Integrated clinical-social care and boundaries of health care

After a decade of growing momentum, the future role of health care in addressing patients’ health-related social needs (HRSNs) through integrated clinical-social care is uncertain. Under the second Trump administration, health expenditures are a focus for federal budget cuts, including proposed Medicaid cuts totaling hundreds of billions. As part of cost-saving proposals, initiatives advancing integrated clinical-social care are being targeted for cuts.Recent debates about integrated clinical-social care reveal broader disagreements about how to reduce US health care expenditures, including rolling back post–Affordable Care Act coverage expansions vs structural reforms to the health care and health care financing systems (eg, single-payer system). Along these lines, opponents of integrated clinical-social care believe that addressing HRSNs in health care represents a coverage expansion that increases inefficiencies and costs, while proponents consider it key to structurally overhauling US health care, citing evidence for reduced costs and, most importantly, improved outcomes—the key metric even in cost-effectiveness analysis. In this Viewpoint, we discuss how 2 disjointed schemas for conceptualizing integrated clinical-social care produce such conflicting conclusions and clarify 3 spheres for policy and programmatic innovation where integrated clinical-social care can be advanced.