Governor’s refusal to expand medicaid makes no sense

Montgomery Advertiser, Editorial, Dec. 15, 2013

The humanitarian aspect of expanding Medicaid under the Affordable Care Act should be its most appealing feature. In our state, more than 300,000 people - mostly the working poor - could gain health care coverage under the expansion allowed under the law. The long-term implications for Alabama in terms of a healthier, more productive population are enormous.

If one is not moved by the humanitarian considerations, then perhaps the fiscal benefits of expansion would touch a chord somewhere. As a study by University of Alabama at Birmingham researchers found, expanding Medicaid would dramatically boost the state's economy. The added jobs and added tax revenue from them would far outstrip even the largest economic development projects our state pursues.

The cost of expanding Medicaid coverage to individuals and families with incomes of less than 138 percent of the federal poverty level - about $32,500 for a family of four - is covered entirely by federal funds for the first three years. After that, the federal portion drops to 90 percent, still an extraordinarily favorable arrangement for the state. Who would not choose to leverage a 90-10 split, especially with the benefit it offers to hundreds of thousands of people?

Yet Gov. Robert Bentley will have no part of it. Instead, he continues to deride "Obamacare" as ruinous public policy, as if by saying enough bad things about it and refusing even the most basic involvement, he can make it go away. He can't, of course, and it is foolish and harmful to proceed on this course. Other Republican governors with conservative credentials as stronger or stronger than Bentley's have recognized this and moved ahead with expansion in their states.

The act is indisputably the law of the land, yet Bentley wouldn't even create the state-run insurance exchange provided for in the law to give Alabamians some options and help them make the best decisions for themselves and their families. He washed his hands of the whole thing and left the establishment of the exchange to the federal government, despite the opportunity under the law for Alabama to form its own exchange in a manner that might better benefit our people.

This intransigence will cost Alabama dearly. A new study by The Commonwealth Fund finds that the 20 states that have chosen not to expand Medicaid will not only fail to make affordable health care available to millions of their people, but also will lose billions in federal funding. The net loss to Alabama alone is put at $942 million in the study.

Alabamians will be paying federal taxes that go to support the expansion in other states, but getting none of the benefit here.

Bentley is forever touting his emphasis on jobs and economic development, and these certainly should be priorities for him. Yet when presented with an opportunity to bring thousands of new jobs, hundreds of millions in new tax revenue and federal funds and improve the health of the state and the lives of the working poor at the same time, he turns his back on it.

Bentley is a physician and even though he isn't practicing medicine these days, we remind him that malpractice can occur in the governor's office as well.

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