Pressure mounts for Medicaid growth in Alabama

MONTGOMERY, Ala. — Kiana George, a 30-year-old who works in child care in Camden, Alabama, finds herself in a precarious situation regarding health insurance. Her income is too high to qualify for Medicaid, yet too low to receive federal assistance for health insurance coverage.

Without any insurance, George has been forced to avoid medical appointments, which resulted in her hospitalization for high blood pressure. “I started receiving bills in the mail, and it discouraged me from seeking medical help,” George explained, highlighting the financial strain she faces. “If I am already in debt, I cannot afford insurance, and thus, cannot pay these medical bills,” she added.

Across the 10 states that have not expanded Medicaid under the Affordable Care Act, approximately 1.4 million people like George are trapped in this coverage gap, according to a health policy research group, KFF. These individuals earn too much for Medicaid but insufficiently to benefit from federal subsidies for health insurance.

On Tuesday, proponents of Medicaid expansion gathered at the Alabama Statehouse in a bid to persuade lawmakers to move past their prolonged hesitation. Advocates argue that the current stance is detrimental not only to working families but also to healthcare providers. However, the advocacy comes amid increasing uncertainty regarding potential modifications to Medicaid by the federal government, which provides healthcare services to 80 million both adults and children in the United States.

The Affordable Care Act initially sought state expansion of Medicaid to include adults aged 19 to 64 with incomes up to 138% of the federal poverty level. This would target an income of approximately $21,597 for individuals or $29,187 for couples. A Supreme Court ruling, however, rendered the expansion optional, leaving those earning above this threshold eligible for federal health insurance subsidies through the online marketplace.
The 10 states that have yet to expand Medicaid include Wyoming, Kansas, Wisconsin, Texas, Tennessee, Mississippi, Alabama, Georgia, South Carolina, and Florida. KFF data reveals that uninsured rates in these states nearly double those of states that have opted for Medicaid expansion, standing at 14% compared to 7.6% in expansion states.

Angelica McCain, a 35-year-old from Hoover, Alabama, experienced this gap while working in the restaurant sector. “Expecting civil workers to afford private healthcare when not receiving a livable wage is unreasonable, as premiums can exceed $500 monthly per person,” McCain stated.
Rural hospitals are feeling financial pressure from uninsured care, states Debbie Smith from Cover Alabama, an advocacy group in support of Medicaid expansion. Fifteen Alabama hospitals have closed since 2011, the Alabama Hospital Association reports.

“When hospitals close, it’s not limited to the uninsured; it impacts everyone,” said Dr. Don Williamson, president of the association.

Despite this, many Republicans in these states remain hesitant about expanding Medicaid, partly due to the uncertainty at the federal government level. “Implementing any changes to Medicaid right now could be too costly,” said Republican House Speaker Nathaniel Ledbetter recently, citing 2025 as a potential date for reconsideration depending on federal government actions.

Mississippi Governor Tate Reeves has similarly supported resisting expansion, citing potential changes that might be introduced by the federal administration.

Smith of Cover Alabama remarked that Alabama’s Medicaid program already operates with minimal resources, catering only to children, people with disabilities, and pregnant women, leaving scant coverage for low-income adults. “We are already running on bare minimum, there’s no room to cut,” Smith emphasized.

Years of stagnation on Medicaid expansion, Smith argues, have inflicted significant damage on the state. “In the meantime, people are suffering and hospitals are shutting down, meaning Alabama is losing billions in potential investments in our healthcare system,” she remarked.