“It would be irresponsible to think about expanding Medicaid.”

Alabama Governor Kay Ivey

Governor Ivey was 100% wrong. But her remarks are not surprising given what has happened over the past decade since the Affordable Care Act (ACA) became law. Apparently, she is currently reviewing the subject yet again given recent national financial incentives and the recent failure of the suit designed to abolish the Affordable Care Act. 

On 02/26/18, twenty Republican controlled states … including Alabama … filed a suit to do away with the Affordable Care Act, citing questionable grounds. They were supported by the Trump administration, which is consistent with the former President’s frequent declarations that he would repeal the ACA and replace it with something better. However, he never came up with any reform proposal to accomplish this aim. Many legal scholars heavily criticized the filing as political rather than legal in nature.   

In addition to ALABAMA, the red states filing (i.e., “state plaintiffs”) include- TEXAS, WISCONSIN, ARKANSAS, ARIZONA, FLORIDA, GEORGIA, INDIANA, KANSAS, LOUISIANA, Maine, MISSISSIPPI, MISSOURI, NEBRASKA, NORTH DAKOTA, SOUTH CAROLINA, SOUTH DAKOTA, TENNESSEE, UTAH, and WEST VIRGINIA. Wisconsin and Maine withdrew in 2019 after Democrats took many state offices, leaving 18 states as plaintiffs. There were 27 states that either defended the ACA, joined in defending on appeal or filed briefs supporting the ACA. 

California v. Texas was recently decided in a 7-2 decision. Essentially, this very conservative Supreme Court found that these 18 red states had no standing to sue. 

But why did they sue in the first place? Several of these 18 states are affluent, but many of these states are among the poorest in the USA, including Alabama and its neighbor Mississippi. 

Almost all of the 18 states which were suing to find the ACA unconstitutional have healthcare insurance rates which are lower than the national average. Three have the largest number of uninsured in the nation, including Texas, Florida and neighboring Georgia. Alabama itself has a 10% uninsurance rate compared to only 3% in deep blue Massachusetts. That means that, even after the ACA, there are still 460,000 Alabamians uninsured.  

When the ACA was passed, many uninsured individuals obtained insurance. By 2016, over 20 million had been added nationally. However, under Trump the rate of insured fell and the number of uninsured went from 26.7 million to 28.9 million. 

Who are the medically uninsured? Proportionality, more are adults than children. The uninsured are disproportionately low income. However, the majority have one or more employed people in the family unit, but just don’t receive healthcare benefits in their jobs. They simply cannot afford to buy coverage.  

Additionally, more of the uninsured are people of color versus Caucasians. The national racial breakdown for uninsured adults is: American Indian-22%; Hispanic- 20%; Pacific Islander- 13%; White- 8% and Asian- 7%.  

People of color vote disproportionally for Democrats. Whites tend to vote for the GOP. Is this a key reason why states like Alabama which are controlled by the GOP wanted the ACA repealed and/or found unconstitutional? There certainly is a correlation, if not a totally provable causation. 

Surveys have shown that America is the world’s most religious democracy and Alabama is our most religious state. Therefore, as patriotic Americans and Alabamians, we should all look forward to the day when partisan politics is not as important as assuring that needy Americans have the healthcare that they need and deserve. In the immortal words of Martin Luther King, Jr., 

“Of all the forms of inequality, injustice in health is the most shocking and inhuman.”


Image Credit: the feature image of the Healthcare Justice march holding banner "Health Care is a Human Right" was taken by United Workers (flickr/Creative Commons).

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.