MONTGOMERY — Gov. Robert Bentley on Tuesday said Alabama will not expand its Medicaid program to cover thousands more low-income residents under the federal Affordable Care Act.
He said the state won’t run its own health care exchange, where people and small businesses can shop for private insurance.
“I am not going to set up a state-based exchange that will create a tax burden of up to $50 million on the people of Alabama,” Bentley said in a written statement Tuesday.
“As governor, I cannot support adding such a tax burden on to our citizens.”
He said he wouldn’t expand Medicaid, which currently serves more than 900,000 low-income and disabled Alabamians, because the state can’t afford it.
“The Affordable Care Act is neither affordable nor does it actually improve health care,” said Bentley, a former physician. “Congress and the president have said they want to work together to solve the fiscal crisis facing this country, and I suggest they start with this health care bill.”
Bentley is not the only Republican governor to baulk at Affordable Care Act. Others, including those in Texas, Florida, Mississippi, South Carolina, Louisiana and Georgia, have said they will not participate in the exchanges, instead leaving them up to the federal government.
“I have been speaking individually and in group settings with governors from all over the country, and I feel that a significant number of these governors will take a similar stand,” Bentley said in the statement.
“That will send a clear signal to all of our elected leaders in Washington that the health care bill should be changed.”
More than 30 million uninsured people nationwide are expected to gain coverage under the Affordable Care Act, the Associated Press reported recently. About half will get private insurance through the exchanges. The rest, mainly low-income adults without children at home, could possibly be covered through Medicaid expansion, but that expansion is up to each state.
In Alabama, some lawmakers recently expressed concern over expanding Medicaid — even if the federal government will pay a majority of the cost — because Medicaid already gets about 36 percent of the state general fund, about $603 million this year. Officials have said expanding Medicaid would cost the state hundreds of millions of dollars by the end of the decade.
State Democrats on Tuesday said Bentley’s decisions represent missed opportunities.
“It is a total lack of leadership for the Republican super majority and the governor to allow the federal government to take over our health care,” state Sen. Roger Bedford, D-Russellville, said. “Robert Bentley told us two years ago he wanted to be a model for the nation and now he’s caved in to the right-wing tea party. Now the federal government will end up running the exchange.”
Bedford argued Tuesday that expanding Medicaid would be a way to cover more Alabama residents, mostly on the federal government’s dime.
A recent University of Alabama Birmingham study noted almost 309,000 Alabamians currently meet the expanded Medicaid criteria under the Affordable Care Act. It estimated that the number of new adult Medicaid enrollees would range between 246,219 and 301,799.
According to the same study, if the state didn’t expand Medicaid, some of those people would be eligible to buy insurance in the exchange, but about 228,000 will likely be left without health coverage.
Shannon Bridgmon, an assistant professor of political science formerly with the University of Alabama Huntsville, said Tuesday that Republican governors’ decisions not to create their own exchanges were “ironic.”
“It is not opting out of the program, it is opting out of saying how you want it to look in your state,” she said. “We are going to stick it to the Obama administration by giving them more control?”
States have until Friday to decide on the exchanges, but Bridgmon said Bentley may have been influenced by some Alabamians’ displeasure. Voters last week approved a statewide constitutional amendment allowing people and employers in Alabama to opt out of the Affordable Care Act. The vote was largely symbolic, though, because federal law trumps state law.
State Rep. Ed Henry, R-Hartselle, one of the lawmakers behind that amendment, said Tuesday he was pleased with Bentley’s exchange decision, and if enough other governors do the same, it will make a difference.
“The feds cannot at this point implement their system without the states doing the heavy lifting,” Henry said. “But if the states refuse to participate and do the work, the feds don’t have the ability to do it. That’s what I’m saying. Just say, ‘No, we’re not going to do it,’ and force their hand.”
Mary Sell is Montgomery bureau chief for the TimesDaily. She can be reached at firstname.lastname@example.org.