Jim Carnes: It’s time for Alabama to go big and expand Medicaid

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Alabamians expect to hear a lofty, future-oriented vision from their governor every four years during the inaugural address. Gov. Kay Ivey, speaking in Alabama’s bicentennial year, rose to this historic occasion in many ways last week. But her speech omitted one huge issue that our state should address this year: Medicaid expansion.

Alabama’s quadrennium – the four-year cycle for election of all executive officers and legislators – lends a rhythm to the governing process. Election years, like 2018, typically see little bold action, as lawmakers position themselves for campaign season. But “first” years, like 2019, are often a prime opportunity to go big and tackle long-term problems.

Ivey took the long view in many areas, committing to strong education funding and seeking serious investment in Alabama’s infrastructure. “Improving our infrastructure is more than an investment in our roads and bridges,” Ivey said. “It’s an investment in economic development, public safety and local communities.”

These investments are critically overdue, and few could argue otherwise. But a limited definition of infrastructure – roads, bridges and prisons – would fall short of the bold vision that our state needs to prosper as it enters its third century. Alabama’s health care infrastructure needs a major boost as well, and Ivey has the power to provide one.

Governor, it’s time to go big. It’s time to expand Medicaid.

Already, 36 states – including Arkansas, Kentucky and Louisiana – have accepted federal support to expand Medicaid coverage to people making up to 138 percent of the federal poverty level. (That’s about $17,000 a year for an individual and around $35,500 for a family of four.) But Alabama is part of the rapidly shrinking minority of states that haven’t.

This inaction is causing pain and hardship across our state. An estimated 300,000 Alabamians caught in the coverage gap – who earn too much to qualify for Medicaid but too little to qualify for subsidies for Marketplace coverage – are just one medical emergency away from financial ruin. And more and more rural communities are at risk of losing local hospitals, as seven already have in this decade.

Failure to expand Medicaid is holding back Alabama’s economy as well. Our state is forfeiting hundreds of millions of dollars in annual federal funding to shore up our health care system. This money would support tens of thousands of jobs and stimulate more than $1 billion a year in economic activity. Alabama is weakening its infrastructure – and its future – by leaving health care out of the equation.

Ivey is right to call for infrastructure investment. But that investment should address a wide range of our state’s needs. We need roads and bridges – and public transportation – that link people to good-paying jobs in vibrant communities that offer the health care they need. We need schools equipped to prepare our children for careers in health care and other growing fields. We need a broadband network that delivers telemedicine across the Black Belt and other rural regions.

We need accessible and effective substance abuse services to lighten the burden on law enforcement and corrections. We need policies to attract more medical professionals to small towns, improving quality of life and making those areas more appealing for industrial recruitment. We need health coverage to strengthen low-income families and promote a more productive workforce. Across the country, Medicaid expansion is driving transformation in all of these arenas and more.

Ivey’s inaugural speech laid out a vision for a prosperous future for Alabama. There’s no better way to jumpstart our state’s third century than by expanding Medicaid.

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Jim Carnes is policy director of Alabama Arise, a nonprofit, nonpartisan coalition of congregations, organizations and individuals promoting public policies to improve the lives of low-income Alabamians. Email: jim@alarise.org.

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