Medicaid is a federal-state program and thus its quality and accessibility depend on the level of commitment from a state.
The sad news is that Alabama is mostly upside-down, demanding more the poor. Alabama’s Medicaid is near the bottom when it comes to the level of poverty it demands to qualify for health care. Same goes for Alabama’s contribution, which has historically been the minimum amount required. When it comes to co-pays from Medicaid enrollees, however, starting next month Alabama will increase them to the highest level allowed by federal law.
Before we completely condemn the Sheriff Nottinghams behind these policies that place a heavy burden on the poorest Alabamians, we should consider things from their point of view. Since the Great Recession of the previous decade, Medicaid has grown to 900,000 enrollees, or more than 1-in-5 Alabamians. This growth along with medical inflation has demanded the state pay an increasing share of its budget for the program; more than one-third of the current General Fund went to Medicaid.
The Republicans in charge in Montgomery surely feel their hands are tied. They need more money, but their ideology and fear of taxes are greater than their concern for the health and well-being of the least of these Alabamians.
Part of this ideological prison is Gov. Robert Bentley’s opposition to expanding Medicaid, which was an option under the Affordable Care Act. The rejection meant Alabama was ignoring billions of federal dollars that would have gone toward an expanded Medicaid program.
“My guess, the guess of most experts, is that in Alabama the expansion would bring in between $15 billion to $17 billion in those first three years with the cost to the state of between $770 million to $1 billion,” Retirement Systems of Alabama CEO David Bronner said recently. “After 2016 the cost to you and me would be 10 cents on the dollar. How dumb would it be not to take that trade? It’s 15-to-1. You’d take that trade all day long.”
The bad news is that Gov. Robert Bentley did not take that trade. An even worse trade is demanding more money from the poor on Medicaid. Unfortunately, that’s the one Alabama took.