In this editorial, we explore the profound implications of Donald Trump's re-election on the U.S. health policy landscape. Recalling the lessons of his first term, marked by a contentious response to COVID-19 and challenges in reducing healthcare costs, we assess the potential trajectories of his administration's health agenda. With a focus on deregulation, market-based approaches, and possible shifts in public health infrastructure, the stakes are high not only for American citizens but also for global health. As Trump's policies unfold, both national and international audiences must confront a complex future that tests resilience, equity, and public trust in health governance.