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Hospital Association begins campaign for Medicaid expansion

By KIM CHANDLER, Associated Press

MONTGOMERY, Ala. (AP) — With one in every 10 patients walking into state hospitals without insurance, the Alabama Hospital Association on Thursday launched a campaign to push for expansion of the state’s Medicaid program.

Politicians in the Deep South have often opposed expansion, but the Alabama Hospital Association is urging citizens and policy makers to think of expansion as they would any other economic development investment, arguing it would benefit communities and the entire state health care system in addition to the estimated 300,000 people who would gain health care coverage

“Health care is part of the state’s infrastructure,” Danne Howard, executive vice president and chief policy officer of the Alabama Hospital Association, said.

Twelve Alabama hospitals have closed since 2011 and Howard said 75 percent of Alabama’s hospitals are operating in the red. She said expanding Medicaid would be a “significant investment in the state’s fragile health care infrastructure and would help maintain access to care for everyone.”

“One in every 10 people who walk into a hospital doesn’t have insurance. At some point those providers, those hospitals, are not going to be able to maintain operation. They are not going to be there, either closing their doors or cutting back services. At that point, it really doesn’t matter what insurance card you have in your pocket. If the provider is not there, the care is not there,” Howard said.

Alabama is one of 14 states that have taken no action toward expanding Medicaid eligibility under the Affordable Care Act, according to the Henry J. Kaiser Family Foundation. Thirty-three states and the District of Columbia have approved raising income limits for Medicaid coverage under the Affordable Care Act and another three will vote this fall in ballot measures.

The Urban Institute estimated that Medicaid expansion would add 314,000 people to Alabama’s Medicaid rolls. Under the Affordable Care Act, states would put up 10 percent of the cost of covering the additional Medicaid patients and the federal government would pick up the rest.

Estimates on what it would cost the state have varied. Gov. Robert Bentley in 2015 estimated that expansion would cost the state $710 million dollars over six years. Other estimates have pegged the cost higher.
Alabama Gov. Kay Ivey said last week that she is not opposed to Medicaid expansion, but questioned how the state would pay for it.

“Medicaid expansion is desirable perhaps, but how are you going to pay for it? That’s not an issue we can tackle at this point,” the Republican told reporters.

Democratic gubernatorial nominee Walt Maddox has proposed striking a gambling compact with the Poarch Creek Indians and using the state’s share of revenue to pay for the state’s cost of Medicaid expansion.

At Vaughan Regional Medical Center in Selma, 10-12 percent of patients are uninsured, and 40 percent of patients are on Medicaid, said CEO David McCormack.

Looming over hospitals are possible cuts to the federal Disproportionate Share Hospital program for treating a disproportionate share of the indigent. Scheduled reductions were delayed several times, but McCormack said they will have a devastating impact if they go through in 2020 as planned.

McCormack said expanding Medicaid would help keep hospitals open and providing services.

“I don’t want to give you a dollar, if you give me ten dollars?” McCormack said questioning the argument that the state can’t afford expansion. “First of all, why would we not want billions of dollars coming into the state?”

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