WASHINGTON — Roughly 170,000 Alabamians could lose health insurance under President Donald Trump’s budget bill, and advocates worry this could have a ripple effect on the state’s health care system.
The U.S. House passed sweeping federal legislation before Memorial Day that seeks to make major changes to Medicaid. The bill will now move through the Senate.
Since Alabama has not expanded Medicaid, one of the biggest impacts of the bill in the state could be that the legislation does not extend the Affordable Care Act’s enhanced premium tax credits, which are set to expire at the end of the year. Congress expanded eligibility for the credits in 2021.
The credits help make health insurance more affordable on the marketplace. Premium costs for enrollees are expected to rise without an extension of the credits.
The estimated 170,000 Alabamians who could lose health insurance under the bill would come from the combination of Medicaid cuts and the expiration of the tax credits, according to the Kaiser Family Foundation.
Debbie Smith, Cover Alabama campaign director at Alabama Arise, said it’s important to remember that real lives are in jeopardy when health insurance becomes too expensive for people.
“They’ll be losing access to health care,” Smith said. “That could be losing their access to prescriptions, somebody (with) diabetes, losing their insulin coverage, and could… lead to them dying.”
Debbie Smith said the premium tax credits have made a huge difference for Alabamians, and losing those could endanger lives and further hurt hospitals, especially rural ones that heavily rely on Medicaid.
“We can’t afford more uninsured people showing up at the ER and causing more uncompensated care costs, and hospitals having to eat up those costs,” Smith told Alabama Daily News. “Our hospitals just cannot afford it.”
Deputy Director and COO of the Alabama Hospital Association Danne Howard echoed those concerns.
“I fear that Alabama’s already high uninsured rate is just going to grow, creating additional issues, particularly in hospitals, in emergency rooms, where that would be the only place these individuals without insurance have to go for just basic health care needs,” Howard told ADN.
Blue Cross and Blue Shield of Alabama said it “continues to advocate for extending the ACA premium tax credits.”
“This will ensure millions of households, including almost 200,000 Alabamians, don’t lose the healthcare coverage they have come to rely on,” spokesperson Sophie Martin said in a statement.
Martin said nearly 200,000 Alabamians are expected to cancel their health insurance during the next two years, specifically in 2026, because without the credits, they will be “unable to afford a partial or full premium.”
Losing the enhanced subsidies could also affect the state’s economy. A report from the Commonwealth Fund shows Alabama could lose $1.142 million in 2026 and roughly 10,000 jobs if the credits expire at the end of the year.
Smith said that someone who lives in DeKalb County and makes 100% of the federal poverty level could see their premiums go from zero dollars to $50 per month.
Howard said having any increase in the number of people uninsured in Alabama will add financial stress to hospitals that already have thin margins.
“It is an issue of grave concern,” Howard said.
Republican leaders hope to get the bill to President Trump’s desk by July 4.