MONTGOMERY — Republicans in Alabama who were waiting to see if President Barack Obama’s 2010 Affordable Care Act and its mandates would vanish on Tuesday now have some decisions to make about its implementation here.

“We have serious concerns about the increased long-term costs associated with expanding Medicaid,” Bentley spokeswoman Jennifer Ardis said in an email to the newspaper today. 

Alabama’s Medicaid program serves more than 900,000 low-income or disabled residents at a growing annual cost — about $603 million from the state’s General Fund in fiscal 2013.

Expansion under the Affordable Care Act would add hundreds of thousands of Alabamians. By 2017, the state would pay about 10 percent of the increased medical costs. Officials have said expanding Medicaid would cost the state hundreds of millions of dollars by the end of the decade.

“While the federal government is handling coverage costs in the short-term, the federal government is not covering all of the administrative and IT costs associated with an expansion,” Ardis said.  “Over time, the increased costs to states could be dramatic.  We are carefully evaluating the issues and will make fully-informed decisions based on what is best for Alabama.”

States are supposed to have up in running by January 2014 health insurance markets, called exchanges, where individuals and small businesses can shop for private coverage from various insurers. Gov. Robert Bentley had said over the summer he was going to wait until after Tuesday’s election to move forward with plans for exchanges.

If states opt out of the exchanges, the federal government will operate them, taking control from the state.

“I’m torn,” said state Rep. Ed Henry this morning. Henry, R-Hartselle, is part of Bentley’s recently formed committee to look at Medicaid costs. “I really don’t want to expand Medicaid.”

Henry and other lawmakers will hear an update on Alabama’s Medicaid costs, and possible containment options, on Thursday.

Meanwhile, Alabama voters signaled their displeasure with “Obamacare” on Tuesday. They approved a Constitutional amendment allowing people and employers in Alabama to opt out of the ACA. The vote was largely symbolic though, because federal law trumps state law.