November 19, 2021

CONTACT: Kathy Melley, (617) 791-0708

(BOSTON, MA) – Today, the U.S. House passed the Build Back Better Act, which would make critical advancements for health care affordability, access and equity, including a four-year expansion of health coverage for more than 2 million people living in the 12 states that have refused to expand Medicaid. This is particularly important for Black and brown people, who represent 60 percent of people impacted by the Medicaid coverage gap due to discriminatory barriers to economic security. Community Catalyst is committed to making this policy permanent and better. Additionally, the bill would extend reductions in health premiums to keep coverage more affordable for 3.7 million people who buy their own insurance on the ACA Marketplace. It would strengthen home and community-based services for older adults and people with disabilities to the tune of $150 billion, provide four weeks of paid family leave, drive down the cost of prescription drugs, and ensure health coverage for both birthing people and individuals leaving incarceration. The bill also supports immigrant communities through protections against deportation and work permits. The Build Back Better Act’s passage, combined with enactment of the Infrastructure Investment and Jobs Act to improve and modernize the nation’s crumbling bridges, rail, transit and the electrical grids, represents a historic and meaningful investment in the health and prosperity of people across America.

Statement of Community Catalyst Executive Director Emily Stewart on House passage of the Build Back Better Act:

“We applaud the House for passing legislation that would make historic and transformative investments to improve people’s health and advance health equity. The Build Back Better Act represents the most significant advancement for people’s health since the passage of the Affordable Care Act.

“The Build Back Better Act would address a grave racial and economic injustice by providing health coverage to more than 2 million people with low incomes trapped in the Medicaid coverage gap. State leaders’ refusal to expand Medicaid has greatly undermined the health of people in their states by cutting off their access to urgently needed care for prevention, chronic illnesses and mental health. Having access to preventive and lifesaving health care shouldn’t be based on your zip code.

“The Build Back Better provisions that reduce the amount people pay for health insurance are a welcome relief for millions of families who too often have to choose between making a health insurance payment or making rent. Policies that improve access to affordable health coverage and care would particularly benefit Black and brown people, who are more likely to work low-wage jobs with fewer benefits due to longstanding, discriminatory economic barriers.

“The increased funding for home and community-based services is essential to ensuring that older adults and people with disabilities get the care they need – and that health care workers, primarily women of color, get the pay they deserve. Policies to provide health care postpartum, paid family leave, free universal preschool, high-quality, affordable child care, and protections for immigrants would make a meaningful difference in the health and lives of children, youth, and families with low incomes.

“The House has done its part to support and improve the health, economic security and well-being of people across the nation. Now the Senate must follow suit and immediately pass the House version of the Build Back Better Act and deliver the President’s landmark legislation to his desk.”


About Community Catalyst:

Community Catalyst is a leading non-profit national health advocacy organization dedicated to advancing a movement for health equity and justice. We partner with local, state and national advocates to leverage and build power so all people can influence decisions that affect their health. Health systems will not be accountable to people without a fully engaged and organized community voice. That’s why we work every day to ensure people’s interests are represented wherever important decisions about health and health care are made: in communities, state houses and on Capitol Hill. For more information, visit Follow us on Twitter @CommCatHealth. 



The House Build Back Better Act extends the two-year improvements in the Affordable Care Act’s (ACA) affordability scale through 2025, significantly lowering the cost of premiums for millions of low- and moderate-income people getting coverage through ACA Marketplace plans. It also creates an affordability fund through 2025, providing states with resources to address premiums and out-of-pocket costs for people. 

  • The American Rescue Plan Act included temporary provisions that eliminate or reduce premiums for millions of Marketplace enrollees through an increase in premium support tax credits. Under this provision, premiums are eliminated for those below 150% FPL. Premiums are lowered for everyone else currently eligible for premium tax credits and a new cap on the total amount of income a person would have to pay would end the “subsidy cliff” under which a small change in income could result a large premium spike.     

  • The bill also includes the creation of an affordability fund. The bill makes available $10 billion annually to states for calendar years 2023 through 2025, providing the option for states to establish a state reinsurance program or use the funds to provide financial assistance to reduce out-of-pocket costs. 

  • The increased ACA tax credits have lowered the cost coverage for 3.7 million more people and made coverage free or nearly free for more than 46% of people who are uninsured.    

  • While low-income people have seen the biggest coverage gains of any income group, they still have highest uninsured rate and comprise the largest share of uninsured people.  

  • This is especially true for Black and brown people, who face discrimination in employment and education. As a result, they are more likely to work in low-wage jobs without good benefits like health coverage.  

Congress’s work to extend the premium tax credits is an important step toward making health coverage more affordable, but we can’t stop there. In addition to reducing premiums permanently – beyond 2025 – we need to reduce high out-of-pocket costs that are putting health coverage and care out of reach for too many people.   

  • Despite the progress afforded by the ACA and the Build Back Better agenda, millions are forced to make choices between basic needs and health care – from seeing a doctor to affording prescriptions to managing a chronic illness. One in four persons taking a prescription drug reported skipping doses or cutting pills in half due to affordability issues.  

  • Recent polling shows that reducing health care costs is a top priority for voters, regardless of political affiliation.   

  • To lower out-of-pocket costs, Congress should pass the S. 499, the Health Insurance Affordability Act sponsored by Sen. Shaheen.  


The Build Back Better Act seeks a way to offer affordable health coverage to millions of people in the Medicaid “coverage gap” in one of the 12 states whose leaders have not expanded Medicaid, which shows a firm commitment to addressing deep inequities in access to coverage and care. By offering Marketplace plans to people in non-expansion states whose incomes are too high to qualify for Medicaid, the House bill provides a pathway for coverage to over 2 million people left stranded in a coverage gap. With over 60 percent of people in the gap being people of color, the coverage pathway takes an important step toward advancing racial justice and undoing a legacy of harm, while also encouraging leaders in the last 12 non-expansion states to finally take up state-led expansion. Expanding the affordability of health coverage and care for people in the Medicaid coverage gap is critical to advancing health equity and racial justice.   

  • Under this provision, the Build Back Better Act would close the coverage gap through 2025 by making people in non-expansion states eligible for federal Marketplace plans. The enrollment would be open year-round similar to the current Medicaid program and in years 2024-25 would provide additional benefits to be more Medicaid-like, including non-emergency medical transportation (NEMT) and family planning services.  

  • For states that rely on this federal pathway for coverage, there will be a reduction in their federal contribution to hospital uncompensated care since the federal government will be providing health coverage to the uninsured through Marketplace plans. 

  • States that have already expanded Medicaid will receive a 3% increase to their federal Medicaid contribution through 2025.  

The Build Back Better’s commitment to closing the coverage gap – and ensuring access to coverage regardless of residence – is a robust response to inequity that we need now, but we can do more. People need permanent, comprehensive coverage in the form of a permanent, federal Medicaid program and/or Medicaid expansion in all 50 states.  

  • We can’t go back. In four years, people who have been able to gain coverage from Build Back Better should not lose it. In fact, it should get better. 

  • It’s not an accident that eight of the 12 states that haven’t expanded Medicaid are in the South, a region that’s long borne the brunt of health inequities and the political disenfranchisement of Black and brown people. Those living in non-expansion states should have equal coverage to those in expansion states, which could be made possible with a permanent, federal Medicaid program. 

  • State-administered Medicaid expansion programs continue to have many benefits, including allowing states to build programs that most effectively serve their unique residents. Therefore, the bill offers further encouragement for the remaining 12 states to expand Medicaid, and state leaders should take a serious look at that. 


The Build Back Better Act proposes to make a historic investment in Medicaid home- and community-based services (HCBS), long-term care services that are provided to individuals in their homes or other community-based settings. States can receive this increased funding if they enact policies to both improve access to HCBS as well as support the home and direct care workforce.  

  • The House bill appropriates a total of $150 billion for states to enhance, strengthen and improve their Medicaid home- and community-based services (HCBS) programs by expanding access to services and self-directed care programs, supporting the workforce through updated payment rates, and requiring states to adopt and report on HCBS quality measures. The majority of this $150 billion will go towards increasing the federal reimbursement rates states receive for the HCBS programs, so long as states implement activities to improve their programs and support the direct and home care workforce.  

  • By both increasing access to home-based care and supporting the home and direct care workforce, this proposal would advance racial justice in the long-term care system in two ways. 

  • The COVID-19 health crisis places the populations who receive and rely on HCBS, including older adults, people with disabilities and individuals with complex care needs, at heightened risk of infection and death. Not only that, but the COVID-19 pandemic has highlighted and increased the need for home-based care, as more than one-third of the nation’s deaths from COVID-19 have been linked to nursing homes and other long-term care facilities.   

  • Additionally, since most older adults would prefer to age in their home and community, increasing access to HCBS would go a long way towards making long-term care in Medicaid more person-centered.  

  • Home and community-based services are (unfortunately) an optional benefit in Medicaid, and even though every state provides HCBS, many have waiting lists for this critical service. Increasing funding for HCBS will help states alleviate their waiting lists so more individuals can live and age at home and in their communities. 

  • Therefore, investing in and increasing access to HCBS is not only long overdue, since it better allows individuals who receive long-term care to do so in the way they would most prefer, but it’s also incredibly necessary in this moment for reducing illness and death from COVID-19.  

Passing the Build Back Better Act is a great step forward but just a start. We will continue working with our partners to advocate for Congress to pass the HCBS Access Act, which would make HCBS a mandatory Medicaid benefit.  


Pregnant individuals with low incomes are eligible for their own category of Medicaid coverage, but this type of Medicaid is currently only available for up to 60 days postpartum under federal law. While a number of states have taken up the state option to extend postpartum Medicaid coverage on their own, the Build Back Better Act changes federal law to ensure this extension is available nationwide. It’s now well established that the United States has an egregious maternal health crisis for Black and Indigenous individuals, and that one third or more of pregnancy-related deaths occur in the postpartum period, up to a year following childbirth. Therefore, extending postpartum Medicaid coverage for a full year is a necessary and proactive, but by no means sufficient, step toward addressing the racial disparities in maternal mortality rates that are the result of systemic racism and implicit bias. This bill would advance birth equity by expanding health coverage postpartum to millions of birthing people and by investing in data collection and the workforce. 

  • The House Build Back Better Act builds on the state option for 12-month Medicaid coverage postpartum by making the option permanent. The change would take effect one year after the bill is enacted.  

  • Other provisions in the bill are important to maternal health. The bill includes a Medicaid maternal health home option for states, recognizing the importance of care coordination and comprehensive care for pregnant people. If a state takes up the option for a health home, they receive a 15 percentage-point increase in federal Medicaid contribution for the first two years of implementation.  

  • The bill also includes a number of provisions from the Momnibus that support workforce development, specifically funding community partners that are providing needed care to Black and brown people. In the case of birthing people, Medicaid saves lives.   

  • Studies have demonstrated the year following the end of a pregnancy to be a concerning period for postpartum people. In fact, one-third of pregnancy-related deaths occur during the first year after the end of a pregnancy, disproportionately among Black women.   

  • Mandating Medicaid postpartum coverage for 12 months is a necessary step toward ensuring birthing people can adequately address their medical and behavioral health concerns during this critical period. In addition, addressing workforce needs for Black and brown pregnant and postpartum people is critical. 

The Build Back Better Act is a historic step forward in addressing the country’s maternal health crisis through investments that would save lives, reduce disparities in maternal health and advance racial justice. We will continue to work alongside Black-led reproductive justice leaders to craft and advocate for additional provisions in the Momnibus to advance Black and Indigenous maternal health. 



The Build Back Better Act enables states to provide Medicaid or CHIP coverage to incarcerated individuals a month prior to their reentry to the community. The House bill state Medicaid option would go into effect two years after the law is enacted for people who qualify for Medicaid or CHIP. The coverage would make it easier for them to access the care they need, improve health outcomes and reduce deaths.  

  • Federal law known as the inmate exclusion policy prohibits Medicaid coverage for people in jail or prison, adding to barriers to physical, mental health and addiction services. Because of mass incarceration of Black and brown people, especially through the punitive policies of the War on Drugs, the prison and jail population is disproportionately Black and brown people, so they are more likely to experience the fragmented health care that can result from incarceration.  

  • This is especially important for incarcerated individuals with substance use disorders, as many are forced into withdrawal while in prison and are at increased risk of fatal overdose upon release.  

  • Starting Medicaid coverage to individuals 30 days before release – known as the Medicaid Reentry Act – is therefore a racial justice issue and would be an important step toward undoing the harms of systemic racism in both the criminal legal system and health system. 

  • Additionally, providing Medicaid coverage during 30 days before release from incarceration will keep our communities healthy. Incarcerated individuals are also at particular risk of contracting COVID-19 because of jail/prison conditions. Making sure these individuals have uninterrupted health coverage, particularly during the transition period when they are reentering their communities, is essential for keeping them healthy, limiting spread of the virus and protecting the health of the community overall.  

Passing the Medicaid Reentry Act as part of the Build Back Better Act is an important step forward, opening the door to this essential health coverage. We and our partners will work at the state level to encourage Medicaid officials to adopt this policy option and to ensure people returning to their communities get the health services they need.  


The House Build Back Better Act would finally make funding for the Children’s Health Insurance Program (CHIP) permanent and include funds for outreach to enroll kids who qualify but are uninsured. It would also ensure 12-month continuous eligibility to reduce churn. 

  • The CHIP program currently insures over 80 million people, with nearly 10 million enrolling since the beginning of the ongoing public health emergency; more than half its enrollees are children of color.  

  • Although states have the option to provide continuous eligibility for children in Medicaid and CHIP programs, the majority do not.  

  • The Build Back Better bill would require all states to provide 12-month continuous eligibility for children in both Medicaid and CHIP. Because Black and brown children are overrepresented in the Medicaid program, this is an important provision that advances health equity, ensuring all children get access to the health care they need year-round.  

Including provisions to secure continuous health coverage for the nation’s children is essential and long overdue. Congress can do more to support children by ensuring that all children have access to needed health services. 


The Build Back Better Act gives Medicare the power to negotiate lower drug prices so that no older adult pays more than $2,000 a year for their prescriptions, and protects every person from high drug price increases at the pharmacy. 

  • Specifically, the bill empowers Medicare to negotiate prices for select drugs purchased at the pharmacy counter and administered at a doctor’s office.  

  • In addition, the bill caps out-of-pocket spending for older adults, protecting them from high drug costs often associated with conditions like cancer, multiple sclerosis and rheumatoid arthritis. Insulin co-pays for Medicare beneficiaries will also be capped at $35 each month.  

  • Finally, the bill bars pharmaceutical companies from raising prices faster than inflation. This will translate into meaningful savings for older adults that rely on Medicare Part D. 

Congress must continue to advance the provisions that will secure lower drug prices for people at pharmacies.