Advocates of Medicaid expansion in Alabama said adding low-income adults to the program could create 28,500 jobs in the state, according to a study from the Commonwealth Fund, a health care policy foundation.

The announcement follows months of effort by advocacy groups to persuade Gov. Kay Ivey to expand the safety net program, even after legislators failed to act during the session that ended last month. The Cover Alabama Coalition represents several organizations that support the expansion of Medicaid. Alabama is one of 12 states where neither voters nor state leaders have opted to increase coverage to all low-income individuals.

Alabama has the country’s second lowest eligibility limits for Medicaid. The program covers most low-income children, seniors, pregnant women and people with disabilities. However, adults without children and caretakers who earn more than $4,000 a year do not qualify for the program. Expansion would provide coverage to all single adults earning less than $17,774 or $30,305 for a family of three, about 340,000 people in Alabama.

Earlier this year, Cover Alabama published the results of a poll that showed a majority of Alabamians support Medicaid expansion. Federal leaders also offered extra funding that would cover 95 percent of the costs to states that hadn’t yet expanded, a total of $732 million over two years for Alabama. Despite the popularity and the extra incentives, expansion has not found much support among Republicans in the statehouse.

The legislature met for the last time on May 17 without taking up the issue of Medicaid expansion. On May 20, supporters of Medicaid expansion began making calls to Gov. Kay Ivey, seeking her support. Ivey can approve Medicaid expansion, but the legislature must budget the portion not covered by federal funding.

“There is no doubt that if Governor Ivey strongly backed an initiative, it would carry weight,” said Ivey’s spokeswoman, Gina Maiola. “However, the Legislature has to agree to buy in to fully fund the expansion.

The Alabama Hospital Association and Medical Association of the State of Alabama have both come out in support of expansion. The hospital association has said rural hospitals would benefit from expansion since many treat large numbers of uninsured patients and operate at a loss. In April, 300 medical professionals signed a letter supporting expansion.

Republican leaders have continued to express doubts about the long-term costs of a larger Medicaid program. Even Alabama’s relatively stingy Medicaid program accounts for about a quarter of the state’s total expenditures, according to the Kaiser Family Foundation. States cover 10 percent of Medicaid costs after federal incentives expire. Efforts to raise more revenue through lottery or gambling bills have stalled in recent years.

The most recent effort to promote Medicaid expansion relies on findings by the Commonwealth Fund, which estimated potential economic gains in all 14 states that have not yet expanded. They analyzed new economic incentives offered as part of the American Rescue Plan Act signed earlier this year by President Joe Biden.

The report found that Alabama would gain 14,200 health care jobs, 2,100 construction jobs, 3,200 retail jobs and about 9,000 jobs in other sectors. Ivey has not opposed Medicaid expansion, but said the state needs to find new sources of revenue for the program.

“The problem has always been how to pay for it,” Maiola said. “She (Gov. Ivey) is open to the discussion, but right now, we simply do not have all the facts. This is a massive package, and our Finance Department and Medicaid Agency will need thoroughly review it before we can fully weigh in on this issue.”

The Equal Justice Center in Kentucky, which advocates for expanded Medicaid, found the state added about 16,000 jobs after adding low-income adults to the program. Kentucky has a slightly smaller population than Alabama.

David Spillers, chief executive officer of the Huntsville Hospital Health System, touted the economic benefits after Cover Alabama released its report.

“The expansion of Medicaid will create many jobs for individuals and make our workforce more productive,” Spillers said. “Hospitals in the Huntsville area are economic engines, directly employing 12,126 people, and a study found that investing in health care infrastructure through expansion would create approximately 30,000 new jobs statewide. It is the fiscally responsible thing to do.”

Additional reporting by Sarah Whites-Koditschek

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Medicaid expansion could create 28,500 jobs in Alabama, advocates say – AL.com