“It is, in my opinion, truly the worst piece of legislation that has ever been passed in my lifetime.”
Those were the words Gov. Robert Bentley used Tuesday to suggest his rejection of the Affordable Care Act was motivated by principle, not by pure political calculation.
The retired doctor announced Alabama would not expand Medicaid as permitted under the federal health-care law.
He also announced the state would not set up an insurance exchange under the law, even though he previously supported the idea.
If Bentley’s decision stands, he will have deprived about 250,000 Alabamians of access to health coverage.
But no matter. Alabama’s poor and uninsured — while more numerous than in almost any other state — are neither a majority nor a particularly effective voting bloc.
While imperfect, this “worst piece of legislation” manages to provide access to health care for 30 million uninsured Americans while reducing the deficit. It provides preventive care, thus keeping people in the workforce and reducing emergency room costs.
The broad strokes of this “worst piece of legislation” were designed by conservatives who recognized America’s health-care system was broken but wanted a solution that incorporated private-sector competition.
The federal government would pay for 100 percent of Alabama’s Medicaid expansion for at least three years, after which the state could drop the program if expected efficiencies do not materialize.
Bentley said a state-managed exchange would cost $50 million a year. Yet the Republican governor of Nevada — who also opposed the Affordable Care Act — decided he could do a better job than the federal government at setting up an exchange.
The Nevada exchange has had some start-up costs — reimbursed by the federal government — but it will cost the state nothing once it is in place.
“We’re going to run as a business, charge fees as a business and stand on our own two feet,” said a Nevada exchange official.
The purpose of the exchange is to increase competition among insurers, thus lowering rates. It would be particularly effective in Alabama, where one insurance company controls 90 percent of the market.
Bentley may be making an astute political calculation.
In the process, though, he is hurting the state and turning his back on hundreds of thousands of Alabamians.