Bentley’s more open approach welcomed

Montgomery Advertiser, December 23, 2014

We're encouraged that Gov. Robert Bentley is softening on providing health insurance coverage to more of Alabama's working poor.

Bentley didn't outright embrace accepting Affordable Care Act dollars to close Medicaid coverage gaps for those earning up to 138 percent of the federal poverty level. But he did say he was open to looking at a block grant program similar to one Republican-led Arkansas has adopted.

The Arkansas model takes federal ACA dollars, but uses them to fund private health coverage – not Medicaid -- for as many as 200,000 low-income residents.

While opening that door for Alabama's estimated 300,000 uninsured citizens may seem like a terrific idea, fiscal conservatives should take note it may be an expensive option to pursue.

Privately managed plans tend to cost more than basic Medicaid coverage, with dollars siphoned off for insurance company profits.

That's why Wyoming, also under Republican leaders, rejected the private option and is pursuing a more traditional expansion of Medicaid.

But there's a fly in that ointment, too. Wyoming wants to charge families earning 100 to 138 percent of the federal poverty level monthly premiums, as much as $50 a month, with possible additional charges even for those below the FPL.

That's a slap in the face to service industry workers, many of whom hold multiple part-time jobs just to pay for basic necessities, and not the way Alabama should go.

Bentley says he would want to tie a hypothetical block grant expansion of coverage for the poor to employment. Recipients, with the exception of individuals with disabilities, would have to be working or seeking work to qualify for aid.

We won't quibble with that, except to point out, again, that many of them are indeed employed.

Another red-state approach to accepting ACA dollars without appearing to support the Obama administration's health law is in the works in Tennessee and deserves examination.

There, GOP Gov. Bill Haslam has received tentative federal approval to cover the uninsured through both traditional Medicaid and private employer plans. Those put in private plans would receive help with co-pays or have premiums waived if they get preventive screenings.

But the most innovative part of the Tennessee plan is how it taps for-profit hospitals to foot the bill for costs not covered by the ACA after 2016.

Those hospitals, some near bankruptcy, are desperate to see Medicaid expanded because they otherwise bear the cost of treating the uninsured, as do Alabama hospitals.

Finding a palatable combination of policies to expand health care coverage to Alabama's uninsured workers won't be easy. But it's a moral and fiscal imperative. State lawmakers should make it a priority, not just a grudging possibility.

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