Alabama Voices - Thomas Vocino: State expanding Medicaid serves the public best
July 7, 2013, Montgomery Advertiser
The country’s and Alabama’s prosperity are impacted positively by a strong and vibrant private sector. Small and large businesses create jobs and sustain growth in the economy. As a society, we must never lose sight of the contributions the private sector makes to the quality of life nationally and locally.
For the most part, and especially in Alabama, we are willing to applaud and shower accolades on the individuals and companies that provide jobs for us and our fellow citizens. Nothing could be more appropriate, as the income from jobs drives prosperity.
However, at the same time that we are willing to acknowledge and applaud the importance of the private sector, we seem to be far less willing to appreciate the critical role that public programs play in the prosperity and overall quality of life in our society. There seems to be a growing belief, especially in Alabama, that it is to our detriment that government plays an important role in the lives of citizens and that a high priority must be to reduce significantly society’s commitment to the provision of government services.
As problems such as the lack of access to health-care services for a large portion of the population and continued high levels of unemployment exist even with an improving economy, I believe that this reality clearly indicates a need for more robust public programs to serve persons who cannot surmount obstacles that keep them in a permanent underclass. Underscoring this societal problem of limited life chances for large numbers of people are the recent reports that a third or more of public high school students in Montgomery County do not graduate.
In a situation of extremely tight budgets in Alabama, there are very few realistic opportunities to make a positive difference for people in marginal financial situations, save one. This option is for Alabama to exercise its right to expand Medicaid under the auspices of the Affordable Care Act.
In this case, Congress has already allocated large dollar amounts to the states to improve the health and wellness of the poor and near poor of all ages. To date, 36 states have realized that for a minimal investment of state dollars to pay for expanding Medicaid, the families of the working poor — persons employed who make an income no more than 133 percent of the poverty level — will have a means to fund the most basic health care services that they had not been able to afford in the past.
The beauty of this program for Alabama is that if we choose to expand Medicaid under the Affordable Care Act, all of the direct care costs of the program will be paid with federal funds for the period of 2014 through 2016. In 2017, if Alabama participates in Medicaid expansion, it will be obligated for 5 percent of the program costs, and by 2020, the state share of Medicaid expansion will top out at 10 percent. A study done at the University of Alabama-Birmingham indicates for the first seven years of the expanded program, an Alabama investment of $771 million would bring $11.7 billion in federal dollars into the state.
If Alabama continues its intention to not participate in the Medicaid expansion under the Affordable Care Act, it will forgo resources that could make an enormous difference in ensuring that medical services such as hospitals and physician practices survive in rural Alabama. Most importantly, Medicaid’s expansion will ensure health care for men, women and children who are unable to secure on their own these critical services.
I hope the possibility of the real health care improvements and economic benefits for Alabama under ACA will prevail over the symbolic need to resist a federal program initiated by a president who is unpopular in Alabama.
Reach Thomas Vocino, executive director of the Center for Leadership and Public Policy at Alabama State University, at tvocino@alasu.