Imagine a group of 300,000 voting Alabamians with perfectly aligned political interests, every one of them furious at the governor and Republican legislators.
The scenario is possible, and it has everything to do with the Affordable Care Act.
For context, the Alabama Education Association is a significant political force with only 95,000 members.
An important step in Obamacare’s success is getting as many people as possible to sign up for health insurance. Widespread acceptance of the law among consumers who are uninsured is important not just for them, but to avoid the high premiums that would result if only those with expensive health issues purchase policies.
Both the federal government and insurers will be advertising heavily in an effort to get as many people as possible to purchase insurance. The advertising campaigns are likely to be especially effective for those between 133 percent and 400 percent of the poverty line, because their premiums will be reduced by subsidies.
As with any advertising campaign, the intended targets will not be the only audience. People with incomes below 133 percent of the poverty line also will be seeing the benefits of having access to health care.
Most of them, however, will be out of luck.
Because Gov. Robert Bentley and the Legislature refused to approve a Medicaid expansion that would have been fully paid by the federal government through 2017, about 300,000 Alabama citizens will fall in an uninsured gap. They will not be eligible for the state’s existing bare-bones Medicaid, but they won’t be eligible for the subsidies that benefit people with higher incomes.
The dirty secret that controls Alabama politics, and has for more than a century, is that few poor people vote. Legislative actions that hurt the poor are routine because they exact no political price.
That could change in 2014. The governor and Legislature denied health-care access to 300,000 Alabamians for purely ideological reasons. Not only would expanded coverage cost the state nothing, it would inject millions into the state economy and save struggling hospitals.
Even if the state continued the expansion beyond 2017, when it will begin having to bear up to 10 percent of the expense, the tax revenue from the federal funds would far exceed the cost. The expansion would lead to about $20 billion in direct and indirect spending in the state and nearly $935 million in new tax revenue in the first seven years, according to a University of Alabama at Birmingham study.
What will be unusual is that the 300,000 Alabamians left out of the Affordable Care Act will be fully informed. They will understand that citizens with more than four times their income have access to low-cost insurance, but they don’t. And they will know the blame lies with a bunch of ideologues whose power depends on the poor staying away from the voting booth.
There are few positives in a political decision that costs the state money while denying health-care access to those who need it. One benefit, however, would be if the decision finally awakes the many poor of Alabama to the importance of voting. Ignoring a huge segment of the population has never been a problem for Alabama politicians. Beginning in 2014, they may do so at their peril.