WASHINGTON — Alabama’s Democratic lawmakers aim to provide health insurance for more than 100,000 Alabamians who are uninsured due to the state not expanding Medicaid.
Alabama is one of 10 states that have not expanded Medicaid under the Affordable Care Act, leaving some Alabamians making too much money to be eligible for Medicaid and too little to afford health care coverage.
The Bridge to Medicaid Act, sponsored by U.S. Reps. Terri Sewell, D-Birmingham, and Shomari Figures, D-Mobile, would provide a temporary option for those in that gap by extending subsidies to them for three years. Individuals in the states that have not expanded Medicaid who make between 100% and 138% of the federal poverty level would also qualify.
“Improving access to quality, affordable health care is one of my top priorities in Congress,” Sewell said in a statement.
“Because of the refusal by the State of Alabama to expand Medicaid, more than 100,000 low-income Alabamians who would otherwise qualify for health insurance coverage are being forced to go without care, putting their health and their lives at risk. If the State of Alabama won’t expand access to health care for our underserved communities, we in the federal government must take action.”
Starting in 2026, the legislation calls for the current Affordable Care Act premium subsidies to be available for those below 138% of the federal poverty level. In 2026, those in that category would be eligible for plans with reduced deductibles and cost-sharing. In the following two years, individuals under 138% of the federal poverty level would be eligible for further reductions in cost-sharing charges.
“This bill will provide relief to people who would have health care coverage if Alabama would simply expand Medicaid, as 40 other states have already done,” Figures said in a statement.
Under the bill, individuals could enroll in coverage at any point during the year. The Federal Medical Assistance Percentage, which is the federal share of Medicaid spending, for people in expansion states would increase from 90% to 93% for three years.
Sewell and Figures also support the COVER Now Act, which would give local governments in states without Medicaid expansion an option to provide health insurance to those who would qualify under an expansion.
The Democrats’ proposal comes as Medicaid is a central issue in President Donald Trump’s “big, beautiful bill” to extend tax cuts and slash federal spending. Republicans revealed a part of that legislation Sunday night that plans to cut more than $880 billion, mostly from Medicaid.
The plan includes adding work requirements to Medicaid for able-bodied childless individuals, increasing eligibility checks to twice a year and other restrictions on the program, including cutting federal funding from places that provide abortion services, such as Planned Parenthood.
The proposal also freezes states’ provider taxes that can help fund a state’s share of Medicaid spending. Alabama has a provider tax on nursing facilities, hospitals, ambulance services, and pharmacies, according to an analysis by the Kaiser Family Foundation.
A Congressional Budget Office analysis requested by Democrats found the proposal could leave at least 8.6 million people without health insurance over the next decade.
The Energy and Commerce Committee, which oversees Medicaid, will mark up the legislation Tuesday afternoon.