Medicaid Expansion in Alabama: The Battle of the Five Armies

Mar 25, 2015

The current state legislation session is underway and one topic that seems to be getting a cold reception is Medicaid expansion. Governor Robert Bentley caused political shockwaves when he said he was at least open to the idea.

That guarded endorsement isn’t winning a lot of support in the state House and Senate.

But a proposal to insure more than 250-thousand Alabamians is not getting anywhere.

“We must take real steps to reverse the trouble health trends that have occurred in our state.”

Alabama Governor Robert Bentley has made it clear that he wants to make sure citizens in his state get quality affordable healthcare, as long as it has nothing to do with the Affordable Care Act.

The ACA just celebrated its fifth anniversary. One hundred and seventy one thousand Alabamians are getting coverage through the federal program.

One of the most important provisions of the Affordable Care Act is the expansion of Medicaid, which provides health coverage to low-income families.  It’s a joint federal and state funded program that provides health care for more than 60 million low income Americans.  A family of four earning 30-thousand or less or an individual making 15-thousand or less are eligible for this program.

However Alabama is one of 19 states that opted out of Medicaid. Critics call it a flawed system and many want a new plan in place.  That prompted Bentley to say, maybe in his State of the State earlier this month.

“But we cannot allow federal bureaucracy and the extremely flawed patient protection affordable care act, to derail our efforts,” Bentley says.  “To make sure Alabamaians have good quality healthcare, especially the poorest and the most vulnerable.”

Letting states Opt-out of the Affordable Care Act Medicaid expansion leaves millions of Americans without coverage, it also costs taxpayers money due to outrageous costs of emergency services if they get sick.

State lawmakers worried about the cost of the program.

“How do you pay for it?”

That’s state senator Cam Ward.  He and many other conservative lawmakers are working with the Governor to try and expand Medicaid. However, Ward says this issue is out of his and the legislature’s hands. He’s challenging the voters to make up their mind about Medicaid.

“I just don’t hear the clamoring from the voters,” Ward says  “I get people from time to time that want it, typically a lot of mental health advocates who are going to have their benefits increase as a result of this.  We’re just not hearing people say, ‘Yes I want to raise taxes to increase Medicaid.’ That’s just something you don’t hear.”

This is how Medicaid expansion works under the affordable car act. The Federal Government pays one hundred percent of the total cost up to 2016.  At that point, states including Alabama will have to cover ten percent of the cost. A study in 2012 by health care economists at the University of Alabama at Birmingham says this could be a money maker. The report suggests the state would gain almost $1 Billion in tax revenue.

So why aren’t GOP lawmakers lining up to support the plan? Democratic State Representative Craig Ford has a one word answer to Republican opposition. That word is Obama.

“And they said it’s too good of an opportunity to provide healthcare to the people in their state,” Ford says.  “It’s nothing more than just a political ploy on the Republican Party here in Alabama.  Just to say that if it has anything to do with Obama or federal, they don’t want to have anything to do with it.”

Tennessee tried a similar approach and ended up with the same result.  Governor Bill Haslam attempted to create a program called “Insure Tennessee” which needed legislative approval.  Haslam called a special session to help create the law but the measure died in a senate and welfare committee.

The bill could have insured more than 220-thousand low-income Tennesseans…

“The biggest complaint and concern that you heard about the law was that it was some way, too similar or too closely-connected with the affordable care act.”

That’s Dave Boucher, the political reporter for the Tennessean, the state’s biggest newspaper. 

“The republicans in the south, live in states where the President is extremely unpopular and anything that could get them tagged as someone who supports the president’s plans, could certainly hurt them in a reelection bid,” Boucher says.

Ward and Ford both argue the state has bigger fish to fry in the state, like the $700 million dollar budget shortfall the state is in right now.  Governor Bentley proposed a tax increase of more than a half billion dollars to plug the holes in the state’s coffers. 

Ford calls it a “travesty” that Alabama is not a part of the Medicaid Expansion under the affordable care act. 

“They treat the federal government like a one night stand.  We’re a taker state.  For every dollar we send to DC, we get three and a half dollars back. The roads that we’re driving on today are 90 percent paid for by federal funds.  You can’t pick and choose what you want from the federal government and unfortunately they’re trying to do that and they’re hurting our people in Alabama for not providing them healthcare coverage but unfortunately, people are buying that argument.”

Until the Alabama Legislature can come to an agreement for the voters to decide on how to proceed and pay for it, both sides believe the murky waters of Medicaid expansion will get deeper.