The Affordable Care Act will have both costs and benefits. Given that Alabama will benefit more than almost any state from the law, it is striking that the state’s politicians focus almost entirely on the costs.
Alabama has been a national leader in the effort to block the health-care reform law, scheduled for full implementation Jan. 1.
The state joined a lawsuit seeking to keep the law from taking effect. The lawsuit was partially successful in that it led to a ruling allowing states to decide whether or not to expand Medicaid eligibility, an important part of the effort to provide universal coverage. Alabama was quick to announce it would not expand its Medicaid, even though the state’s existing program is one of the most skeletal in the nation.
Gov. Robert Bentley refused to create a state insurance exchange — even though he supported the concept when it was not a part of “Obamacare” — in the expressed hope that the burden on the federal government of creating numerous exchanges would undo the law.
Alabama’s elected federal officials routinely vote to eliminate funding for the Affordable Care Act and its representatives to the U.S. House have voted to repeal it more than 30 times.
In a state that was either wealthy or healthy, the opposition might make sense. States like Massachusetts, Oregon or Connecticut — which have life expectancies of about 80 years or more and healthy populations — might reasonably chafe at sharing in the costs of the law, when most of the benefits would accrue to other states. Almost all of their residents already have health insurance; why should they subsidize states that have a large percentage of uninsured residents?
As Alabama politicians — all of whom have health insurance — lead the fight to destroy the Affordable Care Act, their constituents lead the nation in their desperate need for reform.
Fewer than half of Alabamians have employer-provided health insurance, according to the Kaiser Family Foundation. Another 30 percent have governmental insurance, either Medicaid or Medicare. Almost 700,000 in the state — about one in six — have no public or private health insurance.
The life expectancy of Alabamians is 75, the second worst in the nation (thanks, Mississippi) and well below the national average of 79. A Centers for Disease Control study released last month shows that Alabamians who reach the age of 65 can expect to live another 17.6 years, the third worst in the nation. Only 11 of those years will be in reasonably good health, also the third worst in the nation.
Alabama has the third highest infant mortality rate. Alabama has the eighth highest rate of child obesity, an important indicator of future health, and the third highest mortality rate for children. The state has the fifth highest rate of diagnosed diabetes and the second highest rate of deaths related to heart disease.
Alabamians are not just less healthy than the residents of other states, they lack the resources to do anything about it. Almost one in four Alabamians have incomes below the federal poverty level.
The health-care system may work effectively in some states, but in Alabama it is broken. The potential benefits of reform far outweigh the costs. Rather than trying to undermine the first serious effort at reform in a generation, those charged with representing the interests of Alabamians should be trying to make sure it works.