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The push against Medicaid expansion during the Coronavirus pandemic


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. 

Tens of thousands of Alabamians have lost their jobs in recent weeks from the coronavirus, which likely means many also lost their health insurance. There’s a push to expand Medicaid to help those without coverage, but some lawmakers have a different idea in mind.

“I think it’s time to go back and take another look at this. It needs to start in Washington,” Alabama Republican Senator Gerald Allen said, “give some guidelines, some basic rules for the states to develop their program.”

He’s one of several GOP state lawmakers pushing back against expanding Medicaid under the Affordable Care Act also known as “Obamacare.” The healthcare program was put in place by former president Barack Obama.

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Allen is calling for a healthcare overhaul instead of Medicaid expansion with President Trump leading the way. 

“It’s a national issue, not just for Alabama,” Allen said. “It’s a national issue to make sure that everyone gets adequate health care. So the debate needs to start in Washington.”

Other leaders disagree, like Democratic Congresswoman Terri Sewell. She said Medicaid expansion is the best thing Alabama can do right now as workers and businesses grapple with the economic devastation from COVID-19. She’s calling on Alabama lawmakers to act now.

“There’s still more that Governor Ivey and the state legislature can do to help us during this crisis,” Sewell said. “They need to expand Medicaid. Uninsured Alabamians who have lost their job shouldn’t have to choose between getting tested and seeking care for the community.”

Democratic leaders say an expansion would offer healthcare coverage to more than 360,000 uninsured Alabamians, but GOP lawmakers are caught up in the cost. It could run the state anywhere from $155 million to $170 million during the first year of expansion. 

Sewell is sponsoring the Medicaid Expansion Now Act, which would help unburden some of the cost to the state if lawmakers agreed to an expansion.

“We like our bill, which would give a 100% federal match for the first three years regardless from when a state expands Medicaid,” she said. “It’s critical to get that 100% match. Right now it’s a 90% match since the state of Alabama did not expand Medicaid within the first five years that the Affordable Care Act was instituted.”

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Even with financial help planned, expansion critics like Allen say the time is up to invest in programs under the Affordable Care Act. He said, bottom line, “Obamacare” isn’t working. Allen said while he’s looking to leaders in Washington to lead the way on revamping healthcare, he’d like to see certain things included in a new healthcare program.

“To make sure that every state in the county is on level ground so to speak,” Allen said. “Make sure there’s a policy put in place where a fairness, equality is taken care of. Where every citizen needs to be cared for, regardless of who they are or what age level they may be at.”

While state and federal leaders hash out healthcare policy, healthcare workers are on the front lines of the coronavirus fight. Many are struggling to carry out the day-to-day COVID-19 caseloads.

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Dr. Lea Yerby is with University Medical Center in Tuscaloosa. She said she’s concerned about what happens after the pandemic is over.

“On the back end of this virus, is anticipated to be need of all types of health care. There are people sitting at home now, who need a surgery. They’re just able to survive without it until August," she said.

A Keiser health study shows 1.5 million Alabamians have health conditions like diabetes or hypertension that could worsen a case of COVID-19. Yerby said there’s worry over a second wave of health issues that may come after the current COVID-19 caseload is over.

“After the virus comes the unattended to chronic health severity, and the health issues we have of not taking care of ourselves and being stressed out, or losing jobs or dealing with the economy…the mental health,” she said.

Yerby is in favor of expanding Medicaid. She said Alabama leaders need to start looking at what long-term plans will help keep the healthcare system afloat after the pandemic is no longer a threat. 

“We need to make sure we continue to have hospitals and a health care system to take care of us through this and after this,” she said. “The expansion of Medicaid would get people that need the care the most the care they need, and give our hospitals more of an opportunity to take care of our population.”

Democratic leaders and healthcare workers aren’t the only ones pushing for Medicaid expansion. In an open letter to Governor Kay Ivey published on Al.com, several pastors and reverends of groups of faith are urging the Republican governor to be a leader in the fight against the coronavirus and expand Medicaid.

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