The 2024 election sent shockwaves through much of the healthcare industry and health equity community. Its ultimate impact remains to be written. What is certain is that, from the White House to Capitol Hill to state legislatures across the nation, it will bring significant change.

Equally certain is that our work as health equity champions remains as urgent as ever. And to see the way forward, we need a fresh understanding of our new political landscape, what it means for health care, and how to advance equity within it.

On November 19, HealthBegins convened national experts and advocates on a webinar to help us reflect, reassess, and regroup for the next stage. Nearly 1,500 people registered to attend from across the U.S., representing settings as diverse as health systems, managed care organizations, community-based organizations, research centers, and public health agencies.

The panelists were:

• Sadena Thevarajah, JD, Managing Director, HealthBegins (Host)
• Sinsi Hernández-Cancio, JD, Vice President for Health Justice, the National Partnership for Women and Families
• Sarah de Guia, JD, Chief Executive Officer, ChangeLab Solutions
• Anthony Wright, Executive Director, Families USA

The panelists emphasized the need to identify and address threats to key healthcare and health equity programs. Critical concerns included potential cuts to Medicaid, the Affordable Care Act, and Medicare—which could impact 80 million Medicaid beneficiaries and lead to premium increases and coverage losses—as well as federal and state support for housing, food security, livable income, and other health-related social needs.

The panelists also highlighted opportunities for action and underscored the importance of using data and personal stories to advocate for health equity.

This summary highlights the critical threats and opportunities identified during the discussion. Statements below reflect the opinions of the panelists.

Understanding the Landscape

• It’s important to understand the roles and powers of each branch of government (legislative, executive, judicial) to clearly see the structures for effective advocacy. Each branch holds checks and balances against the others. (Sadena Thevarajah)
• These three branches exist at the state level, as well. Some powers belong to state and local, rather than national, government. (Sadena Thevarajah)
• Individuals and organizations can consider how these branches and levels of government interface with their work and identify where they might have levers of power to pursue action. (Sadena Thevarajah)

“As we think about our work ahead, it’ll be important to be clear on who has authority to do what and to not cede power to branches or other areas of government where that power is not given.” —Sadena Thevarajah

Threats to Health Care and Health Equity

• Cuts to Medicaid, Medicare, and Affordable Care Act (ACA) funds and programs are on the table. These cuts might not take the shape of full-on repeals, but rather funding caps, block grants, or new formulae dictating how much federal money states receive to fund their programs, along with bureaucratic barriers that push people out of enrollment. (Anthony Wright)
• Millions of people depend on ACA tax credits to afford health care. If these premium subsidies are not renewed, four million people could lose coverage. (Anthony Wright)
• Features of the election campaign normalized violence against particular communities. Those most at risk of attack are immigrant communities, LGBTQ+ communities, and women’s health. We need to be ready to protect people through policy and to support each other through this moral injury. (Sinsi Hernández-Cancio)
• The tools of law and policy are key to structural change because they express our values as a society, impact a large number of people, and distribute power, resources, opportunity, and authority. (Sarah de Guia)
• The election deepened two legal and policy threats: (1) the role of the judiciary in undermining fundamental rights, and (2) the concept of preemption at the state level, which limits local governments’ ability to address health equity concerns. (Sarah de Guia)
• Three recent Supreme Court decisions (Loper Bright, Corner Post, and Jarkesy), taken together, stand to severely weaken the power of federal agencies, discredit their subject matter expertise, and undercut the protections of their regulations. (Sarah de Guia)

“We know from the previous Trump administration that there can be what feels like a constant onslaught of threats. In some ways, chaos might be part of the strategy: to confuse, to overwhelm, to distract, to exhaust.” —Sadena Thevarajah

“Follow the money. The biggest threats that I see to everybody, regardless of your community, are the attacks of caps or cuts to the core health programs that we all rely on: the Affordable Care Act, Medicaid, and Medicare.” —Anthony Wright

“The regulatory process is where the rubber meets the road in terms of how these protections are much more spelled out. So now we have to be very, very mindful about how we work with legislators, how we work with rule makers.” —Sarah de Guia

Strategies for Action

• The election results revealed a disconnect between outcomes at the top of the ticket, where many winning candidates at the national level were opposed to women’s reproductive rights, and state-level ballots, where voters in several states passed measures protecting abortion. (Sinsi Hernández-Cancio)
• To fuel advocacy, collect and share personal stories and data on the direct impacts of potential health equity threats. Then use this combination of stories and data to reframe issues in ways that enable finding common ground, in terms of human impact, economic impact, anchor institutions, and more. (Sinsi Hernández-Cancio)
• Engage in administrative law and policymaking processes at the national, state, and local levels to protect health equity, along with strategic litigation. (Sarah de Guia)
• Build relationships with newly elected policymakers now to share health equity priorities and stories into the future. Many of them don’t yet know or understand the workings or impacts of these programs. We can help them. (Sarah de Guia)

“Whatever this election was a mandate for, it wasn’t for going backwards on health care. … If this election was a mandate for anything, it was about affordability. There is a real issue of affordability, including in health care. But any effort to shred the safety net, to cut or cap our core health care programs and shift those costs onto people, is the opposite of what people wanted.” —Anthony Wright

“There’s clearly a disconnect, and that is exactly the kind of opening that we need to take advantage of. When you look at polling about a lot of the issues that we have identified as the ones that are at highest risk, they tend to be really popular issues, and that does not align with the rhetoric that we’re hearing from the elected leaders.” —Sinsi Hernández-Cancio

“Facts tell but stories sell. … You need to be able to talk to both the brain and the heart, whether it’s with the public, whether you’re talking to a journalist, whether you’re talking to a policymaker. We need to be prepared to mobilize data and human stories to be able to win.” —Sinsi Hernández-Cancio

“Part of the process is going to be about what is the calculated risk. For each institution and each organization out there, you all are going to have to have those conversations about what is the risk that we are willing to take? What is the information? What is the documentation?” —Sarah de Guia

“How do you reframe issues in ways that enable finding common ground? … We have to, while still remaining true to our vision and our values, find ways to communicate these issues in ways that more people can see themselves as having a stake in better solutions.” —Sinsi Hernández-Cancio

Further Efforts

HealthBegins will continue to host spaces for Upstreamists in many different organizations and environments who want to stay engaged in protecting health equity and receive support for taking action. If you’re interested in participating, sign up for the forthcoming Leadership Academy for Health Equity Action to be informed about future opportunities.

Selected Resources

• HealthBegins – Election Engagement Guide
• National Partnership for Women and Families – House GOP Fiscal Year 2025 Appropriations Bills Would Set Women Back Decades
• National Partnership for Women and Families – Project 2025 Threatens Women and Families’ Health and Freedom
• National Partnership for Women and Families – More than 11 million women gained reproductive rights protections in state ballot initiatives
• Families USA – Valuable Voices, Powerful Stories
• Families USA – A Pro-Consumer Policy Agenda To Achieve Meaningful Health System Transformation
• ChangeLab Solutions – Public Health Law Academy
• ChangeLab Solutions – Blueprint for Changemakers
• ChangeLab Solutions – Improving Social Determinants of Health
• Act for Public Health – Support and Resources for Strengthening Public Health Protections
• The Othering and Belonging Institute – Advancing Racial Equity: Legal Guidance for Advocates
• TED Talk – Loretta J. Ross: Don’t call people out — call them in

Note: AI assisted with the drafting of this summary. Humans expanded and edited the text for depth and accuracy.