Alabama Hospitals Taking Hit, July 20, 2014

Although the number of Alabamians with health insurance has increased, hospital officials said they are still treating the same number of uninsured patients as they were before the Affordable Care Act's implementation.

"In Alabama, we're getting hit multiple times," said David Spillers, CEO of the Huntsville Hospital System, which manages Decatur Morgan General. "We're not expanding Medicaid, the number of uninsured is going up, and people insuring with high deductibles are going up."

Spillers, who serves on the Alabama Hospital Association Board, said these problems are not limited to north Alabama -- it's throughout the state.

According to a report released by the Congressional Budget Office last week, the number of people with health insurance purchased through ACA exchanges will more than double next year. Enrollment numbers are expected to reach nearly 13 million and then grow to 24 million in 2016.

At the end of the last enrollment period, 97,838 Alabamians enrolled for health care through the marketplace.

Spillers said the hospital is also seeing more debt. People might have insurance, but they're underinsured, he said.

"Some people who had good insurance with good deductibles had to convert to plans with high deductibles," Spillers said. "I know many people personally that had $500 deductibles and now have $6,000 deductibles."

Spillers said hospitals are absorbing that cost of uncompensated care. The hospital and its affiliates' debt is up 1 to 2 percent this year.

"One percent of our system expenses is $10 million," Spillers said. "One to 2 percent of that is a lot of money."

Spillers said the Huntsville system requires patients to show proof of their inability to pay the bill.

Expanding Medicaid would significantly help alleviate the problem, he said, adding that more people would have access to coverage.

Even though enrollment numbers are expected to increase, Alabama Arise health policy analyst M.J. Ellington said Alabamians are being left behind.

Singles with an annual income between $4,000 and $11,670 do not qualify for assistance in the marketplace.

"Many people in Alabama still do not know that a lot of folks in the coverage gap are people with jobs," Ellington said. "It's surprising how many people in the gap do actually work. A lot of people do not understand that."

Alabama Policy Institute policy counsel Brandon Demyan said the No. 1 reason to not expand Medicaid is simply because it's not free.

"People say the federal government is going to give us money, and there's no reason to not do it," Demyan said. "The money comes from somewhere."

Medicaid is the state's biggest expense in the General Fund budget. The state allotted $685 million for Medicaid in the 2015 fiscal year, which is a $70 million increase from the 2014 fiscal year budget.

"That's without the expansion. We simply can't afford it," Demyan said. "It's not that I hate people or am saying people are lazy. It's math."

Demyan said a better way to go about insuring more people is to grow the economy.

"We've got to repay the rainy day fund ... there will be a lot of tough budget decisions for everybody to keep what services have been given, let alone expanding them even more," Demyan said.

The enrollment for the marketplace will begin again Nov. 15 and go through Feb. 15, 2015.

Medicaid funding

Alabama's General Fund appropriation for Medicaid since 2003:

2003: $222,328,795

2004: $260,063,045

2005: $364,440,334

2006: $418,801,203

2007: $399,947,450

2008: $471,129,801

2009: $450,729,678

Social Security changes you need to know now.

2010: $314,967,819

2011: $400,287,110

2012: $575,418,345


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