Could opposition to the Affordable Care Act in the Deep South finally be softening? Alabama Gov. Robert Bentley said Thursday he was considering expanding Medicaid under the healthcare law even though he has long opposed doing so. An estimated 139,000 Alabamians would gain health insurance coverage if the state expanded Medicaid.

In December, Bentley told Business Alabama: “It’s not fiscally responsible to expand a broken system,” and that instead, “I am working to make the current Medicaid system more effective and efficient for the people currently enrolled.” 

But the governor adopted a slightly different stance Thursday. "We are looking at that," he said at a legal conference in response to a question from the audience, the Associated Press reported. He said he was "concerned about the plight of the working poor," because if doctors were not paid to see such patients -- in Alabama, Medicaid providers include 66 rural health clinics -- then there would be little incentive for physicians to practice in those areas. 

Under the Affordable Care Act, states can receive federal dollars to expand their Medicaid programs to people earning up to 138 percent of the federal poverty level, or just under $16,000 in annual income for an individual and $33,000 for a family of four. The law initially required states to expand Medicaid, but the Supreme Court ruled in 2012 such an expansion had to be optional.

The exact mechanisms for expanding Medicaid in Alabama have yet to be determined. "We have not made a final decision on that yet, exactly how that would work," Bentley said. He has previously advocated for a state program that would require Medicaid recipients to work and pay monthly premiums, and said the fact the state would gradually have to cover an increasing proportion of the costs of expansion could pose difficulties. The federal government covers 100 percent of the cost of Medicaid expansion through 2017, and after that, support drops to 90 percent through 2020.

Most recently, Montana became the 30th state to expand Medicaid, despite Republican state lawmakers' opposition. Indiana and Alaska are the other states that expanded Medicaid in 2015. The vast majority of the 20 remaining states that have not expanded Medicaid are in the Deep South.

Researchers at the University of Alabama have estimated expanding Medicaid in Alabama could create at least 30,000 jobs. Alabama's median household income, from 2009 to 2013, was $23,680, compared to the national average of $28,155. During the same years, about 18.6 percent of Alabamians lived below the poverty level, according to the U.S. Census Bureau. In 2016, more than 1 million residents of Alabama were expected to be recipients of Medicaid program in its current form.