Why the Health of Americans Will Decline and What Psychotherapists Should Do About It

Compared to Peer Countries, Americans Are Sicker

One metric of a country’s overall health is its citizens’ life expectancy from birth. Life expectancy in the United States peaked at 79.3 years in 2024, with only negligible increases in recent decades. In contrast, life expectancy in other high-income countries has increased significantly over the same period and now averages 80.3 years, with two-thirds of the Organization for Economic Cooperation and Development (OECD) countries having a life expectancy that is over 80 years (OECD, 2025).

Life expectancy in the United States is the lowest among all English-speaking nations, 3 to 4 years lower than most high-income countries, and almost 6 years lower than countries with the highest life expectancy. The United States ranks 43^rd in life expectancy worldwide, placing it near Albania and Cuba (World Population Review, 2025). Additionally, 11 U.S. states have a life expectancy below 75 years (Arias et al., 2022), placing them behind 70 other countries, including Bangladesh and Vietnam. This occurs despite the United States spending much more per capita on healthcare than most other countries, including an average of 30% more than high-performing peer countries (Blumenthal et al., 2024).

The excess mortality in the United States compared to other high-income countries occurs across all age groups and for all the leading causes of death (Dehry & Krueger, 2023). However, compared with other countries, the United States has significantly more deaths due to drug overdoses, homicides, suicides, and traffic accidents (Wilkie & Ho, 2024). Also, infant mortality in the United States is double that of many other high-income countries (Dehry & Krueger, 2023). Although life expectancy varies considerably across racial and ethnic groups within the United States, the life expectancy of non-Hispanic white Americans (close to 80 years old) is still lower than the life expectancy found in most other high-income countries (OECD, 2025).

The Health of Americans Is Likely to Decline

Current administrative policies will likely lead to a decline in Americans’ health. An increase in deaths and disability rates can be anticipated as a result of direct cutbacks in healthcare funding (Basu et al., 2025), reductions in worker and public safety programs (e.g., School of Public Health, 2025), decline in living conditions for low income Americans (such as reduced availability of food stamps; One Big Beautiful Bill Act, 2025), and decreased funding for research to improve treatment approaches and interventions (U.S. Department of Health and Human Services, 2025). While some of these factors will take effect immediately, others will take effect when the Medicaid cuts are implemented after the 2026 election cycle. Some of these factors will take longer to be noticed and felt, although their impact is likely to be just as significant. Even though a vast majority of Americans will suffer in one way or another from these changes, the harm disproportionately impacts those who are economically and socially marginalized. This article outlines several policies that could harm public health.

Reductions in Healthcare Funding

The recently enacted One Big Beautiful Bill Act (2025) will remove an estimated 12 million people from Medicaid coverage, which is expected to significantly contribute to declines in health among those losing coverage (Basu et al., 2025). Medicaid is also a major payer for addiction treatment in the U.S. (Counts, 2025). The loss of treatment options for individuals formerly on Medicaid is likely to contribute to increased substance overdose deaths, which would then undo the recent decline in opioid-related deaths in the United States (Johnson et al., 2025).

As a result of cuts to Medicaid funding, many rural hospitals are likely to close entirely or to eliminate less financially viable programs, such as obstetrics or behavioral health services (American Hospital Association, 2025). 600 nursing homes are also expected to close due to funding reductions, and federal assistance for community supports for older adults has also been cut (Marseles, 2025). Moreover, the One Big Beautiful Bill Act (2025) reduces subsidies for patients covered under the Patient Protection and Affordable Care Act (2010), with the American Hospital Association (2025) estimating that one-third of individuals currently enrolled in the program will lose their coverage.  

Lastly, the One Big Beautiful Bill Act (2025) will significantly increase the national debt (Congressional Budget Office, 2025). Medicare reimbursement is tied to the federal budget deficit, and provider fee reductions will automatically take effect when the deficit reaches a specified threshold. However, Congress has the authority to waive these decreases. If implemented, this will increase healthcare professionals’ reluctance to accept Medicare patients. As healthcare systems lose revenue due to cuts in Medicaid, Medicare, and the Affordable Care Act, they may attempt to cover their costs by increasing the fees charged to commercial insurers or private payers.  

Reductions in Protections for Workers and the Public

There has also been a reduction in staff and in the enforcement at the National Institute for Occupational Safety and Health (School of Public Health, 2025) and the Food and Drug Administration (Tin, 2025), which may lead to an increase in deaths, injuries, and illnesses among the workforce and the public. Additionally, the U.S. Department of Labor has proposed removing many worker safety standards, thus increasing the risk of occupational disabilities and deaths (Bussewitz, 2025).

Reductions in Federal Emergency Management Agency (FEMA) funding will result in reduced staffing of critical positions responsible for issuing early warnings of severe weather, potentially increasing fatalities from natural disasters. Some deaths occur directly as a result of the disaster itself; however, more deaths occur after the immediate disaster ends due to disruptions in access to health care services or medications (Chu et al., 2025).

Additionally, executive orders have been issued to curtail the federal government’s enforcement of anti-pollution laws. Incentives have been introduced to favor the use of coal and oil, which are more polluting than clean energy sources. This will lead to declines in public health as pollution levels continue to rise (Nilsen & Marsh, 2025).

Lastly, a recent presidential executive order instructed the Attorney General to review all federal firearm safety laws. It is believed to be the first step in the federal government’s failure to defend firearm safety laws in court (Schascheck, 2025). If so, deaths from firearms (either from suicide, homicide, or accident)—which are already more than 11 times higher in the United States compared to other high-income countries (Grinshteyn & Hemenway, 2019) —may increase even more in the near future.

Social Determinants of Health

“Health is about more than health care” (Woolf, 2019, p. 196). The social and physical environments in which people live (e.g., stress levels, access to food) also significantly influence their health. As one example of the decline in support for healthy living environments, the federal government has imposed limitations on the Supplemental Nutrition Assistance Program (SNAP) and tightened eligibility requirements for school lunch programs (One Big Beautiful Bill Act, 2025). This is likely to significantly increase the rate of malnutrition, particularly among children and older adults, increasing the risk of disease and premature death.

Reductions in Research Funding

The current administration has halted funding for scientific projects at several private universities for reasons unrelated to the scientific merit of those projects. Additionally, the proposed budget for the National Institutes of Health has reduced its funding by 40% (U.S. Department of Health and Human Services, 2025). The withdrawal of federal funding for healthcare research will slow the development of more effective medications and scientific innovations intended to reduce mortality and improve health. 

Conclusions and Recommendations

The opportunity for a long and healthy life will be even more out of reach for many Americans. Due to space limitations, this article had to omit dozens of other ways new policies will harm public health; such as, appointing anti-vaccination activists to oversee vaccination policy within Health and Human Services (American College of Physicians, 2025), withdrawing the United States from the World Health Organization (Park, 2025), discontinuing the data collection on public health measures (Salmon, 2025), cutting funding for local public health agencies, eliminating funding for Planned Parenthood, reducing or eliminating student loans available for future health care workers, and reducing funding for programs to address domestic abuse (One Big Beautiful Bill Act, 2025).

To push back against these changes, psychotherapists should support efforts by the American Psychological Association (APA), state and territorial psychological associations, and other organizations to expand access to high-quality, affordable health care, advance research, and address social determinants of health. Psychotherapists can do this by:

• Responding to action alerts from these organizations.

• Contributing to the political action committees of the APA and state and territorial psychological associations.

• Meeting directly with public officials to express concerns.  

• Promoting dialogue and public awareness of health care issues.

Also, psychotherapy educators should educate students on their significant role in public health by adding advocacy (Singh et al., 2023), public health perspectives (Patel et al., 2023), social determinants of health (Woods-Jager et al., 2024), and skills in communicating healthcare findings to the public (Panthagani et al., 2025) into their curriculum.

In these discussions and presentations, psychotherapists should remember that promoting public health involves technical expertise (being able to explain scientific findings to a lay audience, avoiding jargon, being transparent about how conclusions were reached, acknowledging relevant limitations to their data) and social skills (listening carefully to the concerns of others, treating them with respect, building relationships, and searching for common ground). Shaming or attacking others does not work well in psychotherapy and is equally ineffective when discussing public policies.