Medicaid's legislative advocates press governor on program expansion
by Tim Lockette
Feb 27, 2013 | 4260 views |  0 comments | 7 7 recommendations | email to a friend | print
MONTGOMERY — Democrats in the Alabama Senate are keeping the pressure on Gov. Robert Bentley to expand Medicaid, having introduced a bill Tuesday that would require the governor to expand the program under the Affordable Care Act.

“We are calling on the governor, who is a doctor, to put people over politics,” said Sen. Quinton Ross, D-Montgomery.

Ross and several other Senate Democrats held a Statehouse news conference Tuesday to announce the introduction of a two-page bill that would require the state to grant Medicaid to “all who are determined to be eligible for assistance and for whom federal matching funds are available.”

That wording is a reference to the Patient Protection and Affordable Care Act, otherwise known as Obamacare, which originally required states to expand Medicaid coverage to eligible people with incomes less than 133 percent of the federal poverty level. After a Supreme Court ruling on the act, states were allowed to opt out of the requirement. Bentley chose not to expand the program.

The state’s Medicaid program currently covers only people at or below the poverty level — about 900,000 at present. The expansion would add roughly 300,000 to the rolls, by some estimates.

Democrats took Bentley to task for the decision Tuesday, noting that the expansion would be covered entirely by federal funds in the first three years and at 90 percent or more thereafter. It’s a simple way, Democrats said, of helping Alabamians make ends meet.

“These are people who have jobs and are working, but neither have insurance, or can’t afford it,” said Sen. Roger Bedford, D-Russellville.

Bentley has maintained that the program can’t be expanded in its current condition. The state’s costs for Medicaid have mounted in recent years, due mostly to increases in enrollment after the recession. The program is now the single most expensive item in the General Fund budget.

Bentley originally stated that he would not expand Medicaid “under its current structure.” The Legislature is expected to consider some sort of reform of Medicaid this year, likely a proposal to move toward a managed-care model.

Asked Tuesday if he would expand Medicaid after this year’s expected reforms, Bentley initially said flatly: “No.”

He later returned to the question. “You said this year?” Asked if he would expand the program when reforms are complete — even if it’s in a future year — Bentley again said he wouldn’t expand under the current setup.

“I am not for expanding a broken system, and the system in Alabama is a very poorly designed system,” he said.

Bentley said that even with the federal government paying for the initial expansion, the expansion comes with a cost.

“People are saying it’s free,” he said. “Folks, you can look at sequestration right now in Washington. There is nothing free.”

Indeed, it’s not clear that reform of Medicaid would actually cut the program’s costs. The state’s Medicaid Advisory Commission, appointed by Bentley to overhaul the program, concluded earlier this year that its proposed reforms would slow the growth in the program’s costs, but wouldn’t cut them.

In their press conference, Democrats invited like-minded Republicans to join them in passing the Medicaid expansion bill. The bill won’t pass without someone crossing the aisle, and in significant numbers; Republicans hold supermajorities in both houses.

Anniston Republican Sen. Del Marsh, the president pro tem of the Senate, isn’t likely to be one of the crossovers. He said it doesn’t make sense to expand the program until the system is overhauled.

“Let’s fix the problem first,” he said.

The bill is the latest in a series of actions by Senate Democrats to draw attention to the Medicaid question. Early in the Senate term, Democrats announced Medicaid expansion was their only legislative goal. On Thursday, Sen. Vivian Figures, D-Mobile, introduced a resolution urging Bentley to expand Medicaid. The resolution prompted Republican leaders to vote for a quick recess, and left Senate Democrats shouting that the recess violated the rules.

Democrats said at the time that they could introduce a similar resolution every day of the session.

Capitol & statewide correspondent: 256-294-4193. On Twitter @TLockette_Star.

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