The case for Medicaid expansion in Alabama
By Ron Pollack, executive director of Families USA, the national organization for health care consumers
Over the past several years, arguments for Medicaid expansion in Alabama have been made using sound economic, budgetary and public health rationales.
They have collapsed, however, under the reflexive antipathy toward the Affordable Care Act of conservatives in the state legislature.
The result: Tens of thousands of Alabama's workers go without health insurance compared to states that expanded Medicaid, according to a study by Families USA. Expansion states, on average, saw a 25 percent decline in their rate of uninsured workers, compared to just 12 percent for Alabama – a difference of more than 2 to 1.
It shouldn't be this way. State/federal partnerships, like Medicaid expansion, have a history of success and have been a hallmark of Republican governance for more than a century.
Let's start with the Land Grant College Act of 1862, sponsored by Congressman Justin Morrill – a founder of the Republican Party – and signed by Republican President Abraham Lincoln.
Under the Act, the federal government gave states federal land they could manage or sell to endow colleges specializing in agriculture and engineering. The states would have to pay for the construction and maintenance of the schools.
Since 1862, more than 20 million people – many who could not have otherwise afforded it – have graduated from the 100 Land Grant colleges were created in every state and territory.
The list of alumni of Alabama's three land grant institutions – Alabama A&M University, Auburn University and Tuskegee University – is a "who's who" of accomplished men and women: Governors, U.S. Senators and Representatives, judges, generals, journalists, and hundreds of business and civic leaders, scientists, writers, artists, musicians and athletes – from Apple CEO Tim Cook to NASA Astronaut Ken Mattingly, who flew in both Apollo and the Space Shuttle.
Not a bad return on investment for a law enacted when the outcome of the Civil War was still very much in doubt.
Another example is the Federal Highway Act of 1956, proposed by Republican President Dwight Eisenhower, who as Supreme Commander of European Forces in World War II had seen first-hand how deficient America's road network was compared to the German Autobahn.
As President, Eisenhower decided the United States needed a national network of modern roads and that it had to be a joint state/federal enterprise. Otherwise our nation "would be a mere alliance of many separate parts," he said.
The bipartisan bill Eisenhower signed called for the construction of more than 46,000 miles of interstate – about 1,100 in Alabama – that would be paid for with a 90/10 split between the federal government and states respectively.
Studies have shown that every $1 invested in the Interstate System returned $6 in economic benefits.
Medicaid expansion is in the best tradition of these historic state/federal partnerships. Helping low-income Alabamans get health care is an investment in human capital every bit as important to our future as building universities and roads.
In Alabama, Medicaid is very restrictive. Parents of dependent children cannot receive coverage if their incomes exceed a meager 18 percent of the federal poverty level, approximately $302 a month for a family of three. Other adults – singles and childless couples – can't get coverage even if they have no income at all.
Medicaid expansion would extend eligibility to adults with incomes at or below 138 percent of the federal poverty level – or about $2,130 a month for a family of three.
The majority of the expansion population – about 300,000 in Alabama – are working men and women who earn too much to qualify for traditional Medicaid, but not enough to be eligible for subsidies on the health care exchange.
The federal government would pay 95 percent of the cost in 2017, sliding to a permanent 90/10 ratio by 2020 – the precise split of the Highway Act.
The Alabama Legislature should revisit Medicaid expansion during this year's session with a vision that extends beyond short-term elections cycles, but rather looks out toward the horizon and generations yet to come – as great Republican leaders like Lincoln and Eisenhower did.