LETTER TO THE EDITOR: It’s time for Alabama to do the right thing and expand Medicaid


The time has come to paraphrase the lawyer Joseph Welch in the famous Joe McCarthy hearing and address Governor Kay Ivey instead: “Have you no sense of decency, ma’am, at long last?”

Alabama’s coronavirus infections and deaths continue to climb. And among the victims are poor people who fell below the Obamacare income qualifications yet are above the Alabama cutoff income to receive Medicaid. These same poor people do not go to the doctor except in case of emergencies, and when they do it is often to an emergency room, where they receive high-cost treatment they cannot pay for, and which the rest of us ultimately do pay for, one way or another.

Meanwhile, the poor — including many working poor — are ill-nourished, have shorter lifespans, generally worse health, and are more prone to a number of serious conditions that are today easily treatable and/or preventable with access to health care.

This is the access that Governor Ivey (and her predecessor and the GOP legislative majority) refuse to provide when they reject the Medicaid expansion that Obamacare offers. This dereliction of duty is especially nonsensical in the time of the Covid-19 virus, when low-income uninsured people have no chance of paying for their hospital stays or other treatment. More than 150,000 Alabamians have contracted the virus; more than 2,500 are dead as a result. We do not know how many of the 150,000-plus are uninsured or not covered by Medicaid, but general healthcare statistics suggest it is a substantial number. 

Indeed, one of the most urgent and wicked aspects of denying poor people access to health care is that it is directly causing them to die from the coronavirus at higher rates than people who can afford health care. People with preexisting conditions such as obesity, coronary artery disease, and type 2 diabetes are more vulnerable to fatal coronavirus outcomes. The poor cannot afford the health care that treats and prevents these conditions, so they suffer them at higher rates. Then, if they contract the virus (which also happens to the poor at higher rates, in part because they have jobs that force them to come into contact with the virus), they will more likely die than people who don’t have preexisting conditions.

Yet Governor Ivey continues to reject the Medicaid expansion, claiming the 10 percent of the cost the state would have to pay since 2017 would break the budget. But a UAB study indicates that had Robert Bentley expanded Medicaid in 2014, the state would have generated $20 billion in new economic activity over the last seven years, while providing coverage to more than 300,000 uninsured or underinsured Alabama adults. Hospitals and clinics, which are absent in some rural areas, or are closing, would also benefit by the expansion. Mental health treatment would be available to the new enrollees. 

The federal government initially paid all the cost of the expansion; since 2017 the feds pay 90 percent of the cost. There is little doubt that Alabama could budget for that 10 percent; not doing so is a lack of will and perhaps hostility to anything that has Obama’s name on it. 

It is past time for Governor Ivey to get over that. 

She claims to be a conservative. A fundamental principle of conservatism is to save money, and one does not have to be an expert to grasp that Medicaid coverage would be more cost-effective than the emergency room and better for the state overall. 

She claims to be a Christian. She would do well to reflect on Jesus’s words in Matthew 25:34-40: “‘Come, O blessed of my Father, inherit the kingdom prepared for you from the foundation of the world; . . . . for I was a stranger and you welcomed me, . . . I was sick and you visited me, I was in prison and you came to me.’  Then the righteous will answer him, ‘Lord, when did we see thee . . . a stranger . . . , sick or in prison and visit thee?  And the King will answer them, ‘ Truly I say to you as you did it to the least of these, you did it to me.’” 

Governor Ivey’s intransigence will haunt her. It is long past time for her to do the right thing and expand Medicaid. 


Randall Williams