Why PIH-US Cares About the Build Back Better Act, And Why You Should Too

The sweeping Build Back Better Act, an attempt to shore up the country’s social safety net, is currently under consideration by the U.S. Senate after its passage by the U.S. House of Representatives just before Thanksgiving.  

While the Senate debates the terms and details of the bill, it’s worth remembering that taken as a whole, many of the legislation’s provisions would transform public health, maternal health, and long-term care for millions of people across the nation. 

Here, we speak with Justin Mendoza, advocacy lead for Partners In Health United States about some of the bill’s high-impact provisions related to public health and equity, and which communities might benefit from the law’s passage. 

How is Build Back Better different from the American Rescue Plan Act? 

Build Back Better is intended to be a larger economic package, delivering longer-term childcare, expanded Medicaid coverage, health insurance primarily for low-income households and some people with disabilities, and major investments in policies designed to curb the impacts of climate change. It builds on programs that were passed, created, or extended in the American Rescue Plan, and also creates new funding for programs that fit the current moment. In addition, it builds on public health investments in the American Rescue Plan and funds programs to strengthen public health infrastructure through 2026.  

The legislation also includes new elements designed to support pregnant and postpartum women, with an emphasis on improving Black maternal health, which has lagged disgracefully in the U.S. Earlier this year, the U.S. Centers for Disease Control and Prevention reported that Black women face a three-fold higher risk of dying from a pregnancy-related cause than white women, due to multiple factors including health care quality, structural racism, and implicit bias.  

How about investments related to health insurance? 

Build Back Better includes language that would extend Medicaid postpartum coverage (health insurance for low-income new mothers) for a full 12 months after birth. This is huge for people who have children in states that have not expanded Medicaid, because prior to the American Rescue Plan, they could only receive six months of health coverage. Experts in maternal health believe this will address some major racial disparities in health outcomes in the United States.  

There’s more: Build Back Better proposes to close the coverage gap in Medicaid. In many states, individuals who earn above the federal poverty line, but below the subsidized private health insurance level (individuals with an income of 150% of the federal poverty line qualify for such a subsidy), are left without health coverage of any kind. As of 2020, that meant around 2.2 million uninsured, low-income adults in 11 states. The Build Back Better Act expands Medicaid to those individuals. 

Health care reforms do not stop at Medicaid. Build Back Better takes on health insurance costs through reductions in health care marketplace premiums, expanding access to Medicaid for people who are transitioning out of incarceration, and adjustments to Medicare—federal government-sponsored health coverage for individuals over 65— to cover hearing services and hearing aids.  

How might all of this impact health coverage, and by extension, care in the United States?  

If Build Back Better were to become law, millions of people who are unable to afford health care in the United States will have new pathways to affordable care. For people with disabilities, expanded home and community-based services would help provide care and support for those that need assistance navigating a system that is set up for able-bodied individuals.  

In addition, changes to public health will help prevent disease, respond to social determinants of health— the basics like food and housing that everyone needs to be healthy, and build out programs and training to combat implicit biases in health care.  

How much money will go into public health? 

Overall, the public health provisions, including those related to workforce development and system strengthening, would invest more than $3 billion in essential health equity work, enable communities to better address social determinants of health, and increase investments at the local and state level.  

Health departments can look forward to a portion of $1.5 billion (allocated through a formula) to state, territorial, and local health departments from 2022-2026; and $750 million in competitive grants during that same period. The CDC will also get a boost of $750 million to help implement programs, expand capacity, and ensure training for health departments across the country. These funds will be used to both bolster public health departments’ response to COVID-19 over the next few years and to build resilience, in the form of staff, systems, and technology, to better handle future outbreaks.  

How would the maternal health provisions benefit new moms? 

First and foremost, the Medicaid expansion for postpartum care is essential for low-income mothers: It allows new moms to secure health coverage for their newborn babies for a full year. But beyond that, Build Back Better focuses on maternal health outcomes based on a set of priorities outlined in what’s being called the Black Maternal Health MOMNIBUS.  

That includes more than $1 billion to help address systemic inequities that lead to worse health outcomes, particularly for communities that have high rates of maternal mortality and/or large maternal health disparities between racial and ethnic groups. The funds are allocated across different programs scaled to meet specific needs in maternal health. For instance, $100 million would go to community-based organizations, tribal organizations, Native Hawaiian organizations, or nonprofits that work with multiple community-based partners. The money can be used to hire and train staff, develop culturally and linguistically appropriate resource centers or materials for particular communities, create demonstration projects that address social determinants of health, and host community-led consultations. These funds will also give communities the ability to develop tailored plans that will address direct care from prenatal workers and build out culturally competent trainings.  

Other funding for maternal health includes $170 million to increase and diversify the nursing workforce in maternal and perinatal care, $75 million for the Office of Minority Health, $50 million to grow the doula workforce, $75 million to increase the maternal mental health and substance use disorder workforce, and $100 million for competitive grants that would allow educational institutions to train midwives, physician assistants, and others in maternal health.   

These grants will help organizations, community leaders, and educational institutions build a more diverse maternal and prenatal workforce across the board—from doulas and community-based workers to nurses and physician’s assistants—all trained with culturally competent tools, community-centered approaches, and programs coordinated with federal and state programs. If these provisions make it into the final version of Build Back Better, and it is implemented well, then the U.S. will truly start to turn the tide on maternal health disparities. 

How does Build Back Better get us closer to health care as a human right?  

Although affordable care alone does not provide health care as a human right, Partners In Health applauds these efforts as a step toward expanded care for those who need it most. To that end, PIH joined a sign-on letter with hundreds of national and state organizations to thank the U.S. House of Representatives for passing the legislation and to urge the Senate to pass the Build Back Better act swiftly. Read the letter here. In August, PIH worked led another letter with 40 organizational partners and allies to urge Congress to make critical public and community health investments. 

We believe now is the essential moment to invest in public and community health and a stronger safety infrastructure for new mothers, children, and families across the U.S. Build Back Better is an important step toward recovering from one of the most devastating periods in U.S. history, and reimagining a more equitable future. 

What can people do to support this? 

Get in touch with your Senators to push for them to support public health and maternal health investments in Build Back Better. We even made it easy to do with our online action tool, here.