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SCRIPT On November 19th of last year, the US House of Representatives passed the highly debated Build Back Better Act, with 220 votes in favour and 213 against. If the Senate passes the bill in its current format, the legislation would target a wide range of areas, including an expansion of health care. For example, the legislation would extend the marketplace subsidies authorized under the American Rescue Plan Act through the end of 2025 and further add hearing benefits to the Medicare program. Moreover, the legislation aims at closing the Medicaid coverage gap. If the bill is enacted as it currently stands, the Congressional Budget Office has estimated a decrease in the number of uninsured people by 3.9 million in the period from 2022 to 2031. But what is the current state of health and health care coverage in the country? Let us look at insurance coverage and how it has changed during the COVID pandemic. The Build Back Better Act should further strengthen the Affordable Care act and expand health coverage in the Unites States, continuing with the upward trend that we have seen for at least the last decade. According to U.S. Census data, the total coverage rate was at 92 percent in 2020, a net increase with respect to 84 percent in 2010. The fraction of uninsured people indeed has been declining steadily throughout the decade, reaching 8.6 percent in 2020. This number could come as a surprise given the widespread worry, at the beginning of the pandemic, that most people would lose their insurance amid the layoffs occurring as a consequence of COVID 19. In the period between 2018 and 2020, the rate of private health insurance coverage decreased by 0.8 percentage points to 66.5 percent, a decrease mainly due to a decline in employment-based coverage to 54.4 percent. On the other hand, during the same period, the fraction of those covered by a public health insurance program increased by 0.4 percentage points, reaching 34.8 percent in 2020. Moreover, it seems that the dispositions put in place by the current administration helped in switching to public insurance for those who lost their job during the pandemic. Indeed, President Biden has stated that since he took office 4.6 billion people have gained health insurance. However, this number does not necessarily immediately translate to better health care. Aside from the direct mortality due to COVID 19, an indirect effect of this pandemic has been that a lot of people decided to avoid medical settings, in which they might have caught covid. According to a recent survey, 40.9 percent of the U.S. adult population has reported that they have delayed medical care because of concerns due to COVID 19. The proportion who reported having delayed medical care is about 36.2 percent for whites, 55.5 percent for hispanics, 48.1 percent for Blacks and 37.75 percent for Asians. Moreover, just as we are seeing a decrease in the number of uninsured, health care expenditures have been rising. While the Build Back Better bill aims at lowering prescription drug costs by allowing Medicare to negotiate prices, one of the criticisms of the Affordable Care Act is that it did not tackle the issue of health care costs, which have been steadily increasing throughout the decade. According to a recent Gallup survey, as of 2021 an increasing part of U.S. population is struggling and worried about health care costs. The percentage of Americans who have reported skipping care because of its cost has tripled from 10 percent in March 2021 to 30 percent in October 2021.