Skip to content
Search

Latest Stories

Top Stories

Medicaid expansion in Alabama: A voter’s guide

Medicaid expansion

House Majority Whip Jim Clyburn and other congressional Democrats hold a press conference about Medicaid expansion in September 2021.

Kevin Dietsch/Getty Images

This story was originally published in Reckon.

In April of 2022, Reckon and partners including Essential Partners, Cortico, and Bridge Alliance, hosted conversations with Alabamians under 40 about the future of their state for a project called Bridge Alabama. This guide focuses on an issue raised in those conversations.


What’s Medicaid?

It’s the public health insurance program for low-income Americans. It’s designed to help people afford things like doctor’s appointments, lab work and surgeries. Each state runs its own Medicaid program, funded with federal and state money.

Eligibility – who qualifies for Medicaid – varies from state to state

Back in 2010, the Affordable Care Act expanded which people are eligible for Medicaid, extending it to adults up to age 64 with incomes up to 138% of the federal poverty level, which in 2022 is about $27,750 per year for a family of four.

But many Republican-led states, including Alabama, pushed back against the ACA’s Medicaid expansion requirement, arguing the federal government was overreaching. The Supreme Court struck down the requirement in 2012, ruling that Medicaid expansion had to be optional for states.

To date, 38 states and the District of Columbia have adopted Medicaid expansion. In those states, the federal government covers 90% of the costs of the program.

Just 12 states, including Alabama, have not expanded Medicaid. Most of them are in the South. Because they didn’t expand Medicaid, it’s harder for low-income people to qualify to receive Medicaid in these states.

Sign up for The Fulcrum newsletter

Alabama Medicaid is a bare-bones program. Coverage is only available to children, people with special health care needs and some caregivers.

For example, an Alabama parent with one child can’t earn more than $3,135 a year and still qualify for Medicaid. If that same parent and child lived in Virginia, which expanded Medicaid in 2019, the parent could earn up to $24,000 a year and keep their coverage.

Now the federal government is trying again to entice holdout states. Last year’s federal coronavirus relief package included financial incentives for non-expansion states to expand Medicaid. Alabama Gov. Kay Ivey has said she’s “open to discussion” but continues to question whether the state can afford it.

Why is it controversial?

In the first years after the ACA (often nicknamed “Obamacare”) passed, Alabama’s conservative leaders balked at the potential cost and questioned the constitutionality of the federal legislation dictating how a state ran its healthcare programs.

In recent years, though, Medicaid expansion has lost much of its stigma. A recent poll from expansion advocates showed two-thirds of respondents supported expansion. More than 100 Alabama organizations, including the state hospital association and medical association, have grown more vocal in their support of Medicaid expansion, saying it could insure an additional 284,000 Alabamians, create more jobs, reduce reliance on emergency rooms for basic healthcare, and improve the state’s poor health outcomes.

Even Republican former Gov. Robert Bentley, who refused to expand Medicaid while he was in office, recently called on Gov. Kay Ivey to move forward with expansion.

Although few Alabama leaders outright oppose expansion now, the ones who express skepticism continue to question how Alabama would pay for it.

A study released this year projected that Medicaid expansion would cost Alabama an additional $225.4 million over the next six years, but could save the state an estimated $398 million.

Who is working on the issue?

Cover Alabama is the state’s largest Medicaid expansion advocacy organization. It’s a nonpartisan coalition of more than 100 organizations across the state, including medical associations, faith groups, businesses and consumer advocacy groups.

Regionally, Southerners for Medicaid Expansion is a multi-state coalition of expansion advocacy groups in Texas, Mississippi, Alabama, Tennessee, Georgia, Florida, South Carolina and North Carolina.

Solutions from other states
States that have expanded Medicaid have improved access to care for low-income adults, seen fewer premature deaths among older adults, reduced medical debt, and seen a drop in hospital uncompensated care costs, according to the Center of Budget and Policy Priorities.

Several non-expansion states in the South, including Georgia, Florida and Tennessee, have chosen to partially expand Medicaid by extending Medicaid to birthing people for longer than the six weeks postpartum required by federal law.

In April 2022, after lobbying by advocates, Alabama extended pregnancy Medicaid from six weeks to one year postpartum. This has the potential for significant impact; because eligibility requirements are broader for pregnant people, Medicaid covers about half of all births in Alabama.

The state extended pregnancy Medicaid in two parts: Alabama Medicaid set aside about $4 million in its budget to extend pregnancy Medicaid to six months postpartum; then the Alabama legislature approved a state general fund budget with another $4 million earmarked to bump the coverage to a full year. Legislators have called it a “pilot program.”

How can I get involved?

There are different pathways that states like Alabama can take to expand Medicaid, involving the governor, state legislators and the Alabama Medicaid agency itself. Anyone interested in Medicaid expansion can write or call their state senator and state representative (find yours here by clicking on the map and entering your address) or the governor’s office.

For those interested in advocacy and information, Cover Alabama offers updates via free email subscription, an online petition to sign, and invites organizations to apply to become Cover Alabama members.

Social media hashtags on Medicaid expansion include #ExpandMedicaid, #CoverAlabama, #south4medex and #ALpolitics.

Resources

Read More

Business professional watching stocks go down.
Getty Images, Bartolome Ozonas

The White House Is Booming, the Boardroom Is Panicking

The Confidence Collapse

Consumer confidence is plummeting—and that was before the latest Wall Street selloffs.

Keep ReadingShow less
Drain—More Than Fight—Authoritarianism and Censorship
Getty Images, Mykyta Ivanov

Drain—More Than Fight—Authoritarianism and Censorship

The current approaches to proactively counteracting authoritarianism and censorship fall into two main categories, which we call “fighting” and “Constitution-defending.” While Constitution-defending in particular has some value, this article advocates for a third major method: draining interest in authoritarianism and censorship.

“Draining” refers to sapping interest in these extreme possibilities of authoritarianism and censorship. In practical terms, it comes from reducing an overblown sense of threat of fellow Americans across the political spectrum. When there is less to fear about each other, there is less desire for authoritarianism or censorship.

Keep ReadingShow less
"Vote" pin.
Getty Images, William Whitehurst

Most Americans’ Votes Don’t Matter in Deciding Elections

New research from the Unite America Institute confirms a stark reality: Most ballots cast in American elections don’t matter in deciding the outcome. In 2024, just 14% of eligible voters cast a meaningful vote that actually influenced the outcome of a U.S. House race. For state house races, on average across all 50 states, just 13% cast meaningful votes.

“Too many Americans have no real say in their democracy,” said Unite America Executive Director Nick Troiano. “Every voter deserves a ballot that not only counts, but that truly matters. We should demand better than ‘elections in name only.’”

Keep ReadingShow less
Hands outside of bars.
Getty Images, stevanovicigor

Double Standard: Investing in Animal Redemption While Ignoring Human Rehabilitation

America and countries abroad have mastered the art of taming wild animals—training the most vicious killers, honing killer instincts, and even domesticating animals born for the hunt. Wild animals in this country receive extensive resources to facilitate their reintegration into society.

Americans spent more than $150 billion on their pets in 2024, with an estimated spending projection of $200 million by 2030. Millions of dollars are poured into shelters, rehabilitation programs, and veterinary care, as shown by industry statistics on animal welfare spending. Television ads and commercials plead for their adoption. Stray animal hotlines operate 24/7, ensuring immediate rescue services. Pet parks, relief stations in airports, and pageant shows showcase animals as celebrities.

Keep ReadingShow less