Alabama is turning down federal healthcare dollars while families struggle, hospitals close, and working people fall into the coverage gap. Doug’s priority is straightforward: expand Medicaid to lower costs, protect rural care, and strengthen the workforce.

The Challenge

• Alabama turns down about $182 million in federal healthcare funding every year.

• Over 154,000 hard working Alabamians, such as restaurant workers, construction workers, and home healthcare aides, fall into the health insruance coverage gap: they earn too much for Medicaid but too little for private insurance.

• Alabama ranks last in infant and maternal mortality, and is among the worst for diabetes and heart disease.

• Since 2011, Alabama has lost six rural hospitals; expansion-state Arkansas lost zero.

• Uncompensated care costs Alabama hospitals $650 million a year, pushing more toward closure.

• The opioid and mental health crisis can’t be solved without Medicaid expansion. Studies show that adults with Medicaid are twice as likely to get treatment.
  

Doug’s Plan

1. Expand Medicaid and close the coverage gap

   • Cover more than 154,000 working Alabamians who earn too much for Alabama’s restrictive Medicaid but too little to afford private insurance.

   • Highlight the reality: a family of three making more than $4,650 annually doesn’t qualify under current rules. 

2. Bring Alabama’s healthcare dollars home

   • Stop turning down roughly $182 million in federal healthcare funding each year. This is money paid in Medicaid taxes by Alabamians but not coming back home.

3. Keep rural hospitals open and reduce uncompensated care

   • Alabama has lost six rural hospitals since 2011; neighboring expansion-state Arkansas lost zero in that period.

   • Reduce the roughly $650 million in annual uncompensated care costs that threaten hospital stability.

   • Learn from expansion states where uncompensated care dropped sharply (e.g., 45% in Montana in the first year).

4. Strengthen mental health and addiction treatment

   • Use expansion to access the 90% federal match for services Alabama is currently funding with state-only dollars (including $26.1 million for mental health and substance abuse programs).

   • Expanding Medicaid expands access to treatment. People with Medicaid are twice as likely to receive opioid addiction treatment as those without coverage.

   • Follow evidence from other states: Kentucky saw a 700% increase in substance use disorder services and a 79% decrease in opioid-related hospitalizations for the uninsured after expansion.

5. Make expansion an economic strategy, not just a healthcare policy

   • A 2022 analysis projected expansion would generate $2.76 billion in additional economic activity in Alabama in 2026 and create nearly 30,000 jobs.
     

What This Delivers

• Lower healthcare costs and less medical debt 

• Stronger rural hospitals and local jobs 

• A healthier, more stable workforce
  

Why It Matters

This is one of the most common-sense moves Alabama can make: healthier families, stronger communities, and a stronger economy.