Civil rights groups: ACA, Medicaid cuts exacerbate health disparities

A national coalition of civil rights groups is warning lawmakers that premium tax credit cuts to Affordable Care Act coverage, plus changes in Medicaid eligibility, will exacerbate racial health disparities in health plan enrollment.

NAACP, Asian & Pacific Islander American Health Forum, the National Council of Negro Women, the National Urban League, the Southern Poverty Law Center (SPLC), UnidosUS, the Coalition on Human Needs, Community Catalyst and Families USA joined forces in publishing the report.

According to the coalition, recent changes to the ACA Marketplaces and Medicaid eligibility will have dire consequences not just for health plan enrollment, but for health equity.

Last July, Congress passed the One Big Beautiful Big Act, which set in place new eligibility requirements for the Medicaid program. These provisions, which include new eligibility checks and the introduction of federal work requirements, are expected to reduce Medicaid enrollment.

Meanwhile, the ACA Marketplaces are undergoing significant change, particularly after Congress allowed enhanced premium tax credits to sunset. Those tax credits previously helped offset the rising cost of Marketplace premiums. Already, the industry has seen lower health plan enrollment.

Citing figures from the Congressional Budget Office, the coalition stressed that nearly 16 million people will become uninsured by 2034 due to those ACA and Medicaid changes.

The coalition found that racial and ethnic minorities will bear the brunt of those coverage losses, with 60% of the individuals who stand to lose Medicaid or ACA coverage coming from communities of color.

This includes 4.3 million Latinos, 2.4 million African Americans, nearly 1 million Asian American, Native Hawaiian and Pacific Islanders (AANHPI) and around 100,000 Native Americans who will lose Medicaid or ACA Marketplace coverage, the coalition's report showed.

More specifically, the share of uninsured is set to rise by 62% for Black people and 80% of AANHPI people.

"These coverage losses will deepen current problems, putting great strain on hospitals, clinics and other healthcare providers that, in many cases, already struggle to meet community needs," the report authors said.

Notably, these disproportionate coverage losses will reverse health equity gains made in recent years. Although there have long been racial health disparities in Medicaid and ACA Marketplace enrollment, the severity of those disparities declined between 2010 and 2024.

For example, in 2010, the number of Latino uninsured people was nearly 20% higher than the national average. By 2024, that number shrank to a 12% difference. A similar trend was observed among Black, AANHPI, Native American and multiracial people.

The coalition called not just for a reversal of coverage changes, but also a better overall infrastructure for health equity. This includes streamlining eligibility checks based on Supplemental Nutrition Assistance Program or tax return data, creating single eligibility for all health programs and funding independent customer service programs for health services.

Additionally, the groups called for better accountability for health programs that might violate civil rights and extension of affordable healthcare regardless of race or zip code.

"We have already seen millions lose coverage because of paperwork and bureaucratic obstacles rather than ineligibility," Derrick Johnson, president and CEO of the NAACP, said in a statement. "As lawmakers consider the future of our healthcare system, they must reject policies that widen racial disparities and instead build programs that are seamless, accountable and fair for the communities that have too often been left behind."

Notably, the HHS and CMS do not bill ACA and Medicaid changes as ploys to undercut health equity. Rather, they have stressed that these changes will root out healthcare fraud.

Be that as it may, structural inequities will inevitably influence how public policy plays out. In this case, the coalition argues that ACA and Medicaid changes are built on a system that disproportionately affects communities of color, further exacerbating inequities that were already present.

Sara Heath is an executive editor at Xtelligent Healthcare Media, where she covers patient engagement, healthcare policy and health IT.