Medicaid expansion debate comes to Decatur

Oct. 17--Democratic gubernatorial nominee Walt Maddox said here Tuesday one of his highest priorities if elected is to expand Medicaid, an action he said would provide health insurance coverage for thousands of Alabamians without it and help prevent more rural hospitals from closing.

"The first thing I do as governor would be signing an executive order expanding Medicaid," Maddox said Tuesday afternoon at a campaign stop in Decatur at the Morgan County Democratic Party headquarters.

"(Medicaid expansion) would provide 330,000 Alabamians, mostly working or veterans, the opportunity to health insurance," he said.

It's a move Republican Gov. Kay Ivey and GOP lawmakers have said is impossible given state budgetary limitations.

Right now, Medicaid covers about 1 million people in Alabama: seniors, the disabled and children, Maddox said.

Under the Affordable Care Act, Medicaid eligibility is extended to nearly all low-income individuals with incomes at or below 138 percent of poverty, that is, $28,676 for a family of three in 2018.

Efforts to reach Gov. Kay Ivey's campaign on Tuesday were unsuccessful, but last month she said Medicaid expansion was unlikely.

"We all want high-quality medicine at an affordable cost available to everybody," she told reporters, "but you've got to figure out how you're going to pay for it, because we've got a bare-bones budget for Medicaid now."

The federal government would pay about 90 percent of the costs of Medicaid expansion.

"How we plan to pay the 10 percent match is two-fold," Maddox said. "No. 1, we will propose to the Legislature that the payroll taxes generated from new jobs that are created from the expansion -- which is an estimated 30,000 new jobs -- would be escrowed to pay off any offset to the expansion of Medicaid."

Maddox also expects Medicaid expansion would result in savings within the existing system.

According to the Louisiana Department of Health, Medicaid expansion saved that state $199 million in fiscal 2017. The savings, according to the department, came from reduced payments to hospitals, increased federal funding, and revenue from a tax hike on organizations that manage Medicaid programs.

That level of savings, Maddox said, would be more than enough in Alabama to pay off the 10 percent local match, an estimated $180 million for Alabama.

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Maddox said numerous studies show the majority of the more than 30 states that have expanded Medicaid have been able to cover their local match through the growth in their economies and savings in their existing Medicaid systems.

According to Maddox, in the first six years, Medicaid expansion would add $17 billion to the state's gross domestic product and increase the wages of Alabama workers by $10 billion.

"It will also stabilize Alabama's health care network and keep rural hospitals open," Maddox said.

According to Danne Howard, executive vice president and chief policy officer of the Alabama Hospital Association, 12 hospitals have closed in Alabama since 2011, and six of those were rural hospitals. That includes the 150-bed Hartselle Medical Center that closed in January 2012.

The hospital association recently launched a campaign, called ALhealthmatters, supporting Medicaid expansion.

"If all things stay the same with our uninsured population, we can easily see hospitals having to lay off employees and discontinue services, and we will probably see more hospitals close," Howard said.

A growing number of working Alabamians do not have health insurance because they can't afford it through their employers' plans or they're not eligible for it, she said.

"That's exactly what Medicaid expansion would help resolve," she said.

"On average, almost one out of every 10 patients that come into (Alabama) hospitals does not have health insurance," resulting in more than $530 million a year in uncompensated care, according to Howard.

Howard said 74 percent of all Alabama hospitals are now operating in the red, meaning the money they receive for patient care isn't adequate to cover the costs of that care.

Ivey recently announced the federal government has approved a new statewide care-management program to enhance the current system of long-term care services provided to about 23,000 Alabama Medicaid recipients.

The Integrated Care Network program is for Medicaid recipients who live in a nursing facility or receive services in their homes through Medicaid's Elderly and Disabled waiver or the Alabama Community Transition waiver.

"We will continue to work with (Centers for Medicare and Medicaid Services) to improve our Medicaid system and look for new, innovative ways to bring quality health care to our citizens, especially those in rural Alabama," Ivey said in a statement.

[email protected] or 256-340-2438. Twitter @DD_MAccardi.

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