However, for District residents, the real fear is not simply lost paychecks; it is the possibility of losing the fragile protections that hold their health care together. They have refused to accept a spending bill that strips Medicaid and allows Affordable Care Act subsidies to vanish. At stake are programs that tens of thousands of District residents rely on, in a city already scarred by racial health disparities and inequitable access to care. Further, East of the Anacostia River, District residents are more likely to report discrimination in care and longer waits to see doctors. Political analysts have noted that the minority party is finally wielding rare leverage to defend health care even at the cost of a shutdown.