By Amanda Scott, a 2018 Truman Scholar from Mobile and a senior at Georgetown University
The Alabama Medicaid Agency opened a new public comment period to solicit feedback on the state's proposal to impose work requirements on Medicaid recipients. Under the proposal, 74,000 Alabamians on Medicaid would be required to do 35 hours of work, job training, education, or community service each week.
These work requirements would only hurt the poorest and most vulnerable families and make Medicaid even less accessible to those who need it. Meanwhile, thousands of other families are already suffering from the state's refusal to expand Medicaid.
According to Alabama Arise Citizens' Policy Project, Medicaid covers about 1 million Alabamians or roughly one in every five people in the state. Children make up 66 percent of those covered by Medicaid in Alabama, and the remaining are senior citizens, people with disabilities, pregnant women and caretakers.
Alabama already has the strictest Medicaid eligibility requirements in the nation along with Texas. You can only qualify for Medicaid in Alabama if your income is above 18 percent of the poverty line, which is $3,740 a year for a family of three or about $312 a month.
But Alabama's leadership seeks to make Medicaid even less accessible through imposing unnecessary and burdensome work requirements. The only exceptions would be for parents of young children and children with disabilities. That means senior citizens, people with disabilities, pregnant women, and those who provide full time care for a family member would still be required to work to qualify for Medicaid.
A person working just 10 hours a week at minimum wage already earns too much to qualify for Medicaid in the state. Regardless of whether people on Medicaid work or don't work, they will lose their coverage, effectively creating a catch-22.
Nationally, six in ten working-age, able-bodied adults on Medicaid are already working, according to the Kaiser Family Foundation. Those who are not working report being unable to work due to illness or disability, caregiving responsibilities, or going to school.
Alabama is one of only 18 states that still refuses to accept Medicaid expansion under the Affordable Care and Patient Protection Act, which has left more than 191,000 Alabamians without health insurance. Then-Governor Robert Bentley defied Medicaid expansion as a conservative political grandstand and my mother and I were among the thousands of Alabamians who suffered for it.
Our story is similar to the stories of many uninsured Alabamians and could happen to anyone. In 2014, my mom and I lost our health insurance when she had to leave her job at Wal-Mart after a long time of suffering from health problems. She was diagnosed with congestive heart failure, chronic obstructive pulmonary disease, and diabetes, which left her unable to work.
While my mom had lost her income and received less than $7,000 a year in social security benefits, neither of us were eligible for Medicaid through the state because we fell in the "coverage gap." She was not eligible because she had not yet turned 65 or been approved for disability benefits. I was not eligible because I was a full-time student without dependent children.
We had to rely on the generosity of Franklin Primary Health Center and Ozanam Charitable Pharmacy in Mobile which serves low-income and uninsured patients in need of health services and prescription assistance. Franklin and Ozanam stepped in and saved my mother's life when the state left her with nowhere else to turn.
Being uninsured leads to deadly and devastating consequences. Uninsured Americans are less likely to visit the doctor and receive preventive health care, more likely to be diagnosed at advanced stages, and once diagnosed, receive less care, according to the Kaiser Family Foundation.
A 2009 article in the Academic Journal of Public Health found that the uninsured had a 40 percent greater risk of dying prematurely than their insured counterparts and nearly 45,000 deaths a year are linked to lack of health insurance.
Uninsured Americans are also at a higher risk of going into medical debt and bankruptcy than those with health insurance. According to the Consumer Financial Protection Bureau, medical debt contributes to over half of the debt collections that appear on consumer credit reports and results in almost half of bankruptcies in the country.
Having no health insurance and being in medical debt is worsened by the fact that employers in Alabama and most states require applicants to undergo credit checks and make hiring decisions in part based on an applicant's credit history. And they make no exceptions for medical debt.
No matter which way you look at it, Alabama leaders' refusal to expand Medicaid and its push for Medicaid work requirements keep Alabama's poorest families and children in a never-ending cycle of poverty. Tell the Alabama Medicaid Agency to withdraw its work requirement proposal, and call your state representatives to urge them to expand and protect Medicaid in Alabama.