The Alabama House Health Committee heard from groups as recently as late March about Medicaid expansion.

Rep. Phillip Rigsby (R-Dist. 25) is a member of the committee and spoke to The News Courier about what has been presented to them.

“At this point, there has only been a public hearing on Medicaid expansion or the alternative to Medicaid expansion. Basically, they laid out the arguments of why Medicaid expansion or the alternative was a good thing, not only for the people it would affect, but also for state revenues and the generation of treatment options for folks,” said Rigsby.

In 2014, after the Supreme Court decided that states could refuse the expansion part of the healthcare law, Alabama, along with 14 other states, opted out of Medicaid expansion under the Affordable Care Act. At the time, the federal government was going to pay 100 percent of the cost from 2014 to 2016 and cover 90 percent of the expense by 2020.

In 2023, discussions of the pros and cons to Medicaid expansion are still continuing.

“The biggest issue I have is making sure that we are taking care of the working poor, how we can leverage that opportunity for those who can’t afford their employer’s health care plan. I also want to help the able-bodied person who could be working, should be working, and give them incentive to get back to work. Those numbers are still low, but it’s a subset we need to look at. I believe we can do that, but I don’t see the finish line just yet,” said Rigsby.

Public Affairs Research Council of Alabama Executive Director Ryan Hankins told The News Courier that many would benefit in the state of Alabama by expanding Medicaid.

“There are some different numbers floating around. They do range between 250,000 and 350,000. The reason for that variance is because you have a number of people who don’t have health insurance, you have a number of people who would qualify under expansion and a number of people who would actually take advantage of the Medicaid. You have some people who will not get health insurance whether they can afford it or not.”

He explained that expanding coverage would help lessen the amount the state pays for coverage.

“For those who are currently on Medicaid in the state of Alabama, the federal government pays 72 percent, and the state pays the other 28 percent. With 90 percent of the cost covered by the federal government, it would actually be cheaper to serve this new population,” Hankins said.

According to PARCA, Medicaid expansion would cost the state an average of $225 million per year through 2027. PARCA also estimates that the additional federal funding, as well as new tax revenues, would allow the state government to realize net savings of more than $1 billion by 2027.

When it comes to Medicaid and Medicare, Hankins says there are those who are confused by which is which.

“Medicare is for those 65 and older, and Medicaid is an insurance program for those with low incomes. Both programs were established during President Lyndon Johnson’s administration. They have similar sounding names, but they operate quite differently. While the federal government pays the cost of the program across the country, Medicaid is a joint effort between the federal government and the states,” said Hankins.

Debbie Smith is a supporter of Medicaid expansion and the “Cover Alabama” campaign director of Alabama Arise, a member-led lobbying organization.

“I think a lot of it is really education. I think a lot of our lawmakers are still unfamiliar with who is in the coverage gap and how Medicaid expansion would benefit our state,” Smith said.

In 2016, Gov. Robert Bentley, who opposed Medicaid expansion at the time, said “the cost was not workable.”

In April 2022, citing that the money is now available for the state to afford their part of Medicaid expansion, Bentley sent a letter to various media outlets stating, “The extension of Medicaid health insurance opens new doors to improving the quality of health care across our state, not just to those men, women and children who fall in the coverage gap. Alabama’s rural hospitals and doctors will see a significant impact in their ability to effectively treat patients in areas that are deeply underserved by any hospital or healthcare provider. I can tell you from my personal experience not just as a former governor, but mostly as a physician myself, rural Alabama must be prioritized when it comes to healthcare.”

“If Alabama were to opt for Medicaid expansion, the state would receive 90 percent of the cost covered indefinitely by the federal government,” Hankins said.

“Right now, if you are an adult seeking to get Medicaid coverage in Alabama, you either have to have a child, be on disability, or be pregnant. If you don’t have any of those things going on, the income threshold is $372 per month. For a family of three to qualify in the Health Insurance Marketplace, they must have a minimum income of $2,072 per month to qualify,” Smith said. “That’s a pretty big gap for those who are left without healthcare coverage. There are a lot of people left without any options for healthcare coverage. Again, not qualifying for Medicaid because of its stringent income guidelines and then, not making enough to qualify for subsidies in the marketplace.”