff.org.

Tracking the Public’s Views on the ACA

Updated: October 6, 2026

Since the enactment of the Affordable Care Act (ACA) in 2010, the KFF Health Tracking Poll has provided routine measures of public opinion of the health care reform law. Public opinion on the ACA has shifted over the years, most notably following Republicans’ unsuccessful efforts to repeal it during the first Trump administration. While overall opinion of the ACA has been more favorable than unfavorable since 2017, there remain deep partisan divides. This page examines how specific groups feel about the law and how those opinions have changed or not changed over time. Access all KFF Health Tracking Poll resources here.

The Business of Health with Chip Kahn

AI: Does Europe Have the Answer?

October 6, 2026

Video

Audio

About this Episode


Episode 18, AI Series: When health systems are stressed, Martin McKee has been there taking notes. He’s spent four decades studying collapse and recovery — the post-Soviet transition, the 2008 financial crisis, the COVID-19 pandemic. Now, as professor of European public health at the London School of Hygiene and Tropical Medicine and research director of the European Observatory on Health Systems and Policies, he’s turned that lens on AI. He arrives at a charged moment: America is locked in a debate over whether AI development should slow down or even pause. Europe made a different choice — binding AI with some of the world’s strictest rules. After a run of episodes examining AI through a U.S. lens, Chip and McKee cross the Atlantic: What does the American debate look like from Europe — and does regulation offer an answer that a pause cannot?

The Host


Headshot photo of Chip Kahn wearing a navy blue suit with a red tie, red pendant on lapel, and glasses.

Sr. Visiting Fellow

Charles N. Kahn III is a senior visiting fellow at KFF. He is also a visiting senior fellow at the American Enterprise Institute and a nonresident senior scholar at the University of Southern California’s Schaeffer Center for Health Policy & Economics. He serves as co-chair of the international Future of Health collaborative.

Guest


Professor, European Public Health at the London School of Hygiene and Tropical Medicine; Co-Director European Observatory on Health Systems & Policy

Martin McKee, CBE, MD, DSc, FMedSci, is Professor of European Public Health at the London School of Hygiene and Tropical Medicine (LSHTM), where he has served since 1990. Throughout his career, he has developed a major research program on health and healthcare in Europe. As Medical Director at LSHTM for eight years, Dr. McKee oversaw professional issues affecting approximately 140 clinical academic staff. During the COVID pandemic, he served on the Independent Scientific Advisory Group on Emergencies (Independent SAGE) in the UK and the World Health Organization’s Pan-European Commission on Health and Sustainable Development.

His contributions to public health have been recognized through numerous honors, including the Andrija Stampar medal from the Association of Schools of Public Health in the European Region (2003), a Commander of the Order of the British Empire by Queen Elizabeth II for services to healthcare (2005), and the Alwyn Smith prize from the UK Faculty of Public Health (2014). He served as President of the European Public Health Association in 2014-2016 and of the British Medical Association in 2022-2023.

Dr. McKee has authored several reports with major policy impact across the European Union and has advised governments worldwide.


SERIES

This weekly podcast features insightful conversations between host Chip Kahn and his guests, who discuss the business of health care, connecting the dots between the health care business, policy, and patients.

The podcast’s first series on AI in health care illuminates how AI is changing health care, and features guests who are deploying this technology, managing its consequences, and designing policy around it.

News Release

Poll: Cost of Health Care and Gas Top Voters’ Midterm Concerns; Democrats Hold Significant Advantage on Health Care Costs and Cost of Living 

Two-Thirds Favor Medicare-for-All, a New High in KFF Polling, but Support Shifts When Competing Claims from Critics and Proponents Are Heard

Published: Oct 6, 2026

Just a month away from the midterm elections, affordability worries continue to top the public’s list of midterm election issues, with health care costs and gas costs tying as the top economic concern, KFF’s new Health Tracking Poll finds. Voters overall trust Democrats more than Republicans to handle the cost of health care and the cost of living.

A quarter of voters say they are “very worried” about being able to afford the cost of health care and gas and transportation (25% and 25%,) and an additional third say they are “somewhat worried” about health care and gas costs (35% and 34%). These worries outrank voters’ concerns about the affordability of food, utilities, and housing. The vast majority of voters say the cost of living and health care costs (90% and 82%) are “very” or “extremely” important for candidates to discuss during the last pivotal weeks of the campaigns.

“Of all the cost-of-living worries hitting voters now, a big health care bill is the least predictable, and that’s a big reason why health care costs are right up there with gas prices and the costs of food and housing on voters’ minds,” KFF President and CEO Dr. Drew Altman said.

Democrats hold nearly a two-to-one advantage over Republicans on whom voters trust more on the issue of health care costs (42% vs. 22%) and a significant edge on the cost of living (39% vs. 25%.) Voters also say they trust Democrats more than Republicans to do a better job handling abortion policy (42% vs. 27%) and are more divided about whether they trust Democrats or Republicans more on immigration (34% vs. 38%) and fraud in government programs (29% vs. 31%).

The Democratic edge on health care costs has grown over the past six months. Democrats held an eleven-percentage point advantage over Republicans in April (37% vs. 26%) and a 20-percentage point advantage over Republicans in September (42% vs. 22%.)

Among independent voters, Democrats hold at least a two-to-one trust advantage over Republicans on health care costs (38% vs. 9%), the cost of living (35% vs. 11%) and abortion policy (42% vs. 14%)—though large shares of independents say they trust neither party on most midterm election issues.

Democrats also hold a major advantage on voter enthusiasm and are more likely than Republicans to say they are more motivated to vote this year than in previous elections (63% vs. 38%.) Most Republican voters (53%) say they are “about as motivated” as in previous elections, while independent voters are split, with similar shares saying they are “more motivated” and “about as motivated” (41% and 44%.)

Amid rising health care costs and affordability worries, there is bipartisan agreement among the public that major changes are needed to the U.S. health care system, with about 9 in 10 Democrats (89%) and three-quarters of Republicans (77%) saying the U.S. health care system needs either a complete overhaul or major changes.

In some midterm races, progressive Democratic candidates have responded to the public’s interest in health care reform by campaigning for the creation of a national health plan—attracting criticism from Republican opponents.

Support for the idea of a national health plan (commonly called “Medicare-for-All”) has grown, rising to about two-thirds (66%) of the public—the highest share since KFF began polling on the topic in 2016, when Senator Bernie Sanders campaigned on the issue. Partisans remain divided, with large shares of Democrats (84%) and independents (72%) in favor and two-thirds (66%) of Republicans opposed. KFF has tracked public opinion on national health plan proposals, including Medicare-for-All, since the late 1990s.

As KFF polling has shown consistently over time, public opinion on Medicare-for-All—and on major health policy proposals generally—is highly malleable and likely to shift over the course of any public debate with competing claims from proponents and critics. The latest poll finds the share who favor a Medicare-for-All-style plan falls sharply when the public is told that it could lead to potential delays in medical tests and treatments (24% still favor), tax increases (35%), or threaten the current Medicare program (38%). On the other hand, favorable views rise to about 3 in 4 when people are told that Medicare-for-All would make health insurance “a right” (76%) or that it would eliminate premiums and cost-sharing (75%).

Designed and analyzed by public opinion researchers at KFF, this survey was conducted September 16-21, 2026, online and by telephone among a nationally representative sample of 1,328 U.S. adults, including 1,0133 voters, in English and in Spanish. The margin of sampling error is plus or minus three percentage points for the full sample and plus or minus four percentage points for the sample of voters. For results based on other subgroups, the margin of sampling error may be higher.

Poll Finding

KFF Health Tracking Poll: Health Care Issues in the Lead-Up to the 2026 Midterm Election 

Published: Oct 6, 2026

Key Takeaways

  • With about a month to go before Election Day, the latest KFF Health Tracking Poll finds a large enthusiasm gap between partisans, with Democratic voters much more likely than Republican voters to say they are “more motivated” to vote this year than usual (63% vs. 38%). As voters make their final assessments before they cast their ballots, the Democratic Party has a clear edge over the Republican Party on who voters trust to handle many top issues in the election, including the cost of health care (42% vs. 22%) and the cost of living (39% vs. 25%). Notably, the size of the gap between the Democratic and Republican parties on health care costs has increased since April of this year, when 37% said they trusted the Democrats and 26% said they trusted the Republicans.
  • Health costs continue to be a top affordability worry for voters, tied with concerns about gas prices as in recent months. Six in ten voters are worried about being able to afford their health care costs, and about half of voters say it is “extremely important” for candidates in the midterm elections to talk about the cost of health care—ranking alongside the cost of living as the top two issues voters want to hear candidates talk about in the closing weeks of the midterm campaigns.
  • There is bipartisan support among the public for major changes to the country’s health care system, but partisans have vastly different views of the type of change needed. Large majorities of adults, including about nine in ten Democrats and three-quarters of Republicans, say the U.S. health care system needs either a complete overhaul or major changes. Reflecting the increased attention to Medicare-for-all in congressional races where some progressive Democrats have campaigned on it, two-thirds (66%) of U.S. adults now support Medicare-for-all, up from 53% when KFF last asked the question in October 2020. Views of a single-payer system remain highly partisan, with majorities of Democrats (84%) and independents (72%) saying they favor it, compared to 66% of Republicans who oppose such a plan.
  • Despite the public’s generally favorable view of Medicare-for-all, support drops when people hear criticisms of such a plan commonly made by opponents about the potential for higher taxes, longer wait times, or threats to the current Medicare program. On the other hand, support for Medicare-for-all increases when people hear claims made by proponents, including that such a system might guarantee health coverage as a right for everyone or eliminate insurance premiums and cost-sharing. Taken together, these findings suggest that while a majority supports Medicare-for-all in the abstract, support is likely to shift over the course of any public debate in which the public hears arguments for and against such a plan. For a summary of historical KFF polling data on opinions of Medicare-for-all, see here.

What Is Motivating Midterm Voters?

With the 2026 midterm campaigns in full swing and early voting about to begin, there is a wide enthusiasm gap between partisan voters, with Democratic voters 25 percentage points more likely than Republican voters to say they are “more motivated” than usual to vote (63% vs. 38%).

Most Republican voters (53%) say they are “about as motivated” as in previous elections, while independent voters are split, with about four in ten saying they are “more motivated” (41%) and a similar share saying they are “about as motivated” (44%) to vote as in past elections. Across partisans, one in six or fewer say they are “less motivated” to vote than usual.

Stacked bar chart showing the share of the public who say they are more motivated to vote than usual, less motivated than usual, or about as motivated as in previous elections. Results shown among total voters and by party identification of voters.

When asked specifically about why they are “more motivated” than usual, there are wide differences by partisanship, although many Democratic and Republican voters say they are motivated to keep the other party out of power. Among those who say they are more motivated, about one in five or more Democratic and independent voters say they want to bring about change (25% and 20%) or to stop the Trump administration (26% and 18%), and another 17% of Democrats say they want to vote out Republicans. Republicans, conversely, most often say they are more motivated to vote to keep Democrats out of power (29%) or because of concerns about socialism or communism (19%). Across partisanship, about one in ten say they are more motivated to vote than usual due to concerns about the cost of living.

Split bar chart showing reasons why voters said they are more motivated to vote in the 2026 midterms elections than in previous elections. Results shown among total voters and by party identification of voters.

With the cost of living weighing heavily on voters, the latest KFF Health Tracking Poll finds that health care costs and gasoline and other transportation costs continue to top the list of voters’ economic worries. Six in ten voters say they are “very” (25%) or “somewhat” worried (35%) about affording health care costs for themselves and their families, including the cost of health insurance and out-of-pocket costs for things like office visits and prescription drugs. Similar shares say the same about affording gasoline and other transportation costs, following a similar pattern KFF polling has tracked this year even as gas prices continue to fluctuate amid the conflict with Iran. Somewhat smaller—but still substantial—shares of voters say they are concerned about affording other household items like food (52%), utilities (51%), or housing costs (41%).

Stacked bar chart showing how worried voters are about being able to afford various living necessities. Results shown among total voters.

The public’s affordability worries are echoed in what issues voters say they want 2026 midterm candidates to prioritize. The cost of living is voters’ top issue they want to hear about from candidates, with six in ten (62%) saying it is “extremely important” for candidates to talk about it. The cost of health care is an important part of voters’ cost of living concerns, with about half of voters (47%) saying it is “extremely important” for candidates to talk about health care costs. About four in ten (44%) say fraud in government programs is “extremely important” for candidates to talk about, while smaller shares of voters say the same about the conflict with Iran (38%), immigration (35%), and abortion policy (21%).

Stacked bar chart showing how important various health issues are for voters for candidates in the 2026 midterm elections to talk about. Results shown among total voters.

The cost of living is the top issue Democratic (73%) and independent (63%) voters want midterm candidates to discuss, while fewer Republican voters (47%) call it “extremely important.” Fraud in government programs is Republican voters’ top issue, with just over half (54%) calling it extremely important, suggesting that Republican leaders’ messaging on this topic is reaching their base. Six in ten Democratic voters (59%) and about half of independent voters (49%) say it’s extremely important for candidates to talk about health care costs, compared to a smaller share (31%) of Republican voters.

Split bar chart showing how important various health issues are for voters for candidates in the 2026 midterm elections to talk about. Results shown among total voters and by party identification of voters.

When asked to say in their own words what they want midterm candidates to talk about when it comes to health care costs, the most common responses were related to a desire to hear about candidates’ plans for how they will lower health care costs for people.

In Their Own Words: Voters Describe What They Want To Hear From Candidates About Health Care Costs

“Making health care more affordable for many people by expanding coverage for a wide range of services.” – 32-year-old Democrat, New Jersey

“Lowering [health care costs] for people who can't afford to pay expensive costs for health care.” – 40-year-old Republican, Arkansas

“To make sure that people's needs are met. It’s sad people have to choose between eating and getting their medicine.” – 37-year-old Democrat, Michigan

“How they are going to lower health care costs. Like medicine and doctors’ visits.” – 23-year-old Independent, Georgia

“I want free universal healthcare for everyone in this country.” –65-year-old Democrat, New Mexico

“Health care needs to be free for all citizens.” – 54-year-old Republican, North Carolina

Note: Responses are lightly edited for length and spelling. These responses reflect respondents' own language and do not represent the views of KFF.

Democrats Have the Edge Over Republicans on Key Midterm Issues

As voters make their final assessments before they cast their ballots in the midterm election, the Democratic Party has a clear edge over the Republican Party on who voters trust to handle many top issues in the election, most notably the cost of health care (42% vs. 22%) and the cost of living (39% vs. 25%). The Democrats also have an advantage over the Republicans on abortion policy (42% vs. 27%) and the conflict with Iran (36% vs. 27%). Voters are more evenly divided on which party they trust to handle immigration and fraud in government programs. On each of the issues measured, between two and three in ten voters say they trust “neither” party and about one in ten say they trust “both equally.”

Stacked bar chart showing which political party voters trust to do a better job handling various health issues. Results shown among total voters.

On health care costs, the Democratic Party’s advantage over the Republican Party has increased over the last six months. In April 2026, 37% of voters said they trusted the Democrats and 26% said they trusted the Republicans to do a better job addressing health care costs, a gap of 11 percentage points. In the latest poll, that gap has increased to 20 percentage points, with 42% trusting the Democrats more and 22% trusting the Republicans.

Line chart showing the difference in the share of adults who say they trust the Democrats vs the Republicans to do a better job handling the cost of health care. Results shown among total voters for April 2026 and September 2026.

Among independent voters, the Democratic Party has at least a two-to-one advantage over the Republican Party when it comes to addressing the cost of health care (38% vs. 9%), the cost of living (35% vs. 11%), abortion policy (42% vs. 14%), and the conflict with Iran (34% vs. 13%). However, large shares of independent voters—ranging from about a third on immigration and abortion policy to more than four in ten on the cost of living, the cost of health care, the conflict with Iran, and fraud in government programs—say they trust neither party.

Stacked bar chart showing which political party independent voters trust to do a better job handling various health issues. Results shown among total independent voters.

Two-Thirds Favor Medicare-for-All, but Opinion Shifts When Public Hears Arguments

Amid frustrations about health care costs, there is bipartisan agreement among adults that major changes are needed to the U.S. health care system. About half of adults across partisanship say, “There are some good things about our health care system, but major changes are needed,” and an additional third (36%) feel even more strongly, saying, “There is so much wrong with our health care system that it needs to be completely overhauled.” Few adults (15%) say the system works well enough that only minor or no changes are needed, though Republicans are about twice as likely as Democrats and independents to say only minor changes are needed (21% vs. 10% each).

Split bar chart showing the opinions of adults on the health care system in America today. Results shown among total adults and by party identification.

Many progressive midterm candidates have been campaigning on their support for Medicare-for-all, an idea that can take different forms but usually refers to a system in which all Americans would get their insurance from a single government plan. The latest KFF Health Tracking Poll finds that two-thirds of the public (66%) say they favor Medicare-for-all, the highest share KFF has recorded since it began polling on the idea in 2016, when Senator Bernie Sanders made the idea a core issue of his primary campaign. For a summary of current and historical polling data on Medicare-for-all and other single-payer proposals, see here.

While favorability of Medicare-for-all has risen over time, there are still wide partisan divides. Majorities of Democrats (84%) and independents (72%) favor it, while a majority of Republicans (66%) oppose it, including about half (48%) who say they “strongly oppose.” There are also key differences by age, with three-quarters of younger adults ages 18-29 (75%) favoring Medicare-for-all compared to a slim majority (54%) of adults ages 65 and older, most of whom are currently enrolled in Medicare.

Stacked bar chart showing share of adults who favor or oppose having a national health plan, sometimes called a Medicare-for-all, in which all Americans would get their insurance from a single government plan. Results shown among total adults, by party identification, and by age.

As KFF polling has consistently found over the years, support for a single-payer health system is susceptible to change as people hear about potential effects of such a plan commonly cited by proponents and critics. The latest poll finds public opposition to Medicare-for-all increases significantly when people hear that such a plan could mean potential delays in medical tests and treatments (76% oppose), an increase in taxes (64%), or threats to the current Medicare program (61%).

On the other hand, larger majorities say they would favor such a plan if it guaranteed health insurance as a right (76%) or eliminated premiums and cost-sharing (75%), demonstrating the wide appeal of universal coverage and lowering health care costs for individuals. The public is more split, with about half (52%) saying they would favor Medicare-for-all if it eliminated private health insurance companies, while 47% oppose. This marks a departure from when KFF last asked this question in October 2020, when the prospect of eliminating private insurance companies led to lower support for Medicare-for-all (37% favored, 58% opposed). Each of these claims shift opinion regardless of things like partisanship and age.

Split bar chart showing share of adults who favor or oppose a national Medicare-for-all if they heard arguments for and against the plan. Results shown among total adults.

This KFF Health Tracking Poll was designed and analyzed by public opinion researchers at KFF. The survey was conducted September 16 – September 21, 2026, online and by telephone among a nationally representative sample of 1,328 U.S. adults in English (n=1,237) and in Spanish (n=91). The sample includes 1,015 adults (n=72 in Spanish) reached through the SSRS Opinion Panel either online (n=990) or over the phone (n=25). 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 313 (n=19 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 171 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, 8 cases were 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 2025 Current Population Survey (CPS), September 2023 Volunteering and Civic Life Supplement data from the CPS, and the 2026 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.
Total1,328± 3 percentage points
Total registered voters1,013± 4 percentage points
Party ID
Democrats446± 6 percentage points
Independents439± 6 percentage points
Republicans347± 7 percentage points
Registered Voters by Party ID
Democrats379± 6 percentage points
Independents304± 7 percentage points
Republicans294± 7 percentage points

 

Current and Historical Public Opinion on Medicare-for-All and Other National Health Plan Proposals

Published: Oct 6, 2026

For many years, KFF has been tracking public opinion on the idea of a national health plan, including questions specifically about “Medicare-for-all” since 2017. This 2026 midterm election cycle, some progressive Democratic candidates have been campaigning on their support for Medicare-for-all, in which all Americans would get their insurance from a single government plan. As U.S. adults struggle to afford their health costs, many are looking for changes to the health care system. This data note summarizes current and historical KFF polling on Medicare-for-all and other national health proposals.

Views on Medicare-for-all are related to the broader question of the role of the federal government in providing access to health insurance, which has wide support among the public. Eight in ten (79%) adults say they favor the federal government doing more to help provide health insurance for more Americans, while one in five oppose a larger role for the federal government. Support for a larger federal role is bipartisan, including nearly all Democrats (94%) and eight in ten independents (82%). A smaller majority of Republicans (61%) favor a larger role for government.

This sentiment is not new. In fact, since KFF began polling on this question in 2006, three-quarters of U.S. adults or more have favored the federal government doing more to help provide health insurance to more Americans.

Majorities of U.S. Adults Across Partisanship Favor the Federal Government Doing More To Help Provide Americans With Health Insurance (Stacked Bars)

Medicare-for-all has reentered Democratic debates in the 2026 midterm elections, with several progressive candidates making it a central part of their campaigns. A September 2026 KFF Health Tracking Poll finds that two-thirds (66%) of the public say they favor having a national health plan, sometimes called Medicare-for-all, in which all Americans would get their insurance from a single government plan. This includes about eight in ten Democrats (84%) and seven in ten independents (72%). Most Republicans, however, oppose the proposal (66%), including about half (48%) who “strongly oppose” it.

Two-Thirds of U.S. Adults Favor Having a National Health Plan, or Medicare-for-All; Most Republicans Oppose the Idea (Stacked Bars)

From 2017 to 2020, views of Medicare-for-all were relatively stable, with at least half of adults consistently favoring the proposal and between four in ten and just under half opposing it. Opposition rose slightly in 2019, coinciding with debate over Medicare-for-all during the Democratic presidential primary, and when KFF asked the question in October 2020, about half (53%) were in favor and about four in ten (42%) opposed.

The latest KFF poll from September 2026 marks a new high, with two-thirds (66%) of the public favoring the proposal, while the share opposed has fallen to about a third (34%).

Two-Thirds of U.S. Adults Now Favor Medicare-for-All, the Largest Share Since KFF Began Polling on the Plan (Line chart)

Support for Medicare-for-all increased across partisans between 2020 and 2026. Most notably, about seven in ten independents (72%) now favor the proposal, up from fewer than six in ten (57%) six years ago. While most Republicans oppose the plan, one-third (34%) now favor it, up from one in five (21%) in 2020. About eight in ten Democrats (84%) now favor Medicare-for-all, similar to the share who said so in 2020 (78%).

Across Partisans, Medicare-for-All Favorability Has Increased Since 2020 (Split Bars)

KFF polling has consistently found that public opinion on Medicare-for-all can shift substantially when people hear about potential effects of such a plan that are likely to be raised in a national debate. The share who favors such a plan rises to as much as three-quarters when people hear it would guarantee health insurance as a right for all Americans or eliminate all health insurance premiums and reduce out-of-pocket health care costs. On the other hand, favorability falls to as low as one in four when people hear it could lead to delays in getting medical tests or treatment, to about one-third when they hear it could raise taxes, and to about four in ten when they hear it could threaten the current Medicare program.

Public Opinion on a Medicare-for-All Plan Shifts When Presented With Claims About Potential Effects, Including Increased Taxes or Reduced Health Costs (Range Plot)

The public has mixed expectations about how a Medicare-for-all plan would affect them personally, but these expectations generally lean more negative than positive. About one-third (35%) say their ability to afford the health care they need would get better if the U.S. adopted Medicare-for-all, while 28% say it would get worse and 37% say it would stay about the same. On other aspects of their care, more U.S. adults expect things to get worse or stay about the same. The largest share, about six in ten (61%) adults, expect the amount they pay in taxes to be “worse” under a Medicare-for-all plan, while one in ten say this would be “better” and three in ten (29%) say it would be “about the same.”

About Six in Ten Adults Expect Medicare-for-All To Raise Their Taxes; One-Third Say Health Care Affordability Would Get Better (Stacked Bars)

Notably, adults who favor Medicare-for-all appear to support such a plan despite having mixed views on how it would impact them personally. While about half (48%) of Medicare-for-all supporters say their ability to afford the health care they need would get better under such a plan, the same share (48%) expects the amount they pay in taxes to get worse. At the same time, at least half of those who support Medicare-for-all say their own access to providers, wait times, and insurance paperwork would remain about the same. Medicare-for-all opponents are more unified, with majorities saying each of these things would get worse under such a system.

Large Shares of Supporters of Medicare-for-All Say the Health Care System Will Stay About the Same if the U.S. Adopted the Plan; Opponents Say It Will Get Worse (Stacked Bars)

Most U.S. adults with private health insurance think they would be able to keep their current coverage under a Medicare-for-all plan. About six in ten (57%) adults with private health insurance, either through an employer or purchased themselves, say it is likely they would be able to keep their current health insurance if the U.S. adopted Medicare-for-all, including seven in ten privately insured adults who favor Medicare-for-all.

This misconception is not new. In a KFF poll from 2019, as Medicare-for-all was debated in the Democratic presidential primary, most adults with private health insurance incorrectly said they would likely be able to keep their own insurance under a national plan. Notably, most Medicare-for-all proposals, including legislation introduced by Sen. Bernie Sanders in 2017, would replace most current private health insurance with a single government plan.

In 2019 and 2026, Majorities of Medicare-for-All Supporters Say They Expect To Be Able to Keep Their Own Health Insurance (Split Bars)

A Historical Look at National Health Plan Polling

Prior to the focus on Medicare-for-all in 2017, KFF polls tracked questions about support for a single-payer health plan back to 1998. These polls showed that fewer than half of adults supported a national health plan until 2016, when it became a focus of the Democratic presidential primary with Sen. Bernie Sanders’ campaign. In KFF polls conducted from 1998 to 2004, about four in ten adults favored a national health plan while a majority opposed it. During the 2008-2009 health reform debate, an average of seven KFF polls shows just under half of adults supported the plan (46%) and about half opposed it (49%). By February 2016, half of adults favored a national health plan while about four in ten (43%) opposed it.

Prior to 2016, Fewer Than Half of U.S. Adults Favored A National Health Plan (Grouped column chart)

Phrasing the Question

Polling shows that the terminology used affects public opinion on a national health plan. A KFF Health Tracking Poll from April 2019 found that majorities of adults had positive reactions to the terms “universal health coverage” (63%), “Medicare-for-all” (63%), and “national health plan” (59%). Fewer had positive reactions to “single-payer health insurance system” (49%), a term for which about one in five did not offer an opinion. In addition, public opinion was split on “socialized medicine” (46% positive, 44% negative).

Public Opinion on a National Health Plan Depends on the Terminology Used (Split Bars)

Additionally, question wording itself can impact the level of support measured for a national health plan. Polls from 2017 show that the term used, whether financing through taxes is mentioned, and whether respondents are offered the option to say they don’t know enough can all affect measured support. For example, a September 2017 Politico/Harvard poll found that fewer than half (45%) favored replacing the current health insurance system with a “single-payer system,” while two-thirds (66%) favored replacing it with a “taxpayer-funded national plan like Medicare.” Polls that mention financing through taxes have found support ranging from an even split in a 2017 NBC/Wall Street Journal poll (47% favor, 46% oppose) to a majority in favor in a CNN poll in 2017 (58%). And when a November 2017 Gallup poll explicitly offered the option to say they didn’t know enough, only about one in five said they favored (17%) or opposed (21%) a Medicare-for-all proposal, with six in ten (61%) saying they did not know enough to say.

Question Wording Affects Public Opinion on a National Health Plan (Table)