As the Build Back Better bill makes its way through Congress, there is a possibility that the bill as it currently stands will soon become law. While the bill covers many areas of American life, for this article, we’re going to focus on the profound impact the bill as it is currently written will have on the healthcare industry if it is passed. Then, we will make an effort to detail how it will specifically affect those living in Wisconsin and North Carolina.

First, it’s important to note the intentions of the Build Back Better bill as they relate to healthcare. The stated aim of the healthcare provisions of this bill is to expand coverage to as many people as possible while still remaining in the framework laid out by the Affordable Care Act. As many readers are undoubtedly already aware, the implementation of the ACA left gaps that resulted in people being denied coverage under programs like Medicaid — a problem that the Build Back Better bill seeks to fix.

Building upon the structure of the ACA, the Build Back Better bill would allow approximately four million uninsured people in the 12 states that have not expanded Medicaid to access federally-subsidized health insurance via the ACA Marketplace through 2025. Furthermore, the temporary assistance for healthcare purchases created by the American Rescue Plan Act would be extended, allowing people with family incomes above 400 percent of the federal poverty level to receive financial assistance for purchases in the ACA Marketplace through 2025.

The potential effect of this is twofold. First, costs will be reduced for those finally able to access either Medicaid or one of the subsidized plans available through the ACA Marketplace. Second, costs for providers could go down, as the expansion of healthcare coverage has the potential to significantly decrease uncompensated care from providing healthcare services to uninsured patients.

But the benefits of the Build Back Better bill don’t stop there. The bill also intends to add 12 months of postpartum coverage for pregnant people, a long-held desire by activists. Build Back Better would also allow the federal government to negotiate prices for some high-cost drugs in Medicare as well as set a hard cap on out-of-pocket drug spending for Medicare Part D enrollees. For both Medicare enrollees and those with private insurance, the legislation would limit annual increases in drug prices, and cap patient cost-sharing for insulin at $35 — a major step toward reducing overall healthcare costs.

You may have noticed that several parts of the bill specifically target states where Medicaid was not expanded. Both Wisconsin and North Carolina are among those states and will thus be affected by those parts of the bill.

While Wisconsin’s previous governors rejected Medicaid expansion, Democratic Governor Tony Evers allowed for funding for Medicaid expansion in his State Fiscal Year’s (SFY) 2022-2023 budget — funding that was rejected by the Wisconsin Legislature’s Republican-led Joint Finance Committee. While Governor Evers has made several additional attempts to reinstate that funding, all moves were ultimately denied by the Republican-controlled legislature. At present, Wisconsin covers adults up to 100% of the FPL in Medicaid but did not adopt the ACA expansion, meaning that those not currently covered could have access to federally-subsidized health insurance via the ACA Marketplace if the Build Back Better bill passes.

North Carolina faces a similar issue. Democratic Governor Roy Cooper offered Medicaid expansion in his state budget proposals for both State Fiscal Years (SFY) 2020-2021 and 2022-2023, but in the end, the Republican-controlled legislature did not include expansion in either final budget. This has caused issues in government; in 2019, Governor Cooper vetoed the SFY 2020-2021 budget due to the omission of Medicaid expansion, resulting in a budget impasse. With the government-led solution proposed by the Build Back Better bill, it is possible that further issues like these may be avoided.

The outlook is currently unclear for the Build Back Better bill. There are still several hurdles in the way of its passage, and as of right now, the bill has only passed the House and awaits further action in the Senate. We will keep you updated as to the status of the bill and any changes it undergoes on its way to becoming law.