Medicaid Matters – Section 4: How can we make Alabama healthier?


What you need to know …

A woman holding an #IamMedicaid sign
(Photo: #IamMedicaid)
  • Medicaid expansion would help hundreds of thousands of Alabamians get the health care they need.
  • States that have expanded Medicaid have seen improvements in infant and maternal mortality and greater access to treatment for mental illness and substance use disorders.
  • Extending coverage would reduce Alabama’s racial health disparities.
  • Medicaid expansion would generate billions of dollars in economic activity and hundreds of millions of dollars in new tax revenues.
  • Expanding health coverage would boost efforts to make Alabama’s prison system more humane, restorative and cost-effective.
  • Medicaid expansion could save hundreds of lives in Alabama every year.

Closing the coverage gap would improve lives

Hundreds of thousands of Alabamians could get the health care they need to survive and thrive if Alabama raised the income limit for Medicaid and allowed coverage for adults who aren’t parents. Medicaid expansion improves lives across a range of health measures, a growing body of research shows. Those areas include better birth outcomes and maternal health, lower overdose rates and improved mental health. Expansion also would increase household financial security and reduce racial health disparities.

A bar graph showing Alabama's current Medicaid eligibilty and eligibility under expansion. Medicaid expansion would bring the eligibilty limit for all adults in Alabama up to 138% of the federal poverty level. Right now, the eligibility limit for parents is at 18% FPL, and the limit for seniors, people with blindness and other disabilites is at 76% FPL. Childless adults without a disability are not eligible right now.

Extending coverage would keep Alabamians healthier

  • Evidence from Medicaid expansion states shows that providing women continuous health coverage before, during and after pregnancy would make a life-saving difference for mothers and babies.
  • Extending Medicaid coverage to adults with low incomes would extend the benefits of ongoing Medicaid reforms to hundreds of thousands more Alabamians. This improvement would give us the tools we need to address the state’s chronic health challenges, making families and our workforce healthier in the process.
  • Research shows that Medicaid expansion increases access to treatment for substance use disorders and significantly strengthens responses to the opioid epidemic.

Medicaid expansion would promote racial equity

A circle graph that shows Alabama's racial/ethnic health coverage gap. 49% of uninsured Alabama residents with low incomes are people of color, while 34% of all Alabamians are people of color.

Alabama’s shameful legacy of segregation and racial discrimination has driven racial health disparities that continue today. Nearly half of uninsured Alabamians with low incomes are people of color, even though people of color make up just one-third of the state’s population. Medicaid expansion would reduce that coverage disparity and increase economic and health security for Alabamians of all racial and ethnic backgrounds.

Medicaid expansion would boost Alabama’s economy and budgets

In the first four years of Alabama’s Medicaid expansion, the federal government would spend $6.7 billion for new health coverage in our state. This direct investment would yield:

An infographic showing a direct investment of $6.7 billion for new health coverage in Alabama would yield $4.6 billion in indirect economic activity, $446 million in new state tax revenues and $270 million in new local tax revenues.Covering adults with low incomes also would save $316 million in current state health program costs. With all these gains, the net cost to the state would be:A bar graph showing that the net state cost of Medicaid expansion would be $168 million in year 1 and $25 million in year 2 and after. Sources: David J. Becker, "Medicaid Expansion in Alabama: Revisiting the Economic Case for Expansion," January 2019; Manatt, "Alabama Medicaid Expansion: Summary of Estimated Costs and Savings, SFYs 2020-2023," February 2019.


Medicaid expansion would support prison reform in Alabama

In 2019, the U.S. Department of Justice put Alabama on notice that prison violence and overcrowding will trigger federal intervention if we don’t get the problems under control. Medicaid expansion would make our corrections system more humane, restorative and cost-effective in three ways:

    1. Untreated mental illnesses and substance use disorders are major contributors to over-incarceration in Alabama. By strengthening support for these services, Medicaid expansion would reduce recidivism and help more people stay out of the criminal justice system in the first place.
    2. When a person leaves prison, it’s hard to get a job that offers health coverage. But to get and keep a job, you need to be healthy. Medicaid expansion would provide former inmates the health security they need to join and remain in the workforce.
    3. Federal funding would cover 90% of the cost of expansion. That would slash state costs for hospitalizing prisoners and free up funds for other needed investments in the corrections system.

Medicaid expansion’s biggest win: saving lives

Across the country, Medicaid expansion saved the lives of at least 19,200 Americans aged 55 to 64 over the four-year period from 2014 to 2017. During the same period, 768 older Alabamians with low incomes lost their lives because they lacked health insurance. (Source: National Bureau of Economic Research, 2019)

If all states expanded Medicaid, the lives saved each year among older adults would nearly equal those of all ages saved by seatbelts.

A bar graph showing Medicaid expansion could save nearly as many lives among older adults as seatbelts save among people of all ages. In 2017, 14,955 lives of all ages were saved by seatbelts. 13,330 lives of people ages 55-64 would have been saved by full Medicaid expansion in every state in 2017. 7,500 lives were saved in expansion states, and 5,830 more lives would have been saved in non-expansion states. Source: National Highway and Transportation Safety Administration and Miller et al., "Medicaid and Mortality," 2019.


Meet Formeeca Tripp

A photo of Formeeca Tripp with her two children.
Formeeca Tripp of Auburn knows firsthand the tough decisions that come with living and working in the coverage gap. (Photo: Julie Bennett)

Formeeca Tripp watched her parents struggle with diabetes and heart disease. She has made efforts to follow a new path. But it hasn’t been easy.

“I have been conditioned to put my health on pause to make sure my children are up to date with all of their health care and mental health needs,” she says.

Formeeca lives in Auburn and is the mother of two children, one of whom was diagnosed with autism. She works full-time as a behavior specialist and part-time as an Uber driver to provide them both with medication they need, sometimes at a great cost to herself. For a long stretch, she fell into the coverage gap. With all her “extra” money spent on her children’s health care needs, Formeeca found herself reporting to work with ailments such as tooth infections and pink eye.

Recently, she gained coverage through her employer’s plan, but many people she knows are not so fortunate. Speaking from her own experience, Formeeca says Alabamians who can’t afford health insurance often work in public-facing jobs.

“It’s the people who are working with the sick and elderly, working with your babies,” she said. “It’s us, out here, hands on, making food, cleaning houses — it’s that gap of people, very important people. People who come into contact with thousands of other people. And you don’t want them to be healthy?”

Medicaid Matters (Main Section)
How does Medicaid work in Alabama? (Section 1)
How is Medicaid improving coverage? (Section 2)
Who’s still left out of health coverage? (Section 3)