Two snapshots of a health care system in precipitous decline: First, the latest Kaiser Family Foundation tracking poll shows Americans’ number one pocketbook concern is now the cost of health insurance and out-of-pocket health care expenses. Fully two-thirds of the public are more worried today about health care costs than food, housing, utilities or gasoline.

Second, the Centers for Medicare and Medicaid Services reports that 1.2 million households dropped health insurance coverage during the 2026 sign-up season, a direct result of the Republican Congress ending the enhanced premium subsidies for Obamacare plan purchasers. The missing 1.2 million came from just 30 states that use the federal exchange.

When the other 20 states report (many have extended the sign-up season to the end of this month), that number will likely reach the 2.2 million that the Congressional Budget Office predicted would drop coverage. The KFF poll found 67 percent of voters now oppose ending the expanded subsidies, including 89 percent of Democrats and 72 percent of independents. Democratic Party attempts to restore the subsidies led to a 43-day government shutdown in October and November.

Those two news items prompted me, in this last post before a three-week break, to take a brief look at where the overall health of the nation and health care policy stand a little over one year into the second Trump administration. I begin by resuscitating a question raised by another Republican president nearly 46 years ago: Are we better off today than we were a year ago?

As sports announcers like to say, let’s go to the video tape.

Compared to one year ago, we have:

• Falling health insurance coverage and a rising uninsured rate.
• Declining health care affordability.
• Less vaccine access.
• Large measles outbreaks.
• States eliminating water fluoridation.
• Less money for public health departments.
• Less money for Medicaid.
• Less money for NIH research, and ideological controls placed over its content.
• Less money for substance abuse treatment.
• Less money for HIV prevention.
• Less money for global health.

Among the social and economic determinants of health (which have a greater impact on the general population than health care system interventions), we face:

• Rising unemployment.
• Rising inflation (especially for health care and groceries).
• Fewer food stamps.
• Less affordable housing.
• Declining consumer confidence.

Less in the pipeline, too

Every arena for improving public health last year suffered major cuts in federal support or detrimental policy reversals or both. Looking ahead, every public and private institution that must deal with the health consequences of a less generous social safety net faces the prospect of years of additional cuts in federal support due to the massive corporate and higher-earner tax breaks passed last year.

They will also have to deal with another “social determinant of health”: A level of social stress and political division that we’ve not seen since the Vietnam War. It is a direct result of the Trump regime’s violent and illegal assaults on America’s immigrant communities, conducted without regard for the citizenship, residency status or civil rights of those assaulted.

The toll so far: Nearly three dozen dead, including Renee Good and Alex Pretti through summary execution. Within immigrant communities, there now exists widespread fear, reduced school attendance, lost jobs and declining economic activity.

Mounting social stress extends well beyond those directly attacked by the poorly trained goons deployed by the Department of Homeland Insecurity. For a majority of Americans, there is growing recognition that we are on the cusp of losing our birthright as U.S. citizens — the right to the constitutional democracy that was founded 250 years ago and has long been a beacon to freedom-seeking peoples everywhere.

Instead, we’ve been forced to watch helplessly (and without effective push back by the minority party) as the executive branch daily flouts the rule of law; an obsequious, dysfunctional Congress that conducts no oversight; a politicized Supreme Court that enables flagrantly unconstitutional executive behavior; and an ongoing attack on free and fair elections by a Department of Justice that acts like the president’s personal law firm. All of this is either overlooked or temporized by a press run by oligarchs, who now control most of the mainstream media that reaches the broad mass of Americans.

The long-term health consequences of these dramatic changes in our daily lives cannot be predicted with certainty. But the one thing health researchers have repeatedly shown is that people under chronic stress are more prone to chronic disease. The Trump regime’s actions are, quite literally, ruining your health.

A Nation Under Extreme Stress

One need look no farther than public opinion polls to know that huge swaths of the U.S. population feels it is under tremendous stress. A Gallup Poll taken in mid-2025 showed over 18 percent of Americans report they have been either diagnosed or treated for depression in the past year, close to the highest level ever. The rate for young people under 30 is 27 percent — the highest ever.

Why wouldn’t young people feel depressed when the oligarch-controlled social media feeds streaming through their smart phones confirm daily that they are living live in a country on the brink of civil war; where an oppressed majority’s beliefs and values are daily being attacked by a regime that makes no attempt to govern on behalf of all the people; where those who express their anger and frustration through constitutionally protected speech and protest are branded as “domestic terrorists,” with their names, license plates and addresses recorded by masked government employees toting pistols and stun guns?

Should we be surprised that the Fall 2025 edition of the long-running Harvard Kennedy School Youth Poll found that nearly two-thirds of young adults (under 29) describe the U.S. today as “a democracy either in trouble (45 percent) or one that has already failed (19 percent).” Just four percent of Democrats and Independents would describe the U.S. as “a healthy democracy.” The number rises to only 12 percent among self-identified Republicans.

I wanted to end this review on a positive note, and the latest report on U.S. life expectancy from the National Center for Health Statistics, an arm of the CDC, provided the opportunity. It showed life expectancy rose seven months to 79.0 years in 2024, finally reaching and slightly surpassing its pre-COVID peak (although we’re still two to three years behind other advanced industrial countries). Analysts attributed the increase to reduced opioid overdose deaths and the waning effect of the pandemic.

A victory for Trump’s crackdown on the global fentanyl trade by blowing boats out of the water off in the Pacific Ocean and Gulf of Mexico? Hardly. The report covers 2024, the year before he resumed residency in the Oval Office. We’ll have to wait until next year to learn how much damage his actions and those of his minions have done to Americans’ health.

Merrill Goozner, the former editor of Modern Healthcare, writes about health care and politics at GoozNews.substack.com, where this column first appeared. Please consider subscribing to support his work.

Reprinted with permission from Gooz News