Two moments in 2025 revealed how vulnerable the U.S. health care system has become. The first was quiet but consequential. The Centers for Disease Control and Prevention (CDC) revised parts of its vaccine guidance in ways that appeared influenced by political pressure rather than scientific evidence. The second was impossible to ignore. Families across the country received notices that their insurance premiums would rise sharply in 2026 unless Congress extended Affordable Care Act subsidies.

The former signaled that national scientific guidance can now tilt toward ideology. The latter showed how fragile and costly it has become simply to stay healthy. Together, they revealed the same truth. America is entering 2026 with a health system that is more politically exposed, more unequal, and more unstable than at any time in recent memory.

As a physician, a mother, and the CEO of a health equity organization, I spent 2025 watching these stress fractures deepen. And while the many health-related crises of 2025—such as maternal mortality, clinician burnout, rapid and unregulated adoption of artificial intelligence, rising costs, and un-scientific, ideologically-driven public health guidances—were often perceived as separate, they all reflect a deeper question. Is healthcare in the United States a public good or a political battleground?

To move forward in 2026, we must be honest about what this year exposed: the U.S. healthcare system is officially broken. 

The American healthcare system does not treat patients equally

Throughout 2025, the federal government and several state healthcare systems advanced new restrictions on diversity, equity, and inclusion. Health systems scaled back or closed equity offices. Federal grants built to reduce racial and socioeconomic disparities were delayed or eliminated. 

This impact is not hypothetical. It is felt most acutely by the people already facing the greatest barriers. Black mothers continue to experience the highest maternal mortality rates in the country. Disabled people lose access to essential services. LGBTQ+ youth face narrowing pathways to mental healthcare. Rural communities fall further behind. Equity work is not an optional initiative. It is the safety net that prevents avoidable harm.

When equity infrastructure weakens, people die.

The cost of care is pushing families to the edge

While politicians focus on elections and budget standoffs, families have been absorbing the true cost of an unstable system. In 2025, insurance premiums rose, prescription drug prices increased, Medicaid coverage narrowed, and surprise medical bills continued to wipe out savings.

As a result, parents rationed asthma inhalers. Pregnant people delayed appointments because their insurance changed mid-year. Adults postponed essential care for chronic conditions until symptoms became too severe to ignore. These are not individual failures. They are predictable outcomes of a system that places the burden of affordability on the very people who can least afford it.

The United States spends more on healthcare than any other high-income nation. Yet millions still cannot access the care they pay for. Affordability is no longer a policy topic. It is the dividing line between health and preventable disease.

Clinician burnout intensified, revealing the promise and risks of AI

In 2025, numerous nurses, midwives, physicians, and emergency workers described conditions that were unsafe for themselves and for patients. As a result, many left clinical practice entirely. Too many of those who remained were stretched beyond their limits.

In response, health systems accelerated the use of artificial intelligence. AI was marketed as a solution to workforce shortages, administrative overload, and clinical decision making. Some tools delivered on those promises. Others mirrored and sometimes amplified the racial and socioeconomic biases already embedded in medical data.

AI can support clinicians. But without transparency, mandatory bias auditing, privacy safeguards, and community oversight, it risks automating inequity rather than reducing it. Technology cannot correct what a system refuses to acknowledge.

A healthcare system cannot function if its workforce is depleted and its technologies are unregulated.

Public trust in health institutions continued to erode

The CDC’s revised vaccine language was more than a change in wording. It signaled that scientific communication can now shift based on political influence. After years of pandemic misinformation, reproductive health restrictions, and legislative attempts to weaken public health authority, Americans have less trust in the institutions tasked with protecting them.

For Black communities in particular, viral videos showing mistreatment in medical settings and continued maternal health disparities were not new revelations. They were reminders of long-standing fears. Trust cannot be rebuilt with messaging alone. It requires accountability, consistency, and structural change.

How to heal our health care system in 2026

The events of 2025 exposed a health system that is dangerously fragile. Repairing it will require structural commitments that reach far beyond short-term fixes. To restore our health care system’s functionality, trust, and fairness, there are several steps we can take. 

First, we can protect health equity work with federal and state safeguards. In 2026, we need federal protections that prevent states and health systems from dismantling disparity reduction programs for political purposes. This includes restoring canceled grants, rebuilding equity offices inside health systems, requiring public reporting of disparities data, and safeguarding community partnerships that were defunded. Equity work must be treated as core healthcare infrastructure, not an optional initiative.

In this vein, we must stabilize access to affordable care with long-term reforms. Families cannot withstand another year of unpredictable premiums and shrinking coverage. Congress must extend ACA subsidies for multiple years rather than temporary increments. States should be incentivized to expand Medicaid and penalized for harmful redetermination practices. We need meaningful regulation of pharmaceutical pricing and stronger oversight of hospital consolidation, which contributed to historic price inflation in 2025. Affordability is not sustainable without structural cost control.

We just also take this moment to invest in maternal and reproductive health on a national level. The maternal health crisis is a national emergency. The United States needs a federally-funded maternal health action plan that expands midwifery and doula services, supports culturally affirming models of care, strengthens birthing centers, and restores access to reproductive health services that were restricted or politicized in 2025. Maternal mental health support must be integrated into prenatal and postpartum care.

This brings us to health care workers. In 2026, the country needs a national healthcare workforce recovery plan that includes competitive wages for nurses and frontline workers, mandatory safe staffing ratios, streamlined licensure mobility to address shortages, expanded loan forgiveness programs, and federal support for training pathways in rural and underserved communities. 

And as clinicians increasingly leverage AI tools, we must establish guardrails. The rapid deployment of AI in 2025 showed both its potential and its danger. In 2026, the country needs a clear regulatory framework that requires all AI tools to undergo bias auditing prior to approval, mandates transparency in training data, establishes protections for patient privacy, and ensures clinicians are trained to use AI safely rather than being forced to rely on tools they do not understand. Community oversight boards should be established to monitor AI’s real-world impact, particularly on marginalized groups. 

Moreover, we must restore scientific independence and strengthen public health authority.. In 2025, political influence weakened public trust in agencies that should be guiding evidence-based decisions. In 2026, federal and state governments must enact measures that protect scientific guidance from political pressure, rebuild systems that were weakened, fund public health workforce pipelines, and protect reproductive health data from misuse. Public health institutions must be empowered to speak clearly and honestly again.

We can help achieve these goals by expanding community-centered and preventive care. Communities filled gaps in 2025 that institutions left behind. In 2026, we must support community health workers, fund mobile clinics and home-based care,, and invest in prevention programs that reduce downstream healthcare spending. These models are evidence-based and cost-effective, and they are essential for rebuilding trust in communities that have been historically marginalized.

As a Black woman physician and mother raising two Black sons, 2025 often felt like watching a system stretch beyond its limits. But I also saw extraordinary resilience. Families advocating for themselves. Clinicians showing up despite impossible circumstances. Communities stepping in where institutions failed.

The question for 2026 is not whether we understand what must change. We do. The question is whether we will choose to build a system where every life is treated with dignity, safety, and care.