Alabama reviewing Medicaid expansion incentives

Alabama Republicans might be cracking the door to Medicaid expansion.

Posted: Mar 21, 2021 7:10 AM

MONTGOMERY, Ala. (AP) — Alabama Republicans for years have opposed expanding Medicaid eligibility. Now, they may be cracking the door.

Alabama Gov. Kay Ivey and legislative leaders said they are reviewing details of the nearly $2 trillion coronavirus relief package that includes new financial incentives for the states that have opted against expanding Medicaid to provide health coverage for more low-income Americans. A spokeswoman for Ivey said the governor is “open to the discussion” on expansion but that state leaders need additional information about the long-term cost projections.

“Ensuring every Alabamian has access to quality health care is important to the governor and always has been a priority of hers. However, as she has made clear, the problem has always been how to pay for it. She is open to the discussion, but right now, we simply do not have all the facts,” spokeswoman Gina Maiola said.

Alabama is one of 12 states that have taken no action toward expanding Medicaid eligibility under the Affordable Care Act. Previous studies have estimated that expansion would add around 300,000 people to state Medicaid rolls. Republican leaders have in the past expressed opposition to expanding Medicaid, at times citing both political opposition to the Affordable Care Act passed under former President Barack Obama and concerns about cost.

Medicaid expansion under the Affordable Care Act allows people with family incomes less than 138% of the federal poverty limit— or around $17,000 for an individual and $29,000 for a family of three to qualify for Medicaid. Currently, Alabama’s Medicaid program covers very few able-bodied adults.

“The bulk of the people who will gain coverage are people who are working,” said Jim Carnes, a policy analyst with Alabama Arise, an advocacy group for low-income Alabamians.

Already, the federal government would pick up 90% of the cost of the expansion. A 2019 study by a University of Alabama at Birmingham projected the state's cost would be about $250 million per year, but that the state would see a resulting boost in economic activity.

The federal relief bill offers a new incentive by giving states a 5% boost to the federal match over the next two years for the people they currently cover.

Democrats in the Alabama Senate have estimated that would generate an additional $900 million for the state.

“I just want to say to Governor Ivey, if not now, when?" Senate Minority Leader Bobby Singleton said in the press conference. “I don’t care if we call it ObamaCare. We could call it Kay-Care. It could be Alabama Health Care. We need to expand Medicaid and the time to do it is right now,” Singleton said.

Dr. Don Williamson, president of the Alabama Hospital Association, said the calculations are complex because of the intricacies of how Alabama funds Medicaid. The cost will also depend on how many people are added to the rolls.

“To me, the most important thing that Medicaid expansion does is it absolutely improves health outcomes. You get earlier cancer diagnosis. You get lower infant mortality rates. You get earlier diagnosis if diabetes,” Williamson said.

State Rep. Steve Clouse, the chairman of the Alabama House of Representatives general fund budget committee, said state officials are trying to gather information about the incentives and what would be the state’s share of costs in the long run.

Sen. Greg Albritton, the chairman of the Senate budget committee, expressed some skepticism about the incentives. He said the incentives sound enticing but said the state has “got to have the answers” before making a commitment.

“I’m not surprised this would be the same old song, the same old dance. ... Buying a new car now. Nothing down, but the payment is due in two years,” Albritton said.

Senate President Pro Tem Greg Reed said the analysis will continue over the coming weeks.

The 12 states that have held out against the Medicaid expansion are: Alabama, Florida, Georgia, Kansas, Mississippi, North Carolina, South Carolina, South Dakota, Tennessee, Texas, Wisconsin and Wyoming.

Mississippi Coronavirus Cases

Data is updated nightly.

Cases: 471092

Reported Deaths: 9165
CountyCasesDeaths
Harrison32160471
Hinds30628574
DeSoto29693344
Jackson23098335
Rankin21062357
Lee14515218
Madison13993264
Jones13112218
Forrest12926231
Lauderdale11301294
Lowndes10206171
Lamar10017125
Pearl River8616208
Lafayette8052136
Hancock7172111
Washington6816146
Oktibbeha6799117
Neshoba6377201
Monroe6343158
Warren6310159
Pontotoc607692
Panola6056123
Bolivar5991143
Marshall5948116
Union562385
Pike5450133
Lincoln5217129
Alcorn516288
George456466
Scott450392
Leflore4392140
Prentiss435275
Itawamba433295
Tippah432480
Simpson4251110
Copiah424784
Wayne422363
Tate4202100
Adams4184110
Yazoo412486
Sunflower4077104
Covington406591
Marion4016100
Leake390485
Coahoma387098
Newton361674
Grenada3511100
Stone343757
Tishomingo323788
Attala319685
Jasper309562
Winston299191
Clay286172
Chickasaw280564
Clarke275587
Calhoun258539
Holmes258585
Smith242246
Yalobusha216447
Tallahatchie214949
Walthall204657
Lawrence203231
Greene202645
Perry195753
Webster191642
Amite191451
Noxubee174438
Montgomery169453
Jefferson Davis164341
Carroll159437
Tunica147634
Benton138232
Kemper136939
Claiborne125534
Choctaw124424
Humphreys123037
Franklin114327
Quitman101425
Wilkinson98435
Jefferson86332
Sharkey61720
Issaquena1916
Unassigned00

Alabama Coronavirus Cases

Cases: 761865

Reported Deaths: 12856
CountyCasesDeaths
Jefferson1087131712
Mobile696141168
Madison47959565
Baldwin35517431
Shelby34948283
Tuscaloosa32719498
Montgomery32358648
Lee21708200
Calhoun19823367
Morgan19140308
Etowah18450414
Marshall17138255
Houston15970340
St. Clair14803270
Limestone13986179
Elmore13893240
Cullman13892229
Lauderdale12986264
Talladega12235203
DeKalb11788220
Walker10110304
Autauga9416120
Blount9329149
Jackson9026132
Coffee8598153
Colbert8257160
Dale8204143
Escambia639399
Tallapoosa6315165
Covington6265153
Chilton6188128
Russell588353
Franklin560093
Chambers5182127
Dallas4595174
Marion4540114
Clarke447871
Pike441488
Geneva419499
Winston402682
Lawrence4018101
Bibb392976
Barbour335567
Marengo318878
Monroe308244
Butler307679
Pickens297366
Henry290752
Randolph290055
Hale284081
Cherokee277249
Fayette269769
Washington242244
Crenshaw229463
Clay220261
Macon212554
Cleburne207346
Lamar185538
Conecuh175237
Lowndes168156
Coosa161531
Wilcox153533
Bullock146242
Perry133132
Sumter122735
Greene118241
Choctaw71925
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