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Debates over Medicaid are a perennial feature of Alabama politics, with progressive reformers frequently entreating the state legislature to let Alabama join the forty states that have already taken advantage of federal subsidies and expanded the program. Conservative groups push back just as vociferously, arguing that expanding Medicaid could hurt the state’s budget and discourage job seeking.
This time though, Medicaid advocates aren’t pushing to expand the program. They’re worried that it’s on the chopping block.
During a press call on Tuesday, speakers from seven different states including Alabama emphasized the potential damage to public health and state economies from the severe cuts to Medicaid Republican members of Congress are reportedly considering.
While Trump and other members of Republican leadership have repeatedly promised Medicaid benefits will not be reduced, budget analysts say that meeting the goals set out by the House’s recent Concurrent Budget Resolution without cutting Medicaid would be nigh impossible, or perhaps literally impossible.
Passed by the House last February, the resolution tasks the Committee on Energy and Commerce, which oversees Medicaid and Medicare, with finding policy changes that could reduce the deficit by $880 billion over the next ten years. Working off of an analysis by the Congressional Budget Office, Alice Burns of the nonpartisan health policy organization KFF wrote that “the math is conclusive: Major cuts to Medicaid are the only way to meet the House’s budget resolution requirements.”
Both of Alabama’s Democratic members of Congress, Reps. Terri Sewell and Shomari Figures, voted against the resolution. In a public statement after the vote, Sewell said that “to rip health care away from millions of Americans in order to give tax cuts to the very wealthy is unconscionable” and called the plan a “betrayal of Alabama families.”
All five of Alabama’s Republican representatives in the House voted for the concurrent resolution, which passed along party lines save for a nay vote from Rep. Thomas Massie, R-Kentucky.
Asked by a reporter to explain the scale of the potential cuts, Alabama Arise executive director Robyn Hyden said “a 20 percent cut in federal matching funds for Alabama’s budget would be a critical blow.”
A recent factsheet from KFF shows the federal government pays 73 percent of Medicaid expenses in Alabama, or about $5.25 billion a year. “We simply would have to make major cuts to our state Medicaid program if we experienced a federal cut at that [20 percent] level, and that is why we are all extremely concerned,” Hyden explained.
According to the Alabama Medicaid Agency’s latest monthly demographic breakdown, 1.08 million Alabamians were eligible for Medicaid in January. And the agency’s 2022 annual report found that 26 percent of Alabama citizens were covered by Medicaid at some point during the 2022 fiscal year, including almost 57 percent of the state’s children.
Hyden also specifically addressed conservative arguments that Medicaid hurts states’ economies by reducing the incentive to work.
“You know many of our elected leaders in Alabama talk about our low rates of labor force participation? They speak about the social safety net provided by Medicaid as a deterrent to working,” she explained. “But the data and the reality show that expanding access to Medicaid increases labor force participation in the states that decide to expand this critical program.”
Alabama Arise’s executive director then referred to surveys of workers dropping out of the labor force and blaming chronic health conditions and argued that work versus Medicaid was a false, constructed dichotomy.
“Yes, we all believe in the dignity of work,” Hyden stated. “We also believe in the inherent dignity of every human being, whether or not they are able to work outside of the home. Whether they’re working in the home as an unpaid caregiver for a child or a sick relative.”
Another speaker, Khaylah Scott of the Mississippi Health Advocacy Program, answered a question from APR about how Medicaid cuts could harm rural hospitals. Several rural hospitals have closed or come close to closing in Alabama recently, causing state legislators and Alabama’s Congressional representatives to propose potential legislative tweaks in order to keep their doors open a bit longer.
Scott relayed that the Mississippi director of Medicaid said “there are two things that the Mississippi Division of Medicaid will have to do if there are cuts to the federal funding that we receive: One would be to cut payments to providers, and the second would be to cut the services provided to people that consume Medicaid.”
“Those two alone would only increase by millions and millions of dollars the already existing uncompensated care that really takes a toll on our rural health system,” Scott explained.
David Keely, a retired physician and president of Health Care for All-South Carolina, noted that “rural hospitals closing has a direct impact on maternal morbidity, mortality, and on infant morbidity and mortality in those areas.”
Although proponents of Medicaid are already sounding the alarm, and healthcare professionals are likely considering the possible ramifications of Medicaid cuts, the House’s February resolution was nonbinding and is not endorsed by the Republican majority in the Senate.
Additionally, the continuing resolution passed by Congress and then signed by President Trump on the 15th did not cut Medicaid funding and the CR will continue to fund the government at present levels through the end of the fiscal year.
Any Medicaid cuts will still have to be passed by the House as well as the Senate, a process that will almost certainly require extensive negotiations in D.C. and then making use of the process of budget reconciliation to overcome the Senate’s 60 vote threshold.
