Alabama’s Pass on Medicaid Expansion Leaves Birmingham’s Uninsured with Weak Safety Net

Media Advisory
Oct. 17, 2013

Alwyn Cassil (202) 264-3484 or

WASHINGTON , DC—Alabama’s pass on the Medicaid expansion under national health reform leaves the Birmingham region’s low-income, uninsured adults with a patchwork safety net widely regarded as limited and inadequately funded, according to a new Community Report released today by the Center for Studying Health System Change (HSC).

Funded by the Robert Wood Johnson Foundation (RWJF) and based on interviews with local health care leaders in 2013, the study examined the Birmingham region’s commercial and Medicaid insurance markets.

After making early progress in setting up a state-run health insurance exchange, Alabama ultimately reversed course and ceded the exchange’s operation to the federal government. Transitioning from the current minimally regulated commercial insurance market to the more stringent standards required by the Patient Protection and Affordable Care Act (ACA) poses many challenges for Alabama. One is federal control of the insurance rate-review process, after federal authorities deemed Alabama’s process ineffective. Another is potential rate shock and instability when the ACA’s rating restrictions take effect—especially in the nongroup, or individual, market, which now has no rating restrictions.

Key findings of the report, Alabama’s Pass on Medicaid Expansion Leaves Birmingham’s Uninsured with Weak Safety Net, which is available online here, include:

As health reform unfolds in the coming years, there will be ongoing issues to track in the Birmingham-area health care market, including:

Birmingham is one of eight metropolitan areas HSC researchers are studying on behalf of RWJF’s State Health Reform Assistance Network initiative—the others are Albuquerque, N.M.; Baltimore; Denver; Long Island, N.Y.; Minneapolis-St. Paul; Portland, Ore.; and Richmond, Va.

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The Center for Studying Health System Change is a nonpartisan policy research organization committed to providing objective and timely research on the nation's changing health system to help inform policy makers and contribute to better health care policy. HSC, based in Washington, D.C., is affiliated with Mathematica Policy Research.