On Monday, Jan. 20, Donald Trump was sworn in as the 47th President of the United States. While cost-of-living and economics seemed to dominate the campaign trail last year, recent alarming (yet not unexpected) news has come out on House GOP plans to take away people’s health care to fund tax breaks for the wealthy and large corporations.  

As an organization committed to race equity and health justice, we know that the next two-to-four years will bring its share of challenges. While we prepare for the new presidency and a new Congress, here are the four things we’re looking to defend – or even advance – in the next couple years. 

1. Protecting Existing Health Care 

As House Republicans look at a lineup of social safety net programs to cut to support tax breaks for the wealthy and corporations in the coming months, it appears taking away health care is very much on the table. For people on Medicaid (a popular health insurance program for children, older adults, people with disabilities, pregnant people, and adults with low incomes), this could take the form of:  

  • Cutting the amount of money states receive to support the program and putting states in the position of needing to take away coverage  
  • Adding reporting requirements, which are no more than piles of paperwork new and bureaucratic red tape to unnecessarily kick people off the program  
  • Repealing the expansion of Medicaid in the Affordable Care Act – a mechanism that has allowed about 25 million individuals (who make up to $19,000/year) to access health insurance that would otherwise be too expensive.

Additionally, congressional leaders are thinking about raising taxes on people who buy their own insurance by getting rid of tax credits that help keep out-of-pocket costs down. For families who receive these tax credits, this would raise how much they pay for health care premiums by more than $2,400 a year at a time when no one can afford that. 

As Congress wrestles with how to pay for extending tax cuts for the wealthy and corporations, we will need to be clear that health care cuts are off the table. We need policies that make health care more affordable, not more expensive.

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2. Saving No-Cost Preventive Care 

One of the great – and most popular – aspects of the Affordable Care Act was no-cost preventive care. In a nation where 100 million people have some form of medical debt, no-cost access to mammograms and other cancer screenings, vaccines, prenatal check-ups and more plays a critical role in identifying health challenges early, accessing treatment and living healthier lives without fear of the eventual bill. Preventive care saves lives and saves money, staving off more complicated and more expensive health conditions.   

Yet a court case now before the Supreme Court threatens to undermine all of that. Should the plaintiffs in this case be successful before the court, millions could lose no-cost protections for more than 50 preventive services. Insurers may be able to deny coverage altogether for these treatments or start charging for them, while employers would be able to offer health plans that don’t cover them, or do so at an additional cost to patients. 

As a protection against court challenges, 17 states and the District of Columbia have passed laws saying that insurance plans in those states must cover a range of preventive services at no cost to patients. As state legislatures begin new sessions, advocates and activists should make their voices heard to ensure their communities continue to have access to critical, no-cost screenings should the Supreme Court throw out these protections.

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3. Addressing Medical Debt and Health Care Costs

Just as no-cost preventive services shield people from taking on even more out-of-pocket costs, we as a movement have made great progress in the last few years both protecting people from incurring more medical debt and mitigating the impact it has on their lives.  

Most recently, the former Biden administration advanced a rule that removed medical debt from credit reports. Medical debt is not a good indicator of someone’s ability to pay off other debts. No one should have to worry that one unplanned doctor’s visit or hospital stay could prevent them from buying a home or securing an auto loan because of its impact on their credit. In the coming months, we will continue to collectively mobilize to protect this important, popular and bipartisan policy. 

We may also have the opportunity to go further in protecting people from medical debt and making coverage more affordable. We will continue to push for a ban on predatory medical credit cards being marketed in health care settings. We’re also working to stop the consolidation in health care and address private equity’s dangerous, profit-maximizing takeovers of our hospitals and doctors’ offices.

4. Stopping Attacks on the Health of Immigrants, LGBTQ+ People, and Pregnant People 

Last year we saw an alarming number of candidates who sought to mischaracterize immigrants, LGBTQ+ people and other marginalized communities as either dangerous or a scapegoat for the country’s larger systemic problems. This “othering” is ultimately about taking away people’s autonomy over their health and bodies and is part of a disturbing trend of politics interfering with decisions that should only be made between a patient and their doctor. 

It is troubling when Catholic bishops decide what health care services you can and cannot receive in a hospital. It is troubling when ideas are promoted about who should and should not be able to access health care based on immigration status. And it is troubling when maternity care clinics continue to close as health systems grow larger and larger and begin cutting less profitable services, creating maternal care deserts.  

To create a health system that prioritizes people over profits, advocates and policymakers must support pregnant people before and after delivery, protect reproductive and gender-affirming care, and affirm the right of all people in our country to access the care they need. 

Moreover, attacks on immigrants that create fear in hospitals and schools, limit the ability of people with DACA to get affordable health coverage, and threaten the basic idea that life-saving emergency care will be covered when needed, threaten the health and safety of everyone in our communities. Immigrants are our neighbors, caregivers, and classmates, and one in four children has an immigrant parent who may be impacted by these policies. 

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I acknowledge that these moments are hard. That the aspirations we have for ourselves, our communities and our society are under attack by individuals and institutions that are counter to our values. And while there is a need to defend against the gains we’ve made and face a flood of executive orders and congressional threats in the coming months, there will also be opportunities to advance our collective work together by passing state-level protections and supporting bipartisan work on medical debt and affordability in Congress. We look forward to our continued work together to build a health system rooted in race equity and health justice, and a society where health is a right for all.