Expert Practical Advice

By Edward Henderson

California Black Media

For years, Los Angeles-based painter Mia Gardner has relied on side jobs and part-time work to keep her art career afloat. But lately, her biggest challenge hasn’t been finding inspiration — it’s finding affordable health insurance.

“I looked at the marketplace last month, and the lowest plan I could find was nearly $500 a month,” Gardner said. “That’s half my share of rent. I’ve had to skip checkups and just hope nothing major happens.”

Gardner’s struggle reflects a growing crisis for Californians who buy their own health insurance. With the introduction of House Resolution (H.R.)1, otherwise known as the “One Big Beautiful Bill Act” and passed by Congressional Republicans, millions could soon face higher premiums or lose coverage entirely.

Rhonda Smith, Executive Director of the California Black Health Network (CBHN), said H.R.1 poses an especially serious threat to people who fall between employer-based and government-sponsored coverage — freelancers, gig workers, and small business owners like Gardner.

“Financing your healthcare will be even more important than ever before, especially in the era of H.R.1,” Smith said.

“There are a few financial burdens that will be placed on individuals, patients, and the states due to significant federal budget cuts to public health programs. Rather than creating a new healthcare financing stream and system, the bill unfortunately puts a lot of burden and risk on patients and state governments, especially as it relates to Medicaid and the Affordable Care Act,” Smith continued.

CBHN hosted a digital webinar on Oct. 22, the final in a five-part series titled ‘Financing Your Health Care’. Dr. Melissa Clarke, a public health physician and policy analyst, led the session which focused on the issues H.R.1 creates along with possible solutions for individuals at risk of losing their coverage.

“The Affordable Care Act created a mechanism for people to buy insurance as individuals, on a sliding scale based on income,” Clarke said. “That opened access for millions. The ‘Big Beautiful Bill,’ by contrast, makes it harder for people to qualify for Medicaid and harder to afford insurance on the Obamacare marketplace.”

Under H.R.1, federal funding cuts of up to $800 billion to Medicaid would shift more costs onto states, leading to stricter eligibility limits and frequent income verifications. Simultaneously, marketplace subsidies that make individual plans affordable are set to be rolled back.

“Without those subsidies,” she said, “the average person simply won’t be able to afford coverage. People make choices based on their pocketbook — and if coverage becomes too expensive, they’ll go without. Over sixteen million people are expected to lose access to healthcare — either because of changes to Medicaid or because they can no longer afford insurance on the marketplace.”

For working-class Californians, especially those earning too much to qualify for Medi-Cal but too little to afford private insurance, the consequences are personal and immediate.

Gardner said she’s already started rationing her asthma inhalers and skipping preventive care.

“I don’t qualify for Medi-Cal, and I don’t have a traditional employer,” she said. “It feels like I’m being punished for trying to make a living doing what I love.”

H.R.1 threatens to undo much of the progress made under the Affordable Care Act, particularly for groups who gained coverage for the first time, such as gig workers and independent contractors.

Clarke emphasized that there are still real options for people navigating this new landscape. Her top recommendation: community health centers, which operate in nearly every county and provide primary care on a sliding scale based on income.

“They are federally funded to see you on a sliding scale, which means they take your income into account. Based on your income, you may have absolutely no out-of-pocket costs. They often provide wonderful care — not just doctors, but social workers, nurse practitioners, and specialists. If they don’t have the specialist you need, they’ll help you get to one.”

You can find community care centers in your area on the California Social Services website.

She also urged patients to look into medication assistance programs, such as NeedyMeds.org or manufacturer discount cards, which can help lower prescription costs for chronic conditions like diabetes or asthma. The CancerCare Copayment Assistance Foundation is another outlet Dr. Clarke mentioned to provide assistance.

Finally, for those losing Medicaid or Medi-Cal coverage, Clarke encouraged appealing the decision. She mentioned that at times the decision is based on missing paperwork or outdated income information, but patients need to act quickly to avoid a lapse in coverage. She also encouraged attendees to negotiate hospital fees even if you don’t qualify for charity care, noting that for hospitals, a reduced fee that gets paid is better than getting no payment at all on a full bill.

“Health insurance isn’t just about emergencies,” she said. “It’s about staying proactive — getting screenings, vaccines, and care before small problems become big ones.”