What budget reconciliation could have been and what Congress must do next

Over the past few months, Congress has checked several important legislative boxes, including new gun safety measures, an expansion of healthcare for veterans and investments in the manufacturing sector. This has culminated with the final passage of the Inflation Reduction Act, the budget reconciliation bill that will make significant investments in addressing healthcare and climate change needs.   

The recent productivity is notable and welcome. The budget bill maintains subsidies to lower healthcare premiums that have helped drive the uninsured rate to its lowest mark on record and will prevent more than 3 million people from losing health insurance coverage next year. Moreover, experts have hailed the legislation as “the most significant action the U.S. has ever taken to combat climate change.” 

But this bill, historic as it is, will only take us so far toward an America in which all people truly have the opportunity for health and wellbeing. Closing the divide between the policies necessary to put health within reach and the political viability of those policies has never been more critical.  

For a nation where policymaking tends to lurch from crisis to crisis and long-term goals are scant, the Inflation Reduction Act is a welcome change. People who receive healthcare coverage through the Affordable Care Act will be protected from potentially debilitating increases in their premium costs over the next three years. Tens of millions of seniors on Medicare will benefit from lower out-of-pocket costs and prescription drug prices, a cap on the price of insulin, and more vaccines available for free; higher subsidies for beneficiaries with low incomes will help those most in need. And with climate change looming as an existential threat and the health and economic effects associated with severe weather events impacting more Americans personally, the new law will help cut high energy costs for consumers in the short term while laying the groundwork for major reductions in greenhouse gas emissions over the next decade.  

Yet even with these provisions becoming law, we must be upfront about what this bill could have been and what still needs to be done. As the nation’s largest health philanthropy, the Robert Wood Johnson Foundation hoped for a far broader and more equitable effort to help create an America in which race, ethnicity, income level, neighborhood, disability, occupation and immigration status no longer determine how long and how well people live. Sadly, this law does not reach that mark, and the barriers to better health and economic opportunity have become more entrenched since the original, more expansive bill was introduced more than a year ago. 

As lawmakers depart Washington for August recess, they and we should celebrate what has been accomplished while at the same time recommitting to the work that remains:

• In the latter half of 2021, the expanded Child Tax Credit lifted more than 3 million children out of poverty. When the expanded credit lapsed in January, those children fell right back into severe economic distress, yet the expanded credit still has not been renewed — even as rising prices make it harder for families to afford food, rent, utilities and other necessities, and the federal minimum wage has not budged since 2009. 
• More than two years into the COVID-19 pandemic that has sickened at least half the country and killed more than 1 million people — and now facing another public health emergency with monkeypox — America remains the only wealthy nation to not guarantee paid family and medical leave, and affordable child care remains out of reach for millions. 
• The Supreme Court’s egregious decision overturning Roe v. Wade will especially impact women of color already facing unconscionably high maternal mortality rates. Unfortunately, Congress did not extend healthcare coverage to more than 2 million people — disproportionately women of color and those with low wages — who are denied government-funded healthcare in 12 states that have refused to expand their Medicaid programs under the Affordable Care Act. Congress also failed to address critical gaps in maternal health, such as extending Medicaid and CHIP postpartum coverage to one year.   
• For the past 2.5 years, every family had the peace of mind of knowing that their children could receive free school meals, the benefits of which are legion. But as a new school year begins, that portion of the safety net has been removed, even as 25 million Americans suffer from food insecurity and food costs have risen at a level not seen in four decades. 
• States that received unprecedented levels of federal funding for rental relief last year to help Americans stay in their homes have either exhausted the funds or refused to spend them at all. Meanwhile, evictions are increasing amid the lack of affordable housing.  
• For decades, domestic workers have received poverty-level wages. A long-overdue push to raise their pay and expand access to quality home healthcare services for older Americans and people with disabilities was left by the wayside.  

During recess, members of Congress will see these health and economic challenges affecting people in their states and districts, in cities and rural areas alike. At various points over the past few years, Congress has found common ground on many of these issues. But temporary commitments are insufficient. A comprehensive, unified and ultimately bipartisan approach is necessary to confront and solve these challenges over the long term; our nation must recognize that families’ economic health is intrinsically tied to physical and mental health. 

The Inflation Reduction Act marks the end of a spate of legislative action, but it must only be the beginning of our efforts to change our health and economic trajectory. When lawmakers return in September, they should remember what they heard and saw back home and act accordingly. The journey toward health equity in America is far from complete; we are not yet the country we can be or should be. It is incumbent upon our lawmakers, and all of us, to continue the fight.    

Richard E. Besser, a physician, is president and chief executive of the Robert Wood Johnson Foundation and former acting director of the Centers for Disease Control and Prevention. Avenel Joseph, Ph.D., is the vice president for Policy at the Robert Wood Johnson Foundation. Twitter: @DrRichBesser, @DrAvenelJoseph.