The Potential Impact of Build Back Better on American Healthcare


Editor’s Note: People who take insulin require consistently affordable and predictable sources of insulin at all times. If you or a loved one are struggling to afford or access insulin, click here

You’ve probably heard about Build Back Better in the news, but it may be difficult to understand the basics of the bill and its potential impact on your life if passed. Additionally, the state of limbo it’s currently in may make it tough to follow. 

In December 2021, Sen. Joe Manchin (D-W.Va.) expressed opposition to the bill, effectively killing it in its current form. For the bill to pass, the Biden administration needs to gain the support of every Democrat in the Senate. Though the bill in its current state has been dismissed, Sen. Tim Kaine (D-Va.) reaffirms that the core of its framework could still find its way forward.

While Build Back Better covers social policies around education, healthcare, housing, climate and more, for this recap, we are focusing specifically on the healthcare aspect of the bill as it is relevant to the diabetes community.

What is Build Back Better, and how could it impact affordable access to healthcare?

The Build Back Better reconciliation plan has two major pieces of legislation that sit at the heart of the Biden administration’s domestic agenda.

The bill passed in the House of Representatives in November 2021 but has yet to pass in the Senate. It is unlikely the bill will pass in the Senate in its current form due to party disagreements, but major portions could be split into smaller separate bills while maintaining the core of its original mission. Therefore, talks about Build Back Better continue. Progress and updates around the bill change almost daily. At this time, the focal point of the conversation revolves around how Democrats can restructure it to push it forward in “smaller bites.” 

Build Back Better promises “the biggest expansion of affordable healthcare coverage in a decade.” The framework for the plan aims to: 

  • Reduce health insurance premiums for nine million Americans who receive healthcare through the Health Insurance Marketplace by extending the Premium Tax Credit.
  • Deliver healthcare coverage to up to four million people who are currently uninsured due to the lack of Medicaid expansion in their states of residence.
  • Help elderly populations access affordable hearing aids and services by expanding Medicare. The Hearing Loss Association of America explains that that would mean “seniors who rely on Medicare to pay their medical bills would also be able to turn to Medicare to cover the cost of hearing aids and related services” for the first time. If the bill passes in its current form, vision and dental health coverage will also be expanded.

The Build Back Better framework is designed to expand access to affordable healthcare. The plan recognizes that 30 million people were uninsured in 2019, with Health Insurance Marketplace coverage too expensive for many Americans. In 2020, confirmed 8.6 percent of Americans (28 million people) still did not have health insurance at any point during the year. 

Even more of the population was at a disadvantage in 2021. According to the CDC, in the first six months of 2021, 9.6 percent of U.S. residents (31.1 million people) lacked healthcare. The November 2021 report found that from January to June 2021, 39.5 percent of all people had public coverage, 60.1 percent had private coverage, and 9.6 percent were uninsured. Of the uninsured, 4.4 percent were children (ages 0-17), and 14 percent were adults (ages 18-64).

The cost of being without healthcare is far too burdensome for many families in America, but paying for health insurance is out of reach due to high premiums and deductibles. 

How would Build Back Better impact me if it passes?

In terms of healthcare, in its current form, Build Back Better is intended to give more people access to Medicaid than previously possible by removing certain income and health limitations to allow more people to qualify. Today, Medicaid reports coverage for 72.5 million Americans, including children, pregnant women, parents, seniors and individuals with disabilities.

Medicaid is a joint federal and state government program that provides help to people with limited income and resources. It also covers benefits not typically covered by Medicare (such as nursing home and personal care services. Note: even though it’s a federal program, specific Medicare benefits may vary by region or state.) Currently, 12 states have not expanded Medicaid, which restricts access to medication and services to adults with diabetes. 

Medicare reimbursable benefits would also be expanded if the bill passes. Build Back Better would ensure that people enrolled in Medicare gain access to vision, hearing, and dental health coverage. Currently, Medicare does not cover this. 

Medicare is a federal health insurance program for people aged 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD). It is separated into three parts (A, B and D) to serve different communities and needs effectively.

In addition to expanding coverage, The Guardian explains that Build Back Better “gives Medicare (AKA the government) bargaining power to negotiate the cost of prescription drugs with pharmaceutical companies for the first time to bring prices down.”

The U.S. still ranks number one globally in the cost of prescriptions, like insulin, because we lack the ability for the federal government to negotiate directly with pharmaceutical manufacturers. Pharmaceutical companies can now set the list price of the medications they sell to the market, increasing the price to counteract the amount they pay to the PBMs as rebates. Build Back Better would give the government some bargaining power with pharmaceutical companies to set the price of prescription medications for those on Medicare.

The bill proposes capping insulin prices at $35 for people with health insurance, leaving those without still paying full list price at the pharmacy counter with no relief. American citizens have scrutinized the bill, saying that it does not properly address the roles of pharmaceutical companies, pharmacy benefit managers and insurance companies price-gouging the cost of insulin. 

The bill does not tackle Medicare For All, continuing the U.S.’s lag behind other developed nations in providing universal healthcare coverage.

What does it all mean?

The healthcare system in the United States has a long way to go. While Build Back Better would benefit people with diabetes who have insurance with a $35 co-pay for each monthly insulin prescription, people without insurance would not benefit from this part of the bill. Though, some of our country’s leaders are pushing to change that so that every American with diabetes is covered whether they have health insurance or not. 

On December 8, 2021, California State Representative Josh Harder and 100 of his colleagues sent a letter to Senate Majority Leader Chuck Schumer requesting the following amendment to the bill: “Extend the $35 monthly insulin payment cap to uninsured people so America finally guarantees that every person with diabetes will only pay $35 for their monthly insulin and that no person ever dies due to insulin rationing again.” 

These requests further solidify the need for change in this country.

The healthcare system needs to work for all people. Those without health insurance should not be penalized with higher drug costs, especially as those who often need it the most are those who do not have the money to pay for them. There are many reasons someone may be without health insurance coverage in the United States, particularly since our healthcare system is often tied to employment and self-purchased insurance premiums remain high. The pandemic exacerbated these issues with unemployment spikes leaving millions without health insurance, a rate that has remained fairly steady ever since.

We believe

Everyone impacted by diabetes—type 1, type 2 and beyond—has a right to the best care possible for their unique situation. This means access to the technology, medications, support and clinical care teams that help each individual manage their chronic condition. We work to increase access and remove barriers, giving our community the tools needed to succeed.

High quality, modern insulin must be available to people with diabetes regardless of employment or insurance status, across all demographics, without barriers and at an affordable and predictable price point.

Our advocacy work focuses on equity: making sure people with diabetes have access to care by tackling issues like systemic racism, financial privilege and discrimination in all its forms.

To get involved with access advocacy, start here

WRITTEN BY Julia Flaherty, POSTED 01/27/22, UPDATED 12/11/22

Julia Flaherty is a published children’s book author, writer and editor, award-winning digital marketer, content creator and type 1 diabetes advocate. Find Julia’s first book, “Rosie Becomes a Warrior.” Julia finds therapy in building connections within the type 1 diabetes community. Being able to contribute to its progress brings her joy. She loves connecting with the diabetes communities, being creative, and storytelling. You will find Julia hiking, traveling, working on her next book, or diving into a new art project in her free time. Connect with Julia on LinkedIn or Twitter.