By Dr. LaToya Lewis
On July 4, the Big Beautiful Bill became law, promising relief by capping certain medical costs. For many Miami families, that is welcome news, but the accurate measure of success will be whether it closes long-standing gaps in access to affordable, compassionate care. Lower bills are a start. Sustainable change means ensuring that every family can not only afford treatment but also receive care that honors their dignity, culture, and community values.
In 2023, the Kaiser Family Foundation noted that 10.7% of Florida residents were uninsured, well above the national average of 8%. In Miami-Dade County, that number rises to 16.7 percent for residents under age 65 reported the Health Foundation of South Florida. These numbers show that while cost transparency benefits those with coverage, many remain excluded entirely.
Angela is a fictional Miami hospitality worker who earns too much for Medicaid yet still cannot afford marketplace insurance, even with the Big Beautiful Bill’s protections. Jessica, also fictional but drawn from everyday real-world situations, qualifies for coverage but remains uninsured due to enrollment confusion and lack of guidance. The bill’s cost limits are beneficial, but accurate equity must include access to palliative and end-of-life care. In Miami, many families face delays in receiving these services, leading to avoidable suffering. Affordability must also mean access to humane care that respects cultural values and supports patients through life’s most vulnerable moments.
Caregivers are often the invisible backbone of our healthcare system. Many of these unpaid caregivers must reduce work hours or leave jobs entirely to care for their loved ones. Without sufficient resources such as caregiver training, respite care, and financial support, they face burnout and economic strain. Recognizing and supporting unpaid caregivers as essential partners in care would amplify the strength of the bill.
According to the Commonwealth Fund, uninsured rates nationwide among working-age adults dropped from 20.4 percent in 2013 to 11 percent in 2023. However, Florida’s decision not to expand Medicaid leaves many in a gap, earning too much for public programs yet too little for private insurance. Cultural and language barriers further limit outreach, especially in immigrant-rich communities.
In order for the bill to reach its full potential, the Big Beautiful Bill must be paired with policies that expand eligibility, simplify enrollment, and deliver culturally responsive outreach. It must also ensure access to palliative care and provide robust caregiver support. This law is a beginning, not an endpoint. Miami can set the standard for a healthcare system that is both affordable and truly equitable to all.
Dr. LaToya Lewis is an internationally recognized nursing professor, award-winning speaker, and a leading voice in healthcare equity, end-of-life dignity, and soul-centered leadership.
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