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Ledbetter talks expanded health coverage through private-public partnership

MONTGOMERY, Ala. – Alabama’s Republican House speaker suggested on Wednesday he may be open to expanding Medicaid, though not in the traditional sense.

Speaking at a breakfast in Montgomery hosted by the Montgomery Chamber of Commerce, House Speaker Nathaniel Ledbetter, R-Rainsville, shared  his thoughts on the upcoming legislative session, naming expanding school choice, improving election integrity and increasing mental health resources as among his top legislative priorities.

The breakfast panel was moderated by Hal Bloom (right), the leader of The Gloom Group, a Montgomery-based lobbying firm.

When asked to comment directly on the quality of Alabama’s health care, Ledbetter bluntly said, “Our health care across the state is not good.”

“We’ve lost 16 hospitals in Alabama already, and mine was one of those rural hospitals that was in trouble. Through work with the Huntsville hospital, we were able to work it out where they came out and bought the hospital, but the cost of doing business at the hospital has gotten so expensive.”

The problem is also impacting Alabama’s economy. With the state’s workforce participation rate at just 57%, surveys have shown that some people fear that gaining a job would mean losing their Medicaid benefits.

As to how to improve the state’s quality of health care, Ledbetter floated the idea of expanding Medicaid with a privatized approach, saying that discussions on the idea among Legislative leaders were ongoing.

Ledbetter said they’d tasked an economist to research the idea, and that he had received a report recently that showed some promising findings were the state to expand Medicaid through a private-public partnership.

“With the money that you get down from the federal government, you could make it last almost ten years if you manage it right,” he said. 

“Not only that, you’re going to bring an additional $175 million to $200 million into the tax dollars. But I think the important part is that there’s a (health coverage) gap with our people in the state.”

Under the 2010 Affordable Care Act, states that expanded their Medicaid programs by lowering eligibility requirements would receive significant federal funding to help offset costs. Alabama, however, has yet to expand its Medicaid program, and remains among just ten states that have yet to do so. Alabama also has among the strictest Medicaid eligibility requirements in the country.

Split along partisan lines, Republicans have historically opposed Medicaid expansion over its cost, which studies estimate would increase state Medicaid expenditures by $225.4 million over six years. On the other hand, Democrats often point to the nearly 300,000 Alabamians who would gain health coverage under Medicaid expansion, as well as the federal funding that would largely offset the increased costs.

While not outright endorsing the idea, Ledbetter noted what he considered to be the benefits of expanding Medicaid through a private-public partnership, rather than the traditional public expansion of the program.

“Just to be candid about it, (in the case of traditional Medicaid expansion), Medicaid is going to take people that’ve got commercial insurance off the rolls; in Alabama, they take about 150,000 people off of commercial rolls, and then they would pick them up. So what a (private-public) partnership would do is keep those people on the commercial rolls, and then it would pick up about 150,000 more.”

Ledbetter would later liken the idea to the Arkansas Health and Opportunity for Me program. Similar to other states’ Medicaid expansion efforts, the ARHOME program expanded Medicaid eligibility to satisfy the Affordable Care Act’s criteria for Medicaid expansion, and thus, entitled the state to federal funds.

Unlike more traditional Medicaid expansion programs, however, which typically see those federal dollars directed toward the respective state’s Medicaid agency, the ARHOME program instead diverts those dollars to private insurance companies.

“There’s some states that have done it, I think Arkansas has done something with it, and I think the best thing we could do right now is take the best from every state,” Ledbetter later told Alabama Daily News.

“I think it’s just a conversation starter, and we’ve got to have the conversation.”

Health care access has worsened in Alabama over the past few decades, with 14 hospitals having closed since 2011, and 25 of the state’s 52 rural hospitals in danger of closing. In 1980, 45 of the state’s rural counties had hospitals providing prenatal care; by 2019, just 16 rural counties had hospitals offering such services, according to the Alabama Department of Public Health.

And with Alabama ranking 49th in the country for life expectancy, Ledbetter said that whatever the solution to improve the state’s health care may be, it would take “political courage” to accomplish, something he felt was possible with the state’s current leaders.

“You’ve got hospitals across the state that’re in trouble, and some of them are not the rural hospitals, so I do think this is a major issue,” he said. 

“I think it’s something that we’ve got to have enough political courage to address, and I really think with our leadership team, hopefully, there’s something we could do in a public-private partnership.”

The legislative session starts Feb. 6.

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