Whoever is kind to the poor lends to the LORD, and he will reward them for what they have done.”

Proverbs 19:17

I’m the increasingly rare Southern bird: a proven fiscal conservative and a social liberal. Take a picture before we go extinct.

I’m a former Chair of a rural Georgia County Commission with a proven record of keeping taxes low in my two terms. And, former Chair of the Georgia Association of County Commissioner’s Tax Committee.

Open heart surgery on Alabama

I’m OK with expending tax money, but it has to be for a good cause… and we must budget for it, just like Gov. Ivey recently said, “How you gonna pay for it?” That’s why I support full Medicaid expansion as it was envisioned in the Affordable Care Act of 2009, along with the identification of increased state revenue sources.

Many Alabamians are still not aware that the state originally refused to accept Federal money to expand health insurance via Medicaid. It was a major mistake on the part of both the legislature and the Governor, especially in view of the fact that there was no matching requirement for the first 3 years.

The short sited, ideological views of our Southern politicians caused our Federal tax money (billions) to be spent in NY, CA, and other states rather than Alabama and the South. According to HealthInsurance.org: “From 2013 to 2022, 152 billion in federal taxes will be collected from residents in states not expanding Medicaid and will be used to fund Medicaid expansion in other states”.

Here’s the current situation. Despite the extreme efforts of the Trump administration to sink the ACA, it has clearly succeeded and is quite popular. In 2018, only 8.5% of Americans were uninsured all year long versus a much higher figure in 2009. It should be noted that, due to the administration’s efforts, 8.5% is a rise from 7.9% in 2017. The number of people on Medicaid dropped 0.7% in 2017.

Alabama is one of the more poorly insured states; it has the twelfth highest rate of uninsured in the nation, 10%. Medicaid expansion caused the rate of uninsured to go down dramatically in two-thirds of the states while Alabama’s has not to that extent.

Status of State Action on the Medicaid Expansion
Status of State Action on the Medicaid Expansion (KFF.org)

Why is Alabama among the worst? The short answer is partisan politics; all of the 14 states that have refused to expand are red, including every deep South state. However, a number of them are now reconsidering, like Georgia which has applied for a waiver to expand (note: their overly complicated waiver doesn’t do that to the extent it should, but it’s just a first baby step, we hope, towards full expansion).

I view healthcare as a right, as do many other Southerners. Alabama should have full Medicaid expansion. But, 10% of the cost is on the State and it must be funded. Here’s how:

  • Move to a more progressive state income tax whereby the very wealthy pay a higher percentage of their earning (Al has one of the nation’s lowest income tax rates);
  • Legalize and heavily tax marijuana, as did Colorado and others;
  • Increase Alabama’s very low fuel tax to be comparable with other states (for example, Florida is much higher);
  • Increase Alabama’s state sales tax to be comparable with other states (its currently lower).

Per PARCA: “Alabama’s state and local governments collect less per capita in taxes than state and local governments in any other state in the union, according to new data from the U.S. Census Bureau.” Even after implementation of these recommendations, it will still be a relatively moderate tax state overall.

It’s not possible in this short commentary to go into great detail as to costs and funding sources. But funding full Medicaid expansion is financially feasible, if Alabama voters have the will. Your choice is to let lower income people go without needed healthcare.

Is that being “kind”? Is being known for self-interest what the people of Alabama, one of our most religious states, really want?


Image Credit: the map showing "Status of State Action on the Medicaid Expansion" is from Kaiser Family Foundation (KFF.org) is a screenshot taken 02-23-2020 (fair use); open heart surgery on Alabama is a composite image created by LikeTheDew.com using a public domain base image of the surgery by the NIH; and a public domain Alabama state map from National Atlas of the United States.


Jack Bernard

Jack Bernard

Jack A Bernard is a retired SVP with a national healthcare corporation. He was Chair of the Jasper County, Ga Board of Commissioners and Republican Party. He was also on the Board of Health for Jasper County and is currently on the Fayette County BOH. Bernard has over 100 columns published annually, primarily in the South.