December 12th is International Universal Health Coverage Day. On this day, advocates around the world remind our governments that universal health coverage—equitable access to affordable, high-quality, comprehensive, and nondiscriminatory health care for all—is a human right. As reflected in the National Health Law Program’s (NHeLP) “Strategic Priorities” and “Universal Health Coverage Guideposts and Principles,” as well as the Medicaid and Reproductive Justice Collaborative’s* “Reproductive Justice Principles for Federal Universal Health Care Reform,” we are committed to advocating for a future in which the United States (U.S.) achieves universal health coverage for all, regardless of race, color, national origin, sex, disability, language, immigration status or length of stay, age, geography, or wealth. Over the last four years, our country made groundbreaking progress toward narrowing coverage gaps and strengthening civil rights through critical federal and state health policy reforms, from legislation enacted during the height of the COVID-19 pandemic to historic administrative reforms. In 2023, we reached the lowest national uninsured rate in U.S. history: 7.7% of the population. Still, the U.S. ranks last among peer high-income countries on health care system performance. We are drastically behind on major indicators such as access to affordable health care, reducing insurance barriers, and equity.
Incoming and returning federal policymakers should be exploring how they will build on recent momentum to close remaining coverage gaps, end health care discrimination, and improve care affordability, quality, and equity for all. Instead, President-elect Donald Trump and his allies in Congress are spending this Universal Health Coverage Day strategizing on how they will pay for tax cuts for billionaires by cutting Medicaid, our country’s public health insurance program for over 73 million people with low incomes. We also anticipate dangerous administrative attacks on Medicaid, the Affordable Care Act (ACA), and related civil rights. These include attempts to rescind rights that we spent the last four years advocating for the Biden administration to restore. If implemented, these dangerous reforms would bring about devastating coverage losses and fuel health care discrimination, jeopardizing the health and lives of millions of low-income and underserved people across the country.
People shouldn’t have to worry about health care access in the richest country in the world, and they certainly shouldn’t have to worry about already inadequate access getting worse. Nevertheless, people across the U.S. are spending this holiday season rightfully afraid that they will imminently lose their health rights. Just a few weeks ago in my dentist’s waiting room, a retired nurse struck up a conversation on this very subject with other patients. She shared that she is frightened because Donald Trump is going to cut Medicaid, her source of health insurance. I told her that I share her fear for Medicaid’s future as a former beneficiary who now works to expand and defend the program. We talked about Congress’ vow to cut the program in myriad ways—adding work requirements, block grants, per capita caps, and/or cutting federal matching funds—proposals that are straight out of the authoritarian Project 2025 playbook. And I promised her that we are going to fight like hell to stop them.
NHeLP is not new to this fight. For more than fifty-five years, we have safeguarded health care access for low-income and underserved communities, holding the line against major threats including many of the last Trump administration’s parade of dangerous attacks on health care. Through policy lawyering and advocacy, litigation, and enforcement, NHeLP has fought attempts to cut Medicaid; defeated efforts to repeal-and-replace the ACA and its Medicaid provisions; and challenged proposals to gut related civil rights. We spent this year preparing for the significant threats that we will face in 2025 and beyond. We are ready to fight whatever attacks come our way.
While we will face long and difficult battles in the coming years, NHeLP’s deep bench of health law attorneys, policy experts, communications strategists, and incredible development and operations professionals who enable us to do this work, together with our remarkable advocacy colleagues around the country, nourish my hope for the future of health care access in the U.S. I continue to believe that one day, we will achieve universal affordable, high-quality, comprehensive, and nondiscriminatory health care access for all. I hope that you will stand with us.
*The Medicaid and Reproductive Justice (RJ) Collaborative fights for reproductive justice in Medicaid law and policy. Convened by NHeLP, the Collaborative also includes Advocates for Youth, In Our Own Voice: National Black Women’s Reproductive Justice Agenda, National Asian Pacific American Women’s Forum, the National Latina Institute for Reproductive Justice, and Unite for Reproductive & Gender Equity.
