Ken Hare In Depth: Bentley bends on Medicaid; RSA looks at oversight rules

WSAF, December 30, 2014

The election is over, Gov. Robert Bentley cannot run again in four years, and now he announces that he is open to an expansion of the state's Medicaid program, provided it is done with certain limitations. Is anyone really surprised?

Mind you, he didn't say he would push Medicaid expansion in Alabama, and he certainly didn't say that he would endorse doing it in a straightforward fashion under Obamacare.

But he did make it clear in remarks to lawmakers earlier this month that he would be open to taking federal money as a block grant under the Affordable Care Act and using it to purchase health insurance for low-income Alabamians through an exchange that involves the private sector.

That approach sounds a lot like one currently pursued by Arkansas and a handful of other states.

While some in the news media maintain that Bentley has been staunchly opposed to Medicaid expansion, his early comments on the issue left a lot of wiggle room. For instance, he once said he opposed expanding a "broken system," leaving the possibility for some sort of expansion once the reforms that he was proposing to Alabama's Medicaid program were in place. He announced details of some of those reforms in recent public remarks.

The Affordable Care Act originally would have required states to provide Medicaid coverage to those whose incomes were 138 percent or less of the federal poverty line — currently about $33,000 for a family of four.

The federal government would cover almost 100 percent of the full cost of the expansion through 2016. After that, the percentage that a state would have to provide would increase gradually until the state had to cover 10 percent of the cost. From that point on, the federal government would cover 90 percent of the cost.

Such an expansion would provide health coverage to an estimated additional 180,000 or more Alabamians.

According to news reports, Bentley also said any expansion should be limited to those who either have a job or are looking for a job.

But that should not be a major stumbling block, since many of the jobless in Alabama already qualify for Medicaid. Any expansion would largely cover the working poor anyway.

Bentley and others have said that Obamacare would push up the national debt, and that is a legitimate concern. But that's going to happen regardless of whether Alabama participates, and Alabamians are going to help pay for it whether or not the state takes part.

Studies have shown the likelihood that the infusion of billions of federal dollars into Alabama's economy from an expansion would create enough growth in the economy to cover much of the state's share of the cost of expansion. The problem is that the state's aggressive earmarking of tax revenues would target most of that revenue growth for education, making it difficult to use it to cover the state's share of expansion costs. But if the governor and Legislature could capture at least some of the growth in tax revenue, it could help cover the state's share.

But the bottom line is that Medicaid expansion could help 180,000 or more working Alabamians get health insurance coverage. The exact number would depend upon the details of how the state might handle a block grant approach. That's the reason that the Legislature and the governor should try to make this happen.

It boils down to this: Alabamians are going to help pay for Obamacare, regardless of what the state does. The question is whether -- in return for their investment -- Alabamians are going to get more health coverage for their fellow citizens and the jobs and economic benefits that come from huge amounts of federal money flowing to the state.

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