Medicaid Expansion

In order to make healthcare more accessible, southern states must take steps to expand, amplify and simplify the Medicaid application and enrollment process. Frontline and essential workers are now vital to how we emerge from this crisis. But those that are people of color are over twice as likely to be uninsured than white people.1 Fourteen states have yet to expand Medicaid, including 7 in the South, leaving 9 million southerners without health insurance coverage. This is especially problematic because several of these states, including Alabama, Florida and West Virginia are among the states with the greatest share of adults with a higher risk of serious illness if infected by the novel coronavirus.2 As a result of not expanding Medicaid under the Affordable Care Act (ACA), southern states which had just 38 percent of all rural hospitals in the U.S. in 2013, have accounted for 77 percent of rural hospital closures from 2013 to 2017.3 Medicaid expansion by these remaining states would extend insurance to 1.3 million Southerners.4 In the 36 states and D.C., which have expanded Medicaid, most workers earning low wages can qualify for coverage, but we know that not everyone who is eligible enrolls, at least in part because of the level of paperwork and red tape in the application process. States with their own health insurance exchanges should create special enrollment periods beyond those required by the ACA. To date, 12 states with this option have elected to implement a special enrollment period right now, allowing people to enroll during the COVID-19 crisis. The Economic Policy Institute advises that southern state policymakers should expand Medicaid coverage and streamline enrollment without introducing additional barriers such as premiums or work requirements.5 States should also implement a state-only Medicaid program to insure essential workers. People who are stuck in the coverage gap or otherwise ineligible for subsidies on the Marketplace are still eligible to purchase coverage—but at full cost (unfortunately, this is not true for people who are undocumented). States could offer funds to pay for premiums and cost-sharing obligations for marketplace coverage.