Medicaid expansion has been a hot topic in the state recently as the 2023 regular session of the legislature looms. As I’m sure you’re aware, the state has twice expanded coverage for new mothers from 60 days to 12 months. Some see the expansion of Medicaid as a moral issue; that the state should have a role in the protection of “the least of these”. However, the converse argument is that government is not the church writ large and that able bodied men and women without young children should not be discouraged from seeking work.

It is anticipated that a further expansion would would enable all adults who meet the income requirements to be eligible for Medicaid, estimated to be approximately 250,000 to 340,000 Alabamians. Though the state would be able to set some level of requirements for benefit recipients, President Biden’s administration has made it clear that work requirements will not be approved. That leaves a state that wants to expand Medicaid in the position of being forced to create a disincentive to work. That disincentive is compounded in an environment of low workforce participation and high demand.

On a national level, Medicaid spending has seen a 59% increase in the past 13 years. The Congressional Budget Office projects that Medicaid spending will be around $800 billion annually by 2032. So, while Alabama’s state government and medical institutions might see a short-term budgetary benefit from a legislative vote to expand Medicaid, the long-term budgetary obligations are likely to outweigh the benefits. API would encourage the legislature to resist the urge to seek short term financial or political gain at the expense of our state’s children and grandchildren. Unfortunately, the expansion of Medicaid now would necessitate the passing of the debts of this generation to the next.