By: Jerry P. Abraham, MD MPH CMQ
Photo by: Pixelrobot | Dreamstime.com
The health care landscape in the U.S. is changing again, and this time the changes are significant enough to affect daily life. With the passage of H.R. 1, the budget reconciliation law that altered federal health programs, including Medicaid (Medi-Cal) and Affordable Care Act marketplace coverage, many people now face the risk of losing insurance, paying more for it, or having to fight harder to keep their current coverage. For anyone juggling work, family, community responsibilities, and the ongoing effort of managing mental and physical health, this uncertainty brings stress that lingers even as the news cycle progresses. Insurance is more than just a card in your wallet, it’s part of how you feel secure in your life.
H.R. 1 introduces several changes to people’s medical care. The most notable changes are the significant cuts to Medicaid (Medi-Cal) funding and stricter eligibility rules, which are likely to leave many people without coverage over the next decade. For those purchasing insurance through market plans like Covered California, premiums may increase and subsidies will decrease, since the enhanced federal tax credits were not extended. Additionally, Medicaid (Medi-Cal) enrollees now face more regular eligibility checks. This means they can lose coverage simply because they missed a letter or a deadline. Community clinics and federally qualified health centers, which are often trusted and accessible sources of care, are preparing for shortfalls as fewer patients remain insured. All these factors contribute to persistent stressors like the fear of losing access to a therapist, reluctance to schedule routine checkups, or anxiety that an unexpected health issue could lead to a financial crisis. Undocumented migrant workers will be most impacted as they may no longer be eligible for health insurance.
When insurance becomes unreliable, the impact is felt not only in physical health but also in mental and emotional well-being. Preventive care is often the first thing to get neglected when people worry about costs or coverage stability. Medical visits that help manage chronic conditions like hypertension, diabetes, HIV care, hormone therapy, or depression become harder to maintain. The stress of these worries can make sleep difficult and increase anxiety. Beyond this, because culturally competent providers are already scarce in many regions, losing coverage can mean losing access to care where you don’t have to explain or defend personal aspects of your identity or experiences.
Even in this uncertain environment, there are practical steps that can be taken to help protect health and create stability. The first step is to keep track of insurance paperwork. With the new eligibility checks, knowing when your renewal is due, what documents you need, and how to submit them on time is crucial. Many enrollment counselors and county offices provide assistance in multiple languages and can guide you through the process for free. If you still have coverage, now is a good time to catch up on preventive care, such as physical exams, vaccines, STI testing, labs, and mental health consultations. Getting updated medical records and maintaining recent contact with a provider can make future transitions easier, even if your insurance changes.
For those without stable coverage, community clinics can still be a vital resource. Many offer sliding-scale fees or free services, while LGBTQ+ centers across California often provide sexual health services, mental health programs, and help with insurance questions. Telehealth has also increased access to counseling and basic medical visits at lower costs, especially for people balancing work and transportation challenges.
Beyond the formal health care system, community support is essential for staying well. Informal networks like close friends, neighbors, coworkers, and chosen family, can significantly reduce stress and assist with practical needs. This support may involve checking in on each other’s mental health, reminding a friend about a renewal deadline, sharing information about low-cost clinics, cooking for someone feeling overwhelmed, or simply providing company during stressful appointments. These caring gestures might seem small, but they create a safety net that legislation cannot dismantle.
Mental health also deserves ongoing attention, especially during these times of deep anxiety and uncertainty. Of course, nothing can replace the importance of trained, professional care. However, daily rituals like writing down your feelings, taking short walks outside, practicing breathing exercises, limiting excessive news consumption, and setting boundaries can all manage stress. When deeper support is necessary, many cities offer low-cost or drop-in mental health services, LGBTQ+-focused groups, and peer support circles. Talking to someone you trust can prevent stress from escalating.
If you lose insurance, remember that not all options are closed. Some people qualify for special enrollment periods on marketplace plans if their income changes or they face specific life events. Many counties have low-cost health programs for residents, regardless of immigration status. Community clinics often offer affordable self-pay rates, and some medications, particularly PrEP and those for HIV treatment, may be available through state programs or manufacturer assistance. Local mental health crisis lines, walk-in centers, and short-term counseling services remain accessible regardless of insurance status.
Policy changes like H.R. 1 can create a feeling like you have lost control, but what we can control is how we care for ourselves and how we support each other. We stay grounded by being informed, acting early, and being gentle with ourselves amid uncertainty. We support one another by sharing information, providing emotional support, and connecting our communities to care. Throughout all this, we remember that health is shaped not just by policy, but by the networks of support, resilience, and solidarity we continue to build. Even in uncertain times, that foundation remains strong. Happy New Year, All!
Remember, you can visit Dr. Jerry Abraham and the whole JWCH-Wesley HIV Street Medicine Team at Tempo Nightclub every Sunday night. Come get HIV-tested, PrEP’d, and all your LGBTQ+ health questions answered.