BACKGROUND:
Public policy analysis highlights the connection between policy expansion and policy dismantling as parts of the same process1. In Brazil, since the constitutionalization of the universal right to health and the creation of the Unified Health System (SUS) in 1988, a conflictual process has unfolded in which policies aimed at guaranteeing this right have expanded pari passu with others involving retrenchment or dismantling2. This dynamic changes under the far-right government (2019–2022), which halted expansion and radicalized dismantling. This study analyzes the characteristics of this dismantling process and its impact on the subsequent expansion of policies aimed at guaranteeing the right to health.

METHODS:
Literature review and documentary analysis of national health policies from 2018 to 2025, focusing on austerity measures, the role of the Ministry of Health, and policies of “high institutionalization”3, including the National Mental Health Policy and the Family Health Strategy.

RESULTS:
Dismantling alters the institutional, organizational, and ethical foundations of health policies by prioritizing the private sector, reallocating fiscal resources, and changing the guiding principles of equity and citizenship, associated with conservative conceptions of health. The scope of these changes affects the socio-political arrangement that sustains the right to health and hinders the adoption of policies aimed at expanding the SUS.

CONCLUSIONS:
In Brazil, the retrenchment of health policies occurs simultaneously with their expansion. The dimensions of recommodification, cost containment, and recalibration4 shape not only retrenchment, but also the configuration of the SUS and the universal right to health. However, the radical nature of the dismantling process and the weakening of structural policies after 2019 have altered power relations in the sector, making it difficult to restore the expansion process.