Healthcare is expensive.
The United States spends more than double per capita on healthcare compared to other wealthy nations, despite using similar amounts of medical services, according to a Johns Hopkins study.
Before healthcare prices were even as high as they are now, the federal government created Medicaid to help struggling ordinary, working-class people get the care they need.
In implementing Medicaid, the federal government set broad requirements, but most of the decisions were made by the states. The federal government has updated those requirements over the years, notably with the Affordable Care Act, but states are still allowed a wide range of flexibility.
So the decision that affects the public — who gets covered — can be reformulated into a question: At what income does the cost of healthcare become too heavy a burden?
Well, if we go with our gut, maybe the federal poverty level seems like a good place to start. That’s only $21,720 a year for a family of three or $12,490 for an individual, after all.
But as the Alabama Medicaid Agency will tell you, it’s lower than that.
For a non-disabled parent of three to qualify for Medicaid in Alabama, he or she would have to make under $4,000 a year.
Now, try to wrap your head around the fact that the average American household spent nearly $5,000 on healthcare last year, according to the data company Clever. I can’t.
In addition, Alabama adults without children who are non-elderly and non-disabled can’t even qualify for Medicaid as things are now.
Basically, if you’re poor and — God forbid — get sick, don’t expect Alabama to help.
17.2% of Alabamians live below the federal poverty level, and in Lee County, 19% do. The Census shows that one out of 10 Alabamians didn’t have health insurance in 2018.
The Alabama Medicaid Agency has chosen not to give healthcare coverage to these people unless they meet a specific set of requirements designed to keep the state from spending a single penny more than it’s required.
If you’re unsure, consider that Alabama has the strictest Medicaid requirements in the country, according to the Kaiser Family Foundation, and they’ve tried to lower that limbo pole again by instituting a work requirement for coverage. (Who would satisfy a work requirement and simultaneously make under $4,000 a year? I think you know the answer.)
And don’t forget that in 2019, Alabama Medicaid Commissioner Stephanie Azar asked for less money from the federal government — $40 million less — to cover Alabamians with Medicaid. Sure, you can say we don’t want the federal government’s help, but enjoy the cognitive dissonance once you realize Alabama was ranked fifth on the list of states most dependent on the federal government’s funding, based on a 2019 analysis by WalletHub.
But perhaps the most damning piece of evidence is the number of times Alabama has turned down federal funding to expand Medicaid in the state under the ACA, touting a dogged refusal to comply with President Obama. Each year since 2010 they’ve turned it down.
Rural hospitals within Alabama continue to close as a result of Montgomery’s ignorance. From 2010 to 2019, six rural hospitals in Alabama closed, according to research by the Chartis Group. Seventeen are currently at risk. The Alabama Hospitals Association is begging for Medicaid expansion so they can keep facilities open.
The association issued a report stating that Medicaid expansion would create an $11.4 billion economic impact over four years.
The report also said 340,000 more Alabamians would be covered.
The Alabama Legislature has not failed to dismiss its constituents’ wellbeing in the name of saving money. It has continually refused to take the federal government’s offer to pay at least 90% of the cost of Medicaid expansion.
The callous defiance by Alabama’s government is selfish and senseless and people will continue to suffer because of it.
No one should die because they can’t pay. No one should avoid the doctor because they’re afraid they’ll be head-high in debt.
Healthcare is a service that every single person should have access to by right. People might ask if such a right even exists. It does; look to public education.
But what is even more foundational than education is having the right to live.
In the end, I don’t know how things should be fixed exactly, but for Alabama, doing more than it does now would be a start.