RSA chief David Bronner says opinions on Obama irrelevant to Medicaid expansion, which he supports, Nov. 21, 2013

Retirement Systems of Alabama CEO David Bronner urged hundreds of lawyers at a conference today to help persuade Gov. Robert Bentley to expand Medicaid under the Affordable Care Act.

“Each of us will benefit from a single signature by the governor,” Bronner said. “I urge you to help me convince the governor. He’s a good guy. He just doesn’t understand.”
For months, Bronner has been speaking out in favor of expanding Medicaid as allowed under the ACA. Most of the November issue of the RSA’s newsletter, The Advisor, is devoted to the issue. The governor opposes expansion, which is optional for states.

Bronner spoke today at a legal conference hosted by the Beasley-Allen law firm at the Renaissance Montgomery Hotel. More than 2,000 lawyers attended the event.

Beginning next year, the federal government will pay states to expand their Medicaid coverage under Obamacare. Studies have shown that expansion would add about 300,000 people to Alabama’s Medicaid rolls. The program already covers about 900,000 Alabamians. Federal funds would pay the full cost the first three years and ramp down to 90 percent after that.

Bronner said opposition to Obamacare and dislike of the president’s policies do not justify turning down $4.5 billion in federal funds over the next three years. “I have never found anybody who wants to hurt a whole population because of some political philosophy of ‘I hate Obama,’ “ Bronner said. “I don’t care if you hate him or love him. It’s irrelevant.”

Bronner, who has worked to recruit jobs to the state for decades, argued that Medicaid expansion was an economic development bargain. He cited a study commissioned by the Alabama Hospital Association and done by the University of Alabama Center for Business and Economic Research that said Medicaid expansion would add 30,700 jobs over a six-year period. He contrasted that with the state spending hundreds of millions on incentives to recruit companies like Airbus and Mercedes, efforts he supports.

“But I’m going to turn down 30,000 jobs and not spend a damn dime?” Bronner said.

The state would have to pay 10 percent of the cost of expansion after the first few years. Bronner said the new tax revenue generated by expansion would more than cover that state cost.

A study by the Kaiser Family Foundation found that expanding Medicaid would cost Alabama about $1 billion over the next decade but found the state would draw $14 billion more in federal funds.

Bentley, who is asked almost daily Medicaid expansion, shows no signs of changing his mind. “Medicaid in Alabama for years has been a broken system, and our focus is on fixing the system – not expanding something that’s broken,” Bentley spokesman Jeremy King said today.

King noted that Bentley this year signed Medicaid reform legislation intended to increase efficiency and improve patient care by setting up a network of managed care organizations. The governor also set up a commission to study ways to reduce Medicaid pharmacy costs.

“Reforming Medicaid is a long-term process,” King said. “Our focus is making sure we have an efficient, well-managed system.”

Much of the recent attention on the ACA has been on problems with the online Health Insurance Marketplace and the cancellations of individual health plans. But one of the main ways the ACA was intended to cover the uninsured was through an expansion of Medicaid. Expansion was intended to provide insurance for those too poor to buy insurance on the new exchanges.

The ACA sets Medicaid eligibility at 138 percent of the federal poverty level, which in 2012 was about $15,000 for an individual and $26,000 for a family of three.

A study by the University of Alabama at Birmingham’s School of Public Health estimated that expansion would add almost 300,000 people to Medicaid rolls in Alabama.

See the UAB Medicaid study.pdf

But a U.S. Supreme Court ruling last year found that Medicaid expansion was optional for states under Obamacare. Alabama is one of 25 states that has opted against it. Bronner said failure to expand Medicaid will not spare Alabamians the cost of paying for health care for the uninsured. He said Alabamians would continue to pay that cost through higher hospital bills because hospitals don’t turn away the uninsured who can't pay but show up at emergency rooms.

Bronner said rural hospitals would close as a result of the failure to expand Medicaid. The ACA calls for cuts in federal payments to hospitals that are intended to offset hospitals’ costs in treating the uninsured. The law cuts those payments because presumably many of those uninsured patients would become Medicaid recipients under an expanded system. Bronner said counties with no hospital stand no chance of attracting new industry or employers. Bentley has said he recognizes problems faced by rural hospitals and plans to work with the state health agencies on solutions.

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