Op-Ed: Medicaid expansion would fix the hole in the roof of Alabama’s health care system


It may not have sounded like it on the surface, but Gov. Kay Ivey recently made one of her most encouraging comments yet about Medicaid expansion. “It would be irresponsible,” Ivey told reporters Tuesday, “to think about expanding Medicaid just for the sake of expanding Medicaid without having a complete and honest discussion about the source of stable funding to pay the match.”

Alabama Arise couldn’t agree more. That complete and honest discussion about funding is exactly what’s been missing from Alabama’s Medicaid expansion denial. It’s the step that can shatter the myths and partial truths that have been holding our state back. The governor’s offer is one that Arise and more than 60 other organizations united in the Cover Alabama Coalition hereby accept.

On the face of it, the 90% federal match for Medicaid expansion would seem a hard bargain to resist. Expansion would make life-saving health care affordable for hundreds of thousands of hard-working Alabamians. It would prevent family bankruptcies from medical debt and stop the wave of rural hospital closures. And it would allow our state to do all of those things for a dime on the dollar.

Expanding Medicaid to save lives, protect families and strengthen our health care system is far different from acting “just for the sake of expanding Medicaid.” But despite these gains, many of our leaders still say the 10% state share is unaffordable.

That’s why the governor’s call for a complete and honest discussion about Medicaid expansion funding is so important. In making momentous decisions of governing, we expect our leaders to weigh costs and benefits, the way we all do when facing major household decisions, especially in lean times.

So far, Ivey and legislative leaders have weighed only the cost side of the Medicaid expansion equation. And they haven’t even had a complete and honest discussion about that.

There’s more to cost than the expense column of the ledger. The decision not to do something has a price tag as well. We welcome Ivey’s invitation to a discussion that addresses the costs Alabama is paying every day for maintaining a broken health care status quo.

The line items in that column include the cost of untreated chronic diseases, substance use disorders and mental illnesses among uninsured Alabamians. They include the cost of uncompensated care delivered by rural hospitals operating in the red. They include the cost of reduced productivity in a workforce beset by delayed care and exacerbated health problems. They include the cost of insurmountable medical debt, the leading cause of personal bankruptcy. And they include the cost of lives lost too young and loved ones left behind to grieve tragic, preventable deaths.

Obviously, the list of current costs to Alabama taxpayers goes on. And we’re glad the governor is ready to talk about them.

The conversation so far also has ignored the full financial benefits of Medicaid expansion. In addition to relieving the pressures cited above, expanding health coverage would fuel local and state economic activity, as UAB health economist David Becker has shown.

The health and economic consequences of COVID-19 – in the short, medium and long terms – will be costly to our state and our communities no matter what. That means Alabama must maximize the value of every state dollar we spend as we rebuild. And the best way to do that is to leverage the 90% federal match for Medicaid expansion. Ivey should make this a top priority in her COVID-19 recovery plan.

We’re hoping House Speaker Mac McCutcheon, R-Monrovia, is also ready for a complete and honest conversation about Medicaid expansion funding. He commented on the topic this week, too. “If you’re not sure you can pay your current monthly mortgage,” McCutcheon said Tuesday, “it doesn’t make sense to start building an addition onto your house.”

Respectfully, the “home addition” analogy is misguided, for the same reason “just for the sake of Medicaid expansion” is. A more useful metaphor is a hole in the roof. A gap in our protection from the elements has costs that only grow with time. Fixing that gap to prevent costly damage is just as important as making the mortgage payment.

Alabama’s health care system has a gaping hole in it. The storm of COVID-19 is making it worse. We look forward to a complete and honest discussion of how Medicaid expansion would mend that gap and protect all Alabamians in their hour of need.

Jim Carnes is policy director of Alabama Arise, a nonprofit, nonpartisan coalition of congregations, organizations and individuals promoting public policies to improve the lives of Alabamians with low incomes. Email: jim@alarise.org.