Medicaid Coverage

Access to Medicaid coverage continues to be an ongoing challenge, leaving millions of Americans at risk of losing their health care coverage. The Congressional Budget Office estimates that when all the changes included in the One Big Beautiful Bill Act (OBBA) are implemented, 16 million people will lose health insurance coverage. Almost half of these people (7.8 million people) will lose coverage due to changes to the Medicaid program.

Medicaid plays a critical role in the sexual and reproductive health outcomes of millions. It is the nation’s largest payer for health care services, including family planning services, pre- and post-natal care, and childbirth care. Black women and girls are more likely to be insured by Medicaid, and the program has been a lifeline for Black women, girls, and gender-expansive people. In our most recent polling, more than 90% of respondents reported that Medicaid has been important to them and/or their families. Approximately 83 million Medicaid enrollees are women; more than half of those women are of reproductive age; and about 4.4 million of those women identify as Black.

Medicaid expansion has been essential to improving health outcomes for Black women, girls, and gender-expansive people, and especially for improving the outcomes for Black birthing people. The expansion of Medicaid postpartum care coverage from 60 days to 1 year has been critical in improving the country’s maternal mortality crisis. Any attacks on the Medicaid program put this policy at risk at a time when maternal mortality rates continue to climb for Black birthing people.

As we learn more about OBBA’s implementation, it is imperative to continue to support policies that bolster the Medicaid program. The program’s federal-state partnership model means that broad changes to the Medicaid program have uneven impacts on people depending on where they live. We must continue to advocate for the protection and expansion of the Medicaid program to mitigate harm while the OBBA is implemented.

Policy Recommendations

• We urge you to fight to restore, defend, and expand Medicaid’s vital services and mandatory benefits.

Abortion Access

Of the 10 states with the highest Black populations, half have either banned abortion care or severely limited access to this essential health care service. Reproductive Justice advocates are at the forefront of the movement to expand access to abortion care and ensure that everyone, regardless of where they live or how they are insured, has access to the full spectrum of sexual and reproductive health care. In states with limited access to in-person abortion care, this includes providing access to medication abortion as a critical way to deliver safe and effective care.

Deadly abortion bans are rooted in anti-Black racism, misogyny, and gender injustice. The latest attacks on our health care infrastructure, coordinated restrictions on access to medication abortion, and attempts to criminalize providers for delivering essential health services will only exacerbate existing inequities in access to abortion care.

Black women, girls, and gender-expansive people have always been the most harmed by baseless restrictions on abortion access and will continue to feel the brunt of increasing inequities in sexual and reproductive health care.

Policy Recommendations

• We urge you to advocate for bold and equitable access to abortion care by supporting critical legislation like the Equal Access to Abortion Coverage in Health Insurance Act (EACH) and the Abortion Justice Act.
• We urge you to join us in advocating for the protection of access to medication abortion.

Black Maternal Health

Black birthing people in the U.S. have unacceptably poor maternal and infant health outcomes, including staggeringly high levels of preventable complications and death. Black women have the nation’s highest rates of maternal mortality and are two-to-three times more likely to die of pregnancy- and postpartum related complications compared to white women. Black newborns also have worse outcomes than their counterparts and have a mortality rate that is two times higher than white newborns.

At the heart of the Black maternal and infant health crisis is a fragmented health care system that perpetuates the existing structural racism embedded in the American health care system. While recent data show an overall decline in maternal mortality, the disparities have widened for Black women.

As attacks on health care and social safety nets continue, Black birthing people and their babies will continue to be disproportionately impacted by cruel policies that ignore the needs of Black communities. Now is the time for bold policy action that directly addresses the unique circumstances and structural barriers faced by Black birthing people and their babies.

Policy Recommendations

• We urge you to advocate for the passage of the Healthy Maternal and Obstetric Medicine (Healthy MOM) Act.
• We urge you to advocate for the passage of the CARE for Mom Act.
• We urge you to advocate for the passage of the Perinatal Workforce Act and other comprehensive legislation that addresses the Black maternal health crisis.

Defending Democracy

The right to vote is a fundamental component of democracy, but coordinated efforts to roll back our rights has created unnecessary barriers to voting. Across the country, voting rights are being eroded by the courts, anti-democratic national and state actors, and inconsistent enforcement of existing federal voting rights laws. Over the last decade, the United States Supreme Court (SCOTUS) has significantly narrowed the critical protections in the Voting Rights Act.

Now, in 2026, a SCOTUS ruling, regarding the ability of voters of color to challenge discriminatory gerrymandering could effectively dismantle Section 2 of the Voting Rights Act, which enforces that the right to vote cannot be denied on the basis of race or color.

Voter suppression has been a key tool of oppression throughout the United States’ history to limit the civic engagement of Black, Indigenous and disenfranchised communities. Black communities are especially at-risk of being deprived of our ability to have full political participation as key components of our democracy are attacked. Across the country, states continue to pass and enact restrictive voting laws that directly target Black women and gender-expansive people’s ability to engage fully in democracy. Stricter voter ID laws, restrictions on mail-in voting, and voter roll purges are common methods policymakers are using to limit our ability to participate in democracy.

Voting is a critical way people can ensure their elected officials reflect their values. Without expansive voter protections, Black women and gender-expansive people will continue to lose access to the ballot box.

Policy Recommendations

• We urge you to advocate for the passage of the John Lewis Voting Rights Advancement Act.

What Can You Do?

• Read more about In Our Own Voice’s federal advocacy priorities for 2026 [PDF]
• Use our resources to advocate locally
• Meet with your members of Congress or their staff
• Attend a public forum or town hall and ask a question. Call the district offices of your senators and representative to request a list of events near you
• Submit an op-ed to your local paper
• Use Facebook or Twitter to engage your members of Congress
• Send an action alert message to your members of Congress or call your members of Congress
• Contact our government affairs staff for advocacy strategies and useful resources