The thread between parent and child should be one of love and stability. But too often, substance use tears at that thread until it frays. Sometimes the fraying goes beyond repair, leaving behind wounds and loss that no one can fix.
This crisis hits home for me. The generational cycle of addiction shaped my life. While I managed to find a path forward, it wasn’t because there was a system of resources and support in place. I survived — but I can’t say the same for people I love, or for countless others across this country.
Recovery Is About Families, Not Just Individuals
When we talk about substance use, we often focus on the individual — their journey, their choices, and their healing. But for mothers, recovery goes far beyond just them. Substance use impacts the entire family. A mother’s journey to recovery is deeply tied to her children, her family, and her community. Without recovery support, trauma seeps between generations like water through cracked foundations, weakening structures that might have otherwise held strong.
Consider two families.
In one, a mother seeks help. She is ready to recover, but does not have access to programming that allows her to stay with her children. There are waitlists. She’s told that programs in her community have been cut back due to lack of funding. Defeated, she tries to hold her family together while struggling alone. Her son grows up carrying the weight of his mother’s pain, internalizing the instability, the stigma, and the silence that follows substance use. Years later, the son turns to substances to cope — and he doesn’t survive his battle. His death represents the loss of a brilliant young man who never got the chance to graduate, walk down the aisle, or become a father — he never had the opportunity to truly thrive. He was one of more than 80,000 people who lost their lives to drug overdoses in 2024.
In another family, a mother enters a treatment program that allows her to keep custody of her children. For the first time, she feels supported rather than punished. She receives counseling, housing support, and guidance from other mothers who’ve walked a similar path. Her children are also welcomed into the process, given therapy and space to process their emotions instead of silently carrying them. Together, the family begins to heal and learns how to overcome the trauma that fueled generations of substance use and pain. By the time the mother completes her program, the family has grown stronger, closer, and more resilient — living proof of what’s possible when recovery embraces the whole family.
The Ripple Effect of Losing Support
In 2023, approximately 19 million children in the United States lived with a parent or primary caregiver struggling with substance use; that’s roughly one in four children. Even more heartbreaking, a child growing up in a home with substance use is eight times more likely to develop an addiction than a child who is growing up in a home free of addiction. This highlights a clear intergenerational cycle of addiction, showing how the cycle repeats when families don’t get the support they need.
When a mother or other caregiver in recovery can’t get the help they need — whether that’s counseling, child care during treatment, peer mentorship, or safe housing — the impact doesn’t stop with them. The consequences ripple outward, shaping the lives of their children and even future generations. For children, this often looks like persistent anxiety or depression, behavioral disruptions or trouble in school, and deep feelings of neglect or abandonment. The effects can linger for years, shaping mental health, relationships, and opportunities well into adulthood.
Children whose mothers lack access to recovery support are more likely to experience housing instability, food insecurity, and trauma. These early hardships not only cause immediate harm but also set the stage for poor health, educational setbacks, and cycles of poverty that are incredibly difficult to break. This is why recovery support must extend beyond the parent — it must embrace the entire family.
The Disproportionate Harm to Black Families
For Black mothers, the stakes are even higher. The child welfare system disproportionately targets Black families, often under the guise of “protection,” but too often mirroring tactics rooted in slavery: separating children from their mothers, weakening family bonds, and undermining the stability of Black households.
Enslaved Black women were denied the right to raise their own children, a deliberate act to dismantle family structures and maintain control. When a Black mother faces substance use challenges, the system is more likely to remove her children rather than provide the support she needs to recover while keeping her family intact. Black children are two to three times more likely to be separated from their families than white children.
This was my own reality. And to make matters worse, after separating families, the system does very little to follow up with the child or parent to ensure their needs are met, their mental health is cared for, and they are not left carrying invisible wounds for years to come.
Policy decisions must be made with care, recognizing their impact not only on individuals but on children, extended families, and entire communities. The conditions we see today in many Black and brown neighborhoods — violence, police surveillance, poor health outcomes, inadequate housing, and limited opportunities — are not the result of individual failings. They are the predictable outcomes of intentional policies and decades of disinvestment. Ending dedicated funding for substance use programs would only intensify these harms, stripping away one of the few pathways to healing and family stability.
What Recovery for Mothers Should Look Like
To create real change, we must invest in a system of care that truly supports recovery and breaks intergenerational cycles of addiction. This means funding and expanding:
Comprehensive, family-centered treatment that allows women to heal without losing custody of their children.
Safe, stable housing that is affordable and located near treatment and support services.
Access to child care during treatment and recovery programs, so mothers don’t have to choose between healing and caregiving.
Peer recovery support led by women with lived experience, who can provide guidance and empathy and reduce stigma.
Culturally responsive care and professionals who address racial inequities and center the needs of Black women and families.
Targeted support for children and youth, ensuring they learn healthy coping mechanisms, build resilience, and receive opportunities to heal as they navigate the impacts of substance use in their families.
Family therapy for parents, children, and extended relatives, designed to strengthen relationships, repair trust, and end intergenerational cycles of addiction.
Research and policy solutions that explicitly connect substance use to mental health and trauma, with a focus on historical and generational trauma as a driver of substance misuse. This includes building a workforce of professionals trained to explore, address, and heal trauma at its core.
The Path Forward
We cannot afford to go backward. Too many lives are on the line. That’s why it’s essential to protect and strengthen funding dedicated to substance use prevention, treatment, and long-term recovery support and services. These resources ensure that people — especially those without insurance — can access treatment, prevention programs, and recovery support. Disrupting these funding streams would be devastating not only to mothers but also to the generations connected to them.
Dedicated and stable funding for treatment, prevention, and recovery services doesn’t just support individuals in recovery, it also creates a lifeline for their children. It ensures families can stay together, heal together, and rebuild together. Without that funding, too many families are left trapped in cycles of trauma, loss, and grief. Ending funding support for substance use deepens racial inequities, perpetuates historical harms, and robs future generations of stability and opportunity.
Instead, we should be expanding investments in family-based recovery models and holding systems accountable for keeping families together. The two families introduced in the beginning stories run parallel, but the outcomes couldn’t be more different. The difference wasn’t the mother’s choices or love — it was access. One family met closed doors while the other found open arms.
Recovery is not just about surviving substance use. For mothers and those they love, it’s about building a future where healing is possible, families are whole, and every generation has the chance to thrive.
For me, this truth carries the weight of my brother, David. He was the son who never got the chance to thrive. His absence is a constant reminder of what’s at stake — the fragile threads that hold families together, and how every policy decision and funding choice determines whether those threads hold or unravel. My heart goes out to every frayed thread that has ended in loss due to substance use. This grief and absence ripple through families, felt for generations to come — a smile no longer there, a presence no longer felt.
The fight for healing and wholeness for families navigating substance use must continue.
Dedicated to “Lil David.” May you rest in eternal peace.
Washington, D.C., September 12, 2025—This week, rulings on two different court challenges ensured that immigrant families will continue to have access to Head Start and other important programs. Earlier this year, several federal agencies issued notices that would reinterpret the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (PRWORA) to restrict eligibility for some federal programs to “qualified immigrants,” in some cases expanding the list of what are considered “federal public benefits.” Last month, CLASP submitted comments in opposition to this harmful new interpretation. At the same time, several court cases challenged the legality of these actions.
The first case, filed by attorneys general in 20 states and Washington, D.C., challenged the federal government’s reinterpretation of PRWORA and resulted in a preliminary injunction blocking the implementation of the reinterpretation in those states and D.C. This challenge was across three government agencies: the Department of Health and Human Services, the Department of Education, and the Department of Labor. In states not covered by the lawsuit, any changes to program eligibility and an implementation timeline are still contingent on additional guidance.
The second case, filed by the American Civil Liberties Union, challenged this interpretation, specifically as it relates to Head Start. Yesterday,a federal judge granted a nationwide preliminary injunctionblocking the directive to exclude immigrant children in Head Start nationwide.
“These court rulings are important victories for immigrant families and our country. Unfortunately, so much damage has already been done because these directives have instilled fear, along with the fact that other actions of this administration—including unprecedented immigration enforcement measures—have caused significant harm,” said Wendy Chun-Hoon, CLASP’s president and executive director. “We believe that every family should have access to the programs and services they need to thrive, and we will keep fighting until that happens.”
Administration officials have already taken steps to challenge these rulings, as their goal is to reduce access to and ultimately dismantle these important programs. The well-being of our next generation depends on protecting these programs and the children and families they have served for decades.
Washington, D.C., September 9, 2025—Today’s release of the U.S. Census Bureau’s national Income, Poverty, and Health Insurance data for 2024 shows that while the overall economy is strong, the nation has much more to do to reduce poverty, especially among women and Black Americans.
For the most part, the poverty rate remained largely unchanged from 2023 to 2024. But the poverty rate among Black Americans increased from 17.9 percent in 2023 to 18.4 percent in 2024. And while overall child poverty rates dropped very slightly from 2023, the number of Black children living in poverty increased from 20.3 percent in 2023 to 22.7 percent in 2024, according to the Supplemental Poverty Measure. This measure looks at not simply earnings, but the resources people have after factoring in work and medical expenses, taxes, as well as tax credits and non-cash benefits.
For the second year in a row, women faced a large earnings gap. The median earnings for women in 2024 were $45,380, while the median earnings for men were $60,020. This gap is greater than in 2023, when median earnings for women were $43,200 and $57,740 for men.
“These numbers are not surprising,” said Wendy Chun-Hoon, president and executive director of CLASP. “The wage gap between men and women has existed for decades, as has the disparity in Black poverty rates compared to the rest of the country. While the nation has made incremental improvements, the reasons for these disparities are systemic, and we must do more to disrupt them. There’s no silver bullet to remedy these inequalities; rather, we need sustained investments to close the gender-racial wage gap—higher wages, more equal access to quality jobs, affordable family care, equitable tax policy, and paid leave. We should solve for people’s basic needs, not eviscerate our social safety net.”
Signs already point to a weakening economy in 2025. For instance, the August 2025 Bureau of Labor Statistics (BLS) jobs report showed an addition of only 22,000 jobs last month, well below economists’ expectations, and unemployment at a four-year high of 4.3 percent.
Black families are the last to do well, even when the economy is growing. The most recent BLS report made that clear, showing the unemployment rate for white men was 3.7 percent, but was 7.1 percent for Black men. The report also showed the unemployment rate for Black women was 6.7 percent, compared to 3.2 percent for white women.
The gender wage gap persists for a variety of reasons, notably that women are still concentrated in some of the lowest-paid jobs, the price of child care remains out of reach for families, and employers are implementing return-to-office policies. The real-world effects of inflexible work policies and unaffordable care are already being felt: the share of working mothers ages 25-44 in the labor market has fallen every month in 2025 and dropped three percentage points between January and June. This is the lowest level of labor force participation from women with children in more than three years.
Increased poverty in 2025 is all but assured due to the severe restructuring of programs that support basic needs in July’s reconciliation bill and the Trump Administration’s executive actions aimed at people with low incomes, immigrant families, women, people of color, and other historically marginalized communities. Congress, with the administration’s approval, has consistently chosen to exclude many families with low incomes and immigrants from the Child Tax Credit, cut Medicaid and SNAP, increase immigration enforcement, and boost tax breaks for the ultra-rich.
“The president promised to lower costs. He and this Congress have clearly broken that promise for so many, making it more expensive for families to afford not just gas and milk but other family basics like housing, health care, and child care. This is not just a broken promise. It’s a breach of contract to the American people,” said Chun-Hoon.
Poverty is not inevitable. It’s the direct result of policy decisions. We know how to reduce it, and now it’s time for policymakers to choose dignity for all and invest in our communities.
This statement can be attributed to Wendy Chun-Hoon, president and executive director of the Center for Law and Social Policy (CLASP)
Washington, D.C., September 3, 2025—On September 9, the U.S. Census Bureau will release national Income, Poverty, and Health Insurance data for 2024. We expect the numbers to show more poverty in 2024, particularly among children, and more people without health insurance. When we see the data, however, we must consider that the outlook for 2025 and beyond is ominous, given how precipitously the conditions for people facing economic insecurity have declined this year.
Since the beginning of President Trump’s second term, the administration and Congress have unleashed a cascade of attacks on people with low incomes, including communities of color, immigrants and their families, and others who have been historically marginalized. These attacks have included slashing public benefit programs; issuing executive orders dismantling diversity, equity, inclusion, and accessibility initiatives; ripping families apart through a horrific mass deportation effort and gutting protections and services to immigrants, including U.S. citizen children; eliminating labor protections for millions of workers; and decimating the nation’s data collection efforts that are critical to accurate and equitable decision-making. Through these and other actions, the Trump Administration’s reckless disregard for people’s health, safety, and well-being will have dire consequences for the future of the country.
These attacks are particularly evident in the reconciliation bill passed by Congress, which is causing unprecedented harm to workers, people of color, immigrants, women, and children. In addition to excluding many families with low incomes from the Child Tax Credit, the bill cuts essential benefit programs, including Medicaid and SNAP. Although these changes will not be fully implemented until 2026 and beyond, they are already having a chilling effect among people who rely on these programs to meet their basic needs. Congress made these cuts to fund historic increases in immigration enforcement that undermine family unity and well-being and to provide tax cuts to the wealthy, which will only exacerbate poverty and wealth inequality.
The September 9 data will likely show another annual increase in people without health insurance coverage. The end of Covid-era protections for Medicaid coverage caused many people to lose coverage in 2024, although the availability of enhanced premium tax credits in the Marketplace likely offset some Medicaid losses. Congress’s action in 2025 to cut Medicaid and enhanced Marketplace tax credits by more than $1 trillion is estimated to cause nearly 15 million people to lose coverage in the coming years.
The full effect of millions of people losing health insurance, food assistance, and other supports—and how that loss will harm not just individuals but their families, communities, and the larger economy—will drive even more people deeper into poverty and instability for years to come.
We will have more to say after the Census Bureau releases the data next week. For now, CLASP reiterates our commitment to fighting for policies that center the dignity and autonomy of all people, especially those whom the Trump Administration and the current majority in Congress are most focused on harming with their punitive and dangerous actions.
This statement can be attributed to Wendy Chun-Hoon, president and executive director of the Center for Law and Social Policy (CLASP)
Washington, D.C., August 12, 2025–During a White House press conference on Monday morning, President Trump declared a public safety emergency in Washington, D.C., despite evidence to the contrary. The president federalized the D.C. police department and mobilized 800 members of the National Guard to remove encampments of homeless residents to, in the president’s words, “fight crime” in the city.
The rhetoric used by all speakers at the press conference was racist, xenophobic, transphobic, and discriminatory against homeless members of the D.C. community, who are disproportionately Black. Using othering language like “they/them” referring to youth of color, “bedlam,” or “slums” pathologizes structural inequality. Coupling this language with deliberate misinterpretations of crime data and sensationalized stories places people experiencing homelessness at even higher risk of dehumanization and violence. Under a recent executive order, this population is already facing renewed attacks on strained support systems and privacy protections.
Furthermore, this move by the president is blatant abuse of the D.C. Home Rule Act of 1973 and the latest refusal to grant the District statehood. Trump is flooding the streets with FBI agents and the National Guard and federalizing local law enforcement in spite of violent crime rates that are at a 30-year low in D.C., and in spite of the wishes of D.C. residents, the majority of whom are Black and brown.
Demanding that people experiencing homelessness leave the city will not make D.C. safer. In fact, the resources diverted toward mass displacement of homeless people will result in a greater police presence. The root causes of homelessness include unaffordable rents, lack of access to mental health and substance use treatment, and unlivable wages. To truly end homelessness, we should invest public dollars in expanding the supply of affordable housing and ensuring accessible, high-quality mental health and substance use treatment services.
Additionally, researchers have repeatedly disproven a direct link between more law enforcement agents and a higher level of public safety, invalidating measures aimed at “restoring law and order,” which ultimately hurt Black and brown people disproportionately. This increased presence can have deadly consequences, as it did inMilwaukee when a local Black man was killed by out-of-town law enforcement brought in to securitize the downtown area for the Republican National Convention.
In addition to the inappropriate takeover of the D.C. police department, Trump’s deployment of the National Guard to strike fear into the local population mirrors how the administration used the deployment of 4,000 guard troops and 700 active Marines in Los Angeles to facilitate the arrest and deportation of immigrants and quell people’s constitutionally protected right to non-violently protest their neighbors’ kidnapping.
Like L.A., D.C. is being used as a testing site to normalize the use of military personnel against people in our community without the existence of an actual crisis. Rather than advance public safety, the administration’s actions further a political agenda rooted in demonizing race and poverty.
At a time when people with the lowest incomes are already struggling with inflation, a softening job market, and the slashing of programs that support basic needs, the last thing our nation should do is to use force against people who don’t have the resources to fight back.
By Ashley Burnside
Supplemental Security Income (SSI) provides critical monthly support—up to $967 in 2025—for over 7 million low-income people with disabilities and older adults. Without these payments, many would struggle to afford rent, food, and basic necessities.
Social Security, SSI, and SSDI are lifelines for millions of Americans, including people with disabilities and older adults. Cuts or delays to these programs would worsen poverty and instability. Protecting these benefits—and the agency that delivers them—is critical to ensuring economic security and equity for all.
I grew up in a modest, working-class household in north Florida that was rooted in Black American and Caribbean heritage. I’m deeply grateful for the sacrifices of my parents and grandparents; each generation strove to provide a better life for their children than they had, including for me and my two younger sisters. In my family’s history I can see a clear arc of social mobility across borders and generations, but progress has stalled in my own lifetime.
That mobility didn’t keep pace for my immediate family was due not to a lack of effort but, rather, rising costs, stagnant wages, and other systemic reasons. This circumstance isn’t unique to my family. Compared to other demographic groups, social mobility among Black families is not sustainable between generations, even among middle-class households and those who are college educated.
According to the Joint Center for Political and Economic Studies, the median wealth of Black households is just $44,900, compared with $192,900 nationally. This significant discrepancy seems almost uncomprehensible, yet given the long history of excluding Black Americans from federal wealth-building programs, it is unsurprising. From the Homestead Act of 1862 to the GI Bill and early Social Security, government initiatives built white middle-class wealth while locking out Black families through discriminatory policies and enforcement.
My Family’s Story
My maternal grandparents immigrated to the U.S. from Barbados in the 1970s, seeking the opportunity they couldn’t find at home despite strong education and high literacy rates. My paternal grandparents grew up on the east and west coasts of the United States, shaped by different kinds of poverty but bound by the same determination. The circumstances of their poverty looked different: rural poverty in Southern California; inner-city poverty in Baltimore; underdevelopment in Christ Church, Barbados; and lack of economic opportunity in St. James Parish, Barbados. Both sides of my family valued education and worked hard, but that wasn’t enough to guarantee lasting mobility in a system designed to favor others.
All of my grandparents were first-generation college students, and two earned graduate degrees as well. My mother, a teacher, has a bachelor’s degree; my father attended some college and built a career in a state business services job with his accounting background. My younger sister and I are both recent college graduates.
But degrees alone do not close racial wealth gaps. According to a 2018 analysis of data from the National Center for Education Statistics’ 2008 cohort of the Baccalaureate and Beyond longitudinal study, white graduates with at least one college-educated parent tend to earn more than their Black counterparts. A greater share of Black graduates fall into the lowest income category compared to whites which limits homeownership: more white college graduates own homes compared to Black graduates due to greater access to generational wealth. A higher proportion of Black families rent—which was true for my family for a long time until recent years—compared to white graduates.
Though both of my parents provided basic needs for me and my sisters, financial trade-offs still shaped our lives. My mother paused her career for nearly a decade when my sisters and I were young, since the cost of child care would have outweighed her earnings. This didn’t only affect her career advancement; it meant living on one income and relying on the Supplemental Nutrition Assistance Program (SNAP) and the Special Nutrition Program for Women, Infants, and Children (WIC). Equitable wages, access to benefits, and paid support for domestic labor could help families build wealth and stability: for example, if my father had earned more, that could have offset my mother’s unpaid labor and given us greater financial security.
Social and Historical Trends
White middle-class wealth was formed through public benefits that excluded Black people. The first public benefit, 1862’s Homestead Act, gave white families 160 acres of land (often stolen from Native Americans) after ten years of settlement and a small fee. During the New Deal, white people benefited from the expansion of the so-called welfare state with the introduction of the first food stamp program and the creation of Social Security, which intentionally excluded Black Americans from building wealth. Even when Black people created their own wealth, as in Tulsa, Oklahoma’s “Black Wall Street,” it was violently destroyed because of racial animosity with no guarantee of restoration. This history has created a gap between white and Black economic fortunes that persists to this day.
Capitalism continues to reinforce these inequities. It commodifies basic needs like food and housing, putting working-class and Black families at a disadvantage. Until the current system is reimagined, survival, well-being, and mobility depend on access to capital. If we care about the well-being of Black youth, adults, and elders—or any part of our communities—then equipping people with the resources to thrive is imperative. So much wealth has been hoarded by the top one percent for generations. But through philanthropy, progressive taxation, unrestricted cash transfers, and other initiatives, it is not only possible but necessary to redistribute assets in ways that empower the most impacted.
Repair, Invest, Empower: The Path to Generational Justice
Many advocates have worked to reform public benefit programs to better serve communities of color, individuals with low incomes, and people with disabilities. Yet in the current political climate, many advocates have been preoccupied protecting existing public benefits programs rather than transforming them. Public benefits were designed to help people meet basic needs including housing, food, and health, but survival alone is not enough.
If we truly want to invest in Black well-being, policy must go beyond helping people just get by and instead focus on building wealth, ensuring that Black families thrive and can pass down resources across generations. Doing this means pairing strong public benefits programs with true wealth-building tools—investments, homeownership, business capital, and direct cash empowerment—so that social mobility becomes a lasting reality. These investments can look like:
Homeownership investment for first-time homebuyers and government subsidies (similar to the GI Bill) for first-time homebuyers under a certain age or income threshold.
Business capital, including grants for Black entrepreneurs starting their first business.
Direct cash empowerment, similar to COVID-19’s stimulus checks, helping working-class people meet important needs and build financial stability.
Higher education tuition assistance in the form of scholarships, to support tuition and the cost of living, as well as loan repayment to help people pursue education without burdensome debt.
As I think about living out the hard work and sacrifices my parents and grandparents made to improve my family’s quality of life, I know my individual decisions alone will not be enough to sustain and build generational wealth. This is as true for me as it is for any other Black person. Equitable investment and rectifying past predatory harms are needed to ensure Black people collectively can thrive not just today, but for generations.
By Suzanne Wikle
Access to health insurance and health care has never been a right in this country. There has always been a division between those that are considered “worthy” and those that are not, mostly along wealth and racial lines. The recent political conversations about Medicaid unfortunately reinforce this division.
When policy makers debate eligibility criteria for Medicaid and other programs, they are really making a value statement about who deserves health care, food, or any other assistance. The new Medicaid rules, which will go into effect for the Medicaid expansion population in most states in 2027, make strong statements about who is worthy of Medicaid and who is not.
The recent bill pushed by President Trump and passed by Republicans in Congress on razor-thin margins cuts over $800 billion from Medicaid—“saving” money by causing people to lose their health insurance. One of the primary ways the bill does this is by changing eligibility for Medicaid and attaching a “work requirement” for the 20 million people who are eligible for the Medicaid expansion program in their state. More than 10 million people are expected to lose their Medicaid insurance as a result of this Republican-led legislation.
About half of people in the country have health insurance through their job, so it may seem like a natural step to attach Medicaid insurance to employment. Nothing could be further from the truth. This fundamental change in Medicaid eligibility undermines the intent of Medicaid and a large portion of the Affordable Care Act (ACA), puts lives at risk, and ultimately declares with more clarity than ever who is deemed worthy of health insurance and who is not. A core vision of the ACA was to provide a pathway to affordable health insurance outside of employment. This meant creating affordable options for people who owned small businesses, retired early, don’t have employer-provided insurance, or aren’t employed.
Who is “Worthy”?
In practice, the new Medicaid law draws arbitrary lines that determine eligibility. For example:
If you’re a parent with a low income and a child under age 13, you are worthy of Medicaid for your health insurance. If you’re a parent with a low income and your child is 14 or older, you’re not worthy unless you’re working at least 80 hours a month.
If you’re a waitress earning a low income and working at least 80 hours a month, you’re worthy. But if you get sick and need a few days off, you’ve worked less than 80 hours that month and are no longer worthy.
If you work for a landscaping company and work at least 80 hours per month during the busy seasons, you’re worthy of Medicaid. But if there’s a particularly rainy month or cold snap and your hours are cut below the threshold set by Congress, you are no longer worthy.
If you’re working in the gig economy to pay your bills and you are able to prove at least 80 hours of work per month, you are worthy and eligible. But if business slows down, your care is getting repaired for a few days, or you simply can’t produce the right documentation, you may not be worthy.
If you’re able to navigate the complex paperwork requirements to prove your work hours, then you’re eligible. But if you can’t navigate the system or you don’t have adequate internet access to upload your documents, you’re not worthy enough.
Racial Inequities in Health Insurance
It’s not a coincidence that large racial inequities exist in health insurance rates. Systemic racism and states choosing not to expand Medicaid are two major reasons behind the disparities. In 2023, for adults ages 19-64 (the Medicaid expansion age range), white and Asian Americans had uninsurance rates of 7 percent and 6 percent, respectively. All other racial and ethnic groups had uninsurance rates at least double those: 23 percent for Hispanics, 12 percent for Black people, 21 percent for American Indian and Alaskan Natives, and 15 percent for Native Hawaiian/Pacific Islanders.
Medicaid disenrollments due to work reporting requirements, like other administrative burdens, will exacerbate these inequities. People of color are disproportionately insured by Medicaid and will disproportionately be harmed by additional red tape.
The ACA took many steps toward righting these wrongs and ensuring access to health insurance for everyone. It created a marketplace where people can get subsidies to purchase insurance that is required to cover essential health benefits. The ACA also expanded Medicaid to those with the lowest incomes—under 138 percent of the poverty line, or $36,777 per year for a family of three.
Collectively, the three pillars of the ACA—employer-based insurance, marketplace insurance, and Medicaid—should have provided affordable health care to nearly everyone. When the Supreme Court ruled Medicaid expansion as a decision left to states, that core pillar of the ACA was cracked because it wouldn’t be part of the health insurance landscape in many states. Ten states are still refusing billions in federal dollars to expand their Medicaid program.
The Current Landscape
What Congressional Republicans and President Trump have done in 2025 is another significant blow to Medicaid. Tying eligibility for Medicaid expansion population to proving work hours will have one outcome: people will lose their health insurance. People won’t lose their insurance because they aren’t working; most people are working, or caring for someone else, or will meet another exemption. The evidence from other programs is crystal clear: this is a red tape and bureaucratic hurdle created to deter people from applying or making it too difficult to complete the application process. This is not about promoting work and will not increase employment.
A Medicaid work reporting requirement also means that Medicaid will no longer be the safety net that someone can turn to when they lose their job. For those of us that receive health insurance through our employer, a job loss also means a loss of health insurance. For many in this position, keeping their insurance through COBRA is unaffordable. If they live in a Medicaid expansion state and their income drops below 138 percent of poverty, they have access to Medicaid.
During the early months of the COVID-19 pandemic when millions of people lost their jobs, Medicaid was there for them. People who lost their jobs or were furloughed were 70 percent less likely to become uninsured if they lived in a Medicaid expansion state. Under the new eligibility rules mandating a work reporting requirement, people won’t have Medicaid to turn to when they are suddenly unemployed.
These decisions have real-life consequences. People will lose their health insurance, which will cause them to forgo medical care and accrue medical debt; and some people will die. Millions of others will live far below the level of dignity they could have if they were guaranteed access to health care.
Health insurance and health care access are policy decisions. CLASP strongly disagrees with the policy decisions of those who supported H.R. 1 and will continue to advocate for health care to be a basic human right for all.
By Ashley Burnside
July is an important month for the disability community, especially this year. Commonly referred to as Disability Pride Month, July commemorates the passage of the Americans with Disabilities Act (ADA) in 1990, a hard-fought legislative achievement that provides the disability community with comprehensive civil rights protections. This year marks the 35th anniversary of the ADA’s passage. 2025 also represents the 60th anniversary of the Medicaid program, which provides life-saving health care for millions of people. People with disabilities have fought for decades to achieve basic civil rights protections, including access to public spaces, public education, adequate health care, and more.
Amid these celebrations, this month also marks the passage of a law that will cause great harm for people with disabilities: President Trump’s budget reconciliation law. This new law will result in disabled people losing health care and nutrition assistance.
During Disability Pride Month, lawmakers should be investing in and celebrating the disability community, not stripping away public benefits that help people afford food, remain healthy, and live in their homes and communities. The reconciliation law will restrict access to health care and food for the disability community, despite false claims from lawmakers to the contrary.
The Reconciliation Law Will Cut Medicaid Access
Medicaid provides life-saving services and care for people with disabilities throughout the nation. Fifteen million people with disabilities use Medicaid, representing 1 in 3 disabled people. Unfortunately, the reconciliation law will make devastating cuts to Medicaid, ultimately leaving just over 10 million people uninsured, including people with disabilities.
One of the changes the law will make is adding work reporting requirements to Medicaid for the expansion population of at least 80 hours per month, which will create red tape for millions of people trying to enroll in Medicaid and for Medicaid recipients. Research has repeatedly found that while work reporting requirements do nothing to improve employment, they do create bureaucratic complexity for recipients and state agencies.
Lawmakers have claimed that people with disabilities will be exempt from the work reporting requirements. But unfortunately, disabled people will inevitably be included in these mandates, and will lose their health insurance unless they can meet the paperwork requirements. Some disabled people qualify for Medicaid due to their disability status, typically having severe health conditions that meet a strict definition of being disabled. People in this category should be exempt from work reporting requirements, but in reality, that will depend on how well states implement the policy.
There are also many people with disabilities who qualify for Medicaid through other pathways because their disability is not deemed ‘severe enough’ to qualify them through the disability eligibility criteria. Most people in this category will qualify for Medicaid through Medicaid expansion. In the ten states that have not expanded Medicaid, people may qualify if they have dependent children at home and extremely low incomes, but are likely to not be insured.
People with disabilities who qualify for Medicaid through their state’s Medicaid expansion but are unable to work 80 hours per month due to their disability will need to prove their disability makes them exempt from the work reporting requirement, a process that requires time, money, appointments, and paperwork. They will likely have to reprove their disability every six months.
Disabled people who can work and qualify for Medicaid through their state’s Medicaid expansion could face further problems if they have a chronic disability that makes it harder for them to work continuously, or during medical episodes. For example, a cashier may be able to work 80 hours one month but then be unable to work that many hours the following month if they have a chronic pain flare-up that prevents standing for longer shifts. This person might lose their Medicaid eligibility because they were unable to meet the 80-hour requirement every single month. And because recipients can’t average the number of hours worked across multiple months, someone who could only work 70 hours one month can’t ensure they remain eligible by working 90 hours the next. The ways that disabilities impact people are often not “one size fits all,” and that will make meeting such an inflexible work reporting requirement impossible for some people.
The indirect results of the Medicaid cuts will also harm members of the disability community who rely on medical care from hospitals and clinics. If hospitals lose federal funding and are forced to close, this will disproportionately affect those who may be unable to drive further distances to get the care they need, especially if they live somewhere without public transportation.
Home and Community Based Services (HCBS) are a crucial Medicaid service for disabled people but are not required by federal statute. One area that states may explore is cutting these services, including reducing payments to care providers or not enrolling people who are stuck on waiting lists.
Disabled immigrants will also be cut off from health care due to the reconciliation law. Previously, lawfully present immigrants who were ineligible for Medicaid due to their immigration status could enroll in marketplace coverage if they earned under 100 percent of the Federal Poverty Level. The new law terminates this coverage, as well as other opportunities for Medicaid, Medicare, and Children’s Health Insurance Program access for certain populations of immigrants.
Collectively, all the Medicaid cuts—including key financing changes—will leave states with fewer federal Medicaid dollars and force states to cut their Medicaid programs.
The Reconciliation Law Will Strip Access to Food
The reconciliation law will also make devastating cuts to the Supplemental Nutrition Assistance Program (SNAP), ending nutrition assistance for an estimated 5 million people. Disabled people are likelier to face food insecurity than people without disabilities, and about 4 million SNAP non-elderly recipients identified as being disabled in 2023. People with disabilities will be cut off SNAP due to the stricter work reporting requirements unless they prove they can meet an exemption, which can be burdensome and time-consuming.
The new law will also require states to spend more of their own revenue to fund the SNAP program, meaning states will either need to make cuts to the program, remove recipients, eliminate SNAP altogether, or make other cuts in their state budget to critical programs, such as child care or education. Some disabilities require specialty diets that are more expensive, meaning disabled people could be especially harmed if states implement such cost-saving measures.
We Must Commit to Advocating for Policies that Allow Disabled People to Thrive
During Disability Pride Month and every month of the year, we must celebrate our progress toward access, equity, and justice for the disability community while also acknowledging areas where improvements are needed. People with disabilities deserve health care, food, and housing and the chance to thrive in their communities with their loved ones, just like everyone else. The recent reconciliation law will be a major setback for the disability community. Lawmakers at the state and federal level should invest in people with disabilities through fully funding HBCS, removing work reporting requirements in the Medicaid and SNAP programs, and ensuring that all people have access to adequate health care and nutrition, regardless of their income or ability status.