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Alabama Arise: More Alabamians lack health insurance

By MARY SELL, Alabama Daily News

The number of uninsured Alabamian increased by 32,000 from 2017 to 2018, a jump that advocates blame on state leaders’ refusal to expand Medicaid. 

“No one should have to go without the medical care they need simply because they can’t afford it,” Jim Carnes, policy director for Alabama Arise said in a written statement Tuesday. “But that’s the reality for a growing number of Alabamians, because our state has refused to expand Medicaid. Gov. Kay Ivey and state lawmakers need to lift this policy barrier that separates hundreds of thousands of Alabamians from affordable health coverage.”

The Arise statement cited recent U.S. Census data that showed 10% of Alabamians are without insurance. Nationally, 8.9% of people are uninsured. 

Alabama is one of 14 states that hasn’t expanded Medicaid under the Affordable Care Act. Publicly, Gov. Kay Ivey hasn’t ruled out expansion.

“The governor continues to explore all options,” Ivey spokeswoman Gina Maiola said Tuesday. “She wants to ensure we have a cost-effective way for people across the state to have access to quality health care.” 

The upfront cost of Medicaid expansion is why Republican leaders in the Alabama State House say it can’t happen. Sen. Greg Albritton, R-Range, said he doesn’t see that changing soon.

“The continual push (for expansion), in my mind, without a recognition of the cost, is just silly,” Albritton, chair of the Senate General Fund budget committee, said. 

“… The answer of how is never there.”

Rep. Steve Clouse, R-Ozark, said he thinks there’s a desire to fund Medicaid expansion, but without a dedicated revenue source for the state’s costs, about $150 million to $200 million — he said it’s not practical at this point. He’s the House General Fund budget committee chairman.

Meanwhile, the state’s 2021 budget will need an additional about $70 million for the Children’s Health Insurance Program. For the 2020 budget, allocating $35 million for CHIP was a significant issue in this year’s legislative session.

About 174,000 Alabama children receive health care funded through the federal Children’s Health Insurance Program. About 88,400 of those children are on Medicaid and the other 85,500  are enrolled in All Kids, a program for low- and middle-income families.

Because Alabama years ago set qualifications at 312 percent of the federal poverty level, a family of four making $81,628 or less a year can qualify for All Kids. Many other states set their qualifications around 200% of poverty, Clouse said.

“It’s benefiting a lot of families,” Clouse said.

A study released by the Alabama Hospital Association earlier year estimated that expansion would generate about $11 billion in four years in increased federal funding and economic activity.

“In the latest available survey information from Alabama’s hospitals, almost two-thirds of them had experienced an increase in the number of uninsured patients,” said Rosemary Blackmon, executive vice president and chief operating officer. “The challenges of treating patients without health insurance coverage, along with decreasing reimbursements, have placed hospitals in a precarious financial situation.”  

The same survey found that the median total margin for all hospitals was negative .1 percent, and that 88 percent of rural hospitals were operating in the red, Blackmon said.

When the 2020 legislative session begins in February, a fix for the state’s crowded and aging prisons is expected to be a major issue and expense. Medicaid will likely also need additional money. Meanwhile, Sen. Arthur Orr, R-Decatur, said there is renewed interest for more funding for mental health programs.

“All these things lead me to believe there will be not be a shortage of needs in the General Fund,” Orr said.


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