Why Alabama and 9 Other States Should Expand Medicaid

On Wednesday evenings during the school year, I spend my time volunteering as a Certified Application Counselor at the University of North Carolina’s SHAC clinic, the oldest student-run free clinic in the nation. Here, most patients lack health coverage, preventing them from seeing specialists and primary care doctors. Out of the dozens of patients I’ve walked through coverage options with, only one has been eligible for North Carolina’s Medicaid program. The struggles and stories of these patients have stayed with me.

North Carolina became the 40th state to sign legislation expanding Medicaid in March. Once implemented on December 1, this legislative change will make affordable health coverage accessible for nearly all adults earning below 138% of the federal poverty level in the state. As I returned home to Alabama for the summer, I began to reflect on why my home state and nine others have not made similar changes.

According to a recent report from the U.S. Department of Health and Human Services, the United States experienced historic drops in the uninsured rate from 2019 to 2021. These decreases were largest in states that had recently expanded Medicaid. Alabama, however, saw the largest increase in its uninsured rates across states during this period. While our nation is making strides in improving access to affordable care, it is troubling to know that our state is falling behind.

The decision to expand Medicaid is more than just a healthcare or economic decision. It’s a policy decision affecting real people, who deserve equitable access to healthcare regardless of their income levels.

There are some concerns that expanding Medicaid will discourage potential workers from joining the workforce, increasing our state’s unemployment rate. However, the research doesn’t back that up. Medicaid expansion has been demonstrated to improve disability participation in the workforce, which is significant given that Alabama has one of the nation’s highest disability rates. Even more, a literature review from the Kaiser Family Foundation highlights the overwhelming studies linking Medicaid expansion to job growth and limited to no effect on wages and employment.

Additionally, expanding Medicaid is estimated to bring significant economic benefits to our state. Currently, the federal government funds 70% of our state Medicaid costs. If Medicaid were expanded, this coverage would grow to 90% of our costs, allowing for net savings. A study from the Public Affairs Research Council of Alabama (PARCA) emphasizes these benefits, estimating that expanding Medicaid would contribute almost $400 million in cost savings and a positive economic impact of $11.36 billion to Alabama's economy over the next six years.

In addition to its economic benefits, Medicaid expansion would have an invaluable impact on the health of our population. Expanding Medicaid in Alabama would extend coverage to an estimated 283,636 people, closing the Medicaid coverage gap (those who are too poor to qualify for federal marketplace subsidies but remain ineligible for their state Medicaid plan). People of color are overrepresented in Alabama’s coverage gap, reflecting a crucial aspect of present health disparities in the state. By increasing health coverage, Medicaid expansion is associated with several significant health benefits including increased access to primary and preventive care, earlier detection and treatment of serious medical conditions, and decreased mortality rates. These impacts are most strongly felt among minority and low-income communities, signifying the importance of Medicaid expansion in reducing health disparities. Ultimately, these benefits translate into healthier communities and a stronger Alabama.

The decision to expand Medicaid is more than just a healthcare or economic decision. It’s a policy decision affecting real people, who deserve equitable access to healthcare regardless of their income levels. Picture the minimum-wage worker, unable to afford health insurance but earning too much to qualify for subsidies, finally able to see a doctor for their chronic pain without the fear of crippling medical debt. Imagine the young couple, whose jobs don’t include benefits, finally having access to preventive care, building a healthier start for their future family.

Think of the communities that could thrive with healthier residents and a stronger, more resilient economy. Expanding Medicaid could improve health outcomes, bring economic benefits, promote health equity, and make these stories a reality for people in our state. Our policymakers must recognize and take advantage of their opportunity to make a profound difference in the lives of hundreds of thousands of their constituents.