Watch the spread of coronavirus cases in Alabama in March 2020
The coronavirus outbreak has upended daily life in Alabama, but one fact remains constant: Republican leaders resist Medicaid expansion.
Despite renewed calls for expansion from Democrats and health care advocates amid the pandemic, GOP leaders in the state this week seemed at best reluctant to consider expansion.
“I’ve not had a single colleague call and ask me about Medicaid expansion on the Republican side,” said Senate President Pro Tem Del Marsh, R-Anniston. “I don’t think the mood has changed on that. If you ask me the opinion of the body, I don’t see anything happening in the session other than getting the budget passed.”
Supporters have continued to press for the program, citing the public health and economic benefits that the program could bring into the state.
A group of more than 60 organizations on Wednesday announced that they would make a push to convince legislators to expand Medicaid, advocates on Wednesday announced the formation of a coalition to bring the program to the state. The coalition will stress the short and long-term benefits of expansion, particularly in light of the coronavirus outbreak.
“It brings all the previous arguments for Medicaid expansion to a single pointed question,” said Jim Carnes, the policy director for Alabama Arise, a group that works on poverty issues and is a member of the coalition. “In the face of a health care disaster, is Alabama willing to hold back and remain satisfied with a stressed, frayed hospital network and a system that leaves hundreds of thousands of people out of affordable health coverage? We say the answer is no, and we have thousands of people who agree.”
The Alabama Department of Public Health (ADPH) reported nearly 4,000 cases of COVID-19 as of 11 a.m. on Wednesday. ADPH said it received reports of 115 COVID-19 deaths. A report last week said African-Americans, about 27% of Alabama’s population, accounted for 52% of deaths from the disease.
U.S. Sen. Doug Jones, a Democrat and a longtime proponent of Medicaid expansion, said on a conference call Tuesday that the pandemic “has put a magnifying glass on all the disparities we see around the country.”
“Our health is dependent on our neighbor’s health, more than we would have liked to think in the past,” he said.
Medicaid in Alabama covers roughly 1 million people, about 20% of the total state population. The vast majority are children, the elderly, and those with disabilities. Able-bodied childless adults almost never qualify, and those with children must make 18% of the federal poverty line or less ($3,909 a year or $325 a month for a family of three) to receive benefits.
Medicaid expansion would expand eligibility to anyone making up to 138% of the poverty line — $17,609 a year for an individual; $29,974 for a family of three. A 2019 study of Medicaid expansion by University of Alabama Birmingham professor David Becker estimated that Medicaid expansion would ultimately cover about 346,000 Alabamians. The study also estimated that expansion would generate between $2.7 billion and $2.9 billion a year in new economic activity in the state.
With the pandemic bringing nearly all business in the country to a halt, advocates have cited those numbers as a reason to opt into the program. But similar arguments made in the past failed to move Republican leaders from their opposition. Opposition to expansion has not led to any political losses for the GOP in Alabama.
Critics within the state have also focused on the cost of the state match for Medicaid expansion. States that opted in at first had three years of the federal government paying the entire cost of expansion, but eventually had to provide 10% of the match. Becker’s study said the state share could be $265 million in fiscal year 2023.
Jones has pushed legislation to provide states late to expansion with the same three-year coverage early adapters enjoyed. The study also suggested that new economic activity, combined with cost savings from more people accessing preventative treatment, could easily offset those costs.
“Health coverage provides a consistent protection of health care,” Carnes said. “It allows people to go to the doctor when they suspect something is wrong. It helps them get preventative care that can prevent the development of long-term conditions that can only worsen with neglect.”
But legislative leaders remain uneasy, particularly amid the cloudy budget picture.
“Any discussion of expanding services would be premature and unwise at this point,” House Speaker Mac McCutcheon, R-Monrovia, said in a statement on Tuesday. “To put it in other terms, if you’re not sure you can pay your current monthly mortgage, it doesn’t make sense to start building an addition onto your house.”
Even when state budgets were flush with cash, Gov. Kay Ivey said the cost of expanding Medicaid on the state side was too great. At a press conference on Tuesday, Ivey did not completely dismiss the thought of expansion, but showed no enthusiasm for it.
“It would be irresponsible to think about expanding Medicaid just for the sake of expanding Medicaid without having a complete and honest discussion about the source of state funding,” she said.
Marsh on Wednesday also dismissed the economic benefits of expansion.
“I just personally don’t think more government programs are the stimulus we need,” he said. “The stimulus we need is getting independent businesses back to work.”
Advocates Wednesday expressed hope that the number of conservative-leaning states that expanded Medicaid would shift the debate. Becker, who authored the study, said on the Wednesday conference call that many of the previous ideological arguments against expansion had lost steam, particularly with the responses to the pandemic.
“If it’s belief in limited government, well, last time I checked, I’m locked in my house,” he said. “We’ve abandoned that belief in limited government.”
Senate Minority Leader Bobby Singleton, D-Greensboro, said Tuesday that Marsh had not moved from opposition to Medicaid expansion, but said there was talk about helping those “disproportionately affected” by the pandemic and the economic slowdown. Marsh said Wednesday they were looking at the use of $2 billion headed to the state to extend some help to individuals affected. McCutcheon said in his statement that legislators would likely “look into our health care system and how services are delivered on both the state and national levels,” though he did not provide specifics.
Advocates argue the best way to address that would be expansion.
“COVID-19 is an immediate and dangerous health threat,” the Rev. Carolyn Foster, a member of Greater Birmingham Ministries, said on the conference call on Wednesday. “But low-income people experience dangerous and immediate health threats every day, because they have no coverage.”
Contact Montgomery Advertiser reporter Brian Lyman at 334-240-0185 or email@example.com.
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