Skip to content
Search

Latest Stories

Top Stories

How Trump’s First 100 Days Will Radically Alter Health Care

How Trump’s First 100 Days Will Radically Alter Health Care

A patient with a medical professional.

Getty Images, Halfpoint Images

As Donald Trump completes the first 100 days of his second term, the consequences of his early health care decisions are already coming into view. Through executive orders and agency directives, his administration has set a clear national agenda: cut costs, shrink government, and reduce federal oversight.

History shows that decisions made during a president’s first 100 days have an outsized impact on the nation’s future. In 2009, Barack Obama faced a similar window of opportunity. With unified control of the government and pressure to act quickly on health care, he confronted a fundamental choice: expand coverage, improve quality, or cut costs.


President Obama made health insurance expansion his first priority, setting in motion what would become the Affordable Care Act (ACA)—the most ambitious health care reform in a generation.

In chaos theory, this phenomenon is known as the butterfly effect: a single action can trigger consequences that magnify across time and space. A butterfly flaps its wings in Brazil and a tornado forms weeks later in Texas. Presidential decisions made in the opening months of a term work the same way.

Trump, in his return to power, has made a different choice than Obama: to cut costs. This early decision has set the nation on a new course—one with consequences that will grow larger and more lasting over time. To understand the significance of Trump’s first 100 days on health care, it’s useful to revisit the path Obama charted 16 years ago.

’09 Obama: Coverage first, built to last

President Obama took office amid economic collapse and a fragmented health care system. With 60 million Americans uninsured, he decided to focus on expanding coverage as the foundation for reform.

Drawing on personal experience—his mother’s cancer battle and his time as a community organizer—Obama believed that access was the gateway to better quality and lower costs.

To ensure the durability of his plan, Obama relied on congressional legislation rather than executive action. In his first 100 days, he convened stakeholders, hosted health care summits, expanded the Children’s Health Insurance Program (CHIP), and proposed a $634 billion “down payment” on health reform in the federal budget.

These initial steps led to the ACA, which has provided affordable insurance to more than 30 million Americans (cutting the uninsured rate in half), offered subsidies to low- and middle-income families, and guaranteed protections for those with preexisting conditions. The law survived political opposition, legal challenges, and subsequent presidencies, becoming a pillar of the nation’s health care system.

However, those gains came at a price. Annual U.S. health care spending more than doubled—from $2.6 trillion in 2010 to over $5.2 trillion today—without significant improvements in life expectancy or clinical quality.

’25 Trump: Cost cutting and asserting control

In contrast, President Trump returned to the White House in January with a focus on lowering taxes, reducing government spending, and asserting greater executive power.

Health care, which represents almost a third of federal spending, quickly became central to his budget-cutting efforts. Rather than pursue time-consuming congressional legislation, he has acted through executive orders and agency restructuring.

At the center of his domestic agenda is a sweeping tax reform bill—the so-called “big beautiful bill”—which the Congressional Budget Office projects will sharply reduce federal revenue and add trillions to the national debt. To win over fiscal conservatives, the administration is pushing massive spending cuts, starting with health care.

Here are some of the most consequential actions taken during his first 100 days:

Cost-driven actions: Reducing health care expenditures

To achieve his economic plan, Trump has sought to reduce federal spending through:

  • Agency layoffs: The Department of Health and Human Services has initiated mass layoffs across the Centers for Disease Control and Prevention (CDC), National Institutes of Health (NIH), and the U.S. Food and Drug Administration (FDA), reducing staff capacity by 20,000 and cutting critical programs, including HIV research grants and initiatives targeting autism, chronic disease, teen pregnancy, and substance abuse.
  • ACA support rollbacks: The administration slashed funding for ACA navigators and rescinded extended enrollment periods, making it more difficult for individuals (especially low-income Americans) to obtain government-subsidized coverage.
  • Medicaid cutbacks: A proposed $880 billion reduction over 10 years could eliminate expanded Medicaid coverage in many states. Additional moves (like work requirements or application hurdles) would likely reduce enrollment further.

Cultural and executive power moves: Redefining government’s role

While cutting costs has been the central goal, many of Trump’s actions reflect a broader ideological stance. He’s using executive authority to reshape the values, norms, and institutions that have defined American health care. These include:

  • Withdrawal from the World Health Organization (WHO): The administration formally ended U.S. participation, citing concerns about funding and governance.
  • Restructuring USAID’s health portfolio: Multiple contracts and programs related to maternal health, infectious disease prevention, and international public health have been ended or scaled back.
  • Reorganization of DEI programs: Diversity, equity, and inclusion (DEI) initiatives have been rolled back or eliminated across several federal departments.

Trump and consequences

President Trump’s early actions are already changing how care is accessed, funded, and delivered. The biggest impact will come from efforts to reduce health care spending.

First, coverage will shrink with Medicaid cuts, ACA rollbacks, and funding freezes disproportionately affecting low-income families, young adults, and people with chronic illnesses. As coverage declines, preventable conditions are likely to go untreated, emergency room visits are likely to rise, and hospitals will be forced to provide increasing amounts of unpaid care.

Second, the rollback of global health partnerships and equity-focused programs has already begun to diminish America’s influence abroad, hinder diverse participation in clinical research, and reduce trust in federal health agencies. Slower scientific progress and weakened preparedness for future health crises will put the United States at major risk.

The U.S. Constitution gives presidents broad power to chart the nation’s course. In their first 100 days, Trump and Obama made different health care choices—one prioritizing coverage, the other cutting costs. Each demonstrates the butterfly effect: early decisions ripple across time, expanding in size and impact, and radically altering American health care for better or worse.


Dr. Robert Pearl is a Stanford University professor, Forbes contributor, bestselling author, and former CEO of The Permanente Medical Group.

Read More

Selective Sympathy: America’s Racial Double Standard on South African Asylum

Unrecognizable person clinging to a fence deprived of freedom

Getty Images//Stock Photo

Selective Sympathy: America’s Racial Double Standard on South African Asylum

It's a peculiar feeling to see the United States, a nation built on the bones of the oppressed, suddenly rebrand itself as a sanctuary for the persecuted as long as those seeking refuge are white. The current executive branch of the American government has managed to weaponize the language of human rights for its own geopolitical and racial ends— that is, selective, self-serving, misguided, and immoral.

The Trump administration is sullying the name of America, with barely a fig leaf of evidence, by trumpeting allegations of "genocide" against white South Africans. The chorus rises from right-wing newsrooms to the halls of Congress, fueled by viral videos and the breathless retelling of farm attacks, stripped of historical context or statistical rigor. White South Africans are an endangered species, so told, and America must fling open its doors, granting not just asylum but a fast track to citizenship—no questions asked.

Keep ReadingShow less
Just the Facts: Who Holds the Cards: The United States or China in Tariff Negotiations
A golden trump head stands before stacks of money.
Photo by Igor Omilaev on Unsplash

Just the Facts: Who Holds the Cards: The United States or China in Tariff Negotiations

The Fulcrum strives to approach news stories with an open mind and skepticism, striving to present our readers with a broad spectrum of viewpoints through diligent research and critical thinking. As best we can, remove personal bias from our reporting and seek a variety of perspectives in both our news gathering and selection of opinion pieces. However, before our readers can analyze varying viewpoints, they must have the facts.

What is the current status?

Keep ReadingShow less
Thoughts on Gathering Storms

Category 4 Major Hurricane Helene approaching the Big Bend of Florida. At the same time the Pacific Category 3 Hurricane John making landfall on southwestern Mexico.

Getty Images, FrankRamspott

Thoughts on Gathering Storms

The North American hurricane season runs from June 1 through November 30. The season, therefore, is hard upon us, even as the federal government is not prepared for what it may bring.

For the past 45 years, the Federal Emergency Management Agency (FEMA) has been responsible for planning and providing national emergency relief to areas in the path of or affected by catastrophic storms the season often brings. The National Weather Service (NWS) and the National Oceanic and Atmospheric Administration (NOAA), both of which are embedded in FEMA, provide critical information that FEMA used in its storm preparation process.

Keep ReadingShow less
AI Is a Weapon Pointed at America. Our Best Defense Is Education.

Elementary students raising their hands to answer the teacher's question in a class in the robotics mechanical and electric classroom.

Getty Images, Cravetiger

AI Is a Weapon Pointed at America. Our Best Defense Is Education.

Foreign adversaries are already deploying artificial intelligence as a weapon against America, not just on distant battlefields, but within our social media feeds, news sources, and critical infrastructure. AI-powered disinformation campaigns designed to sow chaos and division, sophisticated cyber attacks – these are no longer future hypotheticals; they are clear and present dangers. America's most significant vulnerability in this new era isn't necessarily a lack of technology but a lack of understanding among our own citizens. An unprepared public is fertile ground for manipulation and a weak link in our national defense. To secure our future, we must urgently equip Americans with the knowledge to navigate an AI-shaped world.

This isn't just about recognizing deepfakes. National resilience requires citizens who understand the basics of how algorithms shape their information environment and can think critically about AI's influence. Furthermore, our national security apparatus itself desperately needs more AI-savvy personnel. The Department of Defense faces alarming shortages in its cyber and tech workforce – tens of thousands of critical positions remain vacant – hindering our ability to develop, deploy, and defend against AI capabilities. Simultaneously, our economic edge depends on fostering widespread innovation and adoption of AI, which is bottlenecked by a lack of skilled workers across industries. Simply put, AI literacy is now a cornerstone of both national defense and economic competitiveness.

Keep ReadingShow less