Alabama's uninsured rate exposes Medicaid expansion gap
Advocates said Alabama’s coverage gap left working adults uninsured, strained rural hospitals and deepened disparities after ACA enrollment fell sharply.
Adults living in states that have not expanded Medicaid were nearly twice as likely to be uninsured last year as adults in expansion states, according to new federal data.
The uninsured rate among adults ages 19 to 64 was 16.2 percent in nonexpansion states, compared with 9 percent in states that expanded the program, according to Current Population Survey data the U.S. Census Bureau released Tuesday.
Alabama is one of 10 states that have not expanded Medicaid under the Affordable Care Act. Expansion would extend eligibility to most adults with incomes up to 138 percent of the federal poverty level.
Alabama Arise cited the new census figures Wednesday as it renewed its call for Governor Kay Ivey and state lawmakers to expand the program.
“Health coverage saves lives,” Debbie Smith, director of Alabama Arise’s Cover Alabama campaign, said. “But Alabama’s refusal to expand Medicaid continues to leave up to 155,000 people with low incomes caught in a coverage gap, with no access to the affordable healthcare they need.”
The coverage gap includes adults whose incomes are too low to qualify for subsidized coverage through the Affordable Care Act marketplace but who do not meet Alabama’s restrictive Medicaid eligibility requirements.
Smith said many of those affected work in construction, food service, retail and other essential industries that often do not provide affordable health insurance. Others care for family members with serious illnesses or disabilities.
“They are our friends and neighbors, and they deserve better from our elected officials,” Smith said.
Smith also called on Congress to restore the enhanced premium tax credits that lowered the cost of health plans purchased through the ACA marketplace. The credits expired after Congress failed to renew them.
More than 95,000 Alabamians have lost marketplace coverage this year, according to enrollment data Alabama Arise cited. That represents a 23 percent decline in Alabama’s ACA enrollment.
“That is the equivalent of a packed SEC football stadium full of people who have been priced out of coverage,” Smith said.
Smith said the decline will force more uninsured people to rely on emergency rooms rather than regular medical care, increase financial pressure on rural hospitals and cause some patients to postpone treatment until their conditions become more difficult to manage.
“Federal and state officials must do better,” Smith said. “Congress should help reduce families’ healthcare costs by restoring the enhanced tax credits for ACA coverage.”
She also urged Ivey and legislators to expand Medicaid.
Alabama Arise is a statewide, member-led nonprofit organization that advocates for public policies intended to improve the lives of Alabamians marginalized by poverty.
