Top 5 Most-Read Content From the Center on Health Equity & Access in 2025

As 2025 comes to a close, the health care landscape has faced a series of critical challenges and policy shifts, from rising costs and coverage gaps to disruptions in clinical research and setbacks in diversity, equity, and inclusion (DEI) initiatives.

This year’s most-read articles from the Center on Health Equity & Access lay out the growing affordability crisis for millions of Americans, the ripple effects of National Institutes of Health (NIH) grant terminations on clinical trials, looming risks if ACA premium subsidies expire, and the uncertainty surrounding DEI in health care following federal rollbacks and the FDA’s removal of guidance on trial diversity. Showcasing the complex interplay of policy, funding, and equity, these articles have only increased in relevance as the year comes to an end.

Here are the top 5 most-read articles in 2025 from the Center on Health Equity & Access.

5. 11% of Americans Cannot Access Quality Health Care, Survey Finds

Affordable access to quality health care has become unattainable for 29 million Americans. Earlier this year, the West Health-Gallup study found 11% of US adults are now “cost desperate,” unable to afford or access quality health care, reflecting a sharp erosion in affordability since 2021. Rising medical costs outpacing inflation have disproportionately impacted Hispanic and Black adults and those with the lowest incomes, who saw the largest increases in financial strain and the steepest declines in being considered “cost secure.” Access challenges worsened across all age groups and income brackets under $48,000, while higher-income and White adults remained largely insulated, widening disparities. Overall, 35% of Americans reported difficulty accessing affordable, quality care in 2024—the highest since 2021—driving concerns about medical debt, reduced engagement with the health system, and tradeoffs between health care and basic necessities. Researchers warn that without urgent state and federal policy action, both human and economic consequences will continue to grow.

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4. NIH Grant Terminations Disrupt 1 in 30 Clinical Trials, Impacting Over 74,000 Participants

Sweeping NIH grant terminations earlier this year disrupted roughly 1 in 30 active clinical trials, leaving more than 74,000 participants in limbo and disproportionately affecting infectious disease research. The analysis found that between late February and early April, the NIH terminated 694 grants worth $1.81 billion, nearly a third of which had not yet been spent, following directives from the Trump administration to halt funding for projects misaligned with its priorities. Of more than 11,000 NIH-funded trials active during this period, 3.5% subsequently lost grant support, with disruptions cutting across trial phases, regions, and scientific areas. Prevention and behavioral trials, as well as studies conducted outside the US, were more likely to lose funding, while infectious disease trials saw the highest impact at 14.4%. The authors warn that these widespread, uneven disruptions could compromise data integrity, limit future clinical research, and heighten reliance on less rigorous study designs, underscoring the need for ongoing monitoring.

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3. 5 Consequences If ACA Premium Subsidies End in 2026

Enhanced ACA premium subsidies enacted through the American Rescue Plan and extended by the Inflation Reduction Act have significantly lowered marketplace premiums by more than 50% on average, and helped drive record enrollment, but the Congressional Budget Office warns that their expiration in 2026 could trigger major disruptions across the health system. Without congressional action, premiums would rise sharply, especially for middle-income and older adults, potentially doubling costs for many and pushing up to 4 million people out of coverage. The return of the subsidy cliff would eliminate eligibility for many enrollees earning above 400% of the federal poverty level, driving coverage churn and making insurance unaffordable in high-cost regions. These changes could fuel financial hardship, lead consumers to downgrade coverage or delay care, and widen racial, geographic, and income-based disparities. Experts state that hospitals, safety-net providers, and rural facilities would likely face higher uncompensated care burdens and worsening financial instability, with downstream effects on access, affordability, and the overall managed care landscape.

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2. The Uncertain Road Ahead for Health Care After DEI Rollbacks

The DEI movement in health care—rooted in the Civil Rights era and expanded over decades to address systemic inequities—faced a major setback this year following the FDA’s removal of draft diversity guidance for clinical trials after a Trump administration executive order restricting DEI programs. Historically, DEI efforts have improved cultural competency, strengthened patient-provider trust, expanded access for marginalized communities, and driven better outcomes, including increased adherence and reduced disparities. Yet persistent gaps remain, particularly in clinical trial diversity, where progress has been minimal despite longstanding efforts. Experts warn that rolling back DEI initiatives could worsen inequities, undermine precision medicine, and destabilize the workforce as minoritized physicians and employees leave unsupportive environments. Anti-DEI lawsuits and federal actions risk stalling decades of progress, with implications for patient safety, innovation, and equitable care delivery. As policymakers and health leaders respond, the future of DEI in clinical research and the broader health system remains uncertain.

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1. FDA Quietly Removes Draft Guidance on Diversity in Clinical Trials Following Executive Order on DEI

The FDA’s quiet removal of its draft guidance on clinical trial diversity just days after a Trump executive order limiting DEI programs has created significant confusion for drug and device sponsors preparing Diversity Action Plans required under federal law. The withdrawn draft, issued in June 2024, outlined how companies should set enrollment targets by race, ethnicity, sex, and age, identify barriers to participation; and use community engagement and culturally competent approaches to ensure representative trials. Its disappearance, an unusual step without public announcement, leaves sponsors unsure how the FDA will evaluate diversity expectations ahead of a June 2025 deadline for final guidance. The move comes amid longstanding concerns about underrepresentation in clinical research, particularly for women, intersex individuals, and other marginalized groups, and follows a history of harmful federal policies such as the 1977 exclusion of women of childbearing age from trials. Although many companies have already begun voluntarily submitting diversity plans, the withdrawal signals a potential shift in federal commitment to inclusive research and raises broader questions about how DEI-related requirements will be enforced under the current administration.

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