The Biden Administration’s Chance to Keep a Promise on Health Equity

Earlier this month, the $1.9 trillion American Rescue Plan Act was signed into law by President Joe Biden. The law includes an $830 million “bonus” for the state of Tennessee to expand its Medicaid program – the largest-ever such incentive for a state in federal government history.

This incentive sits in stark contrast to the Tennessee Medicaid 1115 Research and Demonstration waiver approved by the Centers for Medicare and Medicaid Services in early January 2021, which gives the state increased discretion over how their federal Medicaid dollars are spent in exchange for a cap on those funds. While the increased flexibility sounds promising, the reality is a harsh one: Without proper funding of Medicaid, critical health care coverage could be rolled back – in the middle of a pandemic – for vulnerable Tennesseans, many of whom are already at higher risk for COVID-19.

Biden has promised to expand health equity and minimize health disparities as critical components of his administration’s public health agenda. With this new Medicaid expansion incentive now in the mix, the Biden administration has an immediate opportunity to deliver on the promise of health equity for all by stepping in to restore Medicaid as a guaranteed safety net for vulnerable residents in Tennessee and rescind the Medicaid waiver that was rushed through by the Trump administration in January.

This is the first time this type of Medicaid waiver has been established. If left standing for the unheard-of 10-year timeframe, it establishes a dangerous precedent that will effectively raise the eligibility threshold for Medicaid – a legacy that could potentially jeopardize access for needed health care services for vulnerable Tennesseans, including individuals of color, low-income individuals, the disabled and the elderly.

Historically underserved populations cannot afford reduced access to health care. Tennessee’s Medicaid waiver isn’t a theoretical fiscal exercise – it could mean an overall reduction in services, limited availability of prescription drugs and even the potential loss of health care access altogether for individuals and families who remain underserved, at higher risk for COVID-19, and who are disproportionately impacted by health disparities.

Under Tennessee’s waiver, it’s these very communities – low-income populations, communities of color, the elderly and those living with disabilities and in need of long-term care – that would be the first to see their services cut. It’s because the decrease in funds will ultimately force Tennessee’s Medicaid program to limit services, drastically cut coverage and force health care services to shift to far higher-cost venues like emergency rooms, shelters and prisons.

If the reality imposed by this waiver becomes the new normal, the result will be a massive increase in the number of uninsured – undermining Tennessee Medicaid’s role as an indispensable safety net, reducing provider payments and increasing out-of-pocket costs for Tennessee state Medicaid enrollees. It would also establish a program in Medicaid that has never been tested before, and whose true impacts are not yet known.

Low-income Tennesseans and Tennesseans of color cannot afford the detrimental effects of this waiver – the very individuals Biden unequivocally pledged to support if he became president. The relegation of care that would result from the waiver flies in the face of new Biden administration priorities around advancing health equity, minimizing health disparities and creating a more equal and more just system of health care for all Americans as the nation continues to battle the COVID-19 pandemic.

If the Biden administration is serious about minimizing health disparities, it must step in to rescind this waiver to protect the solvency of Medicaid in our state. In doing so, Biden would be honoring his promise to stand up for underserved populations – including women and other historically marginalized groups – who rely on Medicaid, and he would ensure that access to health care remains within reach for all Tennesseans.


Cherisse Scott is CEO and founder of SisterReach, a grassroots 501(c)3 nonprofit that supports the reproductive autonomy of women and teens of color, poor and rural women, LGBTQIA+ people and their families through the framework of reproductive justice.

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