On July 4, President Trump signed House Resolution 1,119th Congress (HR 1), also known as the deceptively titled "One Big Beautiful Bill. Included in its provisions are significant tax law changes, increased funding for immigration control and national defense, and spending reductions affecting Medicaid and a large number of other federal programs. In fact, HR 1 would give $75 billion to Immigration and Customs Enforcement (ICE) and $45 billion to expand its detention centers, with a total of $170 billion dedicated to immigration enforcement and "border security." The increase would allow the government to detain up to 100,000 individuals at a time. At the same time, HR 1 would cut federal Medicaid spending over a decade by an estimated $911 billion and increase the number of uninsured people by 10 million. This would mean the 31% of Latinx people and 21% of Black people who utilize Medicaid would be at risk.
The administration disguised the bill as a way to give the middle-class tax relief, secure the border, and protect Medicaid from undocumented immigrants. The bill is a thin veil for the government's war on immigrants and trans people, even when undocumented immigrants are largely ineligible for Medicaid benefits and state laws vary on Medicaid coverage for transgender healthcare. It is a clear example of under-resourcing our communities' access to preventive care and treatment, which opens the door to further criminalization of particular health conditions and other negative effects on well-being.
During recent deliberations of Medicaid cuts and potential HIV/AIDS funding cuts in Louisiana, a Democratic lawmaker sought to criminalize additional sexually transmitted infections (STIs), including HPV and HSV, using the state's HIV exposure law. As introduced, HB 76 would have made "intentionally" exposing another person to an "incurable sexually transmitted disease" a felony. However, neither "intentionally" nor "incurable sexually transmitted disease" was defined in the bill, which left an incredibly broad scope of criminalization possible without proof that a person specifically intended to transmit any disease or did in fact transmit an STI. Though the bill failed, it was presented as justice for survivors of sexual assault and interpersonal violence, as well as a solution to the prevalence of STIs in Louisiana.
Justice is the opposite of what the bill would have done. In fact, in a state that has one of the highest incarceration rates, the bill would have criminalized Black Louisianans the most, as they account for a majority of people with new STI diagnoses. The sponsor of the bill, a Black woman Democrat, touted protecting women and children as her reason. Yet, considering Black women account for 38% of chlamydia diagnoses, and Black young people (10 to 29 years old) account for 56% of gonorrhea diagnoses, it becomes clear that a carceral approach to racist and systemic barriers to healthcare only hurts those she claims she wants to protect. How does further criminalizing Black people help increase wellness, especially in a state where 38% of Black people (more than any other race) utilize Medicaid/CHIP while our public health infrastructure and social safety net are under direct attack? The same question could be asked of the gutting Medicaid and elimination of social services: how can this "Make America Healthy Again"?
However, 2025 isn't the first time we've seen the government, federal or state, abandon vulnerable populations in the name of profits and political games. During the early days of the COVID-19 pandemic, it was revealed that Jared Kushner, President Trump's son-in-law, delayed federal resources to help Democratic-led New York, one of the hardest-hit states. Those who attended a meeting with Kushner reported that his response to state needs was that the free market and states themselves should work out the allocation of COVID-19 resources. Equally insidious as Kushner's laissez-faire decision-making were the claims that he delayed a national COVID-19 response to punish blue states and use the resulting backlash and deaths against Democratic governors.
Another failure of the COVID-19 response was the unequal enforcement of social distancing orders. For example, an arrest warrant was issued for Black New Orleans residents Cecil Spencer and Clifton Smith, who organized a second-line to honor a family member who had passed. However, when white pastor Tony Spell held multiple church sessions, it took longer for him to receive the same violation as the two Black New Orleanians.
The specter of criminalization makes the devastation reach higher levels when we look at other carceral responses to health. As mentioned earlier, Louisiana ranks second in incarceration rates, with Black people being almost four times more likely to be incarcerated compared to their white counterparts. And as we know from Louisiana's HIV criminal legal enforcement data, Black people make up 63% of those suspected of violating the law and 100% of those arrested on suspicion were Black. These HIV criminal laws and COVID-19 enforcement rely on an already anti-Black foundation that sees Black people inherently criminal, thus undeserving of resources to survive and thrive. Furthermore, research has shown that the racist practice of redlining in New Orleans is associated with people living with HIV being more likely to reside in neighborhoods with less access to healthcare and supportive services, ultimately resulting in delayed achievement of viral suppression. Racist laws and policies uniquely criminalize Black, brown, LGBTQ, and poor communities and further stigmatize their ability to access dignifying healthcare.
If public health wishes to curb COVID-19 spread or decrease new cases of HIV and STIs, it would address the systemic barriers that disproportionately burden communities of color, particularly Black communities, through resource investment. Yet here we are in 2025, five years after the COVID-19 pandemic appeared and 40 years after the start of the HIV epidemic, contending with cuts to vital, life-sustaining resources in the name of curtailing waste and fraud. When wellness and resources are held hostage to punish marginalized communities, it only proliferates criminalization and vulnerability. We get federal takeover of Black cities like D.C in the name of "safety" and millions of dollars in resources to kidnap and terrorize Black and brown people, while millions soon will be without healthcare.
How do we move forward? How do we fight back? An obvious solution is to increase healthcare access through more investment in healthcare. This means approaching health through holistic means that honor the bodily autonomy and experiences of those at the margins. We must repeal laws that criminalize people for their health status and instead invest in approaches that give people resources to thrive and allow them to curate their idea of what "healthy" means. In order for this work to be just and equitable, we must fund and listen to Black, Southern collectives and organizations that are rooted in the work and community, especially those who center Black Southerners living with HIV and other health conditions. Our work must center the most marginalized, as a siloed movement not only makes our work harder but also incomplete.
As we fight these unjust laws, we must also be proactive in our approach. We must advocate for public health literacy and sex education as well as culturally competent and compassionate continuing education for legislators, governmental and institutional leaders, and healthcare workers. The change must happen at an institutional level, but also in the hearts and minds of those who hold systemic and political power. We must look beyond the traditional framework of health being an individual responsibility and an indication of morals, but as a societal pillar where we allow and encourage people to be their best selves, as defined by them.