9 Leading Civil Rights Groups Predict the Largest Coverage Decline in Modern History—And Black Americans Will Suffer Most

The nation’s leading civil rights organizations just issued a collective, stark warning on the arrival of a looming healthcare crisis. As conservative Medicaid cuts and the expiration of vital Affordable Care Act (ACA) tax credits threaten to strip millions of Americans of their health coverage, the fallout will not be felt equally—with communities of color pinned first on the chopping block.

Nine civil rights and health advocacy organizations including the NAACP, Families USA, UnidosUS, and the National Urban League released a new report, “Seamless, Accountable and Fair: A Civil Rights Agenda for Reconstructing Insurance Affordability Programs,” forecasting that communities of color will make up 60% of the millions projected to lose health coverage by 2034.

While that projection assumes every demographic loses coverage at an equal rate, the reality is far more severe.

“People of color make up more than 60% of Medicaid beneficiaries and more than half of ACA Marketplace enrollees,” the National Urban League (NUL) told The Root. “When lawmakers enact policies projected to cause the largest four-year coverage decline in modern history, they cannot credibly claim surprise when those losses fall disproportionately on communities of color.”

Related: How The Medicaid Cuts in the ‘One Big Beautiful Bill’ Could Devastate Black Americans

In practice, the NUL says this lack of surprise stems from “not race-neutral” administrative barriers, designed to make retaining health coverage as difficult as possible.

Research by Georgetown University Center for Children and Families explained how confusing, multi-page renewal packets mailed out blindly to old addresses, demanding physical proof of income, household size and residency within razor-thin deadlines create severe administrative burdens.

Additionally, impending work-reporting requirements and mandatory six-month redeterminations will force millions of beneficiaries to routinely upload 80 hours of monthly employment verification or pay stubs.

The report also called out the drastic healthcare cuts under the so-called “One Big Beautiful Bill” Act—which critics say is anything but. Proponents of the bill argue that tighter redeterminations and work requirements protect taxpayer dollars, but does it really?

“Cutting health coverage can reduce government spending on paper, but it does not eliminate the costs of illness,” the National Urban League told The Root. Instead, the policy simply “shifts those costs elsewhere—to hospitals, families, employers, local governments, and ultimately taxpayers.”

Beyond the immediate financial fallout for families facing unaffordable medical debt, the NUL stressed that slashing coverage destabilizes the entire public infrastructure.

“When more people have insurance, uncompensated care declines, hospital finances improve, and healthcare systems operate more efficiently,” the NUL told The Root, issuing a warning on community health: “Infectious disease is detected and treated far more effectively when people can afford to see a doctor… Communities with higher insurance coverage are better positioned to prevent outbreaks and control public-health threats.”

In a monumental ruling in July 2023, the Supreme Court preserved the ability of people to sue government agencies for violating their protections, including civil rights, the California Medical Association reported.

But preserving the right to sue on paper means very little when the actual pathways to accountability are systematically blocked.

“Neither federal agencies nor the courts currently provide adequate accountability when states violate the rights of Medicaid beneficiaries,” the NUL told The Root. “Federal agencies can face resource constraints, political obstacles, and legal challenges from states. At the same time, Supreme Court decisions have made it extraordinarily difficult for families to bring lawsuits when states violate Medicaid requirements or adopt policies that cause unjustified racial disparities.”

The organization added: “Rights without remedies are not truly rights. If federal agencies cannot always act, families need a direct path to court to enforce the law and hold state agencies accountable when eligible people lose coverage because of unlawful practices.”

And make no mistake, these coverage losses are being driven from the top down.

Marc Morial, president and CEO of the National Urban League, mentioned in a statement that the the administration and its Congressional allies are “aggressively erecting administrative barriers.” If it’s not reversed, America is headed toward a healthcare system increasingly defined by paperwork rather than medical need.

“If current trends continue, the burden of navigating the system will fall hardest on working families, people with disabilities, communities of color, immigrants, and anyone lacking the time or resources to manage increasingly complex administrative demands,” the NUL said. “The choice is between a system that requires people to prove over and over that they deserve healthcare and one that is designed to ensure eligible families actually receive it. Without reform, millions more Americans will be trapped in a maze of red tape that denies coverage despite eligibility, deepening both racial disparities and health inequities for years to come.”