On any given afternoon, Anniston-based Don James Construction could have multiple carpenters, day laborers and painters out on a job.
None of them would have health insurance through the company.
Don James, owner of the company, said his business is hardly a fluke — that the construction industry has long found it too costly to provide health insurance to the majority of its workers.
"Out of every 100 employees, it would surprise me if even one out of every 100 had insurance," James said about the construction industry.
According to a report released Wednesday, however, that doesn't have to be the case. The report states that mostly working Alabamians — thousands of workers in construction, food service, retail and other industries — would gain health coverage if the state expanded Medicaid through federal health reform.
Families USA, a national organization that advocates for health care consumers and Alabama Arise, which advocates for the poor, compiled the report based off of recent U.S. Census data. The report states that of the 342,000 uninsured Alabamians who would benefit from the expansion of Medicaid, a joint state and federal program that provides health insurance for some people living in poverty, 54 percent are working or have worked in the last year. Those 185,000 estimated working residents are employed in construction, food service, retail, cleaning and other industries, the report states.
"Our study shows the Alabamians who would benefit are people we all depend on every day," said Jim Carnes, spokesman for Alabama Arise.
The report also states that if Alabama expanded Medicaid, the state could cover residents with incomes up to 138 percent of the federal poverty level, which is $27,310 for a family of three in 2014.
The 2010 Affordable Care Act offered all states extra federal money to expand their Medicaid programs beginning Jan. 1. Gov. Robert Bentley has so far staunchly opposed expanding Medicaid, saying to do so would be too costly to taxpayers and that the program should be reformed instead.
The federal government pays for about 68 percent of the current Medicaid program and the state pays the rest each year. If Alabama approves the expansion, the federal government would pay 100 percent of Medicaid costs through 2016. The federal share would then gradually decrease to 90 percent in 2020, remaining at that level afterward.
Dee Mahan, director of Medicaid advocacy for Families USA, said Medicaid should be expanded in Alabama to help workers and, in turn, the economy.
"We're talking about people who touch all sectors of the economy," Mahan said. "Having health care will help working people be more productive and help make a more stable economy.”
Wayne Reaves of Pell City, who owns nine Jack's restaurant franchises, including some in Anniston and Oxford, said he currently doesn't provide insurance to the majority of his 400 employees.
"Frankly, it would cost too much," Reaves said. "We would exist for no reason other than to pay for insurance."
Reaves noted that under the Affordable Care Act, businesses with 50 or more employees like his are required to offer health insurance to all full-time employees starting in January. But even then, Reaves estimates only about 35 percent of his employees are categorized as full-time workers. Reaves is currently setting up a federally-subsidized health insurance plan to cover required expansion.
Mahan said it’s possible a portion of Reaves' part-time workers could be eligible for Medicaid coverage if it expanded.
"They could be eligible if their income is such that they qualify," Mahan said.
Carnes added that it would be particularly beneficial to have health coverage for as many workers in the food service industry as possible.
"When you think of the sector where health should be a primary concern, it is the one involving the handling and distribution of food," Carnes said.
Sam Almaroad, of Sam Almaroad construction in Jacksonville, said that since he has a small company, he does offer a group health insurance plan to employees who can afford it.
"Some of my employees are under that," Almaroad said.
However, most workers in the construction industry cannot afford to get on insurance plans through their employers, Almaroad said.
"In our industry, when the wife has insurance that the husband can get on, they do that," he said.
Almaroad said he did not know if Medicaid expansion could help construction workers, particularly since many are no longer in the business due to the Great Recession.
"How much of an impact it would be, it's hard to say," Almaroad said. "A lot of people in this trade went and got other jobs because they had to provide for their families."