Letter to Governor Kay Ivey Regarding Medicaid Expansion in Alabama

Today, I sent a letter to Governor Ivey regarding Medicaid expansion in Alabama. I spent over two hours writing this 3-page letter yesterday, including research and implementable solutions to the issue of expansion.

I wanted to share it here as well to make my views on the issue public and encourage donations to Alabama Arise, the organizers behind the Cover Alabama Coalition.

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Plain text version:

[Maroon DS logo on the left of a beige header]

Derek Schmitz
[redacted address]
[redacted email]
[redacted phone number]
web: derekschmitz.com

May 23, 2024 via First Class Mail

The Honorable Kay Ivey
Governor of Alabama
State Capitol
600 Dexter Avenue
Montgomery, AL 36130

Dear Governor Ivey,

My name is Derek Schmitz, and I am a constituent in Calhoun County. I am a 19-year-old disabled
advocate and paralegal student. I am writing to you today to urge you to reconsider your position on
Medicaid expansion for our great state. Please reply to this letter in writing to my mailing address above.

On May 13, 2024, you were sent a letter¹ by the nonpartisan Cover Alabama Coalition (the “Cover
Alabama letter”) reiterating the importance of quality, affordable healthcare for all Alabamians. This letter received support from eighty-five partner organizations and provided hard evidence that supported the expansion of Medicaid in the state. In a statement to Alabama Daily News, your communications director reiterated your concerns for “how the state would pay for it long-term.”² The Cover Alabama letter directly addressed these concerns in a way I believed succinct enough to help assuage your concerns; however, since your “position is unchanged,”³ I thought hearing from a constituent directly affected by this issue and who works in this realm would be beneficial.

I had the privilege of previously working with the U.S. Department of Labor Office of Disability
Employment Policy (ODEP) in a role that allowed me to go deep into the trenches of state-level transition planning (from high school to the workforce/post-secondary education) for disabled youth. A key component in the transition process is ensuring that access to healthcare continues. When meeting with policymakers in states who have expanded Medicaid, I have discovered that providing access to healthcare helps disabled people, and all people, become and stay employed. It is unreasonable to expect someone to work when their basic needs are unmet, so states around the country are helping to meet those needs by providing healthcare. I urge you to do the same, as you hold the power to do so without a vote by the Alabama legislature.

Nearly 300,000 people⁴ (roughly 6% of Alabama’s population) fall into the Medicaid coverage gap. Three hundred thousand of your constituents are faced with two choices if they are ill: “don’t seek medical care or seek very expensive, very inefficient medical care through local hospital emergency departments.”⁵ That is, frankly, unacceptable, given your ability to change that with the swoop of a pen.

I will acknowledge that the expansion of Medicaid is an expensive and time-consuming endeavor. For
most of the last decade, the concern regarding the cost of expansion was valid.

However, times have changed. Having not expanded prior to 2021, Alabama is eligible for up to $624 million in FMAP funding as an incentive to expand Medicaid.⁶ Medicaid expansion costs would also be subsidized by the federal government’s FMAP coverage increase of 90% for expanded states,⁷ leaving the state share at only 10%.

I parrot the requests of the Cover Alabama letter by pleading for an Alabama solution to closing the
health coverage gap. Such a solution must:
● Cover adults with incomes between 0% and 138% of the federal poverty level.
● Support labor force participation by keeping workers healthy.
● Protect rural access to health care.
● Ensure access to all medically appropriate drugs.
● Minimize administrative barriers and red tape to obtaining health coverage.
● Increase insurance coverage across ethnic, racial, age and income groups.
● Maximize federal dollars to reduce state costs and ensure the long-term financial health
of Medicaid.
● Address wraparound services, including non-emergency medical transportation.

Should you wish to trial these changes before making a full commitment to them, the federal Section 1115 pilot program is available to provide five years to assess the impact, costs and sustainability of the
program. In 2020, Georgia was authorized to partially expand Medicaid through the pilot program. In granting their application,⁸ the Trump-appointed CMS Administrator wrote:

We are committed to supporting states that seek to test measures that are likely to increase coverage and improve the health of beneficiaries, and make them more financially independent, which in turn supports the fiscal sustainability of states’ Medicaid programs. We expect that such demonstration policies will improve beneficiaries’ physical and mental health, resulting in these beneficiaries consuming fewer health care services and resources while they are enrolled in Medicaid, which will preserve Medicaid program resources, make the Medicaid program more efficient, and potentially reduce the program’s national average annual cost per beneficiary of $7871.

Seema Verma, CMS Administrator (2017—2021)

If the State of Alabama were to make a similar application, I believe it would be granted, giving you and your Administration adequate time to fully test the hypothesis that expansion will be too expensive.

I hope this information helps you make the right decision for Alabamians and expand Medicaid.

Thank you for your time and attention to this sensitive matter. I look forward to hearing from and
partnering with you to ensure that all Alabamians have access to affordable, high-quality healthcare.

Respectfully,
[signature.png]
Derek Schmitz
Lead Advocate, Derek Schmitz Advocacy
Digitally signed at 2024/05/22 19:56:56

Endnotes

1. May 13, 2024 Cover Alabama Letter
   https://static1.squarespace.com/static/5e5d885fd1d06a5c284ecaf0/t/664378ab9d41d834ebb4d917
   /1715697835928/Website+V ersion+May+2024+Cover+AL+letter+to+Gov+Ivey.pdf
2. AL.com – Alabama Gov. Kay Ivey remains skeptical about Medicaid expansion, May 21, 2024
   (paragraph 3)
   https://www.al.com/news/2024/05/alabama-gov-kay-ivey-remains-skeptical-about-medicaid-expa
   nsion.html?outputType=amp
3. AL.com – Alabama Gov. Kay Ivey remains skeptical about Medicaid expansion, May 21, 2024
   (paragraph 4)
   https://www.al.com/news/2024/05/alabama-gov-kay-ivey-remains-skeptical-about-medicaid-expa
   nsion.html?outputType=amp
4. Community Catalyst – Analysis of Alabama Health Care Coverage Gaps Among Working People,
   August 2023 https://communitycatalyst.org/resource/working-people-health-coverage-gaps/
5. Comeback Town – Alabama paying the cost of Medicaid expansion but getting none of the benefits, March 21, 2023 (paragraph 3)
   https://comebacktown.com/2023/03/21/alabama-paying-the-cost-of-medicaid-expansion-but-getting-none-of-the-benefits/
6. Center on Budget and Policy Priorities – Medicaid Expansion: Frequently Asked Questions, March 18, 2024 (table 1)
   https://www.cbpp.org/research/health/medicaid-expansion-frequently-asked-questions-0
7. Public Affairs Research Council of Alabama – The Economic Impact of Expanding Medicaid in
   Alabama, January 12, 2022 (paragraphs 6-7)
   https://parcalabama.org/the-economic-impact-of-expanding-medicaid-in-alabama/
8. October 15, 2020 Letter from CMS Administrator Seema V erma to Frank W. Berry, Commissioner, Georgia Department of Community Health (page 2)
   https://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Waivers/1115/downl
   oads/ga/ga-pathways-to-coverage-ca.pdf