The damage wasn’t limited to numbers. It has a face.
In South Africa’s KwaZulu-Natal province, HIV-prevention clinics documented abrupt loss of access to PrEP, the medication that reduces HIV transmission by up to 99% when taken correctly.¹⁶ According to Reuters, **2.5 million people worldwide lost access to PrEP after donor funding was suspended.**¹⁷ UNAIDS went further: eight countries risked running out of HIV medicines entirely.¹⁸
A global study cited by Reuters found that development-aid cuts—including U.S. cuts—could contribute to 22.6 million additional deaths worldwide by 2030, including 5.4 million children under the age of five.¹⁹ Those numbers do not measure sorrow, or skill lost, or the cost of a village’s teacher dying before her students graduate. They simply count bodies.
When I began writing this piece, I thought the story might be about budgets. It’s not. It is about a philosophy. In federal rulemaking and memos and waivers that will never trend on social media, the U.S. signaled to the world—and to its own people—that healthcare is optional.
America once defined itself by what it built—the TVA, the interstate system, the moon landing. This year, it defined itself by what it chose not to build.
I look outside now, past the window where winter is arriving again. The wind has shifted off the Atlantic. The cold will get worse before it gets better. And somewhere near the wood stove, Sofia is asleep—curled into herself, breath slow, trusting the house to hold.
It is hard not to think of the millions of people this country once sheltered—who now live without that kind of warmth.
Bibliography (Chicago-Style)
1. Kaiser Health News. “Arkansas Medicaid Recipients Say Internet Log-In Requirement Led to Coverage Loss.” KHN reporting citing interview with Cecelia Crawford.
2. U.S. Department of Health and Human Services. Medicaid Optionality Rule, 2025. Federal rule change permitting state block-granting and eligibility removal.
3. The Denverite. Local reporting on pediatric ER testimony regarding Medicaid lapse and asthma medication gaps.
4. U.S. HHS. Notice of Termination of Cost-Sharing Reduction Payments, February 2025.
5. Federal Register. Rule Reinstating Short-Term Limited-Duration Health Plans, February 2025.
6. Kaiser Family Foundation. Patient Case Archive – Interview with Michele Ray Smith, Tampa, FL, regarding chemotherapy delay.
7. Tampa Bay Times. Coverage of ACA marketplace subsidy disruptions affecting Florida cancer patients.