The political tug-of-war over the existential question of Medicaid expansion in Alabama — fiscal costs vs. human assistance — has caused a dozen Calhoun County clergy and lay leaders to urge Gov. Kay Ivey to act.
On Thursday, Alabama Arise and the Cover Alabama Coalition sent Ivey a letter signed by 278 members of the state’s faith community. In the letter, the clergy wrote that “hundreds of thousands of Alabamians are caught in the health coverage gap,” and appealed to the governor’s better angels because “we need the Alabama government to do its part to protect and provide care for those in need.”
Medicaid expansion under the Obama-era Affordable Care Act has broken largely along party lines, with Republican Party-leaning states reluctant to enlarge the pool of residents eligible for federal health insurance. Alabama is one of the 12 states that has not expanded Medicaid.
The clergy who signed the letter cite well-known data. As many as 300,000 uninsured Alabamians — many who work but make too much to qualify for government aid — would gain health care coverage if Ivey and the Legislature expanded Medicaid. Expansion would include those Alabamians making up to 138 percent of the federal poverty limit, essentially closing the loophole that traps the working poor.
Moral issues rest at the center of the signees’ concerns.
“My position is based on faith, not politics,” the Rev. Tammy Jackson of Anniston First United Methodist Church, who signed the letter, wrote in a text message to The Star. “And if politics ever conflicts with my faith, I’m going to choose faith every time. I still love people who disagree with me, but I’m willing to receive criticism for doing what I think Jesus would do.”
Besides Jackson, several others from Anniston First United Methodist Church signed the letter, including Associate Pastor Kyle Bryan. Also among the signees were the Rev. Michael Dunbar (Goshen United Methodist Church); the Rev. Stanley Easton (St. Luke’s Episcopal Church, Jacksonville); the Rev. Matthew P. Headley (formerly of Weaver First United Methodist Church); the Revs. Laura Hutchinson and Nicki Arnold-Swindle (The Christian Church (Disciples of Christ), Anniston); Audrey Noel of Community Enabler Developer; Bishop Vernon Presley (Greater New Day Apostolic Church, Anniston); the Rev. Ross Reed Jr. (Macedonia Baptist Church, Anniston); and Pastor Anthony Cook (Christian Fellowship Bible Church, Anniston).
Cook, a former editor at The Star, called Medicaid expansion “low-hanging fruit” that would immediately assist thousands of Alabamians. But he drew a direct correlation between his faith and the state government’s responsibility.
“As a follower of Christ, one of the tenets near to my heart is the admonition to care for the least of these,” Cook wrote in a text message. “Not only would (expansion) give them access to emergency care, but also preventative care, which would lead to an overall healthier Alabama.”
Uninsured rate could drop 43%
Since passage of the ACA 11 years ago, lawmakers in the GOP-controlled state Legislature have remained concerned over how to pay for added enrollees. When first introduced, the ACA Medicaid expansion would see the federal government pay for 100 percent of the costs for a number of years, with state contributions gradually increasing but remaining far below the amount coming from Washington.
A recent University of Alabama at Birmingham study estimates Alabama’s annual share might reach $250 million, though money from the Biden administration’s American Rescue Plan Act earlier this year could lessen that amount.
This spring, the Legislature did not include expansion in the state’s next fiscal budget.
“My personal position is when we have an answer on how to fund it, that’s when we’ll talk about it,” State Sen. Greg Albritton, R-Atmore, chairman of the Senate budget committee, told AL.com. “If you talk to the feds, it doesn’t cost us anything. But they are not looking at what we need to pay. They have never completely answered how much it will cost the state of Alabama to do it.”
Here, the tug-of-war becomes not an argument about how to pay for additional costs, but a discussion of humanity.
In 2020, the Robert Wood Johnson Foundation published a study that showed Alabama’s uninsured rate would fall by an estimated 43 percent if lawmakers agreed to expansion. No other state would enjoy a benefit that large, the study said.
Bryan, the Anniston First Methodist associate pastor, said he signed the letter because United Methodists “believe health care is a basic human right that every person is worthy of receiving, and so it’s sort of a no-brainer for me.”
He also waded into the issue’s political scrum, pointing to his belief that funding expansion is a matter of wills and ways, not abject inability.
Former Gov. Robert Bentley, a Republican and a physician, at one point was a mild proponent of expansion and floated the notion of paying for it with a tobacco tax hike. That idea dissolved, and Ivey hasn’t budged.
“One of the consequences of living in a civilized society is paying taxes, and we don’t love to pay taxes in the state of Alabama,” Bryan said. “But the reality is if we want to provide the sort of social services and safety net that people need to ensure the sort of ‘Shalom’ that God talks about can be achieved, then we have to expect our leaders to make difficult and hard decisions, regardless of what their constituencies may or may not think is a good idea.”
Many of the clergy who signed the letter serve congregations in voting districts that are overwhelmingly conservative, including most of those from Calhoun County. Alabama Arise released the letter — and its signatories — to the public Thursday. Congregations have been informed.
Bryan isn’t overly concerned about criticism he and his colleagues may receive over their support of Medicaid expansion.
“The reality,” he said, “is we cannot escape the social implications of Jesus’ invitation to help make the kingdom of God a reality here on earth.”
Cook, the former journalist, appealed directly to Montgomery.
“I’ve met Gov. Ivey, and I believe her to be a compassionate and reasonable person,” he wrote. “I pray that she will set politics aside and do what’s right for the State of Alabama.”