Healthcare Under Siege: How Federal Changes Threaten Access for Millions

by Emily Stout (she) & Micah Caswell (they)

In January 2025, President Donald Trump returned to the White House and wasted no time enacting sweeping federal policies that are putting the healthcare of millions of Americans in jeopardy (79.3 million enrolled in Medicaid, 20.2 million with ACA marketplace coverage). These changes aren’t just numbers on a budget sheet—they have real consequences for real people. People of color, individuals with disabilities, low-income families, LGBTQ+ communities, and older Americans are facing new and devastating barriers to the care they need to survive.

The Attack on Medicaid

One of the most catastrophic blows comes in the form of an $800 billion cut to Medicaid over the next decade. This shift prioritizes $4.5 trillion in tax breaks and defense spending over the lives of 79 million Americans who depend on Medicaid for their health and well-being. This cut, narrowly pushed through a Republican-led House, will mean millions losing healthcare, hospitals shutting down, and critical services vanishing overnight.

For people living with HIV/AIDS, these cuts could be fatal. Many rely on Medicaid for life-saving antiretroviral treatments, and disruptions in care don’t just impact individual health—they increase transmission rates, worsening an already dire public health crisis. States with large Medicaid populations, like California and Texas, are bracing for the worst, as hospitals in underserved areas face closures and vital programs disappear.

Targeting Transgender Healthcare

In one of the most aggressive attacks on healthcare rights, Trump signed an executive order in January banning gender-affirming care for minors nationwide. This sweeping directive cuts federal funding for transition-related healthcare and threatens hospitals that provide these services.

This is about more than just transgender youth—this is about the government inserting itself into personal, medical decisions that should be made between doctors, patients, and families. It sets a terrifying precedent that could endanger specialized care for countless other individuals, including those living with HIV/AIDS who depend on affirming providers. This kind of federal overreach chips away at all of our medical freedoms, paving the way for further restrictions on reproductive healthcare and other essential services.

Dismantling the Affordable Care Act

The administration is also quietly gutting the Affordable Care Act (ACA), rolling back executive orders that expanded enrollment periods and funding for outreach programs. Millions of low-income families, who rely on ACA marketplaces for affordable insurance, are now at risk of being left uninsured.

This rollback disproportionately affects communities of color, who already face systemic barriers to employer-sponsored healthcare. And for those with pre-existing conditions, including HIV/AIDS, this could mean a return to higher premiums, denied coverage, and impossible choices between paying for rent or medication. Proposed cuts to the Ryan White HIV/AIDS Program and federal HIV prevention programs add yet another layer of risk, threatening treatment and access to preventative care for some of the most vulnerable among us.

The War on Health Equity and Civil Rights

As if stripping away healthcare wasn’t enough, the administration is dismantling efforts to address racial and social disparities in medicine. In February 2025, Trump signed an executive order disbanding a federal health equity advisory panel dedicated to improving care for marginalized communities, calling it “unnecessary.”

This move undermines programs tackling maternal mortality among Black women, disability-friendly medical services, and healthcare initiatives supporting LGBTQ+ individuals. People living with HIV/AIDS face increasing stigma and dwindling support as federal agencies dismantle programs aimed at reducing healthcare disparities. This is an assault on civil rights and an open invitation for discrimination to thrive.

Meanwhile, immigrant communities are being pushed out of the healthcare system altogether. The federal government’s aggressive deportation policies have turned hospitals and clinics into places of fear, discouraging undocumented people from seeking even the most basic medical care. Public health experts warn that this kind of exclusion could lead to the unchecked spread of preventable diseases, putting entire communities at risk.

Dangerous Rhetoric on Race and Vaccines

The Trump administration's assault on healthcare extends beyond policy changes with the nomination of Robert F. Kennedy Jr. (RFK Jr.) as Secretary of Health and Human Services (HHS). Known for his anti-vaccine stance and propagation of medical racism conspiracy theories, RFK Jr.'s appointment endangers the progress made in addressing healthcare inequities.

He has targeted Black Americans with anti-vaccine propaganda, suggesting that COVID-19 vaccination efforts are akin to medical experiments on Black people. In March 2021, his organization, Children's Health Defense, released an anti-vaccine video titled "Medical Racism: The New Apartheid," promoting COVID-19 conspiracy theories and discouraging vaccination among Black communities.

This rhetoric is misleading and dangerous, as it exploits historical efforts to spread misinformation. Such tactics threaten to widen existing health disparities by discouraging vaccination in communities already disproportionately affected by diseases like COVID-19.

RFK Jr.'s appointment signals a troubling shift in federal health policy. His influence could lead to decreased vaccination rates, resulting in outbreaks of preventable diseases that disproportionately impact marginalized communities. This development underscores the administration's disregard for health equity and civil rights, further marginalizing communities that have historically faced systemic barriers to care.

The Fight for Healthcare Justice

This moment demands action. Healthcare is not a privilege; it is a fundamental right. Every single person deserves access to the care they need to live a full, healthy life, regardless of their income, identity, or background.

The Trump administration’s policies put the health and well-being of millions of Americans at risk, but history has shown us that people fighting together can create change. Now is the time to organize, to advocate, and to demand that our leaders protect the most vulnerable among us.

The stakes are too high, and the lives of our neighbors, friends, and loved ones are on the line. This is a call to action—because when healthcare is under siege, we all have a responsibility to stand up and push back.