Federal Budget Cuts Reach Well Beyond Medicine, Analysis Warns

Picture a household that loses part of its food aid, faces new Medicaid paperwork and lives near a health department whose federal grant was frozen. It wasn’t through one sweeping law, which is partly why the total is so hard to see. But a new Lancet Regional Health-Americas analysis adds it up, and the conclusion is that federal budget actions since 2025 are likely to harm health in nearly every area examined.

The analysis comes from four political scientists, Holly Jarman, Rachel Kulikoff, Miranda Yaver and Scott Greer, at the University of Michigan and the University of Pittsburgh. Rather than test one program, they used the World Health Organization’s social determinants of health framework, which counts food, housing, schooling, work and the environment as health policy in all but name. They collected executive orders, budget documents, legislation, nonpartisan agency reports and news items covering the first year of the term, through January 2026, then judged each action’s likely effect over three rounds of coding and discussion. That makes it a qualitative policy analysis of documents rather than a trial or a cohort, with no patients counted.

Food aid and insurance take the first hits

The clearest signal is food assistance. The One Big Beautiful Bill Act, signed on July 4, 2025, cuts $187 billion from SNAP (the Supplemental Nutrition Assistance Program), which the authors say serves about 40 million people, while narrowing eligibility and extending work requirements. SNAP enrollment fell by 4.5 million between April 2025 and April 2026, and the authors attribute the drop to those changes, warning of greater food insecurity.

Health coverage is shrinking too. Medicaid enrollment dropped by 4.8 million over that same stretch, before most of the law’s provisions take effect, and the authors link the expiration of enhanced Affordable Care Act subsidies to a 2.2 million person decline in marketplace enrollment between December 2025 and February 2026. Looking ahead, the Congressional Budget Office estimates that reduced enrollment in Medicaid and the Children’s Health Insurance Program would add 7.5 million uninsured people by 2034, and the law asks many expansion adults to show 80 hours of work a month or qualify for an exemption. An earlier peer-reviewed study of Arkansas’s 2018 work requirement found coverage losses and no change in employment. A $50 billion rural health fund is the main offset, but the authors judge it nowhere near proportionate to the cuts, and analysts they cite expect rural hospital closures.

Public health and research lose ground too

Coverage is only part of it. The administration cut more than $11 billion in pandemic-era grants to state and local health departments, and although judges overturned some of those cuts, the authors note it is unclear whether the money has actually been paid out. Federal science took hits through staff reductions and grant cancellations, and the analysis cites a modeling study that projects 14 million avoidable deaths by 2030 from the dismantling of the United States Agency for International Development. Such figures are projections from other researchers, not outcomes this analysis measured.

“Americans are experiencing an uprooting of their healthcare and public health system,” said Holly Jarman, associate professor of health management and policy at the University of Michigan School of Public Health. By the authors’ reading, the harm lands hardest on low-income households, rural communities, disabled people, racial and ethnic minorities and noncitizens.

Why states cannot simply fill the gap

State governments could soften some of this, and California has sued the administration 123 times, winning two thirds of its cases so far, according to the authors. But they list obstacles: many states share the administration’s priorities, local governments answer to state law, no state has an equivalent of the National Institutes of Health or the Centers for Disease Control and Prevention, federal co-financing of Medicaid limits state flexibility, and many states face budget stress of their own.

The study’s own limits matter. It evaluates policies, not measured health outcomes, little peer-reviewed evaluation exists yet, and different provisions take effect at different times. “The policy changes are still being implemented and sufficient data are not yet available to measure their full effects on population health,” said Scott Greer, the Richard Carl Jelinek Professor of Health Management and Policy at the University of Michigan School of Public Health. The authors add that rebuilding will take more than restoring earlier funding, since simply putting money back into badly weakened agencies might not work. Whether the health toll shows up in the data, and how large it is, is the question they leave open.

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