I wish Alabamians could speak plainly to our legislators.
I mean, you can do that, but blunt language won’t get your problems fixed.
That’s why the folks who oversee education in this state measure their words about the challenges facing Alabama public schools.
Poverty? Sure, they’ll discuss that. Low national assessment test scores? Lawmakers bring that up on their own.
Of course, the chief problem with Alabama education is Alabama’s tax system. It makes it difficult-to-impossible for most school districts, particularly rural ones, to raise the local revenue they need to support teachers and students.
Yet public education officials tend to keep quiet about that fact. And with good reason: Legislators don’t want to hear that.
To most of them, taxes are infallibly bad. Making a timber baron kick in a few dollars more to buy textbooks and supplies is just a step away from Bolshevism. You raise the tax issue, and you close off every other avenue of discussion.
Health care advocates, too, have to tread lightly around Medicaid expansion.
Like education, health care in our state has major challenges, from stubbornly high infant mortality to the closing of rural Alabama hospitals. But Medicaid expansion — extending insurance coverage to anyone making 138% of the poverty line — could ease or solve many of those problems.
It could insure over 100,000 Alabamians. It could give hospitals a badly-needed infusion of cash. And it could extend a small bit of peace to struggling families. To be clear: 138% of the poverty line is $35,632 a year for a family of three. That’s poverty, even in Alabama, where the median household income hovers just under $60,000 a year.
But lawmakers have consistently refused.
They said it cost too much. They said that in front of an ideological backdrop with 18-foot high letters saying OBAMA BAD. But let’s assume cost was the actual issue here.
It’s true that the state would have to kick in a 10% match for federal funds that cover 90% of the program. A Public Affairs Research Council of Alabama report in 2022 put that price tag at about $225.4 million a year, or $1.3 billion over six years. (The number is likely higher now because of inflation but probably not by much. PARCA also noted the state would see savings under the plan and additional economic stimulus from it.)
That’s a large sum. But most legislators had no hesitation committing $1.25 billion to a prison in Elmore County.
In fact, they voted for a $1.3 billion construction plan in 2021. But that was for two prisons. And when the Elmore facility consumed all that money, did they halt the program? Did they demand answers? Did they redo the whole project?
Nope. They just nodded and let the price tag climb.
This brings us to ALLHealth, the health program that Blue Cross Blue Shield of Alabama pitched to county commissioners last week.
ALLHealth would take the Medicaid expansion money Alabama has passed up for over a decade and use it to subsidize private insurance plans for about 113,000 Alabamians in the “coverage gap” — those who make between 100% and 138% of the poverty line. BCBS is trying to not call this Medicaid expansion — that OBAMA BAD backdrop is out there somewhere — but the effect would be close.
I’m not crazy about this. BCBS will profit from ALLHealth, and they don’t need the help. But the fact that a private company is involved could help this proposal in our legislature, which views the free market as the Force and anyone with a pile of money as a Jedi.
And ALLHealth would have clear benefits. In a state with high rates of heart disease, strokes, and cancer, expanding access to health insurance can only improve individual outcomes.
But my fear is that it may already be too late. Advisers close to President-elect Donald Trump have proposed reducing the federal government’s support for Medicaid expansion. At a minimum, that would reduce the number of people eligible for coverage. At worst, it could end expansion entirely.
If ALLHealth gets through the legislature in 2025, with all the symbolism of a red state embracing health care, maybe that stays the machetes hovering over Medicaid. I’m not certain. Trump and his cronies are aching for those upper-class tax cuts. Health care for working class people will help pay for them. If that funding vanishes, it’s hard to see how ALLHealth continues. And it’s harder to see how we ever help the uninsured after that.
But just think: We could have done this a decade ago. Think of how many fewer hospitals would be on the brink. Imagine all the Alabamians who couldn’t get health care over the last 10 years given a little relief from the pain and stress of illness.
That’s what Medicaid expansion could have done. And speaking plainly: the Alabama Legislature’s refusal to embrace it is a political and moral failure.
This article was published by Alabama Reflector, which is part of States Newsroom, the nation’s largest state-focused nonprofit news organization.
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