Sign-on Letter Supporting Medicaid Coverage

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July 13, 2021

Dear Democratic Senators and House Members:

We are writing to request your support for closing the Medicaid coverage gap in the upcoming budget resolution and economic recovery reconciliation bill. The coverage gap leaves 2.2 million uninsured people with incomes below the poverty line without a pathway to affordable coverage in the 12 states that have not expanded Medicaid.[1] Of those, 600,000 are African Americans living in eight Southern states: Alabama, Florida, Georgia, Mississippi, North Carolina, South Carolina, Tennessee, and Texas. As legacy civil rights organizations, we believe it is critical that these more than 600,000 people finally gain access to Medicaid, which they should have had beginning in 2014.[2]

Despite substantial federal incentives to do so, including the added incentives in the American Rescue Plan Act passed earlier this year, none of these states many of which have a long history of racial discrimination have taken steps to implement the expansion. As a result, people with incomes below the poverty line in these states continue to have no access to health coverage. Providing Medicaid coverage now would be a huge step toward making health equity a reality.

In the states that have undertaken it, Medicaid expansion has narrowed racial and ethnic disparities in both coverage and access to care, and it has saved lives.[3] But these more than 600,000 African Americans living in the eight Southern states that have refused to take up the Medicaid expansion have experienced none of these gains, solely because of where they live.

Overall, 60 percent of people in the coverage gap in the 12 non-expansion states are people of color,[4] reflecting long-standing racial and ethnic disparities in health care access that Medicaid expansion would do much to address. In these states, African Americans are 19 percent of the adult population but 28 percent of those in the coverage gap.[5]

For example, in Florida, Georgia, and Texas, more than 100,000 African Americans in each state lack access to any health care coverage. In Alabama, Mississippi, North Carolina, and South Carolina, African Americans are a majority of those without a pathway to coverage.[6]

Access to health care is a civil and human right. The COVID-19 pandemic amplified pre-existing inequities in health care, with deadly consequences for many in the Black community as well as other communities of color.[7] Therefore, we are urging Congress to address this by providing a federal pathway to coverage for the millions of African Americans and other people of color shut out of their state’s Medicaid program.

We understand that there are several options under consideration. We want to commend Senator Warnock for his leadership and support his new bill, “Medicaid Saves Lives Act,” which provides for a Medicaid coverage program for low-income adults in non-expansion states. Senator Warnock, along with Senator Baldwin and Senator Ossoff will introduce the bill on Monday.  The critical need now is to address these racial inequities by closing the coverage gap in the upcoming recovery legislation.

We cannot continue the mistakes of the past. It is critical that these low-income African Americans and other people of color are not again left behind because of where they live. Failure to close the coverage gap in the budget and economic recovery package is unacceptable.

We look forward to working with you to take this essential step toward racial equity. If you have any questions, please contact June Zeitlin, Senior Adviser at [email protected].


The Leadership Conference on Civil and Human Rights
Lawyers’ Committee for Civil Rights Under Law
NAACP Legal Defense and Educational Fund, Inc.
National Action Network
National Coalition on Black Civic Participation
National Council of Negro Women
National Urban League






[6] Ibid.