Alabama hospitals launch campaign for Medicaid expansion

Sept. 21--Once focused on health, advocates of Medicaid expansion in Alabama will try wealth.

The Alabama Hospital Association has launched a campaign touting the potential economic benefits of expansion, which could extend health insurance to tens and possibly hundreds of thousands of working people in Alabama. While advocates have emphasized both elements in the past, Danne Howard, the executive vice president and chief policy officer of the AHA, said potential business benefits would be the focus of the campaign.

"It's taking the angle that health care is part of the state's infrastructure," she said. "Businesses are unwilling to come to areas of the state that don't have access to health care."

Howard said the campaign would give also the group the chance to show the chief beneficiaries of expansion would be working individuals.

The AHA has campaigned for Medicaid expansion in part to improve the bottom line of hospitals, most of which are operating in the red, and help out hospitals in rural areas, where several facilities have closed in recent years and most face funding crises.

Medicaid in Alabama currently covers about 1 million people, mostly children, elderly and the disabled. Childless adults almost never qualify, and adults with qualifying children can only receive benefits if they make 18 percent of the poverty level -- $3,740 a year in a household of three. Medicaid expansion would allow those making up to 138 percent of the poverty level -- $16,753 for an individual and $28,676 for a household of three -- to receive benefits. The federal government would pay at least 90 percent of the costs of expansion.

A 2012 University of Alabama Birmingham study estimated expansion could cover 300,000 Alabamians. A June report from the Kaiser Family Foundation, a nonprofit that tracks health care issues, about 75,000 Alabamians are currently in a "coverage gap," making too much to qualify for Medicaid as it currently exists and too little to qualify for subsidies that pay for Affordable Care Act plans. About 57 percent of those in the gap are women; 50 percent are in a working family and 49 percent are people of color.

The 2012 UAB study estimated that Medicaid expansion could generate $2.2 to $4.6 billion of new economic activity in the state annually and between $12 and $26 million in new tax revenue each year.

Republicans in the Legislature have generally opposed expansion, due to opposition to the Affordable Care Act and concerns about the cost of providing the state match, which the UAB study estimated could range from $178 million to $375 million a year. Total state and local economic incentive packages for the Toyota Mazda plant in Huntsville are expected to be north of $700 million.

Howard said states that have pursued Medicaid expansion, like Louisiana have seen "billions" of dollars in economic activity.

"If I were to tell you, 'If you give me a dollar I will guarantee you a $10 return,' would you take that investment?'" she asked. "The return on the investment is the economic activity that results."

Democrats generally have expressed support for Medicaid expansion, and the party's gubernatorial nominee, Walt Maddox, has made expansion a key part of his campaign. Republican Gov. Kay Ivey has expressed skepticism about paying for it.

The Alabama Hospital Association does not appear to be making support or opposition to Medicaid expansion part of its political strategy. According to campaign finance reports, its political action committee contributed $10,000 to Ivey's campaign earlier this year, but through Aug. 31 gave Maddox's campaign nothing.

Howard said they saw the new campaign as a chance to educate people already agreed on the critical role of Medicaid in Alabama's health care system.

"In this circumstance, and we're talking Medicaid expansion, we feel like we're fortunate that everyone understands the importance of health care," she said.

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