Part of The Access Shift — an ongoing series examining how access is being quietly reshaped across American life. New stories every Wednesday at 12:00pm CDT.
The federal government has terminated $42 million in CDC healthcare grants, targeting programs specifically designed to address health disparities in communities of color — including the Racial and Ethnic Approaches to Community Health initiative. The cuts are not hypothetical. They are already in effect.
The broader picture is steeper. Proposed changes to Medicaid and the ACA marketplace are projected to raise premium costs by more than $1,000 a year for over 20 million people who rely on tax credits to afford coverage. Fifty-two percent of ACA marketplace enrollees are people of color. The math is not complicated.
What makes these cuts structurally significant is how federal funding flows. Roughly 80% of the CDC’s domestic budget moves directly to states, localities, tribes, and community partners. When federal grants disappear, they don’t disappear into abstraction — they disappear from the budgets of the local health departments, community clinics, and outreach programs that serve the populations with the least access to private alternatives. The gap doesn’t close. It just stops being funded.
This is part of a broader pattern of federal retrenchment that this publication has been tracking across sectors. As Federal Scrutiny Expands to Medical School Admissions examined, the question is no longer whether federal policy will reshape health access — it’s who absorbs the cost when it does. And as the data in The Black Recession Has Fresh Numbers] makes clear, these cuts are arriving in communities that are already carrying the weight of an economic contraction with no policy buffer in sight.
Several states have moved to block the cuts through legal action. The restraining orders are temporary. The structural exposure is not.
The Access Shift
The gradual redefinition of who systems are designed to serve.
Across sectors—from public infrastructure to healthcare to everyday spaces—access is no longer assumed. As costs rise and systems face increasing pressure, services once built for broad reach are becoming more selective, more conditional, and less universal. The Access Shift explores how these changes are unfolding in real time—and what they reveal about who is included, who is left out, and how the structure of everyday life is quietly being reshaped.