North Carolina just expanded Medicaid, and Alabama should be next

A Black woman health care professional talks to a young white woman.

MONTGOMERY, Ala. – North Carolina became the 40th state to expand Medicaid after Gov. Roy Cooper signed expansion legislation into law Monday. The enactment came after politicians reached across the aisle in recent weeks in a bipartisan effort to expand Medicaid to cover adults with low incomes.

Alabama can and should become the next state to expand Medicaid, Alabama Arise’s Cover Alabama campaign director Debbie Smith said. Cover Alabama is a nonpartisan alliance advocating for quality, affordable health coverage for every Alabamian.

“Seeing this legislation come to fruition in a bipartisan effort brings hope to Alabamians as we look to make our state the next to expand Medicaid,” Smith said. “As a fellow member of Southerners for Medicaid Expansion, we celebrate this milestone achievement for North Carolina and hope it is just the beginning of what’s to come for the rest of the region.”

The humanitarian and economic benefits of Medicaid expansion in Alabama

Medicaid expansion in Alabama would help nearly 300,000 people access potentially life-saving health care. Most of them make too much to be eligible for Alabama Medicaid (more than $4,475 a year for a family of three) yet too little (less than $24,860 a year for a family of three) to qualify for Marketplace subsidies under the Affordable Care Act.

Closing Alabama’s health coverage gap also would invigorate the state’s economy, research shows. Medicaid expansion would create 20,000 new jobs and save the state almost $400 million over the next six years, according to a report by the Public Affairs Research Council of Alabama. That report also projects that Medicaid would have an estimated positive economic impact of $11.4 billion over the same period.

Momentum for Medicaid expansion has been building in Alabama. A 2022 Cygnal poll for Alabama Arise found that 72% of Alabamians, including 66% of Republican voters, support Medicaid expansion. Numerous states with Republican-led legislatures, such as North Carolina and South Dakota, recently have taken action to close the coverage gap.

‘It makes perfect sense from a budgeting standpoint’

North Carolina’s legislation will provide health coverage as early as January 2024 for nearly 600,000 people who were previously in that state’s coverage gap. An estimated 2.9 million enrollees have traditional Medicaid coverage in North Carolina.

Sen. Phil Berger was among the Republican legislators who championed the bill to close North Carolina’s coverage gap. Berger told PBS that he initially opposed expansion but ultimately changed his mind.

“The reality is that, with the way the federal program is designed, more often than not, what you have is a situation where folks who would be eligible for Medicaid in the expansion population are people that are actually working full time,” Berger said.

Berger went on to say there is no precedent for the federal government walking back its commitment to paying 90% of the cost of covering people eligible under Medicaid expansion.

“We have seen almost every iteration that you could have of [federal government] control by one party or the other or joint control. And they haven’t changed that 90-10 split,” Berger said. “In my view, it's something that we ought to do. And it makes perfect sense from a budgeting standpoint at this time.”  

A health coverage blueprint for Alabama

Medicaid expansion in North Carolina has provided Alabama with a blueprint on how elected officials, business community leaders and statewide advocates can come together and bring expanded coverage and prosperity to the state. The North Carolina business community demonstrated its support with 20 chambers of commerce signing onto a resolution in favor of expansion. Their research indicates that statewide expansion would drive $2.9 billion in new business and health care activity and add 37,200 new jobs statewide.

Cover Alabama sister organizations such as the North Carolina Justice Center and Care4Carolina have played a critical role in getting expansion across the finish line in their state.  

“Our mission at the North Carolina Justice Center is to make opportunity and prosperity a reality for all, which requires access to quality and affordable health care,” said Hyun Namkoong, deputy director of the Health Advocacy Project at NCJC.

“We are thrilled with last week’s announcement of Medicaid expansion for the people of North Carolina. And we hope that this milestone will motivate other states to finally grant affordable health care to their residents in the coverage gap.”

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Cover Alabama is a nonpartisan alliance of more than 120 advocacy groups, businesses, community organizations, consumer groups, health care providers and religious congregations advocating for Alabama to provide quality, affordable health coverage to its residents and implement a sustainable health care system.