One of the clearest success stories in US healthcare over the past 20 years has been the dramatic decline in the number of Americans without health insurance. In 2010, the year the Affordable Care Act was enacted, 16 percent of the population lacked coverage. By 2025, according to estimates from the US government, that figure was cut nearly in half, to 8.3 percent.

The increase in coverage hasn’t been a panacea; even people with an insurance card can struggle to afford their medical bills or to secure a doctor’s appointment. But with the US standing alone among its international peers in its failure to offer universal healthcare, it represented significant progress toward ensuring every American had a basic level of access to routine medical services.

Now, however, those gains are about to be reversed.

Last year, when drafting their One Big Beautiful Bill, Republicans had a chance to strike a blow against the ACA — a law they’d vilified for years — 15 years after its passage and eight years after failing to repeal the law in President Donald Trump’s first term. They established work requirements to target the people covered by the ACA’s Medicaid expansion and allowed subsidies that had helped millions of people to buy private coverage on the ACA marketplaces to lapse.

As a result, millions of Americans are dropping their health insurance this year, and millions more are expected to lose their coverage in the years to come.

The uninsured rate has spiked before, but it’s usually the byproduct of an economic crisis; people lose their jobs, and they lose their coverage. What makes the current turmoil different is that it is entirely a matter of policy choices. 

Now, millions of Americans will pay the price.

“I don’t think there’s any historical precedent for the rollback in federal support for health coverage coming with the cuts in Medicaid plus the expiration of enhanced ACA premium subsidies,” Larry Levitt, executive vice president for health policy at the healthcare think tank KFF, told me. “The expected effects of OBBBA on coverage are self-inflicted and dwarf even the historical losses due to changes in the economy.”

ACA marketplace enrollment is projected to shrink dramatically in 2026

One of the major ways that the ACA expanded health insurance coverage was by setting up insurance marketplaces where individuals and families could purchase private health plans with the help of government subsidies.

Enrollment in those marketplaces has ballooned — particularly since 2021, when Democrats in Congress approved an expansion of the ACA’s financial aid that made more people eligible for assistance. Prior to 2021, there had been a strict cutoff at 400 percent of the federal poverty level (about $64,000 for an individual in 2026, or $132,000 for a family of four). Anybody who made a higher income was ineligible for aid. After 2021, anybody could qualify for ACA subsidies, and their insurance premiums were capped at a percentage of their income. (The subsidies were initially authorized for two years and, then, were extended to 2026 through the Inflation Reduction Act.)

It seemed to have plugged one of the obvious holes in the healthcare law: While many people below 400 percent of the poverty level had enjoyed both mandated comprehensive coverage and new government subsidies that offset any increases in costs, people above that threshold had been subjected to significant premium hikes since the ACA passed. Now, they were able to access the same subsidies, and sign-ups boomed. Marketplace enrollment grew from 9.8 million Americans in 2019 to 22.3 million in 2025. 

But, to keep down the cost of their legislation and get it passed with a narrow Senate majority, Democrats allowed the new subsidies to expire in 2026. Then, Trump won the 2024 presidential election, and Republicans took control of Congress. The GOP decided not to extend the subsidies, despite some bipartisan efforts to pull together a plan. When people went to sign up for their health insurance for 2026, many of them no longer had access to financial aid. I spoke last year with some of those people. One family was preparing to allow one parent and child to become uninsured so they could afford a health plan for the other parent who has an autoimmune disease. A young man with asthma also expected to go without coverage after his previous plan ($100 per month and no deductible) was no longer available, and the cheapest replacement he could find was $282 per month with a $10,000 deductible. He told me he was banking on being able to pay for his medication out of pocket or getting it through a charity service.

So, we knew some people would drop their insurance as a result of the expired subsidies, but it was hard to be sure how many. Now, we’re starting to get hard data, and it does not look good. Based on KFF’s preliminary analysis of enrollment data and premium payments, about 4.7 million fewer people will actually end up being enrolled in an ACA marketplace plan in 2026 compared to 2025 — a 21 percent drop in a single year.

Work requirements are going to knock millions of people off Medicaid

The ACA’s other major coverage provision was the expansion of Medicaid eligibility to any American with an income at or below 133 percent of the poverty level (about $21,000 for an individual in 2026, or $44,000 for a family of four). It replaced the preexisting patchwork system for eligibility that created significant differences across states — in particular, millions of childless adults, some of whom were living in deep poverty but had been left out of the program in many states before the ACA, now qualified for Medicaid. 

As of June 2025, more than 16 million Americans who became newly eligible for Medicaid through the ACA had been enrolled in the program, making up nearly a quarter of all Medicaid enrollees.

Republicans in Congress had been sharply critical of Medicaid expansion, even as many GOP-led states adopted it, and 2025’s OBBBA gave them a chance to roll it back. They approved, for the first time, national work requirements for Medicaid, targeted to expansion-eligible enrollees, and made several other technical changes to constrain states’ Medicaid financing. People on the program will be required to work or perform other approved activities for at least 80 hours per month or show they should be exempted from the requirement. Otherwise, they could lose their benefits.

And based on what we know from historical precedent, many of the coverage losses won’t be because people are actually ineligible for Medicaid, but because of the administrative burden of complying with these new requirements, even if you are working, or if you are someone — like a pregnant person — who is supposed to be exempted. Arkansas is the only state to implement Medicaid work requirements prior to the OBBBA, and only a fraction of the people required to submit work activities to the state actually did so; many of the people who lost coverage lost it because they failed to turn in paperwork. 

The Medicaid population is, by nature, hard to reach. This group is lower-income and might work irregular hours, move around more, or have less access to the internet. It’s easy for people to fall through the cracks.

The OBBBA’s requirements go into effect nationally in January 2027 (after this year’s midterm elections), but some states are instituting them early. Nebraska implemented work requirements on May 1, Montana and Arkansas are starting theirs on July 1, and Iowa will adopt the requirements on December 1. Then, starting on January 1, 2027, they will apply in every state.

The coverage losses are difficult to project, and they could take time to accrue, but they are expected to be sizable. The nonprofit research group RAND estimated Medicaid enrollment will drop by 7.6 million people by 2034. 

And they, much like those people dropping ACA coverage, will lose more than just their insurance card. Health insurance, even with its shortcomings, does a lot to help people. Americans with health insurance accrue less medical debt. They are more likely to go to routine medical appointments and receive routine screenings. Prior research on Medicaid expansion’s effects has estimated that it saved tens of thousands of lives.

In other words, the coming increase in the uninsured rate will do more than change some percentage points on a spreadsheet; it will make it harder for millions of Americans to stay healthy and stay alive.

In a family of killer diseases, pancreatic cancer has long been one of the scariest. It could grow undetected for years, and by the time most people knew something was wrong, their prognosis was grim. The vast majority of patients, nearly 90 percent, would die within the first five years of their diagnosis. Even as other cancers saw their mortality rates drop in recent years, pancreatic cancer’s death rate actually increased slightly from 1999 to 2020.

And despite their best efforts, scientists felt stuck. In the 1980s, they identified a gene, KRAS, that seemed to be pivotal to the uncontrolled cell growth that drove the disease’s development. But over and over again, most treatments in clinical trials failed. Dr. Anirban Maitra, director of NYU Langone’s Laura and Isaac Perlmutter Cancer Center and a longtime pancreatic cancer researcher, told me that pharmaceutical companies came to regard pancreatic cancer as a “graveyard” for future drug development. Experts feared the gene was, in effect, “undruggable,” Maitra said.

But recent breakthroughs have brought what once seemed impossible within reach. A group of researchers is preparing to publish results from their clinical trial, already reported in the New York Times, that found a KRAS-targeting pill called daraxonrasib roughly doubled survival, from seven months to 13 on average, among a group of patients who had metastatic pancreatic cancer and had already tried chemotherapy.

“For the first time, there is some optimism in this disease,” Maitra told me. “Oncologists who have been treating this cancer for decades have always been so pessimistic about the fact that so many trials have failed. These patients, unfortunately, live for a few months and die. But now we finally have the foundation on which to build.”

Effectively treating pancreatic cancer — or even possibly, some day, curing it — will ultimately demand more than one successful clinical trial. It’ll require improving the full spectrum of care, which means identifying who is at risk, detecting the disease early, and producing even more effective treatments that can offer patients hope of many more years to live, not just more months.

We are getting closer to being able to diagnose and treat pancreatic cancer with remarkable precision. Here’s what it will take to get all the way there — and what everyone should know.

Doctors are getting better at figuring out who’s at risk

One major problem with pancreatic cancer is that your pancreas is buried deep in your abdomen. You could have cancer growing there for years with no symptoms. Improving the outlook starts with detecting it early — and that work begins with figuring out who is most at risk.

Many people, and even doctors, may not be aware of what to look out for, Maitra told me. There have been some high-profile deaths that temporarily put the disease in the public eye — actor Patrick Swayze, tech titan Steve Jobs — but it hasn’t been the focus of major awareness campaigns like breast or even more recently colon cancer. Pancreatic cancer accounts for about 3 percent of all cancer cases — but more than 8 percent of cancer deaths, about 39,000 every year.

Smoking, age, and obesity are all considered to be risk factors — but that is something pancreatic cancer shares with many other types of cancer. One unique risk factor is the sudden onset of adult diabetes, especially when accompanied by weight loss, Maitra said.

“If you’re like a 65-year-old and you’re presenting with new-onset diabetes and you just lost 10 pounds, I would be very worried about that person. I’d make sure I get some tests done on that person,” Maitra said. “Awareness is so important.” He clarified that most new-onset diabetes in an adult is just that, and isn’t a reason to panic. Still, he said, the connection is something more people and health care providers should be aware of. 

New artificial intelligence programs could also help doctors identify who is most at risk. Hospitals are starting to experiment with scanning electronic health records or genetic samples, Maitra said, and singling out patients who may be at higher risk based on their medical history or the presence of certain genes that are associated with a greater chance of developing pancreatic cancer (including the breast cancer-causing gene BRCA2).

Clinicians have better tools for detecting pancreatic cancer early

Once doctors identify people who are at risk, they can deploy a host of new surveillance tools to look for pancreatic cancer’s development.

Blood tests, commonly referred to as liquid biopsies, have received a lot of investment, as well as media attention. Some companies aspire to create a test that could search for multiple cancers from one sample, but in the meantime, single-disease versions have shown promising if not quite ironclad results — including for pancreatic cancer. One blood test developed by Oregon Health & Science University had an 85 percent accuracy rate in diagnosing early-stage pancreatic cancer when it was used in tandem with an existing antigen test.

Once again, AI programs could help doctors get ahead of the disease. A recent study found that an AI program developed by Mayo Clinic researchers and used to examine routine abdominal CT imaging scans could spot pancreatic cancer at nearly double the detection rate of two human radiologists, finding the disease up to three years before a normal clinical diagnosis would occur.

“This is where AI can really help because they can pick out subtle patterns that the human eye can miss,” Maitra said.

Scientists are developing better pancreatic cancer treatments

Once doctors find the pancreatic cancer, they can treat it — and their options are getting better there too. 

Maitra said the best treatment remains surgical removal plus therapy — and the smaller the tumor, the better, which is why early detection is so essential. It also prevents the cancer from having more time to metastasize and spread.

Even after surgery, the cancer can come back. But new vaccines are showing promise in preventing that kind of recurrence; small preliminary studies have identified multiple vaccine candidates that allowed patients to live longer without a relapse and survive overall longer than the historical norms for pancreatic cancer patients.

And for the people facing the most dire scenario, when their cancer cannot be removed by surgery, that’s where the new treatments targeting KRAS — the gene that drives pancreatic cancer’s growth — could be a game-changer. 

To dramatically simplify the scientific breakthrough here, KRAS has been described by researchers as a “greasy ball” that for a long time no drug molecules were able to attach themselves to. As the Times reported, Kevan Shokat, a scientist at the University of California San Francisco, figured out how to make a molecule attach to KRAS in 2013; around the same time, Greg Verdine at Harvard University was working on a molecular “glue” that could disable KRAS. The new drugs build on this research to deliver a compound to the gene that can slow the out-of-control cell growth that causes pancreatic cancer.

But we should think of daraxonrasib, which seems likely to receive FDA approval, as the “ground floor” for this class of drugs, Maitra told me. Many people still do not respond to the treatment or experience severe side effects. The drug also stops working after a period of time, as people’s bodies develop a resistance to it. But other drugs that combine different molecules in an attempt to extend the treatment’s effectiveness are already in the pipeline. 

In the future, pancreatic cancer treatment could end up becoming a combination of all of the above: early detection, surgical removal to get the bulk of a tumor out, with vaccines and/or KRAS-based treatments used to prevent the cancer from coming back. And people who can’t undergo surgery for some reason might try a combination of vaccines and KRAS-targeting drugs.

The work is far from finished. But for the first time, after decades of disappointments, there is real reason for hope.

A generation or two ago, when Americans had an important but nonemergency medical need, many of them would have called on their family doctor, somebody who had treated them for years. It was a little like going to a family restaurant: The purveyors knew you, knew your tastes and personal quirks, and they were part of the fabric of your community.

These days, patients aren’t visiting the family doctor nearly as frequently. They’re instead heading to what you might think of as drive-thru clinics — some physical, some entirely online — where they order off a menu, undergo a cursory and formulaic interaction with a healthcare provider they’ll never see again, and head off with the product they came to get. It’s like ordering a Big Mac at McDonald’s: When you pull up, you already know exactly what you want.

The very nature of medical care in the United States is changing. It is a transformation driven by the flaws of the preexisting healthcare system, technological progress, evolving patient preferences, and the do-it-yourself consumerism that is the lifeblood of modern medicine as much as any conventional clinical practice. 

In some cases, this drive-thru healthcare approach is filling genuine holes in healthcare access for Americans who are in need, such as people in the United States who live in the states with restricted access to reproductive and abortion services, and who have had no choice but to seek help online from other providers out of state. Beyond that, we’re dealing with a doctor shortage. Wait times to see a physician for all types of care are getting longer and longer — and these new practices promise to put you in touch with one with a simple click of a button. They can also offer competitive prices compared to conventional medicine, even without taking insurance, because they have maximized their efficiency. They’ve eliminated a lot of overhead in terms of physical space or administrative workload. One provider can screen an enormous number of patients and rake in a lot of revenue, which allows the company to reduce their prices.

“The word of the day in health policy is affordability,” said Dr. Ateev Mehrotra, who chairs the Department of Health Services, Policy, and Practice at the Brown University School of Public Health and has studied these practices. “You can see how these can create a more affordable and accessible way” to get healthcare.

But replacing the traditional doctor-patient relationship with something brief and transactional presents real risks to patients and their long-term well-being. Some of the most common reasons for seeking these services — erectile dysfunction medications or hair loss treatments — could be signs of an underlying health condition that would benefit from a more serious conversation with a personal physician.

The trick is in knowing the difference — and that isn’t always easy to do. The US healthcare system in its current incarnation places an enormous burden on individuals to figure out the best way to get the care they need. 

“A lot of quote-unquote empowered consumers are engaging in a lot of do-it-yourself medicine without necessarily understanding the limits of it,” Dr. Sachin Jain, who held several leadership roles in the Department of Health and Human Services during the Obama administration and is currently the CEO of the nonprofit Medicare Advantage insurance carrier SCAN Health Plan, told Vox. “I think even though there are more options for patients today than there were 30 years ago, the degree of fragmentation, in my view, is decreasing quality and truly eroding the patient experience.”

Drive-thru clinics don’t appear to be going anywhere — and that’s exactly why consumers need to be smart about how they use them.

Why drive-thru healthcare is thriving

Drive-thru medical care has emerged as primary care access has shrunk in recent decades. Long-term relationships with a family physician or general practitioner, which were once the foundation of medical treatment, are less common: The number of Americans who say their source of medical care is their personal physician has been steadily declining. As of 2018, nearly half of adults under 30 said they did not have a primary care doctor. By one estimate, 100 million Americans face some kind of barrier (physical or financial) to accessing primary care. More than 30 percent of Americans don’t have a regular source of healthcare, a share that has been steadily growing since 2000.

In hundreds of communities, a doctor shortage is already here. Most of rural America, 80 percent of it, is considered by the federal government to be medically underserved. About 20 percent of the US population lives in rural communities, but only 10 percent of doctors practice there.

“This notion that there’s going to be this available person who’s covered through your insurance, like who schedules visits with you and really gets to know you and is able to provide you with a comprehensive assessment, is just unavailable to most people,” Jain said.

Faced with these barriers, Americans have gravitated toward the convenience offered by urgent care facilities and “minute clinics” in pharmacies or large retail stores. The number of urgent care visits among privately insured Americans doubled from 2008 to 2015. In 2024, more than 80 percent of Americans said they had visited an urgent care or other kind of walk-in clinic; about 7 percent said in 2022 that it was their regular source of care.

The success of those businesses revealed Americans were comfortable with one-time-only healthcare. The idea of visiting a provider for one specific purpose predetermined by the patient started to take hold. As medical marijuana proliferated in the 2000s and 2010s, clinics popped up that offered the kind of routinized service that is now commonplace: Simply answer a few questions, and you’ll get the prescription you desire.

Today, that kind of service is available for an array of medical products and services, including erectile dysfunction pills, testosterone, GLP-1s, birth control, performance anxiety drugs, and Botox. They are finding an audience as Americans desire agency over their own healthcare — driven by the lack of access to conventional healthcare, distrust in the medical establishment, and wellness trends that prioritize self-optimization.

According to one consumer survey, 80 percent of Americans said that they own at least one personal medical device, which could include a blood pressure monitor or smartwatch. Nearly half prefer at-home or virtual care to visiting a doctor’s office. They increasingly consult Google or ChatGPT to investigate their own health before seeing a provider.

“We glorified do-it-yourself medicine through the lens of this idea of consumerism,” Jain said. “What consumerism has really done is it’s created a high degree of fragmentation in a customer base, where they may not fully understand or know what they need.”

Amid those trends, the old-fashioned image of a family doctor you’d call for any range of medical needs looks increasingly out-of-date and out of reach.

“It’s turning medical care into a commodity,” said John McDonough, a public health professor at the Harvard T.H. Chan School of Public Health and author of the new book America’s Wrong Turn: US Health Care in the Neoliberal Era. “You can buy the package of services. You can buy the individual services, and you can go to the store and pull it off the shelf.”

Medical care looks more like Hims and Hers, perhaps the most high-profile examples of this kind of limited-category telehealth. Visit their websites and it looks a lot like ordering at a fast-casual chain restaurant: Have better sex, grow fuller hair, lose more weight, treat menopause, and would you like a side of testosterone with that? In 2025, the company generated $2.4 billion in revenue, an increase of 59 percent from 2024; it now claims more than 2.5 million subscribers.

Many consumers are getting the convenience they desire, but others may feel that the patient experience suffers. Patients on social media who’ve used Hims and Hers, for example, will sometimes complain about how impersonal the interactions feel or worry the service is increasing their dose too quickly.

In a statement to Vox, Dr. Pat Carroll, chief medical officer of Hims & Hers, said:

Millions of Americans face real barriers to healthcare: long wait times, stigma, cost, and provider shortages. Digital health can help close these gaps in care but only when done responsibly.

At Hims & Hers, every treatment decision is made by a licensed, independent provider who reviews a comprehensive medical intake to determine clinical eligibility before anything is prescribed. No shortcuts. As patient expectations rise, that standard should be non-negotiable across the industry.

Why you should be cautious about using drive-thru medical services

The premise of these services is that the patient knows what they want. But even a well-informed patient is not a physician — and, at the same time, these business models are based on doctors selling a specific product, not necessarily on whether they are providing the most clinically appropriate care during this one-time interaction.

“What happened is a number of entrepreneurs started picking off specific pain points, like things that are true pain points for patients, where there’s no clean place to go, and created access,” Jain said. For example, you may not be able to find a dermatologist covered by your insurance but visit a Hims and Hers-type service, and “there’s going to be someone there who’s willing to use their medical license to actually give you the thing you need.”

Patients should be cautious about using these “drive-thru” services, given those misaligned incentives, experts told me. Two of the most popular uses — for men who are seeking treatment for impotence or hair loss — are instructive.

On its face, erectile dysfunction checks all the boxes for this kind of service: It’s a narrow medical question and there is an obvious drug for physicians to prescribe. People who might be embarrassed to bring the problem up can get the treatment they want after answering a few questions from a provider that they will never have to see again, without anybody else needing to know.

“The business model is the provider has a drug they’re trying to sell.”

Vivian Ho, Rice University healthcare economist

But erectile dysfunction can be a more complex medical question than “can you get an erection when you want to have sex?” It absolutely could be something as innocuous as older age, and therefore an ED drug is the right treatment. But it could be a sign of serious underlying health problems such as hypertension, diabetes, depression and anxiety, sleep apnea, and more. 

“Good clinical practice suggests that you have to rule out underlying causes while you’re simultaneously treating it,” Jain said. “I think that’s the kind of stuff that gets lost in clinically sloppy protocols. Oftentimes, these ‘lifestyle conditions’ are the window into broader systemic issues that go untreated or undertreated.”

Likewise, losing your hair can simply be a byproduct of aging and thus responsive to a hair-loss treatment. But it can be an outward symptom of a more serious issue like hypothyroidism or, again, stress and anxiety. Performance anxiety, which some of these services will prescribe a beta blocker for ahead of, say, a public speaking engagement, could be a signal you have deeper issues with anxiety or depression.

Or take GLP-1 drugs, which have become a popular offering for telehealth services. As Vox has reported, these powerful drugs can be effective in helping people lose weight — but they can also have serious side effects, including dramatic loss of muscle mass. They require careful management in terms of eating the right diet and getting on the right kind of exercise regimen. Developing a holistic weight-loss plan would be best done in ongoing consultation with a doctor who knows you and your medical history.

But this is where the economics of drive-thru healthcare fail patients. The doctors who practice in them don’t necessarily make money by offering you the best personalized advice or looking at your health from a whole-person perspective. They make money by prescribing you the medication you came to get; some of these services even ship the drug to you directly themselves.

“The business model is the provider has a drug they’re trying to sell,” Vivian Ho, a healthcare economist at Rice University, told me. Some pharmaceutical ads now even allow you to click through to connect with a provider who will prescribe you the advertised drug.

Secret-shopper research has revealed the limitations of these types of services. When Mehrotra’s team tried out contraception telehealth clinics using different patient profiles, they found these services were generally very good at screening for the specific product that they offer. But the companies did not take a broader look at the person’s sexual and reproductive health.

“They never address the fundamental questions. No one ever asked about STDs. No one ever asked, ‘Did you get your Pap smear?’” Mehrotra said. “There’s some holes here in this.”

Why you may sometimes need a drive-thru clinic anyway

Of course, it’s easy to say that everyone should seek out a primary care physician for some of these services — but, given the access issues faced by many people, it’s not that simple. For a person who needs birth control but can’t get an OB-GYN appointment (wait times were up 33 percent in 2025 compared to 2022), using that uncurious drive-thru clinic might be better than the alternative if the alternative is nothing.

“If a woman wants a freaking birth control, she should have every right to get birth control. … There’s all sorts of research out there about birth control deserts in the world,” Mehrotra said. “So if that’s what she wants, go for it. … You could see how the rationale for these in the context of birth control could be quite viable.”

Jain told me that, in his ideal world, insured patients would at least have a specific general practitioner who would hopefully become their first stop for some of these medical needs. The emergence of direct primary care — where patients pay a flat fee for on-demand access to the same doctor or a group of doctors — could also provide a counterweight to drive-thru clinics. The premise of these practices is that you pay for a subscription to have a doctor on call whenever you need them, and that doctor will already know you and your medical history. But those services tend to target people well-off enough to pay those fees on top of health insurance premiums (or who can afford to just pay for everything out of pocket).

And there may be times when a one-time-only provider is a good option. Going to urgent care or a minute clinic can be convenient for minor medical needs like a strep test or a flu shot. Prior case studies have found that these facilities tend to operate under rigorous clinical protocols that guide the care they offer to their patients. The value proposition is clear: It’s readily available, it’s clinically sound — and it’s cheaper than going to the emergency room.

“When there’s a degree of clinical discipline that is really rigorous and where there’s a high degree of protocolization that ensures people are getting really high-quality care, I have no problem with it,” Jain said. “But a lot of times the work is highly superficial.”

Then there is at least one truly special case, where drive-thru clinics are providing a service to patients when they have no other options available: mifepristone and other abortion drugs in a post-Dobbs America. Requests for telehealth abortion care have doubled since the decision, according to the Center for Reproductive Rights. They have offered a vital lifeline to patients with an urgent healthcare need when the alternative is having to travel out of state: A recent report from the Guttmacher Institute found that the number of American women who lived in a state with a total abortion ban and traveled out of state for an abortion dropped in 2025 while, at the same time, telehealth visits for women in those states were on the rise.

The Supreme Court is still weighing whether to permit doctors to continue virtually prescribing mifepristone. For this special type of drive-thru clinic, the stakes are high. 

“Women in the United States already face real health consequences, including preventable deaths, due to abortion care being denied or delayed,” wrote two women’s rights advocate at Human Rights Watch in May. “Ending telehealth provision would greatly worsen this crisis, especially for women and girls with limited financial resources, or with disabilities, and those living in states with abortion bans or in rural areas.”

But those abortion providers are, in the broader context of DIY healthcare, an exception that proves the rule. Without those services, patients would lose access to lifesaving medical care. 

For other healthcare needs, however, convenience does not always equal quality. Buyer — and patient — beware.

For the first time in the 21st century, the United States has approved a new sunscreen ingredient. Well, new to us.

It’s called bemotrizinol, also known as BEMT, and it’s been available in Europe and Asia for years. But the peculiar way that sunscreen is regulated in the United States — as an over-the-counter drug rather than a cosmetic — had long prevented it from coming to American store shelves. 

In 2020, however, Congress ordered the Food and Drug Administration (FDA) to overhaul its sunscreen approval process, and in 2024, DSM Nutritionals, which manufactures a bemotrizinol-based sunscreen, asked the FDA for approval. After a review of relevant safety and efficacy data, bemotrizinol has become the first new sunscreen ingredient to be approved for sale in the US since the late 1990s. The Environmental Working Group, which has lobbied for bemotrizinol’s approval since 2019, called its approval “a monumental victory for health and wellness.” 

Dr. Adewole Adamson, who is a dermatologist and assistant professor of internal medicine at the University of Texas at Austin, agreed that this is a win for consumers. “We haven’t been able to really have any innovation in US-based sunscreens since last millennium,” he told me. 

Sunscreen use has ticked downward in the US, at the same time that concerns about sunscreen seeping into your body and causing adverse health effects have risen. BEMT’s boosters hope it can change that trend by promising broad protection, a more aesthetically appealing application, and less risk of it permeating your skin.

Sunscreen is already complicated, as Vox’s Allie Volpe covered in her 7 burning questions about sunscreen explainer. Now there’s a new ingredient to consider. Here’s what you should know.

Sunscreen and the sunscreen backlash, briefly explained

The sun emits a spectrum of ultraviolet rays, including two types — UVA and UVB — that can burn your skin if you are exposed for too long without protection. 

That is why experts advise consumers to make sure they are buying “broad spectrum” sunscreen, which means it provides protection against both kinds of UV rays. Those products usually combine several different agents (or “filters”) that protect against different parts of that spectrum. 

“Some filters only cover part of the spectrum, so you have to combine a bunch of them in order to get that broad-based coverage,” Adamson said. 

Sunscreens are either “mineral” or “chemical.” Both types are equally effective if used correctly, assuming they have the same sun protection factor, or SPF, but each come with their own trade-offs. Mineral sunscreens leave unsightly white residue, while chemical sunscreens have faced widespread safety concerns in recent years.

The major shift came in 2019, when the FDA announced an overhaul in its safety assessment of some of the most popular sunscreen ingredients, sparking a backlash against chemical sunscreen in particular. The agency said that the two ingredients primarily used in mineral sunscreens — zinc oxide and titanium dioxide — were generally regarded as safe for human use. Two ingredients (aminobenzoic acid and trolamine salicylate) were said to be unsafe, and more than a half-dozen other ingredients used in chemical sunscreens were left a question mark due to “insufficient data.” New research soon followed that suggested that the ingredients in chemical sunscreens could seep into your blood and body in concerning concentrations, raising the specter of uncertain long-term health effects.

In response to the new findings and the doubts they raised about such a widely used product, anti-sunscreen advocacy spread, bolstered by the broader wellness and MAHA movements. As the Washington Post described, some people online boasted of stopping their sunscreen use — despite its clear effectiveness in preventing skin cancer, which kills thousands of people in the US every year — and promoted DIY formulas featuring, for example, oil and butter. (They do not confer the same protection.) Some influencers have even argued for the health benefits of more sun exposure.

One consumer analysis found that the percentage of Americans who believed sunscreen is toxic grew from 17 percent in 2021 to 24 percent in 2025. And, at the same time, the share of people who reporting using sunscreen at all has slightly declined.

Bemotrizonal is broad spectrum and could be more cosmetically appealing

Into that messy context comes a new sunscreen ingredient. 

A big part of what makes bemotrizinol appealing is that it provides protection against both types of dangerous ultraviolet rays on its own. And not only does it provide that broad level of protection, Adamson said, but it could also be more “cosmetically elegant,” as he put it. It won’t leave those white streaks that mineral sunscreens do, which could encourage more people to actually put it on. 

The shift toward mineral sunscreen in the wake of the chemical sunscreen panic has brought one unfortunate side effect: that white film on the skin of beachgoers and baseball game fans across the country. If you have ever applied zinc-centric sunscreen, you probably know the look (and that heavy feeling of the cream on the skin).

Chemical sunscreens can be annoying for people with sensitive skin, but by and large, people seem to prefer those products because they look better when wearing them. BEMT could make it easier for manufacturers to produce sunscreens that provide that broad level of coverage while being aesthetically more pleasing.

BEMT also comes with fewer safety concerns

The other hope is that bemotrizinol products will ameliorate some of the safety concerns that have driven sunscreen skepticism since 2019, when the one-two punch of the FDA’s announcement that most ingredients had “insufficient” data to judge their safety, followed by a worrying study, damaged the reputation of chemical sunscreens for the better part of a decade.

The study, published in JAMA in May 2019, showed several popular chemical sunscreen ingredients appeared to penetrate a user’s body in volumes sufficient enough that they should trigger new safety studies. The authors noted that some of the ingredients had previously been found in human breast milk and other bodily fluids. The findings raised real concerns, thus the FDA’s policy shift — but those concerns also took on a life of their own in the health and wellness social media ecosystem, stoking doubts about sunscreen overall.

“That freaked everyone out. And everyone was like, ‘I don’t want to do chemical sunscreens. They’re terrible. They’re getting [in] your blood. They’re endocrine disruptors.’ All of that kind of fearmongering,” Adamson said. “This ingredient doesn’t seem to do that.”

He pointed me to preliminary evidence from clinical trials that indicates BEMT does not generally lead to the same kind of concentration in human plasma. The drug has already been in use in other countries for decades and has accrued a strong safety record. But the FDA’s policy of regulating sunscreen as an over-the-counter drug, rather than as a cosmetic, sets a higher standard for approval, which meant that it took more than 25 years for BEMT to finally cross the Atlantic from Europe to the US.

BEMT will be coming soon to stores near you

DSM Nutritionals will have exclusive rights for 18 months to sell their proprietary BEMT formulation Parsol Shield in the United States; after that, other companies will be able to sell sunscreens with it in them too. Going forward, consumers can check for bemotrizinol or BEMT on the ingredients list.

Whether or not you opt for BEMT, here is the thing to keep in mind about protection when you’re buying this or any sunscreen: SPF, or sun protection factor. Experts say that the ideal is between SPF 30 and SPF 50, which blocks 98 percent of the sun’s rays. Just remember that SPF above 50 adds minimal additional protection, and doesn’t mean you can spend longer in the sun without reapplying.

Advocates hope BEMT can revive people’s faith in sunscreen which, despite the recent controversies, remains a lifesaving product. Skin cancer is still the most commonly diagnosed cancer in the United States, with more than 200,000 new cases expected this year. “American consumers deserve access to the best available sun protection,” Alexa Friedman, senior scientist at EWG, said in a statement. “Today they’re finally getting closer to it.”