Looming Medicaid Cuts Could Hurt Black Children, Advocates Warn

Advocates are warning the Medicaid cuts in President Donald Trump’s tax and spending law will disproportionately harm Black women and children who depend on the program, worsening already disparate health outcomes among Black Americans.

Although Black people represent about 14 percent of the U.S. population, they account for more than 20 percent of Medicaid enrollees, according to Pew Research Center — and almost 60 percent of all Black children are enrolled in Medicaid, according to a recent analysis from the NAACP and other advocacy organizations.

The looming cuts, advocates say, could limit resources in high poverty schools, exacerbate maternal mortality rates and leave Black families without critical care.

“States right now are having to make decisions on what services they’re going to cut ... and their allocation of funding toward this population,” said Patrice Willoughby, chief of policy and legislative affairs for the NAACP. “It is unconscionable that Congress would leave American children, which are the future of the country, without the supports that they need and the interventions that they need to contribute meaningfully to develop to their fullest potential.”

The impact on services to Black children in particular, she added, could have long-term negative effects throughout their entire lives.

“We know that Black boys, particularly if they're having a learning disability, you've got to catch it by third grade in order to be able statistically to remediate it,” Willoughby said.

Medicaid — which is the fourth largest federal funding source for K-12 schools, according to a 2025 report by the School Superintendents Association — supports over $7.5 billion of school-based health services each year for low-income students, including screenings for learning disabilities.

Thirty-seven percent of Black students attend high poverty schools, according to a 2023 analysis by National Center for Education Statistics.

“Schools can often be the first points of contact to identify a health problem with a lower income child that is affecting their schoolwork, and then make the appropriate referrals,” Willoughby said.

Through Medicaid, high poverty schools are also able to provide medical care. They can also provide insight into whether a student needs additional screening for a more accurate diagnosis.

But one report from a coalition of education groups earlier this year found that the Medicaid cuts could force schools to reduce the number of school nurses, limit access to early intervention programs or impact funding for special education programs for those with learning disabilities.

As a result, Willoughby said, it could create financial hardship on families as they try to treat medical issues later in life.

“These are the supports that are cheap to fix on the front end, but much more expensive to fix on the back end,” Willoughby said.

Advocates say the cuts are part of a broader pattern of the American medical system inadequately serving Black patients.

“These cuts really are continuing a pattern of forcing Black families to take care of ourselves without the proper support,” said Brittany Packnett, an equity strategist who co-founded Campaign Zero and supported Vice President Kamala Harris in the 2024 presidential campaign.

In a statement to POLITICO, the U.S. Department of Health and Human Services said the claims “misrepresent” the One Big Beautiful Bill Act.

"The OBBB is a decisive step toward building a stronger, more resilient healthcare system,” an HHS spokesperson said. “This legislation modernizes Medicaid to deliver greater efficiency and long-term sustainability, while expanding access to high-quality care for those most in need, in every community across the nation.”

A spokesperson for the White House also dismissed the worries of advocates, arguing they were coming from supporters of Trump’s defeated 2024 opponent.

“I’m surprised Axel Springer allows Democrat Party press releases to be published as articles,” Alex Pfeiffer, White House deputy communications director, said in a statement, referencing POLITICO’s parent company.

It remains to be seen what the long-term impacts of the cuts will be. Many of the cuts are not set to go into effect for years, and Congress has a track record of approving reductions and changing eligibility rules, only to later extend deadlines or revise the law entirely.

But if they do go into effect, they could also endanger Black babies and pregnant people, advocates warn.

Medicaid covers nearly 65 percent of births to Black pregnant people, a 2023 study published by the National Institutes of Health found, and Black mothers and babies already face disproportionate health outcomes: the infant mortality rate for Black babies is more than two times higher than the rate for white babies, according to a 2022 review from the U.S. Health and Human Service’s Office of Minority Health. They also have the highest rate of infant mortality than any other race.

The disparity is due in part to low birth weight — Black babies are more than three times as likely as white babies to die from low birth weight. Black pregnant people also have a preterm birth rate of 14.7 percent, almost one and a half times higher than the national average, according to a 2024 study by March of Dimes.

“Having these cuts is something that's going to limit that access for a lot of Black women out there, and that's something that will have a ripple effect on maternal mortality and morbidity,” said Rolonda Donelson, a reproductive health equity legal fellow at the National Partnership for Women & Families.

And cuts to Medicaid could harm outcomes for mothers and babies who are not enrolled in the program themselves, advocates argue. The federal program plays a vital role in supporting preterm babies who need special care or extended hospital stays. It also helps support research on how to avoid preterm births.

“My first son spent over 100 days in the NICU,” said Packnett. “The hospital where he was born was able to have a state-of-the-art NICU that could serve anybody because of Medicaid payments. Those Medicaid payments kept the doors open for children like mine, kept research flowing, kept new machinery coming in. Those Medicaid payments made a difference for my child, even though we're not recipients of Medicaid.”