Senate Budget Resolution Lays Groundwork for Necessary Investments in the Country’s Health


Aug. 10, 2021 

CONTACT: Jack Cardinal, (781) 960-5208 

(BOSTON, MA) -- Yesterday, the Senate unveiled a $3.5 trillion budget resolution that outlines its priorities for the upcoming budget reconciliation process. The resolution signals support for a number of critical health policies, including making permanent the tax credits that have significantly lowered the cost of health coverage and getting millions of people the Medicaid coverage they deserve as intended by the Affordable Care Act (ACA). According to the Department of Health and Human Services (HHS), the ACA provisions make health insurance premiums under the Affordable Care Act more than 25 percent cheaper. Closing the Medicaid coverage gap in states that have refused would get coverage to millions of people, the vast majority of whom are Black and brown people working in low-wage jobs without benefits due to unfair and discriminatory barriers to economic security. The resolution also supports increased funding for home and community-based services and support for workers, primarily women of color, who despite being underpaid and devalued, provide essential care that allows older adults and people with disabilities to live independently. 

The resolution also seeks to invest in maternal health; address the high cost of prescription drugs for people; extend vision, dental and hearing benefits to Medicare enrollees; and more. While the resolution serves merely as guidance to the various committees in charge of the budget process, it provides insight into policy items Senate leadership wants to prioritize in the upcoming legislative package.  

Statement of Emily Stewart, executive director of Community Catalyst, in response to the Senate’s budget resolution:

“We applaud Senate leaders for proposing policies that will improve the health of millions of people across the country. From more affordable insurance premiums to guaranteed coverage for the millions who have been left in the Medicaid coverage gap – these policies would go a long way to providing relief for families struggling with the cost of medical care. We strongly urge Congress to pass these policies, all of which carry broad public support. In addition, Congress should prioritize comprehensive dental benefits for adults in all state Medicaid programs, address high out-of-pocket costs like copays and deductibles, and remove the 'five-year bar' that prevents immigrant families from accessing necessary health care.”  




The Senate’s resolution signals making the 2-year improvements in the Affordable Care Act’s (ACA) affordability scale permanent, significantly lowering the cost of premiums for millions of low- and moderate-income people getting coverage through ACA Marketplace plans. 

  • 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 — consistent with current Medicaid law. 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 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 40 percent 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. 

The Senate’s desire 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, we need to reduce high out-of-pocket costs – from deductibles to prescription drug prices – that are putting health coverage and care out of reach for too many people.  

  • Despite the progress afforded by the ACA and the American Rescue Plan, 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 and prescription drug prices, Congress should pass the S. 499, the Health Insurance Affordability Act (Sen. Jeanne Shaheen) and H.R. 3, the Elijah E. Cummings Lower Drug Costs Now Act (Rep. Frank Pallone). 


The Senate resolution seeks a way to offer affordable health coverage to millions of people in the Medicaid “coverage gap,” which shows a firm commitment to addressing deep inequities in access to coverage and care. Expanding the affordability of health coverage and care for people in the Medicaid coverage gap is critical to advancing health equity and racial justice.  

  • In June 2012, the Supreme Court ruled that the Medicaid expansion had to be optional for states. This created a “coverage gap” in states because assistance to purchase health insurance on the ACA Marketplace is not available for people with incomes below the poverty line. As of May 2021, 38 states have closed the coverage gap. 

  • There are still 12 states that have not expanded Medicaid to more than four million low-income adults as originally envisioned. These individuals would be eligible for Medicaid had their state chosen to expand coverage.  

  • People in the Medicaid coverage gap are working people in low-wage jobs, mostly single adults: three quarters are adults without dependent children and nearly 60 percent are people of color who face unfair and discriminatory barriers to economic security. According to Kaiser Family Foundation, of the people who remain uninsured, 29 percent are Hispanic and 23 percent are Black – both groups stand to benefit dramatically from closing the gap. During the pandemic, Medicaid enrollees are more likely to be working essential jobs, placing them at risk for illness. For states that have yet to close the coverage gap, these workers have few if any options to access health coverage when it is needed most.   

  • There is broad support for expansion among the public. In the most recent KFF Health Tracking Poll that assesses public views on the Medicaid program, it was found that a large majority of the public has a favorable view of the program and believes it works well for low-income people covered by the program. 

  • Research shows better access to Medicaid has been shown to reduce inequities in coverage and improve health.    

  • Medicaid serves 75 million people in the U.S., providing health insurance and economic security to children and their families, older adults, people with disabilities, and others.   

  • Medicaid provides critical support to Black and brown people, who face unfair and discriminatory barriers to health and economic security, which the COVID-19 pandemic is exacerbating. 

  • We encourage Congress to craft a comprehensive solution to the coverage gap that provides swift access to health care for the millions left behind. 

The Senate’s commitment to closing the coverage gap—and ensuring access to coverage regardless of residence—is a robust response to inequity, but we can do more. In addition to closing the coverage gap, we support the Senate’s signaling of support for addressing deep inequities for people with disabilities, justice-involved people and pregnant people, specifically Black women. 

  • The health crisis places older adults and people with disabilities at heightened risk. 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, most older adults would prefer to age in their home and community, and so increasing access to home and community-based services (HCBS) would go a long way towards making long-term care in Medicaid more person-centered. 

  • Lastly, because HCBS involves services such as non-medical transportation, home-delivered meals and home modifications such as shower “grab-bars” to make someone’s residence safer to live in, HCBS is an important way that the Medicaid program addresses the social determinants of health. 

  • Congress needs to support the president’s full proposal for additional investments in HCBS in reconciliation. 

  • Additionally, providing Medicaid coverage during 30-days before release from incarceration will help save lives and keep our communities healthy.  

  • People reentering the community are 129 times more likely to die of an overdose than the general population, as many incarcerated people have a substance use disorder and are forced into withdrawal while in prison. If more people were able to have continuous health coverage and access to life-saving addiction treatment through Medicaid during reentry, fewer people would die. 

  • Incarcerated individuals are also at particular risk of contracting COVID-19 

  • 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. 

  • 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 deathsoccur 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.  


Coverage is still out of reach for too many. People either lack access to important benefits like dental, or are denied coverage due to immigration status due to policies like the “five-year bar.” Having a healthy country means ALL people have access to coverage regardless of income level or immigration status. 

  • Poor oral health hurts more than our mouths. It can impede an equitable and lasting economic recovery by harming people’s overall health, employability, and financial security. However, dental care presents the highest financial barriers compared to any other category of health care.  

  • Lack of comprehensive dental coverage and high out-of-pocket costs put oral health out of reach for millions of people, especially Black and brown people, tribal communities and individuals with low incomes. In fact, cost barriers to dental care for adults have only increased in recent years, with Black and Hispanic communities reporting the highest financial hurdles to accessing the care they need.  

  • Congress can help address inequities in oral health and access to dental care by making comprehensive dental coverage mandatory in all state Medicaid programs. Recent research shows that policies like the Medicaid Dental Benefit Act (H.R. 4439) could address disparities in oral health and access to dental care while generating cost savings on the medical side. 

  • Access to health care for immigrants and their families has been undermined for decades due to barriers to health care such as the five-year bar. Lawfully present nonelderly immigrants represent a quarter of the nonelderly uninsured population with an estimated uninsured rate of 25%.  

  • Immigrants and their families have few options for affordable health care options during the five-year bar that often result in delayed, costly and fragmented care as a result of limited services at community health centers and high out-of-pocket costs associated with private health insurance.  

  • The five-year bar also causes confusion among mixed-status families and public benefit agency workers due to varying immigrant and citizenship statuses different family members may hold and varying eligibility requirements from state-to-state and from program-to-program.  

  • As such, the five-year waiting period for Medicaid, CHIP and all other federally-funded programs subject to the bar should be eliminated.  

  • Additionally, the 2019 proposed public charge rule has disincentivized immigrants and their families from seeking health care for fear and confusion of becoming a “public charge.” Despite the fact that the proposed public charge rule is currently blocked, it has had a lasting impact on immigrant communities' comfort in seeking health care.  

  • Congress must consider the impacts of the Trump administration's proposed public charge rule. The package should include funding for state and local governments and agencies to increase their capacities to educate eligible immigrants and agency employees about Medicaid coverage, SNAP, TANF and other similar benefits, similar to a recently-released recommendation from Centers for Medicare and Medicaid Services recently issued, for successful implementation. 

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.  

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