Doctors say it's very critical to expand Medicaid

Alabama Arise, in partnership with D.W. McMillan Memorial Hospital and Atmore Community Hospital, held a forum to discuss the importance of Medicaid Expansion in the state of Alabama Monday afternoon to fill in the gaps for the 220,000 people without coverage who fall into the gap of making too much money to qualify for Medicaid but not enough to afford insurance through the Marketplace coverage. The coverage gap is made up of veterans, working parents and low-wage workers. Alabama is one of 11 states which have not yet expanded Medicaid.

The coverage gap is made up of 53 percent of the employed in Alabama, 12 percent of the unemployed, 35 percent who are not in the labor force, 55 percent of whites, 39 percent of blacks and 6 percent of Hispanic, Latino or other.

In 2010, the Affordable Care Act required Medicaid expansion in every state. It was overturned in 2012 and afterwards became optional. Alabama has not expanded Medicaid. That lack of Medicaid coverage has impacted rural hospitals in Alabama. Since 2010, 14 rural hospitals have closed, leaving less accessible healthcare to the population in rural areas.

Dr. Dan Raulerson told a story emphasizing how important the Brewton hospital was in his surviving complications from a knee replacement surgery five years ago. Raulerson, who has atrial fibrillation and takes blood thinner, said blood loss he was initially unaware of might have cost him his life following a successful surgery. Feeling bad, he said doctors found a bleeding ulcer and thought they repaired it. There was more blood loss, but the doctors finally stopped the bleeding, he said.

Raulerson said he required 8 units of blood in the end.

"The moral to the story, no hospital, no emergency room to come to," said Raulerson. "No hospital, no surgery. No hospital, no lab. No hospital, no blood bank that was able to come up with 8 units it took. No anesthesia to put that big black snake down your throat. No hospital, no ICU. Do what it takes to keep the hospital in this town and in this county."

Ryan Hankins, executive director of public affairs with the Research Council of Alabama (PARCA) said Medicaid is 51 different programs, required by the federal government and provided in every state.

According to the PARCA's report, the federal government currently pays at least half the Medicaid costs in every state. In Alabama it pays about 72 percent. In 2023, a family of three must make less than $4,475 or about $5,000 for a family of four a year to qualify for Medicaid. In 2023, a family of three must make at least $24,860 a year to qualify for private insurance.

Last fiscal year, Medicaid served 1.2 million, or about 25 percent of the population of Alabama in the last fiscal year. He said people fall into and out of qualifying for Medicaid monthly. In Alabama, children qualify the most for Medicaid. The largest share of dollars go to children or births and those with disabilities.

"If you work more than 11 hours a week at minimum wage, you do not qualify for Medicaid in Alabama," said Hankins. "If you do not have children, no income, you're homeless, you're not pregnant, you don't have breast or cervical cancer, or a disability, you do not qualify for Medicaid in Alabama."

The report said in Escambia County, 23,827 people, or 32 percent of the population was covered by Medicaid last year. Hospitals gave uncompensated care last year in the amount of $17.8 million, leading to multiple hospital closures. There are 17 percent of Escambia County residents who have medical debts in collections. Thirteen percent of childbearing age women are uninsured.

Over the next six years, expanding Medicaid in Alabama would: yield a benefit of $2.3 billion and generate an annual economic impact of $1.89 billion; it would increase Medicaid enrollment by as many as 283,636 people; see Alabama's uninsured decline by 43 percent' create an average of 20,083 new jobs per year, cost an average of $225,4 million above current medicaid expenditures and yield an estimated average annual savings of $397.8 million, the report said.

In Escambia County, 1,890 people would be eligible for health insurance; there would be a 54 percent reduction in uninsured adults in the county, closing the Medicaid coverage gap; there would be a $95.7 million in additional economic impact in one year; and more than 20,000 new jobs would be created.

There would be access to health care, increased jobs, a healthier overall population, more preventative care and reduction of medical debt.

Currently, 71.5 percent of voters in Alabama support Medicaid Expansion in Alabama, compared to 66.7 percent before educating voters on the benefits of Medicaid Expansion. Strong support comes from 50.2 percent of the voters. Republicans support the expansion by 65.8 percent and 17.5 percent of Alabama voters oppose it, according to PARCA's report.

Pediatrician Dr. Marsha Raulerson said as a pediatrician who came to Brewton in 1980, many of her first patients are now grandparents, so she has seen a lot of families and a lot of changes.

"I've seen a lot of families come through and I've seen a lot of things happen over then years," said Raulerson. "I noted that if parents have healthcare, their children did better, so I want my parents to have healthcare."

Raulerson said one of her biggest concerns is when kids turn 19, they lose their healthcare and could no longer get their medications and healthcare, they became disabled, they had to go on disability and did not want that. The reimbursement for our state is going to slowly over this year because the COVID health emergency is over, but if we expanded Medicaid, it would actually go up and we would have more money to provide services for everyone that we take care of."

Raulerson made the point that in Arkansas, since they expanded Medicaid in 2013, they lost only one rural hospital. In that same period of time, Alabama lost 11 hospitals. No rural hospital in Louisiana has closed since they expanded Medicaid in 2016. Let's get this done."

Raulerson emphasized how important it is to reach out to the legislators and voice the importance of expanding Medicaid.

Rep. Alan Baker can be emailed at [email protected] or calling 334-261-0420.

Rep. Matthew Hammett can be emailed at [email protected] or by calling 334-261-0421. Sen. Greg Albritton can be emailed at [email protected] or by calling 334-261-0483.