On August 11, 2021, Senate Democrats approved a budget reconciliation plan known as the Build Back Better Act. Intended to expand the social safety net, this bill provides funding for a wide array of policy initiatives, many of which center the needs of children and families. Through efforts to close the Medicaid coverage gap, subsidize child care for working families, extend the child tax credit, and more, this plan invests in the success of children and empowers families in a way that has never been seen before.
One of the most important provisions of the Build Back Better Act aims to close the Medicaid coverage gap. Under the Affordable Care Act (ACA), states were given the option to expand Medicaid eligibility to ensure that more Americans with low incomes would have access to coverage. In states that have expanded Medicaid, individuals are eligible for coverage based on income alone rather than the combination of income, family size, and other factors that are required for eligibility in non-expansion states. Medicaid expansion has improved access to care and has lowered uninsured rates, especially among children and within communities with lower income and communities of color. Although Medicaid expansion has improved access to healthcare for millions of children and families throughout the country, not every state can boast of its benefits.
As of 2021, 38 states and Washington, D.C. have expanded their Medicaid programs. In the 12 states that have not yet expanded Medicaid, there exists a coverage gap in which over two million adults are left ineligible for coverage of any kind because their incomes are too high to meet their states’ income eligibility requirements for Medicaid, yet too low to afford insurance on the marketplace. Furthermore, the effects of non-expansion are felt most intensely within southern states and within communities of color. Eight of the 12 non-expansion states are located in the South, and people of color disproportionately account for most of the individuals in the Medicaid coverage gap.
To address these healthcare disparities in non-expansion states, the Build Back Better Act proposes to offer premium tax credits that would allow people who are ineligible for Medicaid to pay for coverage in enhanced plans offered in ACA marketplaces. Additionally, the Build Back Better Act proposes to establish a federal Medicaid program in non-expansion states that would permit the Secretary of Health and Human Services (HHS) to contract with managed care plans and third party administrators to extend coverage to more people. Not only will adults in the Medicaid coverage gap finally have a pathway to coverage through these methods, their children will likely be made eligible for coverage. When children have access to health coverage, they are more likely to receive continued care and to have improved health outcomes. Successful efforts to close the Medicaid coverage gap would be a major victory for children and families in non-expansion states.
Child Tax Credit
In addition to subsidized child care, the Build Back Better Act calls for an extension of the Child Tax Credit that would permanently increase it from $2,000 to up to $3,600 per child. As the costs associated with child care, education, and housing continue to rise, families experiencing economic instability may struggle to access the support they need to provide for their children. Without adequate support to children and families, child poverty rates climb. According to U.S. Census Bureau data, in 2019, the poverty rate for children was higher than that of any other group, and Black and Latinx children were disproportionately affected by poverty. During the pandemic, however, poverty rates fell among children due to expansion of the Child Tax Credit, pandemic economic stimulus checks, and other policies. This upcoming bill offers a long-lasting solution to child poverty and provides greater support for families experiencing financial insecurity. With extensions of the Child Tax Credit, the basic needs of children can be met more easily, and racial and ethnic disparities in child poverty rates can be reduced.
Another provision in the Build Back Better Act includes subsidized child care for working families. Despite being a necessity for many families, child care is often inaccessible to those with limited resources, and this has been exacerbated by the COVID-19 pandemic. Furthermore, thousands of jobs in the child care industry were lost as child care centers closed to limit the spread of the virus. The combination of rising costs and declines in the number of available programs has made accessing care more difficult than ever before, propelling the country into a child care crisis. Often, parents scramble to find alternatives to ensure children are cared for, including seeking help from family members, opting for lower-cost, lower-quality care centers, or leaving the workforce altogether. However, when families do have access to affordable, high-quality child care, children are given the opportunity to grow in a safe environment that caters to their social, emotional, and physical needs. And caretakers can re-enter the workforce and continue to provide for their families. In aiming to subsidize child care for working families, this bill seeks to create a country in which children and families can thrive.
From its efforts to close the Medicaid coverage gap, subsidize child care, and expand the Child Tax Credit, the Build Back Better Act seeks to make long-term investments in children and families. As child advocates committed to supporting children through policy and advocacy, the Policy And Advocacy team at Children’s Health Fund is thrilled to see a bill that truly centers the well-being of children.