2026 SESSION RECAP: Health Equity

Federal action drastically shaped the health equity landscape leading up to the 2026 legislative session.

H.R.1 , one of the most destabilizing policies passed under the current federal administration, will reduce Medicaid and Supplemental Nutrition Assistance Program (SNAP) coverage, add work and volunteer requirements, and shift additional cost burdens onto states already navigating tight budget constraints. To help state lawmakers understand what this means locally, Voices created a mapping resource that outlines the projected impact across Virginia.

Projected total SNAP and Medicaid funding loss in Virginia by 2034.

At the same time, additional cuts to ACA enhanced premium tax credits have made accessing coverage through the marketplace more difficult. These federal decisions are deepening affordability challenges and limiting equitable access to care, particularly for families who rely on subsidized coverage to remain insured.

These changes are unfolding as Virginia’s uninsured rate continues to rise following Medicaid unwinding in April 2023. This trend is expected to continue, putting more Virginians, especially those already facing barriers, at risk of worse health outcomes and delayed care.

Across Virginia, more families are struggling to afford food, and the impact is showing up in real ways.

The data tells a clear story:

Not having enough food does not just create stress. It impacts physical and mental health, from anxiety and depression to chronic conditions like high blood pressure. For children, these effects can shape long-term development.

For families already stretched thin, managing these health challenges often requires time they simply do not have.

In these moments, families rely on paid leave policies to care for themselves or their loved ones. Yet despite the well-documented public health and economic benefits of paid sick days, 1.2 million private sector workers in Virginia, 41 percent of the workforce, do not have access to a single paid sick day.

For longer-term needs like cancer treatment, caring for a newborn, or supporting a loved one at the end of life, paid family and medical leave (PFML) is critical. However, 3.5 million workers in Virginia, 76 percent of the workforce, do not have access to paid family and medical leave.

These systems are deeply interconnected. Changes in health coverage, food access, and workplace protections do not happen in isolation. Together, they shape whether families can remain stable or fall further behind.

Over time, these challenges compound, creating what is often referred to as a health-poverty trap, where poor health outcomes and financial instability reinforce one another.

This legislative session required policymakers to respond to harmful federal changes while also advancing solutions like paid leave, free school meals, and expanded health access. Without these interventions, more families will continue to fall deeper into this cycle.

This session reflected both meaningful progress and clear gaps in advancing health equity across Virginia.

The decisions made this session directly shape whether families can access care, afford food, and take time to care for themselves and their loved ones.

Progress on paid leave and school-based health services will improve stability for many families. At the same time, gaps in coverage, food access, and affordability remain.

Without continued investment, too many families will continue navigating impossible trade-offs, choosing between seeking care, paying bills, or putting food on the table.

Whether it is caring for a newborn, managing a chronic condition, or supporting a loved one through treatment, these policies determine what is possible for families in real life.

The reality is simple. When families lack access to care, food, and time to recover, health outcomes worsen. When health outcomes worsen, financial stability becomes harder to maintain.

This is how the health-poverty trap continues, especially as federal policy changes place additional strain on state systems and household resources.

Much of the final impact of this session will depend on the state budget.

Key areas to watch include:

• SNAP funding and administrative costs, including proposals ranging from approximately $135M to $211M across House and Senate versions
• Medicaid policy changes, including potential work requirements and coverage limitations
• Replacement funding for ACA tax credits to stabilize marketplace coverage
• Maternal health program investments and workforce support
• Paid leave implementation funding, including staffing and administrative capacity
• School-based health and food access funding

Some of these investments are included in current House and Senate proposals, but final decisions will be made during the special session beginning April 23.

There are also proposals that are unlikely to move forward this year, including expanded CHIP eligibility and universal school meals, though advocacy efforts will continue to build momentum over time.

At the same time, Voices and coalition partners will continue advancing long-term goals, including expanding children’s health coverage, strengthening food access, and ensuring effective implementation of paid leave policies. These efforts reflect a broader strategy to prevent families from falling into the health-poverty trap before it begins.

Progress this session is meaningful. But it is not complete.

Without additional investments in health coverage, food access, and economic supports, too many families, especially young people and their caregivers, will continue to face rising costs without the resources they need.

Virginia has the tools to go further. And the work continues.