Estimates of excess deaths in 2020-21 only begin to capture the devastating health impact of the COVID-19 pandemic in the US. More deaths will occur, and a larger number of Americans will experience disease complications as delays in accessing care and increasing socioeconomic precarity take their toll. No other high-income country experienced as high a death rate during the pandemic. For decades Americans have experienced poorer health outcomes than people in peer countries because of deficiencies in the health care system, adverse socioeconomic conditions, unhealthy physical and social environments, systemic racism, and policies that jeopardize health. The pandemic exposed problems in each of these areas and highlighted the power of policy makers, including those in state government, to alter health outcomes.