Examining the Effects of U.S. Presidential Transitions on Health Equity and Justice for Marginalized Groups
Every four or eight years, the United States undergoes a presidential transition. These changes bring in policy priorities, governance strategies, leadership. As a result, there are significant impacts on health equity and justice—areas where even minor policy changes can have profound implications for vulnerable populations. While some administrations may introduce initiatives to advance health equity, others might prioritize cost-saving measures that unintentionally (or intentionally) worsen these gaps.
Presidential transitions influence healthcare access, funding, and strategies for addressing disparities. Vulnerable groups—such as low-income communities, racial and ethnic minorities, people with chronic illnesses, and individuals living with HIV/AIDS—are most affected by these shifts. To understand how these changes have historically impacted health equity, examining specific examples of past policies, their outcomes, and the enduring challenges they create is essential.
Historical Context: The Legacy of Federal Health Policies
Health disparities in the United States have roots in policies that perpetuate systemic inequities. For example, mid-20th-century redlining policies segregated neighborhoods, relegating Black and minority populations to areas with limited healthcare infrastructure and fewer opportunities for economic mobility. This legacy of disinvestment left many communities without access to hospitals or primary care, reinforcing cycles of poor health outcomes.
In the 1960s, the introduction of Medicare and Medicaid during President Lyndon B. Johnson’s administration marked a pivotal moment for health equity. These programs expanded healthcare access to elderly individuals, low-income families, and people with disabilities, disproportionately benefiting minority communities. However, subsequent administrations have varied in their commitment to maintaining and expanding these programs. For instance, the Reagan administration’s cost-containment policies limited Medicaid funding, restricting access for vulnerable populations.
Special Federally Funded Programs Addressing Health Equity
Ryan White HIV/AIDS Program
The Ryan White HIV/AIDS Program is a federal initiative that provides medical care, medication, and support services to low-income individuals living with HIV/AIDS. Established in 1990 during President George H.W. Bush’s administration, the program addresses gaps in healthcare for uninsured or underinsured populations.
By 2021, the program served over 500,000 individuals, with 89% achieving viral suppression—an essential metric for improving health outcomes and preventing HIV transmission (Health Resources and Services Administration, 2023). Continued funding of this program has been vital for marginalized communities, particularly Black and Hispanic individuals, who are disproportionately affected by HIV/AIDS.
HUD Housing Programs
The U.S. Department of Housing and Urban Development (HUD) administers housing assistance programs that intersect with health equity. Programs like Housing Opportunities for Persons With AIDS (HOPWA) and public housing initiatives address the social determinants of health by providing stable housing to vulnerable populations.
Research shows that stable housing significantly improves health outcomes for individuals with chronic conditions, including HIV/AIDS and diabetes. During the COVID-19 pandemic, HUD programs played a critical role in preventing homelessness among low-income families and ensuring access to essential healthcare services.
Recent Policy Shifts and Their Impact:
Affordable Care Act (ACA)
President Barack Obama’s administration marked a transformative era for health equity with the passage of the Affordable Care Act (ACA) in 2010. The ACA expanded Medicaid eligibility, provided subsidies for private insurance, and prohibited insurers from denying coverage based on pre-existing conditions. These changes significantly reduced the uninsured rate among low-income and minority populations, with Black Americans, Hispanic Americans, and women experiencing the greatest gains in coverage.
Between 2010 and 2016, the uninsured rate among Black Americans dropped from 19.9% to 10.6%, while the rate among Hispanics fell from 30.7% to 19.9% (Artiga et al., 2020).
ACA Repeal Efforts Under President Trump
The Trump administration sought to repeal the ACA, raising concerns about the potential loss of coverage for millions. While full repeal efforts failed, policy changes—such as eliminating the individual mandate penalty and approving work requirements for Medicaid—created barriers for low-income populations.
Medicaid work requirements implemented in Arkansas in 2018 led to over 18,000 individuals losing coverage within six months, disproportionately affecting racial and ethnic minorities who faced logistical and technological barriers to compliance (Gangopadhyaya et al., 2019).
Biden Administration’s Focus on Equity
The Biden administration has embedded health equity into federal initiatives, including the American Rescue Plan Act, which expanded ACA subsidies, and the Ending the HIV Epidemic (EHE) initiative. These policies aim to reduce disparities and improve outcomes for underserved populations.
Through the EHE initiative, targeted funding for jurisdictions with high HIV rates has increased access to prevention and treatment services, particularly for Black and Hispanic communities, who bear the brunt of the epidemic.
Actions to Advance Health Equity
Medicaid Expansion: States that have not yet expanded Medicaid can do so to provide coverage to millions of uninsured individuals.
Support Federal Programs Locally: Ensure that federally funded programs like Ryan White and HOPWA are effectively implemented to reach those in need.
Develop State Health Equity Initiatives: Invest in programs that address the social determinants of health, including housing, nutrition, and education.
Elected Officials
Advocate for Continued Funding: Support reauthorization and funding for essential programs like Ryan White, HOPWA, and Medicaid.
Address Social Determinants of Health: Pass legislation that improves access to affordable housing, transportation, and nutritious food.
Support Federal-Local Collaboration: Promote partnerships between federal programs and local agencies to maximize impact.
Individuals
Engage in Advocacy: Contact elected officials to support funding for health equity programs.
Volunteer Locally: Work with community organizations supporting Ryan White clients, housing programs, or food security initiatives.
Promote Awareness: Share information about health programs and resources in underserved communities.
Presidential transitions significantly influence federally funded programs that address health equity and justice. Programs like Ryan White and HUD’s HOPWA exemplify the government’s ability to mitigate disparities, but their success depends on sustained funding and support from federal, state, and local stakeholders.
While policy shifts can either advance or hinder progress, states, elected officials, and individuals all have critical roles to play. By expanding Medicaid, advocating for vulnerable populations, and supporting programs addressing social determinants of health, the U.S. can build on these programs to create a more equitable healthcare system. As history has shown, the stakes are high for the nation’s most vulnerable populations—and collective action is essential to achieving and sustaining meaningful change.
References
- Artiga, S., Orgera, K., & Damico, A. (2020). Changes in Health Coverage by Race and Ethnicity under the ACA. Kaiser Family Foundation. Retrieved from https://www.kff.org
- Gangopadhyaya, A., Kenney, G. M., & Zuckerman, S. (2019). Medicaid Work Requirements in Arkansas. Urban Institute. Retrieved from https://www.urban.org
- Health Resources and Services Administration. (2023). Ryan White HIV/AIDS Program Annual Client-Level Data Report. Retrieved from https://ryanwhite.hrsa.gov
- HUD Exchange. (2023). Housing Opportunities for Persons With AIDS (HOPWA) Program. Retrieved from https://www.hudexchange.info
- Office of Disease Prevention and Health Promotion. (2023). COVID-19 Vaccine Equity Task Force Report. Retrieved from https://health.gov‘
About Dr. Fredrick Echols, MD
Dr. Fredrick L. Echols, MD is the founder and Chief Executive Officer of Population Health and Social Justice Consulting, LLC, an Obama Foundation Global Leader, sought-after public speaker, black men’s health advocate, and accomplished physician with over 15 years of experience in public health. He has worked extensively with public and private sectors to address complex health issues through evidence-informed approaches. Dr. Echols is a graduate of the Centers for Disease Control and Prevention Population Health Training in Place program and the ASTHO-Morehouse School of Medicine’s Diverse Executives Leading in Public Health program.
Passionate about health and justice, Dr . Echols’ notable roles include serving as Chief Executive Officer for Cure Violence Global, Health Commissioner for the City of St. Louis, and Director of Communicable Disease and Emergency Preparedness for the St. Louis County Department of Public Health. In these roles, he oversaw public health regulations, led COVID-19 response efforts, managed daily operations, and developed strategic partnerships. Dr. Echols also served as Chief of Communicable Diseases for the Illinois Department of Public Health and as a physician in the U.S. Navy. He continues to contribute to public health research and guides health organizations globally.
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