What a Patients’ Bill of Rights Could Mean for Black Women

The healthcare affordability crisis isn’t new to us. But a bold new proposal could change the game.

If you’ve ever sat in a doctor’s office wondering whether your insurance is going to cover what you need, you’re not alone. Nearly half of all adults in this country say it’s difficult to afford healthcare. One-third say they’ve had to skip or delay care because of cost. And for Black women, who are already navigating a system that has historically undervalued, underdiagnosed, and undertreated them, the financial burden of healthcare isn’t just an inconvenience. It can be the difference between life and death.

A new report from the Center for American Progress, A Patients’ Bill of Rights to Lower Health Care Costs, lays out a bold, concrete set of proposals to bring down premiums, reduce deductibles, and end the practice of prior authorization that forces patients to fight their insurance companies for care their doctors have already deemed necessary. At the Black Women’s Health Imperative, we believe this conversation is one Black women can’t afford to sit out. We read it and here’s what you need to know.

The Numbers Tell a Story

The average family premium for employer coverage now sits at about $27,000 a year, with families paying nearly $7,000 of that out of pocket. Over the last decade, deductibles have more than doubled in many markets. Nearly one in three workers now has a deductible of $2,000 or more.

These are not abstract statistics. They are the reason Black women delay cancer screenings. They are the reason a mother chooses between her blood pressure medication and her child’s school supplies. They are the reason our maternal mortality crisis goes unaddressed at the individual level, even when we know the clinical solutions exist.

Our 2025-2026 National Health Policy Agenda makes clear that access to quality, affordable healthcare is the foundation of everything else. You cannot address maternal health, chronic disease, reproductive justice, or HIV if people can’t afford to walk through the door.

What the Report Proposes

The CAP report outlines four major areas of reform:

1. Capping excessive premium increases. The proposal would require that premium hikes above the growth in actual medical costs be presumed excessive and require justification. In states where this standard would have applied in 2025, individuals could have seen premiums reduced by an average of $415.
2. Lowering deductibles by reining in outlier hospital prices. Some hospitals charge commercial insurers more than three times what Medicare pays for the same services. The report proposes capping those prices in concentrated markets, with savings passed directly to patients in the form of lower deductibles. The estimated average reduction for workers in affected markets is $933.
3. Preventing price gouging by insurance companies. Health insurance markets are among the most concentrated industries in the country. The report proposes decoupling insurer profits from premium and spending levels so that insurance companies can’t quietly boost their bottom line simply by raising what they charge and what they pay. Rebates would go back to enrollees when insurers exceed the benchmark.
4. Banning prior authorization. This one hits close to home. Prior authorization is the process by which insurance companies require your doctor to get approval before you can receive care. It was originally designed as a narrow tool. Today it has become a blanket obstacle. Physicians complete an average of 39 prior authorizations a week, burning through nearly two full business days. Studies show that in Medicare Advantage, 95% of prior authorization requests are ultimately approved, meaning the vast majority of delays and denials are simply unnecessary.

The report proposes replacing prior authorization with independent, evidence-based clinical review, getting insurance company bureaucrats out of the exam room and returning medical decisions to doctors.

Why This Matters for Black Women

At BWHI, Pillar I of our National Health Policy Agenda is dedicated to Access to Quality and Affordable Healthcare. This is not a peripheral concern. It is the foundation on which all of our other work rests.

Black women are disproportionately enrolled in Medicaid, which has already absorbed brutal cuts under the One Big Beautiful Bill Act signed into law last year. Those cuts, including new work requirements, more frequent eligibility redeterminations, and mandatory copays, have pushed hundreds of thousands of Black women out of coverage or to the edge of losing it. For those who remain in private insurance markets, the dynamics described in the CAP report hit our community with particular force.

Black women are more likely to hold jobs without paid time off, carry primary caregiving responsibilities, and live farther from healthcare facilities. We are more likely to have conditions like fibroids, lupus, diabetes, and hypertension that require regular specialist care and ongoing medication management. Those are exactly the kinds of conditions that prior authorization most often delays and disrupts.

“When we talk about healthcare affordability, we’re not talking about an inconvenience. We’re talking about a structural barrier that determines whether Black women live or die,” said Ifeoma C. Udoh, Ph.D., Executive Vice President of Policy and Research at the Black Women’s Health Imperative. “Every dollar a Black woman spends fighting a prior authorization denial, or trying to meet a $2,000 deductible before she can see a specialist, is a dollar stolen from her health, her family, and her future. These reforms would go a long way toward dismantling a system that has never been designed with her in mind.”

The Bigger Picture

We want to be clear: a patients’ bill of rights does not replace the deeper structural reforms our communities need. We still need Medicaid expansion in every state. We still need the Hyde Amendment repealed. We still need comprehensive postpartum coverage as a national standard, Medicaid reimbursement for doulas and midwives, and real investment in the perinatal workforce. Those fights are ongoing, and BWHI is not stepping back from any of them.

But the CAP report reflects something important: bold, near-term action is possible. We do not have to wait years for systemic overhaul to bring down costs for people who are struggling right now. Premium rate review works. Hospital price caps work. Eliminating prior authorization would remove one of the most burdensome and arbitrary obstacles in the healthcare system. These are not radical ideas. They are practical tools with a track record.

Black women have always been asked to wait. To be patient. To be grateful for incremental progress. We are done waiting. Our health is too urgent, our lives too valuable, and our community too organized to accept anything less than the full range of reforms our families deserve.

Read the full Center for American Progress report: 

A Patients’ Bill of Rights to Lower Health Care Costs

Read BWHI’s 2025-2026 National Health Policy Agenda at bwhi.org