The spread of COVID-19 and the strain it has placed on Alabama’s health care system has inspired a new coalition to push for Medicaid expansion in the state, but support from Republican leadership still seems doubtful.

Cover Alabama is a nonpartisan alliance of about 60 Alabama advocacy groups, businesses, community organizations, health care providers and religious congregations.

Expanding Medicaid in Alabama to more low-income people under the Affordable Care Act has been a long-sought issue for Democrats and advocacy groups in the state, but the coalition’s members say their wide range of supporting members shows that now is the right time to expand Medicaid.

“We are here to show that we are a statewide base of support that is demonstrably large,” said Jim Carnes, the policy director for Alabama Arise, an advocacy group that has pushed for expansion for nearly a decade. “We want to demonstrate that there is broad constituent support for this issue.”

Gov. Kay Ivey said on Tuesday she is aware of the interest in expanding Medicaid but the issue of figuring out where the state’s share of funding, estimated to be about $250 million per year, would come from.

“It would be irresponsible to think about expanding Medicaid just for the sake of expanding Medicaid without having a complete and honest discussion about the source of stable funding to pay for the matching,” Ivey said during a press conference.

Alabama is one of 14 states that hasn’t expanded Medicaid under former President Barack Obama’s signature law. State leaders have cited fiscal concerns for their opposition.

Alabama Republican leadership told Alabama Daily News earlier this month that talks of expanding Medicaid were not currently underway.

“Right now, if you were to ask me if there is an appetite for Medicaid expansion in the Senate among Republicans, my answer would be no,” Senate President Pro Tem Del Marsh, R-Anniston, said.

In the House, General Fund budget committee chairman Steve Clouse, R-Ozark, has been more receptive to Medicaid expansion conversations of late. He said if states were offered again the original ACA proposal — three years of expansion at no cost to them — Alabama officials should consider it.

Dvid Becker, a member of the coalition and professor of public health at the University of Alabama at Birmingham, said that as the argument against Medicaid expansion changes from ideology to fiscal, he is hopeful that if new financial incentives are offered Alabama will take advantage of it.

“The circle is closing in and I think the pressure has changed and I think the pressure is going to be ratcheted up against the lawmakers and governor,” Becker said.

Becker researched and published a study last year that estimates around 220,000 Alabamians could be insured if expansion were approved, and that the move would generate around $3 billion a year in economic activity.

He said on Wednesday the number of people who could be insured from expansion would likely be greater now because of COVID-19.

Democratic U.S. Sen. Doug Jones is still pushing for incentive dollars to be given to states that haven’t yet expanded Medicaid. He said he hopes that will be included in the next coronavirus economic relief package.

Jones is sponsoring the States Achieve Medicaid Expansion (SAME) Act, which would provide states that choose to expand Medicaid now the same level of federal matching funds as states that expanded earlier.

Jones said during a conference call with the press on Tuesday that he thinks states should consider going ahead and expanding Medicaid regardless of whether the incentive money is approved.

“The money is still going to end up coming from the federal government somehow, some way,” Jones said. “Whether we do it on the front end with Medicaid expansion or on the back end by trying to provide states additional money in order to deal with the health care related part of this (COVID-19 response).”

Jones also said that the current funding relief from the CARES Act, approved last month in response to the coronavirus, is not the best way to provide people with good health care coverage.

“I think it is in effect ‘robbing Peter to pay Paul,’” Jones said. “…We’re looking at this for the long haul. There is all manner of innovative ways (the state) could fund this if they wanted to but we’re going to have to back fill it anyways, so it just makes sense to figure out how to go straight up with it.”

The CARES Act contained $150 billion to help states and local governments recover from the financial impact of the outbreak and specifically included provisions to help states shore up their Medicaid programs.

According to the U.S. Treasury Department, Alabama is poised to receive around $1.9 billion in state allocations based off of a formula considering state population sizes from 2019.  But right now, it’s unclear just how much of that will go toward Alabama Medicaid.

Jana Ingels, the public information officer for the Alabama Department of Finance, told Alabama Daily News that funds from the various COVID-19 relief sources will be determined through formula calculations.

“These formulae are based on factors relevant to the type of funding and the receiving institution such as population or established federal funds matching rate,” Ingels said. “Further, some funds are being sent directly from the disbursing federal entity to the corresponding state agency.”

The offices of Jones and Sen. Richard Shelby had no information on how much Alabama Medicaid would be receiving in CARES Act funds.

Alabama Daily News reporter Todd Stacy contributed to this report.