Closing The Medicaid Coverage Gap: Preventing a Separate and Unequal Result

Executive Summary

Expanding Medicaid is an urgent moral, anti-racist, health equity, reproductive justice, and economic imperative. Yet today, policymakers in twelve states refuse to do so—a discriminatory political choice intertwined with racism in policymaking. The result is the Medicaid coverage gap: an estimated 4.4 million people with low incomes—nearly all of whom live in Southern states and a majority of whom are Black, Latinx, or other people of color—were uninsured because of non-expansion in 2020. Emerging proposals to close the Medicaid coverage gap center on establishing a federally administered Medicaid program or fully subsidizing Marketplace coverage in lieu of Medicaid coverage. Any federal coverage gap fix must guarantee access to Medicaid’s robust protections as the ACA intended. Otherwise, it could enshrine in federal law a separate and unequal system of health coverage that furthers structural racism in U.S. health policy.
NHeLP’s new paper, “Closing the Medicaid Coverage Gap: Preventing a Separate and Unequal Result,” provides foundational principles for equitably solving the Medicaid coverage gap. The principles aim to empower federal policymakers and advocates with a framework for developing, evaluating, and responding to proposals. A high-level executive summary of the paper can be accessed here.

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