Open Enrollment 2025: Why Healthcare in 2026 May Look Different — and What We Can Do About It
Healthcare is changing — here’s how to protect your care, your community, and your peace.
Open Enrollment Isn’t Business as Usual
This open enrollment season, many people are signing up for healthcare like it’s any other year. But 2025 is not business as usual. What happens over the next few months will shape how accessible — or inaccessible — healthcare becomes in 2026 and beyond.
In July 2025, Congress passed the One Big Beautiful Bill Act (OBBBA), a sweeping law that reshapes Medicaid, the Affordable Care Act (ACA), and federal mental health programs. Combined with the possible expiration of enhanced ACA subsidies at the end of 2025, we’re facing a moment where:
Coverage could become more expensive
Mental health resources may shrink
Entire communities may experience deeper inequity
For marginalized communities — especially Black women and women of color — these changes affect much more than coverage. They shape care, safety, and mental well-being.
This guide breaks down (1) what’s changing, (2) what it means for our communities, and (3) what we can do to protect our health and our power.
What’s Changing: The One Big Beautiful Bill Act (OBBBA)
A Quick Overview
Signed in July 2025, the OBBBA pays for major federal tax cuts by reducing spending on healthcare and social programs.
Key Provisions
$1 trillion in Medicaid cuts over the next decade
New Medicaid work reporting requirements for beneficiaries
Elimination of SAMHSA and HRSA, replaced with a smaller agency: the Administration for a Healthy America
One-year defunding of Planned Parenthood
Cuts to mental health workforce programs, including clinical training pathways and loan repayment programs
Why This Matters
These changes will disproportionately affect people who rely on Medicaid and community-based mental health services:
Millions could lose coverage — especially those in Medicaid expansion states
Maternal mental health programs will lose critical funding
Crisis systems like 988, school-based mental health, and local counseling will face disruption
Providers may experience lower reimbursement and higher administrative burdens
“When you cut Medicaid, you’re not just cutting numbers — you’re cutting lifelines for people who already have the fewest safety nets.”
Why 2026 Will Look (and Feel) Different
ACA Subsidies Are Set to Expire
The enhanced ACA premium tax credits — originally expanded during COVID and extended several times — are scheduled to expire at the end of 2025 unless Congress renews them.
Without action:
Marketplace premiums will rise sharply in 2026
People just above Medicaid income eligibility will face unaffordable costs
Millions more could become uninsured
The Ripple Effect
Higher uninsured rates lead to:
More medical debt
Hospitals closing or reducing staff
Fewer behavioral health and therapy resources
Longer waitlists and fewer in-network providers
And for Black women — who already face disparities in diagnosis, treatment, and quality of care — the gap widens.
“For Black women, whose mental health needs are often minimized, fewer providers and more barriers mean we risk losing more than coverage — we risk losing care rooted in dignity.”
What This Means for Our Communities
Who Is Hit Hardest?
Low-income individuals
Disabled people
Black, Indigenous, and other people of color
Rural residents
Mothers and caregivers
People needing consistent mental health care
Specific Community Impacts
Maternal mental health programs lose crucial support, even as Black mothers continue to face high risks during and after pregnancy
Community mental health agencies will be stretched even thinner, often serving more people with fewer resources
Lack of stability in coverage increases chronic stress, worsening anxiety, depression, and burnout
“Policy instability is trauma — and Black women are tired of being expected to be resilient through it.”
What You Can Do Right Now — Individual & Community Actions
This is where personal empowerment meets collective care.
For Individuals & Families
1- Check Your Coverage During Open Enrollment (Nov 1–Jan 15)
Don’t rely on automatic renewal
Update your income to ensure accurate subsidies
Compare plans through Healthcare.gov or your state marketplace
Review your mental health benefits — telehealth, therapy limits, medication coverage
2- Ask Your Providers About 2026 Insurance Changes
Clinics may shift which plans they accept due to new policies.
3- Save Your Documentation
Keep records of:
Employment
Disability status
Income
These will matter under new work reporting requirements.
4- Build Your Care Circle
If coverage changes:
Look into community health centers
Seek sliding-scale therapy options
Explore peer support or trauma-informed community spaces
5- Make Use of Telehealth
Especially helpful for rural residents — many states still cover it through Medicaid.
For Community Members & Advocates
1- Organize Locally
Support coalitions protecting Medicaid and mental health programs:
Black Mamas Matter Alliance
National Health Law Program
Maryland Health Care for All
2- Share Your Story
Lived experience fuels advocacy and legislative momentum.
3- Support Community-Based Healing Models
Examples include:
Community Health Worker (CHW) programs
Trauma-informed care collectives
CareOregon’s Health Resilience Program
Maryland’s State Health Equity Plan
4- Invest in Mutual Aid & Peer Support
Emotional support networks are protective during policy changes.
5- Contact Your Representatives
Ask them to:
Extend ACA subsidies
Oppose Medicaid cuts
Protect maternal and mental health funding
What Communities Can Build Moving Forward
Even with policy shifts, our communities continue to innovate:
Expanded telepsychiatry for rural and remote areas
Faith-based mental health ministries
Black-led wellness collectives
Mental health workforce pipelines for BIPOC providers
We may not be able to outrun every policy decision, but we can build networks that make care possible even when systems fail.
Protecting Our Health and Our Hope
This year’s open enrollment isn’t just about choosing a plan — it’s about protecting our right to care, to rest, and to live fully.
As a therapist and a Black woman, I know policy doesn’t exist in a vacuum. It lives in our bodies, our stress levels, our parenting, our relationships, and our ability to breathe deeply.
But we are not powerless.
Stay informed
Advocate together
Protect your care
Protect your peace
Care is a form of resistance. Staying informed, organizing with your community, and prioritizing your wellness are acts of liberation.
