A Year In, Trump’s Spending Cuts Hit Hardest in Black Communities

When President Donald Trump signed the One Big Beautiful Bill Act, into law last July 4, health advocates, academics, and economists warned that the spending legislation — which cut trillions of dollars from Medicaid and food assistance budgets — would force millions of people to forego healthcare, and push millions more to the brink of starvation.

The OBBB Act and its anticipated effects were so controversial that Vice President J.D. Vance had to vote to break a 50-50 tie in the Senate for it to pass. 

A year later, a range of experts say those predictions are coming true. The budget cuts are landing hardest on the low-income Americans who rely on them most — and hitting Black communities with extreme force.

The law’s shredding of the health and nutrition safety net is already measurable. Medicaid and enrollment in CHIP, the government-subsidized health insurance program for children, has fallen by 4.6 million people nationwide between April 2025 and March 2026, according to an enrollment tracker by KFF, a public health analysis nonprofit. 

The marketplace for health insurance coverage through the Affordable Care Act has dropped even further, from roughly 22.3 million enrollees in 2025 to as few as 16.5 million this year. Average deductibles on ACA plans have simultaneously climbed 37% to a record $3,786, squeezing the people who’ve managed to hold onto coverage.

What’s more, the expiration of the ACA tax credits at the end of 2025 meant many households saw skyrocketing premiums for private, employer-provided medical insurance. 

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The cuts have hit Black Americans particularly hard because Black households depend on Medicaid, the ACA marketplace and SNAP at higher rates than the general population. Almost 26% of SNAP participants, or approximately 10.2 million people, are Black. Participants receive an average of $187 a month—or just over $6 per day. 

The strain is also visible in the closure of health infrastructure many Black and low-income communities depend on. 

More than 1,000 hospitals, clinics and maternity wards have shut down or scaled back services since the law passed, and nearly 30 Planned Parenthood health centers have closed, two-thirds of them in rural or medically underserved areas. Researchers caution that most of the law’s provisions won’t be fully phased in until 2027 and 2028, meaning the full scope of its impact on Black health outcomes is still to come.

RELATED: Vanishing Care: GOP Healthcare Cuts Hit Black America Hard 

The law also cut nearly $187 billion from SNAP funding—the largest reduction in benefits since the program was created. The abrupt rollout of the changes last November led to the nation’s first interruption in food assistance benefits ever. 

By March, more than 4 million people, or 10% of enrollees, had lost their SNAP benefits and participation has dropped in every state. All but eight states saw declines of 5% or more, 21 states had the number of people getting help to eat fell by at least 10%, and at least 700.000 children nationwide had lost food assistance.

U.S. Department of Agriculture Secretary Brooke Rollins recently attributed the steep drop in SNAP participants to the government’s efforts to prevent what it claims is widespread fraud in the program and to an improved U.S. economy.

Medicaid Enrollment Already Down 4.6 Million

KFF reporting on 2026 ACA marketplace enrollment shows the number of Americans covered fell from about 22.3 million in 2025 to as low as 16.5–17.5 million in 2026, while average deductibles rose 37% to a record $3,786. 

According to KFF’s Medicaid/CHIP enrollment tracker, national Medicaid/CHIP enrollment fell by 4.6 million people between April 2025 and March 2026, with declines seen in nearly every state.

A preview of what nationwide Medicaid work requirements may look like already exists in Georgia, which instituted work requirements in exchange for health care coverage. The state’s Pathways to Coverage work-requirement program enrolled fewer than 7,500 of an estimated 300,000 eligible adults in its first year. The changes forced the state to spend more than $40 million mostly on administrative costs rather than enrollees’ medical care.  

Meanwhile, the Medicaid cuts have also caused more than 1,000 hospitals, clinics, nursing homes, maternity wards, and healthcare providers to close or reduce services–and some may be forced to do so soon.

This is a departure from the program’s intended purpose.

In a statement on the OBBB Act’s anniversary, Protect Our Care, a nonprofit advocacy group, pointed out that Trump’s signature legislation goes against the established goals of publicly subsidized health insurance.

Since the creation iMedicare and Medicaid, “the broad arc of federal health policy has been toward expanding access to care,” according to the statement. Trump’s signature legislative accomplishment, the statement says, “bends sharply in the opposite direction — representing the biggest cut to the healthcare safety net the country has ever seen.”

The Protect Our Care statement also noted that “the first cracks are already showing.” That includes a rural hospital in Georgia that stopped delivering babies, the closure of a Nebraska clinic that served farmers and their families, and a and a hospital outside of Las Vegas that laid off 70 workers and eliminated key services. 

“All pointed to the looming federal Medicaid cuts as a factor,” according to the statement.  statement.

The bill also defunded Planned Parenthood, which has caused it to close nearly 30 of its health centers since July 2025. A disproportionately high number of Black women depend on Planned Parenthood for free reproductive healthcare, including breast cancer screenings, contraception and other forms of preventative care.

Two out of three of the closed Planned Parenthood health centers were in rural areas, medically underserved areas, or in areas suffering a shortage of primary care health professionals. All of the centers were in counties recognized as “contraceptive deserts.” Since the OBBB Act became law, Planned Parenthood’s distribution of birth control packs has fallen by 25%, visits for breast exams dropped 20% and STI testing declined by 10%. 

Alexis McGill Johnson, the organization’s president and CEO, said in a statement that by targeting Planned Parenthood in the OBBB Act, Trump and Congressional Republicans “worsened a public health crisis, making it harder for people to get the essential and lifesaving care they needed at their trusted provider.” 

To cushion the blow, fourteen states committed more than $400 million in emergency funding to replace lost federal funding and cover essential services for Medicaid patients. But states that only partially covered the cost of providing care — or didn’t cover it at all — saw twice as many Planned Parenthood health centers close than states that replaced all of the federal dollars lost. 

Though the OBBB Act has been in place for a full year, experts say the fallout will continue, since the law’s major provisions are still being phased in. Last year, the nonpartisan Congressional Budget Office estimated that because of the healthcare and food assistance cuts, the nation’s poorest households will see their income fall by $1,200 each year on average, while the wealthiest households will gain about $13,600. 

Others, like The Commonwealth Fund, a public-interest nonprofit, estimate a harsher impact for households at the bottom of the income bracket. They predict the lowest 10% of earners will lose an average of $1,600 a year due to the cuts. Meanwhile the bill’s tax cuts for the wealthy will increase resources for the highest-earning 10% of households by $12,000. 

Researchers caution that most of the harshest changes to the health and food assistance programs will happen between 2027 and 2028.  So, the full weight of its effect on Black Americans — and on the nation’s health and wealth disparities—won’t be clear for several more years.

RELATED: Judge Orders Halt to SNAP’s Ban on Sugary Foods 

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