Healthcare in America has never been simple, but we’ve started to see some fundamental changes making it easier for people to get the care they need. Significant shifts in major federal initiatives and smaller, local wins help remove some of the access barriers.
But is Washington building back the barriers with the new “Big, Beautiful Bill” that has been signed into law?
Medicaid Expansion – Steady Progress Now in Reverse?
Medicaid expansion has been one of the most significant policy moves since the passage of the Affordable Care Act. A slow roll of states expanding Medicaid produces:
- Millions of more Americans have health insurance
- Fewer rural hospitals are closing their doors
- Better access to mental health and preventive services for populations that need them the most.
States expanding Medicaid saw uninsured rates drop dramatically in marginalized communities. Even conservative states had voters saying, “Hey, we want healthcare, too.”
And then the “Big, Beautiful Bill” became law, making $1 trillion in cuts to the Medicaid program over the next 10 years. The expansions completely fall onto the states as their responsibility.
We have serious concerns about the states’ abilities to maintain the expanded Medicaid services and the access they create for millions of Americans.
Rural Health Gets a Boost – to be Pulled Back Down?
Rural areas have been experiencing a healthcare crisis for some time. Fewer doctors, miles of driving to get basic care, and hospitals that can’t afford to stay open.
Policymakers were paying attention, with Federal and state funding recently increasing for rural health clinics and critical access hospitals. Some states offer student loan forgiveness to encourage new doctors and nurses to practice in rural areas.
There’s funding for mobile clinics and telehealth hubs bringing care directly to people in rural areas. Grants and programs under the bipartisan Infrastructure Law and the American Rescue Plan upgrade rural broadband to make Telehealth viable where it’s needed most.
According to KFF, the “Big, Beautiful Bill” would result in approximately $155 billion in Medicaid rural cuts and establish a $50 billion rural hospital fund. Will this be enough to keep rural hospitals open?
Will broadband expansion continue to make Telehealth more accessible in rural America? At this point, we don’t know.
Mental Health Finally Gets a Seat at the Table
For a long time, mental health has been an afterthought, especially in low-income and rural communities. Recent legislation has turned that around, with states investing in integrated care models that place mental health services within primary care clinics. Medicaid expansion was used to cover peer support specialists, crisis intervention teams, and community mental health centers.
Federal funding was growing for school-based mental health programs and the 988 Suicide & Crisis Lifeline, helping people who need it the most.
Now, the transgender Suicide and Crisis helpline is closing soon, and we’ve discussed the uncertainty around the Medicaid cuts’ impact on state Medicaid expansions. We don’t know at this point what will happen to this progress, but we will watch it closely.
Local Wins That Add Up
Some of the most effective changes are happening on the local level. We’re talking about counties teaming up with nonprofits to open sliding-scale clinics, cities investing in community health workers, and school districts rolling out health centers for students and their families.
It doesn’t make the national news, but these local policies are the ones making the most difference for underserved populations. When regional leaders invest in access, they tailor programs to meet real community needs, whether it’s language access, transportation support, or on-site care in places like shelters and food pantries.
Policy Changes Matter A LOT
Access to healthcare shouldn’t depend on your ZIP code, income, or whether your state has chosen to participate in Medicaid expansion, but for now, it does, mainly due to policies. Policy literally changes lives, and the good news is we’ve recently seen movement in the right direction.
More leaders are recognizing that expanding healthcare access isn’t just compassionate, but also smart policy. Whether it’s a new law, a local initiative, or a funding boost, every step counts.
Recent events at the Federal level are clouding this picture, bringing back uncertainty on the direction healthcare access will go. All of us must remind ourselves and policymakers that access isn’t just about getting through the clinic door; it’s about making sure the door is open, nearby, and welcoming to all.
And in many places, it’s already happening. We work daily on healthcare access policy, so would you like to join us in making this happen in even more places?
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