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From Scandal to Redemption: The Time Is Now for Alabama Medicaid Expansion

Alabama has one of the highest rates of poverty and also has one of the most stringent Medicaid income requirements.

Another political scandal, another forced resignation. It seems as though we have become immune to these all-too-common headlines. But there are certain scandals that must remain at the forefront of the public’s mind and that should be translated into positive action. In this case, we have the former Governor of Alabama, Robert J. Bentley, who resigned on April 10 under the threat of impeachment for misusing state funds and resources to cover up an extramarital affair with a female staffer.

It is extremely ironic that a governor who has repeatedly refused to expand Medicaid and make it available to the poorest residents in his state — approximately 300,000 people would have benefitted from this expansion — would find it “appropriate” to misuse state resources in an attempt to hide an affair in lieu of providing much-needed health care to the most vulnerable citizens in the state.

Although Alabama has one of the highest rates of poverty, it is also known to have one of the most stringent Medicaid income requirements — a family of three cannot make more than $302 a month — making it nearly impossible to qualify for Medicaid. This also decreases the chances of the working poor qualifying for the program because they would earn too much.

The Affordable Care Act included an important provision, which required states to expand Medicaid coverage to individuals who make less than 138 percent of the poverty line — basically enough to cover the previously uninsured working poor. However, in 2012, the Supreme Court held that states could voluntarily choose to expand Medicaid.

To date, only 31 states and the District of Columbia have expanded Medicaid. Many of the states that have chosen not to expand Medicaid are in the South and home to the largest share of people of color – in fact, 58 percent of blacks live in the South. Southern states are also known for having higher rates of poverty and preventable chronic disease, worse health outcomes, and higher uninsured rates compared to the rest of the country.

Expanding Medicaid provides the opportunity for Southerners to have access to the program’s preventative services, which could help to lower the rate of chronic disease and improve their overall quality of life.

Unfortunately, Alabama is among the southern states that have yet to expand Medicaid, a decision firmly held to by Governor Bentley, who is a trained physician. Alabama ranks among the worst states in terms of health outcomes — infant mortality, life expectancy, diabetes, heart disease, and obesity. Moreover, a task force appointed by Bentley essentially recommended that the state expand Medicaid to improve its health coverage. In addition, approximately 70 percent of Alabama hospitals are now operating at a deficit as a result of an increase in uncompensated care for the uninsured sick.

To forfeit $3 billion in Medicaid funding to provide access to lifesaving health care for hundreds of thousands of people is unconscionable. There is an undeniable hypocrisy to it all — that a doctor who has sworn to “first do no harm” would find it OK to squander state resources to cover up immoral activities but not OK to use state resources to cover the most vulnerable residents.

As Governor Bentley stepped down last week, Kay Ivey was sworn in as the 54th governor of Alabama, only the second female to do so. After being sworn in, Governor Ivey, while promising to lead a different administration than Bentley, stated that this change in administration is “one of opportunity” with a goal to “improve Alabama’s image.”

So, I call on Governor Ivey to turn the tide and finally offer the citizens of Alabama access to health care through the expansion of Medicaid, a move that will most certainly improve the state’s image. There is no better time than the present to do the right thing by Alabamans and undo former Governor Bentley’s destructive decision to forgo Medicaid expansion.

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