The United States is currently at a political crossroads as recent policy changes threaten to unravel decades of advances towards healthcare equity and accessibility. Healthcare is a battlefield for competing political and economic ideologies, with each administration leaving its mark. However, as new policies emerge, the problems remain. Is the current political change simply the latest iteration of a familiar cycle or is it representing a deeper erosion of basic healthcare reforms?
Under the Trump administration, health policy supports deregulation, consumer choice, and cost-cutting initiatives, often leading to an increase in the number of people who are uninsured. The new policy eliminates individual delegation penalties, which were an important part of the Affordable Care Act (ACA). Extend the duration of your Short Term Limited Insurance (STLDI) plan.
Originally designed as temporary coverage, these short-term plans now last up to 12 months, and in some cases, they have the option to renew for up to three years. It is significantly cheaper than ACA-compliant plans because it does not need to cover health needs such as maternity care, mental health services, and existing condition care.
Healthcare is a battlefield for competing political and economic ideologies, with each administration leaving its mark.
These changes come at sudden costs for vulnerable people. The elimination of individual missions has reduced the pool of healthy people purchasing ACA-compliant plans, increasing comprehensive coverage, particularly premiums for those who rely on low-income and those with chronic illnesses.
It does not take into account the requirements for Medicaid work. This could lead thousands of individuals together to lose compensation if they fail to meet strict job reporting rules. “We're looking forward to seeing you in the world,” said Janet Murguía, president and CEO of the advocacy group Unidosus. “Medicaid is more than a healthcare program. Medicaid is a fundamental pillar of economic security for 70 million Americans, including 20 million Latinos. These reductions not only harm individuals, they emit essential resources and local economies to our communities and nations.”
Georgia's limited Medicaid expansion
Meanwhile, states like Georgia are experimenting with Medicaid alternatives. As a result of Gov. Brian Kemp's limited expansion plan, fewer registrations are available than traditional Medicaid expansions offer.
The pathway to the Georgia coverage program, launched in July 2024, was designed as a “conservative alternative” to a full Medicaid expansion under the ACA, pledging compensation for low-income people who meet specific job or volunteer requirements.
Despite forecasts that the program will register more than 25,000 residents in its first year, only around 3,500 individuals had signed up by March 2024. In particular, “conservative alternatives” have so far been around $26 million in taxpayers, with 90% of which being allocated to administrative fees. Only $2 million was directed towards the real health care of low-income people.
KEMP is consistently opposed to a complete Medicaid expansion under the ACA. If Kemp had accepted full ACA Medicaid, estimates suggest that around 290,000 Georgians who were not currently insured could have obtained coverage. Instead, the limited scope of the Georgia Pathway Program, coupled with its strict eligibility requirements, led to lower than expected enrollment, allowing many to access affordable health care and did not exacerbate existing health disparities in the state.
KEMP plans to exempt young children's parents and guardians from meeting job requirements, but does not necessarily mean an increase in the number of people eligible for the plan. What it does is make it easier for those individuals to gain and maintain coverage by removing it from their monthly 80-hour service report.
KEMP promotes the pathway to coverage programs as a success, but underlying data reveals that maternal mortality, limited Medicaid expansion, and significant administrative costs of healthcare programs continue to negatively impact the state's health care system.
“Conservative alternatives” (for ACA Medicaid) cost (Georgia) taxpayers about $26 million.
National trends in privatization and funding
Georgia is not alone in these initiatives to reduce Medicaid. At the national level, recent federal government policies have shown movements towards privatization and cut funding for public health initiatives, consistent with previous conservative efforts to reduce government involvement in healthcare.
With Medicaid coverage narrowing and public health programs reduced, nonprofits could experience increased demand for services while suffering from financial uncertainty.
Judicial rulings, state policies, and federal decisions reveal a recurring trend towards expanding access to healthcare under one manager and contracting under another control, particularly through changes in Medicaid rollbacks and public health funding. The ACA itself has withstanded multiple attempts to abolish it, with key elements being upheld by the Supreme Court, allowing more control over the expansion of Medicaid, leading to a severe disparity in the press.
However, current trends may represent more than simple ideological changes. The scale of privatization efforts suggests a deeper restructuring, along with a freeze in funding and systematic cuts to healthcare. It can fundamentally reconstruct the healthcare landscape in America, making it difficult for future policies to be reversed without substantial policy intervention.
Mobilize collective action
For healthcare nonprofits and advocacy groups, the impact of these policy changes is directly felt. The ongoing federal funding freeze poses a major threat to social services and limits the resources of organizations that provide direct care, advocacy and community support. With Medicaid coverage narrowing and public health programs reduced, nonprofits could experience increased demand for services while suffering from financial uncertainty.
However, nonprofit leaders are now at the forefront of advocating for a more equitable and equitable health care system. They must simultaneously maintain critical services in their resources and double advocacy efforts to protect health rights for vulnerable people.
“Medicaid is a lifeline and provides essential health care to millions of individuals and families. Cutting that funding exacerbates inequality and puts more people at risk,” said Mara Udelman, managing director of federal advocacy for the National Health Act Program.
To effectively counteract these policy reversals, healthcare nonprofits and athletic activists need to organize and act strategically.
It focuses on uniting diverse organizations around shared advocacy goals, protecting Medicaid expansion and restoring funding for preventive care.
Take advantage of data-driven advocacy.
Using compelling localized data, it explains real-world outcomes of healthcare reduction, making it difficult for policymakers to ignore community impacts.
Engage in targeted digital activism.
Mobilize grassroots supporters through social media and digital platforms, adopt storytelling to inspire policy, and maintain public awareness and pressure.
Holding policy makers accountable.
It continues to advocate for transparency in healthcare spending and highlights management inefficiencies as revealed by Georgia's programs. Accountability in allocating public funds directly to healthcare.
The current changes in healthcare policy could be more than just a cyclical swing, but a permanent reorientation towards privatization, reduced coverage and inequality. Nonprofit leaders and activists must respond with sustained advocacy and co-mobilization.
The viability and fairness of the American healthcare system depends on the balance. Now it's time to resist policies that undermine decades of healthcare reform and advocate for comprehensive and accessible healthcare as a fundamental human right.
