The Supreme Court handed to state governors the decision on whether to expand the income limits for Medicaid under the Affordable Care Act of 2010. Alabama Governor Robert Bentley refuses to do so.

Governor Bentley's decision leaves some 300,000 Alabamians without health insurance and only one medical emergency from financial disaster. Statistics show that without expanding Medicaid, more than 700 Alabamians will die needlessly each year.

Hospitals are also "dying" without Medicaid expansion. The Alabama Hospital Association says hospitals are closing at an alarming rate, particularly in rural areas.

When hospitals close, people suffer. We know too well the differences in survival rates between the wait for a distant medevac helicopter and the speedy arrival of an ambulance from a nearby hospital. A North Carolina mayor – a Republican - told of just such a life lost four days after the nearest hospital closed. He walked 273 miles to Washington D.C. to draw attention to the death and Medicaid Expansion's positive impact on rural hospitals.

Since last year, 22 rural hospitals have closed, 20 in states that blocked Medicaid expansion, according to the National Rural Health Association. In Alabama, 10 have closed in the last three years; up to a dozen face closure.

People without health insurance delay care until it becomes a serious condition, then go to more costly emergency rooms. As a result, hospitals fold. The public ultimately pays through higher taxes, insurance or hospital costs. Areas without suitable access to health care often attract less industry.

Expansion is not welfare. On July 30, consumer advocacy group Alabama ARISE reported that of the 300,000 eligible, 185,000 are working Alabamians. They work at places like McDonalds and Walmart, employers that often pay poverty wages and offer no benefits. Ultimately, employers that hire part-time and pay low wages shift the burden onto the taxpayers for their employees' medical care.

In response Bentley says I'm "committed to fixing Alabama's program and not expanding it." He apparently believes that no system is better than a system that needs repair. The facts are so skewed in favor of expansion; it's obvious that Bentley places his political agenda above life and death.

ARISE's recent letter to the federal government questions Bentley's proposed "fix". ARISE was the only consumer advocate on the 28 person commission finally appointed by Bentley to address Medicaid "problems". ARISE says that Bentley uses a piecemeal array of programs that could be covered more comprehensively and cheaper through Medicaid Expansion. While Bentley goes about "fixing" the problem, people die and the state loses out on $3.9 million-a-day in economic stimulus.

Apparently Bentley doesn't care that the federal government pays 100% of direct costs for Medicaid expansion for the first three years. Administrative costs amount to only $39 million a year during that time.

Bentley has been unmoved by the reputable predictions that economic benefits of Medicaid expansion far outpace direct and administrative costs. Expansion will create 12,000 health care related jobs and up to 30,000 jobs in total - by far the biggest job producer and economic development engine in Alabama.

Gov. Bentley, a doctor, who likely took an oath to have the utmost respect for human life, has a moral and ethical responsibility to save lives.

In the words of the Rev. William Barber, who organized an 80,000 person rally in North Carolina this year in support of Medicaid Expansion, "... if we ask people to go deeper than left or right, ...Democrat or Republican, or their skin color, we can transform America." Medicaid expansion is a moral issue. Saving hospitals, saving lives, we all have a stake.

Submitted by:

Sophia Bracy Harris, Executive Director Federation of Child Care Centers of Alabama (FOCAL)

Scott Douglas, Executive Director Greater Birmingham Ministries

Al Henley, President Alabama AFL-CIO

Barbara Howard, Save Ourselves, (S.O.S.) Health Committee Chair

Roberta Watts, President Alabama New South Coalition

John Zippert, Board Member, Greene County Hospital and Nursing Home