• ± 223,000 Alabamians are caught in the coverage gap, unable to afford health insurance. Another 120,000 or more are stretching to pay for private or employer-based coverage.

• 13 Alabama hospitals – including 7 rural ones – have closed since 2011.

• 88 percent of Alabama’s rural hospitals operate in the red.

• If we expand Medicaid to cover low-income adults, the permanent federal match is 9:1.

• The first four years of federal match would generate $11.4 billion in new economic activity:

— $6.7 billion in direct federal spending

— $4.6 billion in indirect economic activity

• Over four years, the enhanced match would free up $316 million in current state spending to address additional unmet health care needs:

— Existing Medicaid groups – $87.1 million

— Mental health & substance abuse – $121.6 million

— Corrections – $46.8 million

— Public health – $60.6 million

• Expansion-related economic activity would generate $446 million in state tax revenues over four years. New local tax revenues would total $270 million over four years.

• Net cost to the state would be $168 million in the first year, dropping to about $25 million annually in the following years because of savings and revenues, for a total of $239 million over four years. (This figure does not include local revenue gains.)

Bottom line

Medicaid expansion would help more than 340,000 Alabamians get health coverage, stabilize our rural hospitals and jump-start our economy – all for a dime on the dollar. It’s a bargain Alabama can’t afford to pass up.

(Sources: U.S. Census Bureau; Alabama Hospital Association; David J. Becker, “Medicaid Expansion in Alabama: Revisiting the Economic Case for Expansion,” January 2019; Manatt, “Alabama Medicaid Expansion: Summary of Estimated Costs and Savings, SFYs 2020-2023,” February 2019.)