By Marti Webb Slay

Two Alabama Democratic representatives, Shomari C. Figures (AL-02) and Terri Sewell (AL-07) are sponsoring the Cover Outstanding Vulnerable Expansion-Eligible Residents Now (COVER Now) Act to expand health care coverage to millions of Americans who are still uninsured because of state-level refusals to accept federal Medicaid expansion funds.

Alabama is one of those states, so this legislation would establish Medicaid pilot projects in the state that would allow the Center for Medicare & Medicaid Services (CMS) to work directly with counties and cities to provide coverage for Alabamians who would qualify for Medicaid if the state had chosen to expand.

This is the third time the bill has been introduced in Congress. “I don’t think there’s a strong possibility that this makes it any further than it did in the last congress under similar dynamics, but it’s a fight we have to keep pushing,” said Figures, a lead co-sponsor of the bill. “Statistically, Alabama has third lowest life expectancy in the US. We have some of the worst healthcare outcomes in the nation. A lot of that has to do with access. I don’t think there could be a more important issue than helping people live longer, healthier lives.”

Figures said this issue goes beyond healthcare, important as that may be. “It’s also an economic issue,” he said. “It’s tough to recruit businesses and people to live in your communities when you don’t have a hospital; when you don’t have physicians. Over half the people in my district don’t have a pediatrician, let alone other specialists. We are on pace right now to lose every single hospital in my 13-county district that isn’t located in Mobile or Montgomery or Pike County. That is unacceptable, especially through the lens of long-term viability in these communities. We have to do everything we can, both on the federal level as well as on the state level, to get healthcare resources, and if the state refuses to take advantage of something that the vast majority of states have taken advantage of, then we have to look at ways to bypass that resistance and provide healthcare to those that need it.”

The COVER Now Act would:

• Authorize CMS to contract directly with counties and other political subdivisions to establish demonstration projects expanding Medicaid coverage to their residents.
• Offer participating entities the same deal previously made available to states: 100% federal funding for the first three years and a gradual reduction to 90% federal funding by year seven and thereafter.
• Allow participating entities to apply individually or jointly to establish a regional expansion project.
• Maintain existing Medicaid rules and systems which would apply to the local expansion programs.
• Authorize access to State Medicaid systems for participating entities, with additional federal administrative Medicaid funding for cooperation and federal penalties for non-cooperation.
• Should a State expand, eligible beneficiaries enrolled in a local expansion program would be automatically enrolled into the State Medicaid program.

The COVER Now Act is one of the first bills Figures has sponsored since being elected. “When we went across the district campaigning, this was the number one issue, the one people consistently raised,” he said. “It had some traction last year in the state legislature, but ultimately that fizzled out. But the status of our overall healthcare system in this state was amplified by several high profile hospitals closing in this district over the past year as well as some maternity services being scaled back at other institutions across the district and across the state.”

He believes Medicaid expansion is one way to strengthen the healthcare system, especially in our rural communities. “Since this was a top issue, we wanted to show people we were listening. We want to collaborate with people across the country that are dealing with the exact same issue. When we got here, we focused on addressing this issue first,” he said. “This is just step one.

“At the end of the day, there’s a stark reality. This is an opportunity for states to do what’s right and provide healthcare coverage that not only will save lives but also save hospitals.”