Politicians speak of such good play on the importance of health care that you would think the United States has long ago achieved universal health care coverage. But we are far from it. Millions of people are uninsured because there is a chasm between politicians’ healthcare rhetoric and their actions – or, in some cases, their inaction. For years, the decision-makers of 12 states refused to expand their Medicaid programs under the Affordable Care Act. The case for expansion is strong: higher coverage rates, fewer premature deaths, reduced racial disparities in health, and increased economic activity. Yet these states continue to perpetuate what is known as the Medicaid coverage gap, under which 2.2 million people – disproportionately low-income and black people of color – are denied quality health care coverage that can mean the difference between life and death. Congress has a historic opportunity to adopt a federal solution that corrects this injustice. However, we fear that he is giving way under the weight of a political calculation that underestimates the lives of black, brown and low-income populations. As the coronavirus pandemic has clearly illustrated, this nation has been far too willing to prioritize politics over people’s health. This paradigm, like the Medicaid coverage gap itself, must no longer be tolerated.