Alabama Republicans for years have opposed expanding Medicaid eligibility. Now, they may be cracking the door.
Alabama Gov. Kay Ivey and legislative leaders said they are reviewing details of the nearly $2 trillion coronavirus relief package that includes new financial incentives for the states that have opted against expanding Medicaid to provide health coverage for more low-income Americans. A spokeswoman for Ivey said the governor is "open to the discussion" on expansion but that state leaders need additional information about the long-term cost projections.
"Ensuring every Alabamian has access to quality health care is important to the governor and always has been a priority of hers. However, as she has made clear, the problem has always been how to pay for it. She is open to the discussion, but right now, we simply do not have all the facts," spokeswoman Gina Maiola said.
Alabama is one of 12 states that have taken no action toward expanding Medicaid eligibility under the Affordable Care Act. Previous studies have estimated that expansion would add around 300,000 people to state Medicaid rolls. Republican leaders have in the past expressed opposition to expanding Medicaid, at times citing both political opposition to the Affordable Care Act passed under former President Barack Obama and concerns about cost.
Medicaid expansion under the Affordable Care Act allows people with family incomes less than 138% of the federal poverty limit— or around $17,000 for an individual and $29,000 for a family of three to qualify for Medicaid. Currently, Alabama's Medicaid program covers very few able-bodied adults.
"The bulk of the people who will gain coverage are people who are working," said Jim Carnes, a policy analyst with Alabama Arise, an advocacy group for low-income Alabamians.
Already, the federal government would pick up 90% of the cost of the expansion. A 2019 study by a University of Alabama at Birmingham projected the state's cost would be about $250 million per year, but that the state would see a resulting boost in economic activity.
The federal relief bill offers a new incentive by giving states a 5% boost to the federal match over the next two years for the people they currently cover.
Democrats in the Alabama Senate have estimated that would generate an additional $900 million for the state.
"I just want to say to Governor Ivey, if not now, when?" Senate Minority Leader Bobby Singleton said in the press conference. "I don't care if we call it ObamaCare. We could call it Kay-Care. It could be Alabama Health Care. We need to expand Medicaid and the time to do it is right now," Singleton said.
Dr. Don Williamson, president of the Alabama Hospital Association, said the calculations are complex because of the intricacies of how Alabama funds Medicaid. The cost will also depend on how many people are added to the rolls.
"To me, the most important thing that Medicaid expansion does is it absolutely improves health outcomes. You get earlier cancer diagnosis. You get lower infant mortality rates. You get earlier diagnosis if diabetes," Williamson said.
State Rep. Steve Clouse, the chairman of the Alabama House of Representatives general fund budget committee, said state officials are trying to gather information about the incentives and what would be the state's share of costs in the long run.
Sen. Greg Albritton, the chairman of the Senate budget committee, expressed some skepticism about the incentives. He said the incentives sound enticing but said the state has "got to have the answers" before making a commitment.
"I'm not surprised this would be the same old song, the same old dance. ... Buying a new car now. Nothing down, but the payment is due in two years," Albritton said.
Senate President Pro Tem Greg Reed said the analysis will continue over the coming weeks.
The 12 states that have held out against the Medicaid expansion are: Alabama, Florida, Georgia, Kansas, Mississippi, North Carolina, South Carolina, South Dakota, Tennessee, Texas, Wisconsin and Wyoming.