In Camden, Alabama, Kiana George, a 30-year-old working at a child care center, faces a troubling gap when it comes to health coverage. Her income disqualifies her from Medicaid and she’s also ineligible for federal health insurance subsidies. As a result, George avoided medical visits until her condition deteriorated, leading to a hospital stay for high blood pressure.
“The arrival of medical bills really discouraged me from seeking help,” George shared. “If I’m already in debt, how can I afford to pay for health insurance or the bills for not having it?” Her situation is emblematic of a broader issue affecting approximately 1.4 million people across the ten states that haven’t expanded Medicaid under the Affordable Care Act. These individuals earn too much for Medicaid yet too little for federal assistance, as reported by health policy organization KFF.
This pressing issue has led advocates to gather at the Alabama Statehouse, urging legislative leaders to reconsider the state’s stance on Medicaid expansion. They argue that the lack of expansion harms both families and healthcare facilities. However, these appeals come at a challenging time, with potential federal changes and cuts in Medicaid causing further uncertainty.
The Affordable Care Act intended for Medicaid to support individuals aged 19 to 64 with incomes up to 138% of the federal poverty line, equating to about $21,597 for singles or $29,187 for couples. While some states adopted the expansion, others did not, leading to significant discrepancies in insurance coverage levels. States without expansion like Alabama see uninsured rates nearly double those that have expanded, standing at 14% compared to 7.6%, based on KFF findings.
For individuals like Angelica McCain, a 35-year-old from Hoover, Alabama, the coverage gap narrows options. Having worked in the restaurant industry for years, McCain remarks, “Employers don’t provide a livable wage for workers to afford private health care, which costs around $500 monthly per person.”
Hospitals, especially those in rural locales, also struggle with the fallout from uncompensated care. Debbie Smith, from advocacy group Cover Alabama, points out that 15 hospitals have shut down in Alabama since 2011. Dr. Don Williamson, president of the Alabama Hospital Association, emphasized, “A closed hospital impacts everyone, not just the uninsured.”
Despite these challenges, expansion remains a contentious topic among some Republican leaders in non-expansion states. Concerns about potential federal Medicaid reforms contribute to their hesitance. “Implementing changes with Medicaid seems financially unfeasible for now,” revealed Republican House Speaker Nathaniel Ledbetter. There’s a prevailing wait-and-watch approach concerning federal movements.
Mississippi Governor Tate Reeves recently urged state lawmakers to oppose Medicaid expansion in anticipation of possible policy shifts under President Trump’s administration. Back in Alabama, Smith argues that their Medicaid system is already minimal, covering only specific vulnerable groups, and insists there’s no room for service cuts.
“Inaction over the years on expanding Medicaid has deeply affected Alabama,” Smith added. “As people suffer and healthcare facilities close, the state forfeits billions that could have bolstered our healthcare infrastructure.”
