Over 1 million Alabamians are now enrolled in Medicaid, the government healthcare program for families and individuals with low incomes or certain disabilities.
According to the Alabama Medicaid Agency, the number of Alabamians on the program jumped by roughly 30,000 this year as ObamaCare started taking effect, spiking Medicaid’s enrollment above the 1 million mark for the first time in state history.
1,020,000 people were enrolled in Medicaid as of March, the most recent available numbers. Part of the increased enrollment also includes over 100,000 Alabama women who currently received free birth control through Medicaid, but none of the program’s other services.
In 2003, Medicaid consumed 18 percent Alabama’s General Fund budget. This year that number has skyrocketed to an incredible 35 percent. Roughly 220,000 Alabamians have been added to Medicaid’s rolls since the housing market crashed in 2008. And in spite of the slowly improving economy, the Medicaid boom isn’t showing any signs of slowing down.
Alabama Governor Robert Bentley has made Medicaid reform one of his top priorities since taking office in 2011. He established the Alabama Medicaid Advisory Commission in October of 2012 to “evaluate the financial stability of Alabama Medicaid and the care that is provided to patients.” In 2013, he signed into law a bill based on the commission’s findings, moving the state from a “fee-for-service” model to a “managed care” structure. Under “managed care,” the government basically says “we have X dollars to provide care,” and private companies are tasked with finding innovative ways to make it work.
It is too early to determine how effective the Medicaid reforms will ultimately be, but the implementation of the president’s healthcare law has put an additional strain on the program.
The success of ObamaCare is at least in part contingent on states’ willingness to expand Medicaid to cover adults who earn up to 138 percent of the federal poverty level. The federal government promised to pay 100 percent of the expansion’s cost for the first three years, then would start decreasing its share of the costs in future years down to 90 percent.
Many conservatives rejected the idea immediately, noting that Alabama having to cover even 10 percent of the expansion would be unrealistic. Lawmakers had to borrow $400 million from the Alabama Trust Fund in 2011 just to make up for the massive shortfall in the General Fund Budget. Piling on more Medicaid enrollees would be insurmountable, they said.
RELATED: Hold the line on Medicaid expansion, Gov. Bentley, we’ve got your back
But Alabama Democrats have continued making Medicaid expansion their top priority in the Legislature, as well as on the campaign trail.
Senate Minority Leader Vivian Figures (D-Mobile) penned an open letter to Gov. Bentley touting the benefits of making the ever-growing program even larger.
“I plead with you to reconsider your stance on Medicaid expansion,” she wrote.
Parker Griffith, the Democrats’ nominee for governor, has made Medicaid expansion the centerpiece of his campaign.
“The first day of my administration, I will call a special session to expand Medicaid,” he proclaimed at a recent event.
Bentley, however, has maintained that expanding the program is not in the state’s best interest.
Here’s an excerpt from his 2014 State of the State address:
Under Obamacare, Medicaid would grow even larger… Here in Alabama alone, an estimated 300,000 more people would be added to the Medicaid role, to a system that by our own admission is absolutely broken and flawed.
The federal government has said they will give us money to expand. But how can we believe the federal government will keep its word? The anything but Affordable Care Act has done nothing to gain our trust.
First, they told us we could keep our doctor – that turned out not to be true. Next, they told us we could keep our policy – that’s not true. Then they told us our premiums would not go up – nothing could be further from the truth. Now they are telling us we’ll get free money to expand Medicaid.
Ladies and Gentlemen, nothing is free. The money the federal government is spending with wild abandon is not federal dollars – those are your dollars, your hard-earned tax dollars. There is no difference between federal money and your money.
Our great nation is 17.2 trillion dollars in debt and it increases by 2-billion dollars every single day.
That is why I cannot expand Medicaid in Alabama. We will not bring hundreds of thousands into a system that is broken and buckling.
But even if Gov. Bentley sticks to his word and refuses to expand Medicaid, it’s current growth trajectory will undoubtedly pose one of the greatest challenges of his second term.
Follow Cliff on Twitter @Cliff_Sims
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