Letter to Chuck Schumer, Senate Majority Leader, and Nancy Pelosi, Speaker of the House - Closing the Coverage Gap in Reconciliation to Improve the Health of our Neighbors in Non-Expansion States


Dear Senate Majority Leader Schumer and Speaker Pelosi:

Thank you for your longstanding leadership on increasing and protecting comprehensive, quality, affordable health care for so many Americans. We have taken monumental steps to improve health care in our nation, but unfortunately too many hardworking individuals and families across America are currently without coverage that would safeguard their health and their pocketbook due to a dangerous ideology in our state capitols. For too long, politicians in our states have prevented 2.2 million people who would qualify for Medicaid expansion from gaining access to high-quality coverage.[1] As Congressional members from the 12 non-expansion states, we strongly urge you to include language to close the Medicaid coverage gap in reconciliation.

On November 19, 2021, the House passed the build Back Better Act, a historic step towards bolstering our economy and making our government work for all Americans. The bill would expand coverage to the millions of Americans who fall within the Affordable Care Act (ACA) coverage gap by expanding the law's premium tax credits to below 100% of the federal poverty level (FPL) and providing enhanced cost-sharing assistance. Closing the coverage gap could help lower health care costs by reducing uncompensated care and help reduce medical debt and financial pressure on people struggling with the rising costs of everyday living.[2]

As negotiations continue on reconciliation legislation, we want to once again reiterate the importance of closing the Medicaid coverage gap. It would help advance racial health equity in our nation, as nearly 60% of people in coverage gap are Black, Hispanic, Asian, or Pacific Islander.[3] Expansion states have narrowed the gap in uninsured rates between Black and Latino people and white people more so than non-expansion states, and have helped reduce racial disparities in certain chronic illnesses.[4] Additionally, at a time when reproductive rights are under attack across the country, including in the recent Dobbs v. Women's Health Organization decision, it is more critical than ever to ensure that the 800,000 uninsured women of reproductive age currently in the coverage gap have access to comprehensive health care. Finally, an already dire situation is made even more so because when the COVID-19 public health emergency ends, so will the federal continuous coverage requirement that is currently preventing state Medicaid programs from disenrolling individuals.

Medicaid is a lifeline for many in the United States, and we know that consistent access to insurance improves health and well-being, eases financial concerns for families, promotes equity, and lowers overall health care costs. We must seize the opportunity to take action now to close the coverage gap in any upcoming reconciliation package. Congress can and should fix the gap and move us towards a future where everyone can get the health care they need, no matter what state they live in.

We are grateful for your tireless efforts to secure a final package, and hope that you will do everything possible to finally tear down this barrier to health coverage for our neighbors in non-expansion states. We stand ready to work with you to push this investment in health care over the finish line, and get all Americans covered.