Opinion: Medicaid Expansion Would Mean a Larger, Healthier Workforce for Alabama

By Robyn Hyden of Alabama Arise


Robyn Hyden of Alabama Arise spotlights Medicaid expansion as a pro-work policy that supports not only healthier families and communities but expanded workforce participation and economic gains.


People need to be healthy to work, and consistent access to health insurance is vital to staying healthy. But too many people who are sick and suffering in Alabama find themselves caught in a no-win situation: They’re unable to work because of illness, and unable to recover or manage chronic conditions without adequate care. Without a steady income, how can anyone afford health care?

We’ve heard a lot recently about Alabama’s low unemployment rate. At 3.9 percent, we’re doing well, on par with the national average. But that’s not the whole story. Our state’s labor force participation rate for civilians ages 16 and older is the fourth lowest in the country. At 57.5 percent, Alabama’s rate is ahead of only Mississippi, South Carolina and West Virginia.

So what should we make of the fact that so many Alabamians are out of the workforce? Unfortunately, many of them have chronic illnesses or disabilities and find themselves unable to work. Those who are able to qualify for Alabama’s bare-bones Medicaid program must continue living in poverty to maintain eligibility for coverage.

While disabilities and chronic illnesses keep thousands of Alabamians from entering the workforce, many employers report problems finding enough workers. Raphael Bostic, president of the Federal Reserve Bank of Atlanta, recently addressed this issue at the Public Affairs Research Council of Alabama’s annual meeting.

About two-thirds of Alabama firms struggle to hire for jobs that don’t require a bachelor’s degree, Bostic told attendees. He also shared a remarkable figure: “If Alabama’s labor force participation rate were closer to the national level, then another 200,000 people would become part of the state’s workforce.”

How can Alabama increase labor force participation and boost its economy? Expand Medicaid to cover those trapped in the state’s coverage gap. With the right set of early interventions, at least some workers who suffer from untreated and debilitating conditions could remain on the job, Bostic said.

Those words reflect what I’ve heard repeatedly across our state. Hundreds of thousands of Alabamians could join the workforce if they were healthy. But Alabama’s underinvestment in work supports has left them struggling to make ends meet and unable to access health care.

It doesn’t have to be this way. People who live in one of the 36 states that have expanded Medicaid can enter the workforce and increase their earnings without risking the loss of vital health coverage. Medicaid expansion has made those states more competitive in education, worker retention, health and economic development, research shows.

I asked Bostic what he thought about Medicaid expansion as a way to ensure fewer people drop out of Alabama’s workforce. He said Georgia Gov. Nathan Deal has put together a task force to look into that issue. And Bostic said he hopes Gov. Kay Ivey might consider doing so as well.

Ivey took the stage later that day and said Alabama now has more workers than ever before. She also said we’re on track to add 500,000 new highly skilled jobs by 2025. That’s great news.

But reflecting on Alabama’s anemic workforce participation, I have to wonder: Where will we find those workers? And will those jobs lift more people out of poverty, or continue to leave hundreds of thousands of potential workers out of the workforce?

Medicaid expansion supports work. It promotes a healthier workforce, economic growth and stronger communities for everyone. Alabama should look to the successes of other states that expanded Medicaid, including standout programs like Montana’s HELP-Link, where work supports – not work penalties – helped people get back to work.

The governor and the Legislature should consider the pro-work impact of Medicaid expansion. Our state can’t afford to miss an opportunity to help 200,000 Alabamians re-enter the workforce.


Robyn Hyden is Executive Director of Alabama Arise, a nonprofit, nonpartisan coalition of congregations, organizations and individuals promoting public policies to improve the lives of low-income Alabamians.

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