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How Medicaid expansion could help Alabamians amid coronavirus outbreak



An APR News Feature --Part of an innovative collaboration between Alabama Public Radio, the commercial newsroom at WVUA23-TV, and the University of Alabama's Center for Public Television.

State leaders are doing what they can to keep Alabamians safe as coronavirus cases and deaths climb in Alabama, but some say there’s more lawmakers can be doing right now, like expanding Medicaid.   

Linda Blumberg is an institute fellow in the Health Policy Center at the Urban Institute. She said Medicaid expansion is the best move for the state as it deals with the COVID-19 outbreak.  

“It’s a reminder of the vulnerability of our healthcare financing system, and the vulnerability of people when they’re at their worst moment with regard to both their health and incomes,” she said. 

With the deadly coronavirus plaguing Alabama, there’s a renewed push to do just that.

“Not to sound opportunistic, but a lot of policy decisions we make come out of crisis,” said Dr. David Becker, an associate professor in the Department of Health Care Organization and Policy in the UAB School of Public Health. “That’s really the story of America. Freedom came from a bloody Civil War. The creation of Social Security came out of the Depression.” 

Becker has advocated for the expansion of Medicaid since 2012, but now, some people see the COVID-19 outbreak as a chance to get the ball rolling on legislation that’s long overdue. Becker made his case in a recent op-ed for AL.com. He said, bottom line, now is the time to act.


“Here we look at the crisis that the state is facing with potentially a huge number of unemployed Alabamians lacking health insurance as a result of also losing their jobs, and you have to wonder if this crisis creates an opportunity,” Becker said.  


The 2010 passage of the Affordable Care Act extended Medicaid benefits. The insurance safety net went to all households earning up to 138% of the poverty line. But in 2014 when Medicaid expansion took hold, Alabama opted out. That year then-Republican Governor Robert Bentley argued it would burden taxpayers and foster “dependency on government.”  


Advocates like Blumberg say an increase in unemployment is just one major issue hitting Alabama hard as a result of the coronavirus pandemic.  


“For a lot of them, they are losing their health insurance,” she said, “so if they have health insurance through their own employment or through their spouse or parent, and that main worker loses that job, everybody loses their health insurance.” 


Blumberg said in states that haven’t expanded like Alabama, there are people who are eligible for coverage if their incomes are 100% to 400% of the poverty line. Medicaid expansion will pay for part of their insurance through the market place healthcare.gov, but Blumberg said this current setup could be troublesome as the state is faced with troubling times with COVID-19. 

“You could end up in a non-expansion state with a lot of folks losing income, and not be eligible for any health insurance coverage at all when they need it most in the midst of a pandemic,” she said. 


State health leaders are telling Alabamians who experience coronavirus symptoms to call their healthcare providers for screening to see if there’s a need to set up a COVID-19 test, but with some in the state losing their job, which is leading to a loss of insurance coverage, they don’t have a provider to turn to. 


Susan Ellis is the Executive Director of People First. She said that can mean trouble.  


“Right now they’re telling people, don’t just get a test. They’re saying contact your healthcare provider first, and get them to order the test,” she said. “If you don’t have health care insurance, you likely don’t have a health care provider. What is that telling people that don’t have health insurance?” 


The organization People First advocates for Alabamians with developmental disabilities who often don’t have insurance. Ellis says she worries about the community she serves. That includes workers who’ve lost their insurance coverage during this dangerous pandemic.  


“It just increases the risk that they are going to be transmitting it unknowingly,” Ellis said, “or they are going to have symptoms and think it’s a cold, and not go to the doctor because they don’t have health insurance, and it turns out to be the virus.” 


Blumberg agrees with Ellis. She said being without insurance right now doesn’t just affect single Alabamians, but the state as a whole.  


“The situation is such that you don’t want to be in a position where people who are infected aren’t getting tested because they are afraid of the cost or they don’t think they can get the treatment anyway,” Blumberg said. “And that you now have more people moving around in populations that could be affecting others in addition to harming their own health and potential for recovery.” 


The Seattle-based Institute for Health Metrics and Evaluation predicts coronavirus cases in Alabama will peak in April. A decline isn’t expected until this summer. With the virus not going anywhere anytime soon, lawmakers are urged to take the best steps for the state to protect Alabamians.  


“We hurt ourselves by not taking care of this” Ellis said. “So it’s actually helping the whole state by taking care of people, who especially in this time, do not have any health care.” 

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