🇺🇲🤔 American Healthcare: Explained To A Brit

Trump! Tariffs! MAHA! Measles! Dr Oz! Wars! America! 
Buzzwords! Headlines! Every day, a new move from the Trump administration. Made, unmade, and then re-made once again.

It’s frankly exhausting trying to keep up with it all. And it doesn’t even affect me. I’ve sold my soul for free medication and an 8-month-wait for a physio appointment.
No regrets. Mostly.

But it’s true. Americans are loud. Like my pub next door on Saturday. You try to tune it out, but the drama is so juicy, it’s impossible to ignore. 

So, whether you were considering a change of scenery or just want to be a little bit more in the know, we’ll dive into the timeline changes that have occurred over the last 12 months.

American Healthcare is the definition of “a lil bit of this, a lil bit of that” system. A real Frankenstein’s monster vibe going for it. 

They operate on a fee-for-service model(they charge for everything). They’ll send a bill for the ambulance, the MRI, the bed and the paper used for the discharge letter. Who pays depends on who you are, where you live and if your boss likes you.

The main players are:

Then there are the uninsured. This is around 8.5% of the American population. Around 27 million Americans have to pay out of their own pocket for services. Crazy thing is, this is an improvement. In 2010, before the Affordable Care Act, it was a whopping 16%.

But the Trump Administration has been doing everything in its power to disrupt this balance. Kicking off in January 2025…

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She was goofy. Loyal. A little embarrassing.
But you loved her anyway.

And at the time, [email protected] felt like a forever thing.
By 16, you realised… it wasn’t.

Then came uni.
She was older. Respected. From the prestigious .ac.uk lineage.
But on your final day, she pulled a Leonardo DiCaprio and dumped you for a fresher.

Next… the @nhs.net era.
Every rotation, a new address. Messy. Endless awkward breakups.
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The Administration's objectives are to shift emphasis from treatment to prevention, enhance personalised care, reduce drug costs (how implementing tariffs aids this, idk), and implement regulatory and market reforms. 

Trump wasted no time. In a classic Republican vs. Democrat tug-of-war, he cancelled Biden’s cancellation of his own Executive Order 13813. 

EO 13813 sounds nice. “More healthcare choice and competition”. Until you realise it just greenlights short-term, low-coverage insurance plans. The kind that proudly don’t cover pre-existing conditions and maternity care. 

Nobody likes a snake-oil salesman, but Trump has made it into an official business model.

Next up, Project 2025. The Heritage Foundation’s dystopian vision board. It’s a 900-page conservative blueprint for how to reshape the entire U.S. government, and the Trump administration is going full steam ahead with it. Which is kind of funny, because during his campaign, Trump claimed to have “no idea what Project 2025 even is.” 🤷

I’m not sure if it’s good or bad that the President is this open to new ideas…
Especially since the changes include:

But of course, with most things, Trump's brazen actions have opposition. Medical institutions and 22 states sued. So, by Feb 10th, a federal judge VAR checked his action and halted the funding cuts.

So much chaos, so so many cut attempts:

It’s the 4th of July. 

In amongst the fireworks, corndogs and all the other patriotic hoo-ha, Trump signed the One Big Beautiful Bill Act into law. 

What is it?

A sweeping piece of legislation that “solves” 3 major political goals in the U.S right now: cutting federal spending, shrinking Obamacare and reshaping welfare policy. 

I’ll save you 1000 page read and tell you this. The main takeaway is a $1 trillion cut to healthcare programmes over the next decade. One Trillion! The largest rollback of Federal healthcare support of all time. 

The sentiment from supporters of the bill is simple. There are too many able-bodied people on Medicaid. 

To quote the House speaker, Mike Johnson

“If you are able to work and you refuse to do so, you are defrauding the system… You’re cheating the system.”

To address this, the bill introduces the first-ever national Medicaid work requirement.

Adults aged 19 to 64 will need to complete 80 hours per month of work, education, or community service in order to keep their coverage.

Fail to meet that requirement, and you lose it.

The CBO estimates 5.3 million people will lose access through this mechanism alone. 

On top of this, it would seem Obamacare(ACA) may also be thwarted. The bill will not extend the subsidies that keep marketplace insurance policies affordable. 

That’s 22 million people facing an average premium increase of 114% and an estimated 10 million more people going uninsured by 2034. Deary Deary me.  

To practice in the USA, you need a couple of things. USMLE completion, matching to a US hospital and, of course, a valid visa.

There are two main visas needed to practice in the States: the J-1 and the H1-B Visa. 

A J-1 visa is more common for IMGs wanting American residency. But this requires a two-year home-country residency after finishing the course. AKA back to stinky Britain before you return to the land of the free. 

The more attractive visa is the H-1B visa. This is because there is no return requirement. As with all attractive things, it’s a bit rarer too. Fewer programmes sponsor it, but if you do get it, happy days. 

On the 19th September 2025, the Trump Administration announced plans to raise the price of this coveted visa from a maximum of $4500 to $100,000. That’s a six-figure bet your residency programme now has to place on you.

This was done to deter tech companies from hiring IMGs, but as with a lot of this new administration's decisions, it clearly hasn’t been fully thought through… considering the states already has doctor shortage (86,000 by 2036), and they made plans to make it easier to emigrate a couple of months ago.  

Some preliminary reports suggest healthcare professionals will be exempt, but with a POTUS as unpredictable as the end of Shutter Island, don’t bet on it.

Trump has officially channelled his inner Oprah Winfrey:

“You get affected! You get affected! Everyone gets affected!”

For Patients: 

For Healthcare Providers:

Goodness gracious me, even explaining all this has me dizzy. And this is by no means everything that’s happened either. I’m sure by next week, all this information will be obsolete and redundant.
Oh, the futility of life 😣. 

The Trump administration says it wants to reform the system, cut costs, and increase access. And maybe some of that’s true. But when the reforms look like a bonfire of public health programs, slashed research budgets, and, on top of international instability, it’s hard not to feel like the patient being left behind in the waiting room.

Bottom line: Shout out to the NHS. Eight months for physio never looked so premium.

Handover Over 🫡

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