Skip to Main Content

Lawmakers are in the midst of deliberations over the Build Back Better Act, a landmark legislative package to transform the U.S. for the better. One piece of the bill that would have a huge impact is a provision that would provide health coverage to millions of uninsured Americans who live in states that haven’t expanded Medicaid by opening up coverage for people with incomes below a certain level.

But with House lawmakers still waiting on financial details of the package, and the Senate still squabbling over a variety of provisions, it likely will take quite some time to get the bill finalized. Or worse, legislators could forgo the package entirely.


That comes with a dire cost. Every moment of delay, more uninsured Americans are getting sick and dying. I know this all too well. I lead the Mississippi Center for Justice which, along with local and national advocacy partners, has been spearheading efforts to expand Medicaid in Mississippi. Every day, we encounter people who cannot afford health care — leading to devastating harms for them, their families, and their communities.

Here’s how Build Back Better would have such a big impact on health care. The Affordable Care Act (ACA) enabled states to expand Medicaid to people with incomes up to 138% of the federal poverty level — that’s $37,000 for a family of four — with the federal government covering the vast majority of the costs. Most states have already taken advantage of this program, unlocking health care for millions of people. But 12 states, primarily in the South, still refuse to expand Medicaid.

That leaves a huge coverage gap for people who aren’t poor enough to currently access Medicaid but also don’t make enough to get subsidies for coverage through the marketplace, which was created by the ACA so people could shop for coverage. All told, that amounts to 2.2 million people, most of whom are people of color. More than half a million of these people are essential workers — like nurses, bus drivers, and cashiers — and are disproportionately susceptible to the wrath of Covid-19.


The Build Back Better Act would close this gap by temporarily allowing people with incomes below 138% of the federal poverty level to access marketplace coverage while paying virtually $0 in premiums.

That’s life-changing. People could get regular preventive care and detect health issues like cancer or heart disease or diabetes before they become dangerous. They could get consistent care to manage chronic conditions. They could get treatment for mental health issues. The list goes on.

I know the dangers of missing out on this care firsthand. When I was starting law school, I found a lump in my breast but didn’t have insurance to afford treatment. So I waited until I finished school and had health coverage to get the lump removed. While I got lucky to finally get insurance in time to save my life, many people don’t.

Indeed, a mountain of research shows how Medicaid expansion saves lives. It prevents premature deaths, improves the management of chronic conditions like diabetes and high blood pressure, ensures the early detection of cancer, reduces instances of depression, and more.

Health doesn’t exist in a vacuum. It affects every aspect of every community across the country. If a mother dies prematurely, that has immeasurable consequences for her children. If a teacher ends up bedridden because he didn’t have the tools to manage a chronic condition, that can affect dozens, even hundreds, of young learners. If a pastor develops severe depression and can’t get help, that has devastating repercussions for a congregation.

I hear so many stories like this in Mississippi. The same sad stories are told in the other states that haven’t expanded Medicaid. And it’s infuriating that these painful instances are avoidable.

The health care coverage gap needs to be closed. Now. While I am hopeful that Congress will make it happen, I am also concerned. Lawmakers have been delaying the package for months, and there are indications that the negotiations could stretch even longer.

Health cannot wait. Devastating health conditions don’t stop appearing just because Congress wants to take its time with partisan negotiations. Lives are being lost.

And even once Build Back Better is fully in motion, there’s still more work to do. The package would resolve the coverage gap only until 2025, after which it would expire. To permanently close the gap, lawmakers in Mississippi and other non-expansion states need to expand Medicaid at the state level. On top of ensuring health care access, doing so would create more than a million jobs and supercharge the economy. It’s irresponsible for state lawmakers to deprive residents of such needed benefits.

Low-income Americans deserve the chance to thrive and contribute meaningfully for their communities. Without health care, that’s all but impossible. Washington, the time for change is now.

Vangela M. Wade is president and CEO of the Mississippi Center for Justice, a nonprofit, public interest law firm committed to advancing racial and economic justice.

Create a display name to comment

This name will appear with your comment

There was an error saving your display name. Please check and try again.