The United States currently stands at a political crossroads as recent policy changes threaten to unravel decades of progress toward healthcare equity and accessibility. Healthcare is—and has been—a battleground for competing political and economic ideologies, with each administration leaving its mark. But as new policies emerge, the question remains: Are current political shifts merely the latest iteration of a familiar cycle, or do they represent a deeper erosion of foundational healthcare reforms?
Under the Trump administration, healthcare policies favor deregulation, consumer choice, and cost-cutting initiatives, often resulting in an increase in the number of uninsured people. The new policy eliminates the individual mandate penalty, which was a key part of the Affordable Care Act (ACA); and extends the duration of short-term limited insurance (STLDI) plans.
These short-term plans, originally designed as a temporary coverage, can now last up to 12 months, with the option to renew for up to three years in some cases. They are significantly cheaper than ACA-compliant plans because they are not required to cover health needs such as maternity care, mental health services, or care for preexisting conditions.
Healthcare is—and has been—a battleground for competing political and economic ideologies, with each administration leaving its mark.
These changes come at a steep cost for vulnerable people. The repeal of the individual mandate reduced the pool of healthier people purchasing ACA-compliant plans, increasing the premiums for those who depend on comprehensive coverage, especially low-income individuals and those with chronic conditions.
That’s not considering the Medicaid work requirement, which could cause thousands of individuals to lose coverage all together if they don’t meet strict job-reporting rules. As president and CEO of advocacy group UnidosUS, Janet Murguía, stated: “Medicaid is more than a health care program….Medicaid is a fundamental pillar of economic security for 70 million Americans, including 20 million Latinos. These cuts would not only hurt individuals but also drain communities and states of essential resources, putting public health and local economies at risk.”
Georgia’s Limited Medicaid Expansion
Meanwhile, states like Georgia are experimenting with alternatives to Medicaid. Governor Brian Kemp’s limited expansion plan resulted in fewer enrollments than traditional Medicaid expansion would have provided.
Launched in July 2024, the Georgia Pathways to Coverage program was designed as a “conservative alternative” to full Medicaid expansion under the ACA, promising coverage to low-income individuals who meet specific work or volunteer requirements.
Despite projections that the program would enroll over 25,000 residents in its first year, only about 3,500 individuals had signed up by March 2024. Notably, the “conservative alternative” has cost taxpayers approximately $26 million so far, 90 percent of which has been allocated to administrative and consulting costs. Only $2 million was directed toward actual medical care for low-income individuals.
Kemp has consistently opposed full Medicaid expansion under the ACA. Had Kemp embraced full ACA Medicaid, estimates suggest that approximately 290,000 currently uninsured Georgians might have gained coverage. Instead, the limited scope of the Georgia Pathways program, combined with its stringent eligibility requirements, has resulted in lower-than-expected enrollment, leaving many without access to affordable healthcare and exacerbating existing health disparities in the state.
While Kemp plans to exempt the parents and guardians of young children from satisfying the work requirements, it doesn’t necessarily mean that the number of people eligible for the plan will grow. What it does do is allow those individuals to more easily gain and maintain coverage by excluding them from the monthly 80-hours service reports.
Kemp promotes the Pathways to Coverage program as a success, but the underlying data reveal that high maternal mortality rates, limited Medicaid expansion, and significant administrative costs in healthcare programs continue to impact the state’s healthcare system adversely.
The “conservative alternative” [to ACA Medicaid] has cost [Georgia] taxpayers approximately $26 million….Only $2 million was directed toward actual medical care for low-income individuals.
The National Trend of Privatization and Funding Cuts
Georgia isn’t alone in these initiatives to scale back Medicaid. On a national level, recent federal policies indicate a move toward privatization and reduced funding for public health initiatives, aligning with previous conservative efforts to shrink government involvement in healthcare.
As Medicaid coverage narrows and public health programs face cuts, nonprofits will likely experience increased demand for services while struggling with financial uncertainty.
Judicial rulings, state policies, and federal decisions reveal a recurring trend where healthcare access expands under one administration and contracts under another, particularly through Medicaid rollbacks and shifts in public health funding. The ACA itself has withstood multiple repeal attempts, with key elements upheld by the Supreme Court while granting states more control over Medicaid expansion, leading to stark disparities in coverage.
Yet current trends may represent more than a simple ideological shift. The scale of privatization efforts, alongside the funding freezes and systemic cuts to healthcare, suggests a deeper restructuring—one that could fundamentally reshape America’s healthcare landscape, making it challenging for future administrations to reverse without substantial policy intervention.
Mobilizing Collective Action
For healthcare nonprofits and advocacy organizations, the impact of these policy changes will be felt firsthand. The ongoing federal funding freeze poses a significant threat to social services, limiting resources for organizations that provide direct care, advocacy, and community support. As Medicaid coverage narrows and public health programs face cuts, nonprofits will likely experience increased demand for services while struggling with financial uncertainty.
But nonprofit leaders now stand at the front line of advocating for a fairer, more equitable healthcare system. They must simultaneously sustain crucial services amid dwindling resources and redouble advocacy efforts to protect healthcare rights for vulnerable populations.
Mara Youdelman, managing director of federal advocacy at the National Health Law Program, stated, “Medicaid is a lifeline, providing millions of individuals and families with essential health care. Cutting its funding would worsen inequities and push more people into crisis.”
To effectively counteract these policy reversals, healthcare nonprofits and movement activists must strategically organize and act:
- Form broad coalitions.
Unite diverse organizations around shared advocacy goals, focusing on defending Medicaid expansion and reinstating funding for preventive care.
- Leverage data-driven advocacy.
Use compelling, localized data to illustrate real-world consequences of healthcare cuts, making it difficult for policymakers to ignore community impact.
- Engage in targeted digital activism.
Mobilize grassroots supporters through social media and digital platforms, employing storytelling to humanize policy impacts and maintain public awareness and pressure.
- Hold policymakers accountable.
Persistently advocate for transparency in healthcare spending, spotlighting administrative inefficiencies such as those revealed in Georgia’s program. Demand accountability in allocating public funds toward direct healthcare.
The current shifts in healthcare policy represent not merely a cyclical swing but potentially a lasting reorientation toward privatization, reduced coverage, and inequity. Nonprofit leaders and activists must respond with sustained advocacy and collaborative mobilization.
The viability and equity of America’s healthcare system hang in the balance—now is the time to collectively resist policies undermining decades of healthcare reform and advocate for comprehensive, accessible healthcare as a fundamental human right.
