Medicaid expansion can’t wait

Alabama lawmakers can walk, chew gum and whistle Dixie simultaneously when their goal is to undermine public schools.

When it comes to offering health care to 300,000 uninsured Alabamians, however, multitasking is beyond them.
The Alabama Accountability Act began as a bill to provide flexibility for local schools.
Many expected the flexibility law was a first step toward the creation of charter schools. No problem. Some school districts have horrible outcomes. If they had time to take advantage of the flexibility bill and their students still struggled to get a good education, then competition made sense.
In a back-room deal, however, legislators rushed the process. Rather than give the flexibility bill time to work, they lumped it together with previously hidden provisions that reduce funding for all public schools. The result is a poorly drafted law that legislators still don’t seem to understand.
There was no reason to rush the “school choice” portions of the Accountability Act, but there were many reasons not to. Delay would have given school districts a chance to innovate without an additional drop in the state funding that already has fallen 22 percent since 2008. Delay also would have allowed informed input, which would have improved the sloppy law.
When it comes to expanding Medicaid, however, there is a reason to move quickly.

The federal government will fund 100 percent of Medicaid expansion costs in 2014, 2015 and 2016. In 2017 and beyond — if the Legislature decides to continue the expansion — Alabama would have to pay 10 percent.

If the state sticks with the expansion beyond 2016, it would add $771 million in expenses over seven years. It would simultaneously bring in about $11.7 billion in federal funds and generate $935 million in new tax revenue for the state.

GOP lawmakers, or at least some of them, acknowledge the expansion would bring in more tax revenue than it would cost. They acknowledge it would provide health care to 300,000 uninsured Alabamians still reeling from the recession. They recognize it would restore viability to the many hospitals that are struggling because uninsured Alabamians have no choice but to use emergency rooms as their first and only health-care provider.

Their only objection is they want to reform the state Medicaid program first, to chew gum before they walk.

Once the legislative session ends, though, their insistence on implementing Medicaid reforms before expanding the program will cost the state one of the years in which the federal government will cover 100 percent of expansion costs. A one-year delay will result in a loss of $900 million in federal funds. Alabama hospitals and residents will help pay for the expansions implemented in other states, but Alabama will not enjoy the tax revenue from the economic activity and 300,000 Alabamians will remain uninsured.

Reforming the state Medicaid system may be a good idea. Hundreds of millions of dollars and the health of hundreds of thousands of Alabamians are compelling reasons to accept the federally funded expansion while making the reforms.

If the Legislature and Gov. Robert Bentley can walk and chew gum at the same time, now is the time to do it.

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1 Comment

Filed under Alabama politics, education, Medicaid

One response to “Medicaid expansion can’t wait

  1. lee mccain

    Agree here completely. Our state cannot conceivably move forward without taking the Federal Medicaid monies- our health care system will collapse. My concern has always been the future projections especially in light of today’s article. I would really like to know why Alabama claim costs will go up 60% (or Ohio’s 80%). Really thought the states with the most monopolistic private insurance markets would have the highest percentages but as a whole I do not think that holds true. I suspect we will see a massed migration from private insurance in this state- no doubt these cost will be passed on to the point they are prohibitive for most. In this scenario will Medicaid through an exchange make up the difference?

    And thank you for posting these essays. I do not always agree but at least each and every one makes me think. Lately anonymity on the internet has been annoying me and at least you have the chutzpah to sign your name to your pontifications!

    “Anonymity on the internet is the cloak of the coward”- Joe Howard

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