Health policy in the United States in 2025 featured a series of executive and agency actions that were defined not just what was achieved, but how those changes occurred and who exercised authority.
From January 2025 through January 2026, the Trump administration led the direction, Supreme Court decisions clarified the legal landscape, and Congress was largely absent from the playing field.
The COVID-19 chapter closed early in the year. Public health leadership had overplayed its hand during the pandemic, and the first steps in moving health policy forward in 2025 involved dismantling the centralized authority that had characterized its response. Pandemic emergency authorizations were allowed to expire, COVID-19 era grants were clawed back, and federal funding of new mRNA vaccine research was ended, marking a move toward more precision technology.
At the same time, federal health institutions were reorganized to cut waste and overhead. Leadership changes and subsequent workforce reductions took place at the Centers for Disease Control and Prevention and the National Institutes for Health. Federally funded research at academic centers also was reviewed, and NIH capped inflated overhead payments that researchers had passed onto the government for years – supplemental charges which added as much as 70% to the final bill.
In January 2025, the administration directed agencies to end federal funding and coverage for medical treatment of gender dysphoria in minors. The Supreme Court’s June ruling, United States v. Skrmetti, affirmed state authority to regulate these practices in children.
In May 2025, the administration released the Make America Healthy Again report. MAHA did not propose a new legislative agenda. Instead, it focused attention on chronic diseases, nutrition, environmental exposures, and overmedicalization. The influence of MAHA in 2025 was arguably most apparent in the administration’s approach to vaccination.
Rather than a single decision on vaccines, 2025 featured a series of changes affecting both individual vaccines and the overall process for deciding which ones would be included in the universal schedule. In June, all members of the Advisory Committee on Immunization Practices were dismissed over concerns related to conflicts of interest, and in the months that followed, the newly composed committee offered recommendations to the CDC which led to multiple changes to the vaccine schedule.
COVID-19 vaccines were removed from the routine pediatric schedule. ACIP voted to pull the recommendation for the combined measles, mumps, rubella, and varicella (MMRV) vaccine in very young children and to eliminate the recommendation for the universal hepatitis B birth-dose. These and other changes accumulated throughout the year, steadily narrowing what would be considered “routine” vaccinations.
In December, the president issued a directive ordering a review of U.S. childhood immunization recommendations as compared to international schedules used by peer nations. That same month, the Supreme Court vacated and remanded a lower-court decision that until then had allowed New York to deny religious exemptions for school vaccines. The court did not comment on vaccine mandates specifically but directed reconsideration in light of its June 2025 ruling, Mahmoud v. Taylor, in which it had supported parental religious free-exercise rights in schools. The implication was clear: laws restricting parental religious rights in any context, including vaccination, would draw scrutiny.
This month the CDC narrowed the childhood immunization schedule, reducing routine vaccine recommendations from 17 diseases to 11. Since most vaccines require multiple doses, this change means that children will receive dozens fewer doses while still maintaining protection for common and serious diseases. This was the culmination of a year-long recalibration. The revised schedule reflected diminished reliance on external professional organizations, greater emphasis on individualized risk assessment and shared decision-making, and consideration of international norms.
In its report on this change to the schedule, the Department of Health and Human Services, in consultation with CDC, FDA, NIH, and CMS, emphasized the fundamental medical values of “personal autonomy, self-determination, and informed consent.”
One area executive action did not explicitly address was health care affordability. This issue came to the forefront in October 2025, as temporary COVID-era ACA subsidies were set to expire at the end of the year. Unlike other areas of health policy in 2025, this was a problem Congress alone could address. As 2025 closed, no agreement had been reached, positioning subsidies specifically, and affordability more generally, as a central issue for 2026.
Taken as a whole, the record from January 2025 to January 2026 demonstrates a coherent governing approach. Pandemic-era structures were dismantled early, institutions were reconstituted, and Supreme Court decisions clarified constitutional boundaries. Executive agencies then acted within those bounds, and administrative authority, rather than legislation, defined a consequential year. Health policy moved decisively in 2025, and it did so at President Trump’s direction. Now Congress needs to follow suit.
