Wasserman Schultz and Castor Lead Letter to Close the Medicaid Coverage Gap

Washington DC – U.S. Reps. Debbie Wasserman Schultz (FL-23) and Kathy Castor (FL-14) led 36 Democratic members, from the 12 Medicaid non-expansion states, in urging Senate and House leaders to close the Medicaid coverage gap in the forthcoming reconciliation package.

The Medicaid coverage gap, induced by partisan politics, has prevented 2.2 million eligible people from gaining access to high-quality coverage, putting our neighbors and health providers at a financial disadvantage. Closing the coverage gap could help lower health care costs by reducing uncompensated care, improving efficiency in our health systems, and reducing medical debt and financial pressure on people struggling with the rising costs of everyday living.

“Closing the Medicaid coverage gap in states like Florida will save lives. In a country with as many resources as the US, it is unconscionable that people would rather forgo care than go to the doctor because they don’t want to live with overwhelming debt,” said Rep. Wasserman Schultz. “As we continue to fight COVID and fend off an attack on our reproductive rights, no one should be prevented from getting the help they need simply because they cannot afford it. Families are struggling financially, and they need and deserve good and affordable health care now.”

“Under Medicaid expansion, an estimated one million Floridians would gain health coverage – instead of playing partisan politics, we could be saving lives, improving health outcomes and lowering costs. Congress must seize the opportunity to act now when Republican governors, including Florida’s Gov. DeSantis, have shown their refusal to act in the best interest of Americans. We can deliver hardworking Floridians access to comprehensive health coverage and a better quality of life by providing steady health coverage, diverting routine health care out of hospital emergency departments and reducing uncompensated care, all of which would lower costs. It is a win-win all around, one that our neighbors in Florida and across the country depend on,” said Rep. Castor.

At a time when reproductive health 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 approximately 800,000 uninsured women of reproductive age gain access to comprehensive health care. In Florida, approximately one million individuals do not have access to affordable health care because of the state’s refusal to expand Medicaid.

The letter is endorsed by a wide range of advocacy groups, including Alabama Arise, Children’s Defense Fund-Texas, Every Texan, Florida Health Justice Project, Florida Voices for Health, Florida Policy Institute, Georgia Budget and Policy Institute, Georgians for a Healthy Future, Mississippi Center for Justice, North Carolina Justice Center, South Carolina Appleseed Legal Justice Center, and Tennessee Justice Center.

“We must close the Medicaid coverage gap now. Low-income people in non-expansion states have been waiting to see the benefits of the ACA for more than ten years. They cannot wait any longer. If Congress fails to get this done more mothers and fathers will die because they lack basic health insurance,” said Jane Adams, Campaign Director, of Alabama Arise.

“How much longer can we ask low-income, uninsured Americans to wait for a basic human right? Medicaid expansion saves lives, helps hospitals stay open, and improves people’s health and well-being. Those benefits should not be denied to Americans simply because of where they live—especially not in regions that have long, enduring legacies of structural racism and violence. Our Congressional leaders must close the Medicaid coverage gap, or else be complicit in perpetuating this deep injustice,” said Adrienne Lloyd of Children’s Defense Fund Texas.

“We cannot continue to abandon our neighbors in the coverage gap who have no access to health coverage. Some of the most restrictive states for abortion access are the same states who have refused to expand Medicaid. This makes it even more dire for Congress to close the coverage gap. Lives are on the line. The Southerners for Medicaid Expansion coalition members are profoundly grateful for the members of Congress from non-expansion states who stepped up to lead the charge with this letter, and indeed have been champions for Americans in the coverage gap for so long. Now is the time for Congressional leaders to hear their call,” said Holly Bullard, Chief Strategy and Development Officer, of Florida Policy Institute.

“The TN Justice Center stands with Amber and thousands of people in other non-expansion states who will die from preventable deaths because they can’t afford adequate healthcare. The failure to expand healthcare coverage should not be an option that we are willing to accept. We urge you to take action to close the gap now by creating a pathway to permanent, comprehensive coverage for all!” said Chanda Freeman, Health Advocacy Manager, of TN Justice Center.

The letter can be read below:

The Honorable Charles S. Schumer

Majority Leader

United States Senate

Washington, D.C. 20510

The Honorable Nancy Pelosi


U.S. House of Representatives

Washington, D.C. 20515

RE: Close 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.


[1] Solomon, J. (2021, May 6). Federal Action Needed to Close Medicaid “Coverage Gap,” Extend Coverage to 2.2 Million People. Center on Budget and Policy Priorities. https://www.cbpp.org/research/health/federal-action-needed-to-close-medicaid-coverage-gap-extend-coverage-to-22-million.

[2] Inna Rubin, Jesse Cross-Call, and Gideon Lukens, “Medicaid Expansion: Frequently Asked Questions,” CBPP, June 16, 2021, https://www.cbpp.org/research/health/medicaid-expansion-frequently-asked-questions.

[3]Kelly, R.L., Clark. Y., Beatty, J., Chu, J., & Ruiz, R., Tri-Caucus Letter to Close Medicaid Coverage Gap (117AD). https://www.dropbox.com/sh/kci68orcrob34b9/AABts_W-T9L2CN8-GsJKvXjBa?dl=0&preview=Tri-Caucus+Medicaid+to+Close+Medicaid+Coverage+Gap+WH.pdf

[4] Lukens, Gideon (2021, June 14). Closing Medicaid Coverage Gap Would Help Diverse Group and Narrow Racial Disparities. Center on Budget and Policy Priorities. https://www.cbpp.org/research/health/closing-medicaid-coverage-gap-would-help-diverse-group-and-narrow-racial