How 2025 Changed American Healthcare

From coverage loss to crumbling trust

Unquestionably the most significant year in American healthcare this century, 2020 hit us like a tidal wave. But I think we are closing the door on a year that might be even more significant from a longstanding impact and insult to our collective health. From my vantage point in the emergency department, I have seen how policy decisions ripple through the lives of ordinary people—and the effects of this year’s biggest stories are just beginning.

Here are the healthcare stories that defined 2025 for me, and how they affect healthcare going forward, not because they shocked us, but because of what they have destroyed or how they have shifted our collective trust.

We are reversing gains maximized by the Affordable Care Act.

Enhanced ACA subsidies are expiring without congressional intervention, threatening unprecedented coverage gains. Thanks to marketplace options, state investments, and Medicaid expansion, from 2023 on, fewer than 8% of Americans were living without health coverage. Now we’re watching that progress unravel at the local level as new legislation undermines both Medicaid access and the tax credits that make insurance exchanges affordable.

As an emergency physician, I see the direct consequences of these decisions: Stripping healthcare access guarantees poor outcomes. Though Medicaid isn’t sufficient for comprehensive preventive care, it’s vastly better than nothing. Our system can’t function well with everyone on Medicaid, but it fails when people have no coverage at all. Without insurance, patients can’t afford medications or access primary care. That, coupled with Medicaid reductions, leads to rural hospital closures and deteriorating community health.

This isn’t partisan. The worst outcomes will appear in rural, conservative areas where state and local governments won’t compensate for lost federal support. States could theoretically provide healthcare independently, but most won’t because they don’t have the budgets for it. In emergency departments, we’ll continue seeing the preventable consequences: undiagnosed cancers, worsening diabetes, heart attacks and strokes that earlier intervention could have caught.

We already know how this ends. People delay care. Conditions worsen. Our safety net stretches thinner. People die. We use clinical terms like “uncompensated care” and “burnout,” but we’re really describing what happens when policy failures arrive at the bedside. What concerns me most isn’t just the coverage loss, it’s how quietly we’ve accepted losing ground, as if it were inevitable rather than a choice.

We have a patchwork of reproductive healthcare laws that changes every few miles–causing confusion and harm.

In the three years since the Dobbs v. Jackson Women’s Health Organization decision, we’ve experienced constant policy changes at state and federal levels. States have restricted reproductive care in several ways: intimidating physicians into delaying or withholding treatment, limiting access to medication abortion (like Louisiana’s law that also harms miscarriage patients), and creating new ways to sue people suspected of helping with abortions, as Texas has.

Now we’re seeing something even more troubling: criminal charges against doctors who are protected by shield laws. These physicians prescribe medications from states where abortion is legal to patients in states where it isn’t. As these cases head to a likely Supreme Court showdown, we’re facing a fundamental question about federalism not seen since the Civil War. What happens when one state’s laws clash with another’s? What protections exist for doctors following their own state’s laws while treating patients from other states?

Reports of doctors giving patients transfusions patients to stabilize them and then discharging them without definitive care or delaying diagnosis of life-threatening ectopic pregnancies have permeated the news, and we must ask ourselves who is making healthcare decisions for American women: their doctors or politicians?

Despite these assaults on reproductive healthcare, there’s some progress. Advocates and physicians are learning state regulations to provide care within legal boundaries, though state legislatures have offered little help. As someone who speaks with emergency physicians nationwide, I can tell you this: The commitment to excellent patient care remains strong. That gives me hope.

We are deploying AI across healthcare faster than we can ensure it’s safe or fair, and the consequences are just beginning.

Artificial intelligence became one of the defining stories of 2025, including in healthcare. Health systems expanded AI-driven clinical decision support, imaging interpretation, and administrative automation. Insurers and employers rolled out AI assistants to help patients navigate benefits and care. AI is now embedded in workflows meant to reduce clinician burden, speed diagnoses, and improve access. For example, Open Evidence, an AI search engine connected to some of the leading healthcare associations in the United States, has become a game-changer in the clinical area for real-time evidence-based care. AI in healthcare is no longer experimental; it’s operational.

At the same time, as in all AI advances, equity and bias emerged as central concerns. A widely cited Reuters report detailed the NAACP’s push for “equity-first” AI standards in medicine, warning that algorithms trained on biased or incomplete data risk worsening racial and socioeconomic health disparities. This advocacy reframed AI governance as a public health and justice priority, highlighting how tools used in triage, diagnosis, and resource allocation could systematically disadvantage marginalized communities if left unchecked.

Professional organizations have stepped in to fill the gap between innovation and regulation. Groups such as the American Medical Association emphasized “augmented intelligence” rather than replacement of clinicians, calling for transparency, evidence-based validation, and human oversight. These efforts reflected growing recognition that workforce readiness is as important as the technology itself.

Finally, without any comprehensive regulatory framework, uncertainty shapes U.S. healthcare and AI. Overlapping federal guidance, state-level transparency efforts, and national debates about oversight influenced how health systems and startups deployed tools. The result was a year defined by tension: AI’s promise to improve efficiency and outcomes versus unresolved questions about safety, bias, accountability, and governance. AI is now both one of healthcare’s most powerful opportunities and one of its most urgent policy challenges.

The Trump administration is dismantling HHS, the agency responsible for American public health, and we are all paying the price.

The most significant development this year has been watching Health and Human Services collapse from within. This agency, which once had more than 80,000 employees overseeing American healthcare, has become a shell of itself under ideologically driven leadership that undermines public health and science daily.

Just over 100 days ago, we watched Centers for Disease Control and Prevention leaders resign after being asked to ignore decades of scientific evidence and restrict vaccine access. Health Secretary Robert F. Kennedy Jr.’s obsession with questioning vaccine effectiveness has resulted in policy change faster than even his most ardent supporters had expected. This zealous activism was clear to anyone following his litigation career and public advocacy for years but somehow fell on deaf ears during his Senate hearings as he hedged his answers about vaccine availability. Well, now his intentions are undeniable.

The committee charged with making vaccine recommendations recently debated and then modified approval for a cancer-preventing vaccine for newborns. We’re seeing questions about the childhood vaccine schedule, whether to eliminate vaccines or reduce how often children receive them. These questions aren’t based on new science or evidence. They’re based on this administration’s ideology.

I cannot overstate how dangerous this is. It threatens not just preventative medicine and disease control, but public trust in our institutions. When scientific consensus and transparency are constantly undermined, people lose confidence in vaccines and other health interventions. That erosion of trust will have consequences for years to come.

The spread of misinformation compounds this crisis. When false claims about vaccine safety circulate unchecked or worse, when they’re amplified by those in positions of authority, it becomes nearly impossible for the public to distinguish between legitimate scientific debate and dangerous conspiracy theories. Healthcare providers find themselves spending precious appointment time debunking myths instead of addressing genuine health concerns. Parents who want to make informed decisions are left confused and anxious, unsure whom to trust. This environment doesn’t just threaten vaccination rates, it also undermines the entire foundation of public health, which depends on a shared understanding of facts and a collective commitment to protecting our communities.

We are living through a crisis of trust in public health, but we have the power to rebuild it.

The people running HHS are undermining public trust daily, but collective efforts and advocacy can help rebuild confidence in our institutions. Recovery seems difficult now, but it’s not impossible.

Looking toward 2026, I want to offer this: Policy decisions around reproductive healthcare and access can be reversed and improved. You have agency in this fight. Change is possible, and your voice matters.

What worries me most is the lasting damage from conspiracy theories and disinformation spread by the secretary of Health and Human Services and his appointees. They seem to take perverse pleasure in spreading fear, anxiety, and mistrust. These effects will persist long after this administration ends.

But here’s what I know from speaking with healthcare workers across the country: The commitment to excellent patient care remains strong. Advocates are organizing. Physicians are learning how to navigate hostile legal landscapes to protect their patients. The work continues, even in the hardest moments. That’s where I find my hope, not in the people at the top but in the professionals and advocates refusing to give up.

Dara Kass is an emergency physician and the founder of FemInEM, an organization dedicated to the advancement of women in emergency medicine and addressing reproductive healthcare issues in our emergency departments.

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