October 18, 2025
In recent years, discussion surrounding healthcare policy in the United States has shifted dramatically. The contrast among the policy discussions in the American healthcare space during the 2020 election, the 2024 election, and after this past election are striking; the discourse has shifted among various topics, including the role of Medicare and Medicaid as public American healthcare provisions and the retrenchment of longstanding policy regarding vaccine mandates in schools [1]. Amidst the changing climate of healthcare discussion, it is becoming ever more apparent that the political structures and private actors influencing healthcare policy are failing Americans.
Pew research data reported July of 2025 suggests that a majority of Americans are disillusioned with the influence that insurance agency lobbyists have on healthcare policy. 69% of U.S. adults believe that insurance companies have too much say in how healthcare related policy is discussed and developed [2]. In a 2024 report by Gallup, Americans’ positive views of healthcare coverage and quality have decreased significantly over time, with good quality ratings dropping from 54% in 2020 to 44% in 2024, and positive coverage ratings dropping from 29% in 2020 to 28% in 2024. Also in 2024, only 19% percent of Americans reported being satisfied with healthcare costs [3].
In past years, primarily during the 2020 election cycle, discussions of the public option, Medicare For All, and other models of government subsidized healthcare arose in conversations that took place during the Democratic National Convention. At this time, more progressive candidates pushed for greater healthcare reforms, like the expansion of Medicare, while moderate leaning democratic leaders pushed for the introduction of the public option, which would build on the Affordable Care Act’s protections for individuals with pre-existing conditions [4].
Now, with the establishment of the “One Big Beautiful Bill Act” (OBBBA; H.R.1) as law, fewer Americans will have access to wider reaching public benefits. The Congressional Research Service stated that 7.8 million Americans will be uninsured by 2034 due to the Medicaid cuts within the OBBBA [5] In addition to this, the bill raises the work requirement age caps for social service benefits including snap. The summary of the bill states,“This section raises the age for those who must meet these additional work requirements to include adults who are 65 years old and younger, whereas these requirements currently apply to adults who are 55 years old and younger” [6]. Cutting SNAP benefits ignores the reality of nutrition and health related issues. Eliminating benefits for these individuals exacerbates poverty related nutritional deficiencies, perpetuating health problems. Beil, Evans, and Clarke describe this in their research regarding health and nutrition within the community setting, “Low-income people have a higher incidence of nutrition-related, preventable ailments, including obesity, heart disease, hypertension, and diabetes, than the more eco nomically advantaged” [7]. This element of the bill ignores the unique physical and mental health challenges that individuals aged 55-65 may face that might impede their ability to work, including the early onset of cancer, hypertension, high blood pressure, and other mental health issues that may impact work-capabilities. As a result of the move towards austerity in public health spending, the loss of coverage is only hurting Americans.
Americans suffering under these shifts in healthcare subsidies may want to see change, but moving the broader perspective of Americans to adopt a more robust public healthcare system seems rather challenging. While Medicare for all may be an unimaginable concept in the modern political climate of the U.S., especially given the composition of our federal and state governments, the introduction of the public option may be a much more viable policy proposal in the short term. Public polling suggests 44% of bipartisan voters favored Medicare for All and 47% favored the implementation of the public option, though only 29% supported the public option over reforming the current healthcare system [8]. Successful outcomes from further expansions to the ACA might help bridge individuals who are skeptical of more robust publicly funded healthcare programs. This polling also suggests that Americans prefer expanding ACA benefits, with 60% of respondents stating they believe in expanding ACA subsidies [8]. If adopted, extensions of the ACA would provide the opportunity for more people to access preventative care, allowing the burden of illness and injury to be alleviated.
The danger of a majority privatized healthcare insurance system, with only 23% of U.S. adults on Medicaid and CHIP, lies within the unpredictability of an individual’s personal health outlook [9]. Anyone could be forced to handle a devastating financial burden upon experiencing a major health incident, injury, or onset of a chronic condition. Around 8% of Americans were uninsured in 2023 which was a bifold decrease from the 16% of uninsured Americans present before the implementation of the Affordable Care Act (ACA); this indicates the benefit of expanding subsidized healthcare [10]. The ACA specifically is a helpful policy in its unprecedented expansive capacity, as researchers Mark Borgschulte and Jacob Vogler describe, in its ability to reach broader demographic groups.
In its ability to aid more people, the ACA enacted true material reforms. Past expansions have already provided a groundwork for addressing this problem “Medicaid leads to increases in visits to physicians, overnight hospital stays, emergency department visits, and rates of diagnosis for medical conditions” [11]. With the increase in access to visits with healthcare providers, possibilities for early diagnosis and preventive treatment are increased, lowering rates of mortality. Borgschulte and Vogler’s research also found that the ACA contributed to a significant mortality rate decrease: “ACA Medicaid expansion reduced mortality in the portion of the population that is between 20 and 64 years of age by 11.36 deaths per 100,000, a 3.60 percent reduction, within the first four years of the reform” [12]. Given this impact of the ACA, future expansions and revisions could have the capability of decreasing mortality rates even further.
Works Cited
[1] Kekatos, Mary. 2025. “What Florida Ending Vaccine Mandates Could Mean for Rest of US.” ABC News. September 9, 2025. https://abcnews.go.com/Health/florida-ending-vaccine-mandates-rest-us/story?id=125360736.
[2] Nadeem, Reem. 2025. “Americans’ Views on Who Influences Health Policy and Which Health Issues to Prioritize.” Pew Research Center. July 10, 2025. https://www.pewresearch.org/science/2025/07/10/americans-views-on-who-influences-health-policy-and-which-health-issues-to-prioritize/.
[3] Brenan, Megan. 2024. “View of U.S. Healthcare Quality Declines to 24-Year Low.” Gallup.com. Gallup. December 6, 2024. https://news.gallup.com/poll/654044/view-healthcare-quality-declines-year-low.aspx.
[4] Pereira, Ivan. 2020. “Biden Discusses Healthcare Plan at Dem Convention.” ABC News. ABC News. August 19, 2020. https://abcnews.go.com/Politics/biden-discusses-healthcare-plan-dem-convention/story?id=72457748.
[5] “Health Coverage Provisions in One Big Beautiful Bill Act (H.R. 1).” 2025. Everycrsreport.com. Congressional Research Service. June 13, 2025. https://www.everycrsreport.com/reports/R48569.html.
[6] Congress.gov. “H.R.1 – 119th Congress (2025-2026): One Big Beautiful Bill Act.” July 4, 2025. https://www.congress.gov/bill/119th-congress/house-bill/1.
[7] Biel, Melissa, Susan H. Evans, and Peter Clarke. “Forging Links Between Nutrition and Healthcare Using Community-Based Partnerships.” Family and Community Health 32, no. 3 (2009): 196–205. http://www.jstor.org/stable/44954774.
[8] Tong, Noah. 2023. “Voters Reject Repealing the Affordable Care Act but Are Wary of Medicare for All: Poll.” Fierce Healthcare. December 7, 2023. https://www.fiercehealthcare.com/payers/voters-reject-repealing-affordable-care-act-are-wary-medicare-all-poll.
[9] DeSilver, Drew. 2025. “What the Data Says about Medicaid.” Pew Research Center. June 24, 2025. https://www.pewresearch.org/short-reads/2025/06/24/what-the-data-says-about-medicaid/.
[10] Collins, Sara, and Avni Gupta. 2024. “The State of Health Insurance Coverage in the U.S.” The Commonwealth Fund. https://doi.org/10.26099/byce-qc28.
[11] Finkelstein, Amy, Nathaniel Hendren, and Erzo FP Luttmer. “The value of medicaid: Interpreting results from the oregon health insurance experiment.” Journal of Political Economy 127, no. 6 (2019): 2836-2874.
[12] Borgschulte, Mark, and Jacob Vogler. “Did the ACA Medicaid Expansion Save Lives?” Journal of Health Economics 72 (2020). https://doi.org/10.1016/j.jhealeco.2020.102333.
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