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: 308111

Reported Deaths: 7122
CountyCasesDeaths
DeSoto20826248
Hinds19910411
Harrison17510302
Rankin13334276
Jackson13118243
Madison9908210
Lee9871170
Jones8297160
Forrest7525147
Lauderdale7198237
Lowndes6272144
Lamar611084
Lafayette6039117
Washington5281133
Bolivar4772129
Oktibbeha455897
Panola4445103
Pearl River4428141
Warren4284118
Marshall4276100
Pontotoc416972
Monroe4061132
Union403975
Neshoba3994176
Lincoln3871109
Hancock372885
Leflore3468124
Sunflower329589
Tate322782
Pike3188104
Scott310872
Yazoo304468
Alcorn298065
Itawamba297177
Copiah293265
Coahoma289778
Simpson288284
Tippah284868
Prentiss275759
Marion266079
Leake261373
Wayne261341
Grenada255384
Covington254780
Adams246082
Newton245161
George238147
Winston225981
Tishomingo222267
Jasper219748
Attala213473
Chickasaw205057
Holmes186872
Clay182854
Stone179331
Clarke177076
Tallahatchie175540
Calhoun163531
Yalobusha159236
Smith158834
Walthall130643
Greene129433
Lawrence126423
Noxubee126233
Montgomery125542
Perry125138
Carroll120926
Amite120141
Webster113532
Jefferson Davis105432
Tunica102725
Claiborne101330
Benton97325
Kemper95428
Humphreys94332
Franklin82123
Quitman78916
Choctaw73417
Wilkinson64928
Jefferson64828
Sharkey49617
Issaquena1686
Unassigned00

Alabama Coronavirus Cases

Cases: 520503

Reported Deaths: 10722
CountyCasesDeaths
Jefferson754091487
Mobile38938798
Madison33898495
Tuscaloosa25297443
Montgomery23992567
Shelby23124239
Baldwin20652300
Lee15541165
Calhoun14301311
Morgan14145270
Etowah13665346
Marshall11967219
Houston10381278
Elmore10001200
Limestone9822147
Cullman9481188
St. Clair9435234
Lauderdale9223227
DeKalb8748181
Talladega8071171
Walker7100275
Jackson6762110
Autauga6734103
Blount6497135
Colbert6210130
Coffee5404112
Dale4766110
Russell429038
Franklin419982
Chilton4087109
Covington4056114
Tallapoosa3898146
Escambia388574
Dallas3531149
Chambers3503122
Clarke346560
Marion3066100
Pike305876
Lawrence295395
Winston272572
Bibb256459
Marengo248661
Geneva245875
Pickens233059
Barbour225255
Hale218775
Butler212566
Fayette209260
Henry187744
Cherokee182144
Randolph176941
Monroe172040
Washington164238
Macon154848
Clay149555
Crenshaw149257
Cleburne146241
Lamar139334
Lowndes136553
Wilcox124327
Bullock121340
Conecuh109128
Perry107926
Sumter102932
Coosa99328
Greene91034
Choctaw58724
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