For too long, systemic barriers have made it harder for disadvantaged communities to access quality health care. Unfortunately, the “Big Beautiful Bill” that was just passed will erase much of the progress we have made. The slashing cuts to Medicaid and the impractical barriers added to the Affordable Care Act (ACA) Marketplace will disproportionately impact communities of color, not just across Georgia but across the United States.
Coverage from the ACA Marketplace, supported by enhanced premium tax credits, has been a lifeline for communities of color by helping to break down systemic barriers faced when it comes to access to care, especially in states that have not expanded Medicaid. From 2020 to 2023, plan selections increased for all demographics – but selections doubled for Latino and Black consumers. In 2024, marketplace enrollment among Black people in non-expansion states increased by 116%, compared to just 78% among White, non-Hispanic people. These gains are now at risk.
The new law not only fails to extend the enhanced premium tax credits that lower monthly premiums, but it also ends auto re-enrollment and deliberately destabilizes the marketplace. The Congressional Budget Office (CBO) estimates that these changes could result in almost 14 million Americans losing coverage, with Black communities facing particularly severe impacts because of their higher reliance on ACA Marketplace plans and Medicaid. The CBO also notes when the changes laid out in the Republican Reconciliation Bill go into effect, the uninsured rate would rise by about 30%, reversing years of decline following the implementation of the ACA.
Nathaniel Smith
Manipulating health care access in such sweeping, drastic ways is unconscionable. This “beautiful” bill will inevitably lead to devastating stories, from rural hospitals closing their doors to cancer patients missing treatments. A recent study by the Urban Institute found that the cuts to Medicaid in the reconciliation bill and the expiration of the enhanced premium tax credits would lower health spending by $1.03 trillion from 2025-2034.
Rural hospitals and clinics in low-income areas would see higher rates of uncompensated care than facilities in affluent communities, where residents are more likely to have access to employer-sponsored insurance and less likely to lose health coverage due to this bill. This decrease in revenue for facilities in low-income areas would be catastrophic, especially considering that one-third of all rural hospitals in the country are already at risk of closing.
In this way, those relying on Medicaid, or the enhanced premium tax credits to purchase their insurance on the marketplace will not be the only ones to lose access to care, as facilities would close and entire communities would be forced to travel long distances to receive care.
Though the provisions in this law will harm Americans of all colors and backgrounds, we must not overlook the outsized impact they will have on communities of color. We cannot afford to stand by as the gains we have made to narrow the gap in health care access are erased. I urge policymakers to protect access to health care by extending the ACA Marketplace. Our elected officials must ensure that no one is left behind when it comes to accessing the care they need to live healthy, productive lives.
Nathaniel Smith is the founder and Chief Equity Officer of the Atlanta-based Partnership for Southern Equity.
