Fact Sheet: Health Care for Black Families Is on the Line as GOP Cuts Drive a Health Care Crisis

Black Americans are being forced to navigate a health care crisis created at the hands of Donald Trump and Republicans in Congress. Access to affordable, quality care is one of the most powerful tools for addressing the systemic and structural barriers that contribute to health outcomes in Black communities, including the mortality gap between Black and white Americans. Yet, Donald Trump and Republicans chose tax breaks for billionaires over affordable health care. Last year, they slashed $1 trillion in Medicaid and ripped away health care tax credits, driving up health care costs for millions of families. These cuts threaten the coverage and care that have helped reduce Black uninsured rates and expand Black Americans’ access to quality health care. Black communities will bear the brunt of these cuts. As premiums skyrocket, coverage is ripped away, and providers face growing financial strain, the racial inequities in the American health care system will only deepen. At a time when the country should be working to close racial health disparities, Trump and Republicans are widening them, making it harder for Black Americans to afford coverage, access care, and stay healthy.

By the Numbers:

• Black Americans remain 1.5 times more likely to be uninsured than white people.
• Black women are nearly three times more likely to die from a pregnancy-related cause than White women.
• Black Americans are 2.5 times more likely to be hospitalized for complications of diabetes and have nearly three times higher rates of emergency department visits for the disease than their white counterparts.
• Black Americans are 30 percent more likely to die from heart disease and 30 percent more likely to have high blood pressure than their white counterparts.
• Communities with the highest proportion of Black residents face four times the odds of hospital closures compared to those with the fewest Black residents.

Medicaid

Medicaid is the largest health insurance program in the country, providing health care for over 77 million Americans of all races. It is a critical source of health care and financial security, especially for Black families in rural and urban America who experience poverty at a higher rate than white Americans and remain less likely to have access to quality care, an important driver of health. Republicans know this and passed over $800 billion in cuts to Medicaid anyway, as well as instituting strict work requirements. Work requirements put communities of color at greater risk of losing coverage than their white counterparts, and disproportionately affect Black mothers and families; additionally, for people of color, loss of health coverage due to Medicaid cuts will be especially compounded by Republicans raising premiums and health care costs.

Medicaid Reduces Disparities In Coverage. As of 2024, Black Americans make up 13.7 percent of the U.S. population, but about 20 percent of Medicaid enrollees. Children of color also disproportionately rely on Medicaid, making up nearly 52 percent of all American children, but nearly 67 percent of the children on Medicaid. This coverage not only provides health coverage for these children, but also provides significant long-term benefits, such as being less likely to be hospitalized and more likely to graduate from high school and college.

Increasing Medicaid coverage is the single most important action to expand access to quality care and improve health outcomes.

Medicaid Expansion Saves Black Lives. Created by the ACA, Medicaid expansion extends coverage to adults 65 and under who earn up to 135 percent of the federal poverty line. Expansion has been shown to save lives and drastically reduce racial/ethnic health coverage disparities. In the remaining 10 holdout states that haven’t expanded Medicaid, 6 in 10 people in the coverage gap are people of color. States that expanded their Medicaid programs saw a 51 percent reduction in the gap between uninsured white and Black adults after expansion, and a 45 percent reduction between white and Hispanic/Latino adults.

Medicaid Improves Financial Security for Families of Color. In 2023, the annual median household income for white Americans was nearly $30,000 higher than that of Black households. Over the past decade, research has shown that the gap in medical debt between Medicaid expansion and holdout states has grown by approximately 30 percent. In 2020, Americans living in holdout states carried an average of $375 more in medical debt than their counterparts in expansion states. Poverty can produce negative long-term consequences for children and adults alike. Medicaid has long been considered one of the most effective anti-poverty programs in the nation, and its expansion has significantly improved health outcomes for people of color. In a nation where Americans are one medical bill away from being pushed into poverty, Medicaid serves as a lifeline not only for health care, but for economic stability.

Trump and Republicans Are Driving Hospitals, Clinics, and Nursing Homes Into the Ground. Trump’s Big, Ugly bill cut over $500 billion from hospitals and other essential care facilities. As a result, over 330 rural hospitals, 100 urban hospitals, 570 nursing homes, and nearly 200 Planned Parenthood health centers across the country are at risk of closure. Thirteen hospitals, 37 maternity wards, and 298 clinics have announced or closed since the passage of the bill. Already, communities with the highest proportion of Black residents faced four times the odds of hospital closures compared to those with the fewest Black residents; these cuts will only further exacerbate an access to care crisis that has been growing across the country. Hospital closures lead to crowded emergency rooms, longer ambulance waits, longer hospital stays, fewer available patient beds, and higher patient mortality among Americans. Worse still, Trump and Republicans’ hospital closures will raise prices for a hospital stay by an average of $500 at nearby facilities that remain open. Some rural counties are even forced to hike taxes to make up for the funding shortfall. The impact won’t be limited to rural areas, however. An analysis by Harvard researchers found that 85 percent of hospitals most exposed to the Trump-GOP Medicaid cuts are in urban areas. These hospital closure risks are not colorblind either; around 20 percent of all hospitals at risk of closure are within just five states where 42 percent of Black Americans reside.

Source: Center for Healthcare Quality and Payment Reform and U.S. Census Bureau, 2024 Population Estimates

The Affordable Care Act

Republicans Have Increased Premiums for Millions of Black Americans. In 2025, Republicans in Congress failed to extend premium tax credits that lowered the cost of insurance for over 20 million Americans with health coverage through the ACA Marketplace. They are now facing doubled or even tripled premiums totaling $20 billion more in health care costs, while CEOs and yacht owners pocket $120 billion in tax breaks thanks to the GOP. Families in the ten largest Black majority metro areas will pay $740 million more in annual premium costs in the coming years. Thanks to Republicans, health care is now out of reach for the nearly 75 percent of uninsured Black adults who were able to access plans for less than $50 a month with tax credits. Countless families have been pressured to cut back on food, clothing, and other basics to afford health insurance with greater out-of-pocket costs.

The Trump Administration is Increasing Uninsured Rates. Black Americans remain 1.5 times as likely to be uninsured as white people, and thanks to Republicans’ massive cuts to the ACA, over 1.4 million fewer Americans were able to get their health coverage through the ACA marketplace. Premium tax credits were especially important for Black Americans, who experienced the greatest reductions in the percentage of uninsured people. The continuation of tax credits would have increased insurance rates across every racial group, with a projected one in three uninsured Black adults gaining coverage. The GOP’s failure to extend premium tax credits is estimated to lead to the preventable deaths of 200 Black Americans each year.

Sources: CMS 2025 Open Enrollment Period Report, CMS 2026 Open Enrollment Period Report, KFF, and U.S. Census Bureau, 2024 Population Estimates

Note: Black enrollees on the ACA marketplace are an undercount, as 50 percent of enrollees on the ACA marketplace KFF has listed as “unknown” for race/ethnicity

The Maternal Health Crisis

Racial Disparities Have Worsened Over the Last Century. American women suffer the highest rates of maternal mortality in the industrialized world, and those bearing the brunt of this crisis — Black, American Indian, and Alaska Native women — have experienced staggering rates of maternal mortality generation after generation. While maternal mortality has been falling since 2020, new research suggests this decrease is most significant for white non-Hispanic women, while maternal mortality among Black women has increased. In 1915, the maternal mortality rate for Black women was 1.8 times higher than for white women, with disparities increasing in subsequent decades. In 2018, the maternal mortality rate for Black women was 3.2 times higher than for white women; the rate of maternal mortality for Black, American Indian, and Alaska Native women over 30 is four to five times higher than for their white counterparts.

New Mothers Are Being Stripped of Their Medicaid Coverage During Postpartum. The United States routinely strips new mothers of their insurance coverage, just weeks after giving birth. Women rely on the Medicaid program, which covers 41 percent of the nation’s births and 65 percent of births from Black mothers, the largest financier of childbirth in the country. Lack of access to quality, affordable health coverage is both a health and racial justice emergency. Medicaid coverage during postpartum is vital, as one in three maternal deaths occurs between six weeks and one year after delivery.