The American healthcare system in 2025 is showing signs of structural distress — not through one single collapse, but via a chain reaction of closures, policy clashes, and institutional reconfigurations that are rapidly reshaping how millions of Americans access care. Pharmacies are disappearing from towns and cities, Medicaid is facing sweeping cuts, and a massive federal reorganization is underway. In parallel, the White House is pursuing aggressive drug pricing reforms that have drawn both support and alarm. Together, these forces suggest not a recalibration of healthcare — but a systemic unraveling in real time.
Over the past several months, more than 300 pharmacies across the United States have closed. Industry projections suggest that more than 2,000 additional closures could follow before year’s end, as chains like Walgreens and Rite Aid implement cost-cutting shutdowns. These closures are largely tied to the mounting influence of pharmacy benefit managers (PBMs), intermediaries who control drug pricing for insurers and government programs. As PBM fees rise and reimbursement rates stagnate, pharmacies — especially independents in rural and underserved communities — are no longer able to remain financially viable. Legislative efforts to rein in PBMs have stalled, and as a result, so-called “pharmacy deserts” are now forming in more than half the country, leaving patients without access to basic prescriptions.
In the midst of this accelerating crisis, the federal government is attempting to respond. On May 12, President Donald Trump announced his intent to sign an executive order aimed at lowering prescription drug prices through a “most favored nation” policy. The plan would benchmark U.S. drug prices against those paid by the lowest-paying developed countries. The administration argues that this move could reduce costs by up to 80% on key medications and ease the burden on both patients and the national budget. Supporters frame it as a long-overdue correction to a system that has allowed pharmaceutical companies to set prices unchecked for decades.
However, opponents of the policy warn that such sweeping price controls could undermine pharmaceutical innovation, reduce investment in new treatments, and potentially create supply shortages. Drug manufacturers have signaled they may challenge the order in court, and several healthcare economists question whether the policy can be implemented effectively without legislative backing. The debate underscores the tension between urgent affordability needs and the long-term sustainability of medical research in the U.S.
Meanwhile, in Congress, House Republicans are pursuing a different form of healthcare reform — one focused on reducing federal spending. A proposal introduced in early May calls for $880 billion in Medicaid cuts over the next ten years. It includes the reinstatement of work requirements for able-bodied adults, more stringent eligibility checks, and a freeze on provider taxes. GOP leaders argue that these reforms are essential to control runaway costs. Critics, however, warn that the measures could leave millions of low-income Americans — including children, the elderly, and people with disabilities — without coverage, especially in states where Medicaid expansion has already been scaled back.
Layered on top of these shifts is the Trump administration’s proposed overhaul of the Department of Health and Human Services. The restructuring plan calls for a 26% reduction in discretionary funding and the elimination of nearly 20,000 staff positions. Key sub-agencies would be consolidated, and a new office for strategic innovation and pandemic preparedness would be created. While officials describe the reorganization as a modernization effort, public health experts worry that essential services — from maternal health programs to rural hospital support — could be severely disrupted or eliminated entirely. The absence of a detailed transition framework has only deepened uncertainty within HHS itself.
Each of these developments — from pharmacy shutdowns to executive orders and departmental overhauls — may appear distinct. But taken together, they reveal a broader pattern: a healthcare system under stress from multiple directions, without a unified strategy to stabilize it. The closures limit access. The cuts reduce safety nets. The reforms, while bold, come without guarantees. And through it all, the American public is left to navigate a system that increasingly feels less reliable, less accessible, and more uncertain by the day.
Whether this moment becomes a turning point toward recovery or a deepening slide into fragmentation will depend not only on federal decisions, but on how state governments, providers, and communities adapt in the months ahead. For now, the signs are clear — the system is shifting, and not always for the better.
