It’s time for Alabama to expand Medicaid

It has been a decade of missed opportunities. On June 28, 2012, the United States Supreme Court ruled in NFIB v. Sebelius that Alabama and other states were not required to fully implement the Affordable Care Act. The ruling said states could choose not to expand Medicaid to provide health coverage to low-income adults who could not otherwise afford insurance.

Despite the ruling, a generous offer remained on the table: The federal government would fund the Medicaid expansion in full for the first three years and cover 90% of the costs thereafter. Yet Alabama sat back and did little even as 17 of our hospitals have closed since 2010.

We looked without answer because over 300,000 of our friends and neighbors — people who earn too little to afford private insurance but too little to qualify for our rudimentary Medicaid program — have struggled to pay for needed health treatments or simply been left without care. We waited for help as key health indicators – including labor force participation rates, maternal mortality rates, substance use disorders and mental health outcomes – continued to languish.

During these ten years, we have seen 38 of our neighboring States accept the agreement that we did not accept. The results speak for themselves.

While many rural hospitals in Alabama closed, Arkansas expanded Medicaid in 2014 and retained its rural hospitals and providers. Whereas more than 600 Alabamians die every year due to lack of health coverage, Louisiana expanded Medicaid in 2016 and saw a reduction in premature deaths. And while Alabama lost more than $1 billion in additional tax revenue that would have strengthened our economy and supported our long-term economic success, our federal taxes went to fund health care in other growing states, including Kentucky, Missouri, Oklahoma, and Virginia.

The good news is this: a new Medicaid expansion deal is now on the table, and it’s even better off financially than before. US bailout law offers additional incentives to states that have not yet expanded Medicaid to make sure we don’t miss anything. With these incentives, Alabama could more than afford to provide coverage for those 300,000 friends and neighbors struggling to make ends meet and pay for health care.

The evidence is strong that states that build a strong social safety net, including larger Medicaid programs, enjoy faster economic recovery from recessions than those that don’t. And those federal funds will benefit those most affected the most during the COVID-19 recession. Medicaid expansion will also help K-12 schools and universities across Alabama by generating significant increases in revenue from income tax and sales — the funding sources most at risk of decline in times of economic instability.

When we look back to this moment ten years from now, I wish the story of Medicaid expansion was one of opportunity. Let’s say the leaders of Alabama took home billions of dollars to invest in our health care, our economy, and our people. Let’s say we weathered the ups and downs of economic instability and emerged stronger. And let’s say we did it all because of leaders who had the courage, vision and foresight to invest in the Alabama of 2032 today.

Robyn Hyde is executive director of Alabama rises, a statewide member-driven nonprofit that advances public policy to improve the lives of Alabamians marginalized by poverty. Arise members include faith-based, community, nonprofit, and civic groups, local leaders, and individuals from across Alabama. E-mail:

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