This letter appears in HealthBegins’ July 2026 newsletter.

Dear friends,

At the midpoint of 2026, it’s time for a halftime report.

The first half of the year has been a stress test for everyone working in or touched by health care, public health, and health equity — and not the kind we would have chosen. As a result of Congressional actions, 5 million fewer people are currently enrolled in ACA marketplace plans compared to last year. More than 4 million people (and counting) have lost SNAP benefits, the steepest drop in decades, disproportionately hitting children. The Congressional Budget Office projects Medicaid work requirements will further increase the number of uninsured by 5.3 million over the next decade, and Commonwealth Fund modeling predicts 229,000 job losses nationally in 2026 alone. Some state legislatures have doubled down by enacting additional Medicaid restrictions, such as those to immigrant eligibility, that go beyond federal cuts. 

The impacts of these cuts are starting to land on states, hospitals, clinicians, public health leaders, payers, and most importantly patients and families. The stress has exacerbated all the social drivers of health, including housing, food, transportation, and access to justice. And the strain has fallen hardest on the communities we most seek to serve: Medicaid beneficiaries, immigrants, and pre-and post-partum mothers.

In medicine, a cardiac stress test deliberately provokes the heart under exertion to find what’s hidden at rest: the narrowed vessel, the inflexible artery, the muscle segments most at risk of injury. Under a federal administration bent on consolidating money and power for the moneyed and powerful, this year has been exactly that kind of provocation for our health and equity infrastructure — forcing our institutions to exert themselves under duress, and in doing so, revealing exactly where they’re most vulnerable.

What the test has shown isn’t subtle. We’ve seen a severe narrowing in the flow of vital health and equity resources. We’ve seen how little flexibility our most established institutions — health, financial, and democratic — have to withstand a sustained assault. We’ve seen worsening injury to our most vulnerable communities, which is only likely to increase as policy choices intensify the preventable harms of poverty and unmet social needs. And we feel deepening moral injury (the psychological harm of being forced to act against one’s own ethical commitments) among the health professionals who show up to care for them despite these threats.

But a stress test doesn’t only find your weaknesses. It also reveals where you have reserve capacity — the collateral vessels that have quietly built up over years, ready to carry the load when the main pathway narrows. 2026 has revealed that kind of resilience, too. We’ve seen multisector partners and local governments join forces to respond to threats together and provide mutual aid. We’ve seen (and helped) health care, public health, and community leaders resist attempts to undermine scientific rigor and medical autonomy. The lesson to carry into the rest of 2026 and beyond is that the institutions that invest now in the infrastructure of resilience will be the ones still able to fulfill their mission — this year and in whatever comes next.

At HealthBegins, we’re committed to playing our part by creating opportunities for health professionals to strengthen programs that improve social needs and population health for all, to unlock and align financing and capital for the people and places that need them most, and to transform moral injury into shared agency and actions that protect the vital institutions and infrastructure at the heart of our health and democracy. We’re doing that in three key practice areas:

• Integration: To help partners build robust connections between health and social care, we’re expanding access to our Community Health Detailing program, a proven model that leverages the power of community to increase clinic-based referrals to evidence-based health interventions and enrollments in public benefits and social services by up to 50 percent in less than six months. We’re also expanding opportunities for more states to use our practice transformation and CBO-readiness resources to drive outcomes-focused social health integration for a range of social needs, including food and nutrition. Check out our Food Is Medicine step-down model or visit this new Food Is Medicine Toolkit, which includes resources co-developed by HealthBegins, to help design, implement, and sustain FIM programs. 
• Investments: As previous funding streams and revenue models evaporate, clinical, public health, and social sector leaders need shared spaces and supports to align and reimagine health equity and social needs financing. We provide a Blended Value for Health Equity course (and will soon be launching a Blended Value for Food Is Medicine program) to help executives and managers calculate the financial, economic, and social value of their programs. Our new Billing for Medicare course equips clinics and CBOs serving Medicare and dual-eligible populations to actually get paid for vital navigation and care coordination services. And springing from a landmark convening we hosted this year at UC Berkeley, we will be launching a new field-building initiative to help leaders unlock and align capital flows for the populations, programs, and places that need them most.
• Power building: As we witness the rise in moral injury among health professionals and leaders struggling to respond to political and economic threats, we’ve seen that the only way to translate moral injury into agency is through collaborative action. Building on insights and resources from our Health Equity Policy Tracker and Mobilization Network (launched last year with funding support from the Robert Wood Johnson Foundation), we’ve developed a collaborative action framework and network to help individuals, organizations, and place-based collaboratives build skills and strategies to meet this moment. The framework is rolling out in Arizona, California, Texas, Georgia, and Massachusetts, and we aim to expand it into up to five more states by the end of the year.

Looking back at the first half of 2026, I’m still deeply concerned about the upstream stressors that are putting more people in harm’s way. As we mark the passage of 250 years since the signing of the Declaration of Independence and look to the future, let’s remember that we are not simply providers of essential services. We are part of this nation’s civic muscle, vital elements of the infrastructure at the heart of our health and democracy. With the skills, coordinated strategies and emerging solidarity to advance equitable care, unlock capital, and mobilize collective action, we can overcome present threats and any others that may come our way. 

Best,

Rishi