FACT SHEET: RECA’s Deadly Tradeoff

As the U.S. implements a long-overdue expansion of the Radiation Exposure Compensation Act (RECA) as part of the so-called “Big Beautiful Bill,” we compiled this fact sheet to better understand the broader implications of the legislation — particularly what it means for health care access in the very states RECA aims to support.

The data focuses on 16 RECA-eligible states — those whose residents were directly impacted by nuclear testing, uranium mining, or radioactive fallout. These are the communities that lived through radiation exposure, and many continue to suffer from long-term health impacts, including elevated cancer rates, respiratory disease, and birth defects. 

But while the legislation renews and expands RECA eligibility, its cuts to Medicaid and threats to Americans with Affordable Care Act plans will result in millions of Americans losing health coverage and their rural hospitals — including many of the same people impacted by radiation exposure.

To examine the impact, I pulled a list of states from statements on RECA eligibility from the U.S. Senate. I then cross-referenced those states with previously published data from the Center for Healthcare Quality and Payment Reform, which provides state-by-state numbers for rural hospitals at risk of closure, and the Senate Joint Economic Committee Minority, which offered state-by-state estimates of Americans expected to lose Medicaid or ACA coverage under the Republican budget. (The latter resource looked at the House version of the legislation, the most recent state-by-state analysis available at the time of publication.)

Overall, I found that in these 16 RECA-eligible states, over 240 rural hospitals are at risk of closing — and 81 of those are at immediate risk. At the same time, an estimated 3.9 million people across these states stand to lose health insurance. This includes over 1.4 million people losing Medicaid coverage and another 2.5 million losing Affordable Care Act coverage.

This data makes one thing painfully clear: the same populations finally being acknowledged for their suffering are now being put at risk again — this time through cuts to the care they need to survive.

This fact sheet was created to underscore the contradiction at the heart of this moment. While the expansion of RECA is long overdue and absolutely necessary, it must not come at the expense of basic healthcare infrastructure in rural and low-income communities.

Download this fact sheet as a PDF here.