The Trump health cuts are no longer a warning about what might happen. They are a receipt. On July 4, 2025, Donald Trump signed H.R. 1, the One Big Beautiful Bill Act, which pulled more than $1 trillion out of federal health programs in what the Center for Medicare Advocacy calls the largest rollback of federal health care support in American history. The Congressional Budget Office estimated 11.8 million people would lose coverage. Eighteen months later, we do not have to project anything. We can count.
Medicaid and CHIP enrollment fell by 4.6 million people between April 2025 and March 2026, according to KFF’s enrollment tracker, with declines in nearly every state. Affordable Care Act marketplace enrollment collapsed from roughly 22.3 million in 2025 to as low as 16.5 million this year, after the enhanced premium tax credits expired at the end of December. For the people who managed to hold onto a plan, the average deductible climbed 37 percent to a record $3,786. That is the ballgame, and it is the part most coverage of the Trump health cuts skips, because Medicaid does not make for dramatic television the way a firing does.
Then the buildings started closing. More than 1,000 hospitals, clinics, nursing homes, and maternity wards have closed or reduced services, with providers pointing directly at the Medicaid cuts as a factor. Planned Parenthood was defunded by the same bill and has shut nearly 30 health centers since July 2025. Two out of every three of those closed centers sat in rural areas, medically underserved areas, or communities already facing a shortage of primary care doctors. A disproportionately high number of Black women rely on Planned Parenthood for free breast cancer screenings and preventive care. When people ask whether the Trump health cuts touched cancer, that is the honest answer. Not a line item in a budget document. A locked door where the screening used to be.
Food went next. H.R. 1 cut nearly $187 billion from SNAP, the largest benefit reduction since the program was created. The rollout last November produced the first interruption in food assistance in the history of the program. By March, more than 4 million people, about 10 percent of enrollees, had lost their SNAP benefits. Participation dropped in every single state. At least 700,000 children lost food assistance. Agriculture Secretary Brooke Rollins attributed the drop to fraud prevention and an improved economy.
The worst is still loading. National Medicaid work requirements take effect starting in December 2026, mandating 80 hours a month of qualifying activity and eligibility redeterminations every six months instead of every twelve. Georgia already ran this experiment. Its Pathways to Coverage program enrolled fewer than 7,500 people out of an estimated 300,000 eligible adults and burned more than $40 million, most of it on administration rather than anybody’s medical care. The lesson from Arkansas was the same. People do not fail the work requirement because they refuse to work. They fail because of paperwork.
Now the research, and this is where the Trump health cuts stop looking like budget policy and start looking like something else. NIH terminated 2,291 grants and withdrew $2.45 billion in research funding. The National Institute on Minority Health and Health Disparities was hit second hardest of any institute in the entire agency by dollar amount, losing 77 grants and $223.5 million. A study published May 5, 2026 in The Lancet Regional Health Americas surveyed 941 scientists whose grants were killed and found that Black researchers, Latinos, Native Americans, Native Hawaiians, and women were more likely to receive targeted terminations. BIPOC women had nearly three times the odds of an equity related termination compared to white men. The people studying the health of Black communities were removed at a higher rate than everybody else.The administration has not been coy about why. When STAT asked the Office of Management and Budget about new rules that health disparity researchers fear will be used to defund their work, an OMB spokesperson said that in the past, unaccountable deep state bureaucrats had funded woke and wasteful projects, and then named, as an example, a grant on engaging Black youth social media influencers. That is the government describing research into Black health outcomes as waste, on the record, to a reporter.
The Trump health cuts hit the National Cancer Institute too, though here the truth is more complicated than the headlines and worth getting right. The proposed 37 percent cut, roughly $2.7 billion, was a budget request. Congress did not pass it, and the House has since moved to increase NCI funding. But the administrative damage arrived anyway. NCI lost staff in the May 2025 layoffs, terminated grants nationwide, and began cutting the contracts that maintain its biological specimens, the physical samples that cancer research literally cannot function without. One NCI lab chief who had been there three decades told KFF Health News he lost six of his thirty people in a single year. Another employee said efforts that are lifesaving right now are being curtailed, and that people will die.
The smaller cuts are the ones that tell you the most. NIH ended federal participation in the Safe to Sleep campaign in April 2025. Black infants die of sleep related causes at more than twice the rate of white infants. The Surgeon General’s advisory declaring gun violence a public health crisis was deleted from the federal website in March 2025, the White House Office of Gun Violence Prevention was closed, and CDC injury and violence prevention staff were cut. Gun violence is the leading cause of death for Black children and teenagers in this country. Congress cut the Minority HIV/AIDS Fund by $4 million and Trump signed it. NIH terminated HIV prevention, treatment, and vaccine research grants starting March 2025, including a program targeting HIV prevention in adolescents. OMB tried to claw back $600 million from California, Colorado, Illinois, and Minnesota, including HIV and STD prevention money, until a federal judge blocked it in February.
And while all of that was happening, the machinery that detects disease was being dismantled. More than 20,000 HHS jobs were eliminated. CDC was ordered to cut $2.9 billion in contract spending, about 35 percent of its contract budget. HHS tried to pull back $11.4 billion in public health funding from state and local health departments, and courts only restored it for the jurisdictions that sued. CDC narrowed its FoodNet surveillance from eight foodborne pathogens down to two. The H5N1 bird flu emergency response was shut off entirely. RFK Jr. fired all seventeen sitting members of the vaccine advisory committee, and a federal judge later stayed fourteen of his replacement appointments.So here is what is happening right now. There are 2,231 confirmed measles cases in the United States in 2026, across 42 jurisdictions, with 32 outbreaks, and we are on pace to pass 2025, which was already the worst year in 33 years. Three people have died since this began, two unvaccinated children in Texas and one unvaccinated adult in New Mexico, the first measles deaths in this country since 2015. The Pan American Health Organization reviews America’s measles elimination status in November, and CIDRAP says we are highly likely to lose it after 26 years. Canada already did.
Be precise about the cause, because the truth is bad enough. Epidemiologists do not blame the budget cuts for the measles outbreak. They blame falling vaccination. MMR coverage among children dropped from 95.2 percent to 92.5 percent, and you need 95 percent for herd immunity. Ninety three percent of this year’s cases are in people who were unvaccinated. What the Trump health cuts did was remove the ability to see it coming and to stop it once it started, while the man in charge of American public health spent the same eighteen months telling the country that the vaccine schedule is negotiable.
Some of it got stopped. The courts blocked NIH’s 15 percent indirect cost cap permanently. Congress rejected the proposed NIOSH cut and funded it at $366.8 million after the administration asked for $73 million, and HHS reversed the NIOSH layoffs. A judge blocked the halt of $1 billion in school mental health grants. Congress refused most of the proposed $1.5 billion cut to domestic HIV programs. The Trump health cuts have a long record of getting stopped, which is itself the most damning fact in the file, because it means judges and Republicans in Congress looked at the same proposals and said no.
H.R. 1 is the one nobody stopped. It passed. He signed it. It is working exactly as designed. And he signed it on the Fourth of July.
