For decades US life expectancy at birth increased. Many clinicians and demographers assumed it would always be that way. However, an exhaustive, detailed long-term analysis by Woolf and Schoomaker1 in this issue of JAMA strengthens reports from the National Center for Health Statistics (NCHS)2 documenting recent declines in US life expectancy. Combined, the studies confirm that downward trends in life expectancy, which declined after 2014 for 3 successive years, represent a US health disadvantage compared with peer high-income nations, despite the United States having the highest per capita health care spending in the world.1