Governor Robert Bentley is a licensed dermatologist. Perhaps that’s why his compassion for poor people seems to be only skin-deep.
Last weekend, while most folks prepared to watch The Team O’ Destiny march toward Pasadena, about 70 people gathered at Kelly Ingram Park to call attention to a significant public policy issue: increasing the number of Alabamians eligible for Medicaid.
It’s a policy that would move the state in a positive direction, but one the aforementioned Alabama governor refuses to implement, contrary to some Republican counterparts in other bright Red states. Ardent Obama foe Governor Jan Brewer has already signed on to expansion for Arizona citizens and even wacky Texas Governor Rick Perry is reportedly open to the prospect.
Medicaid is nothing new. The State Health Insurance Assistance Program, as it was originally titled, became an option for low-income Americans during a Social Security Act revamp in 1965, when Lyndon Johnson was spending his considerable political capital to construct a “Great Society.” As a means of fighting poverty, Medicaid was designed to provide insurance coverage for those who could not afford it, including certain pregnant women, blind and disabled citizens and the elderly.
A cooperatively funded venture, Medicaid is run by individual states, each of which sets its own rules for administration within federal guidelines. It has enthusiastic supporters and detractors, as is usual for any program that affects a significant portion of the population. Some of Medicaid’s most vocal critics are physicians who complain about the program’s low payments to medical care providers, while proponents point to the way Medicaid has controlled healthcare costs to cover nearly 50 million Americans.
The political fight over the Affordable Care Act brought new attention to Medicaid in 2010. The original version of the bill required states in the Medicaid program to enroll families and individuals with incomes up to 133 percent of the so-called “poverty line,” but the Supreme Court subsequently ruled that the requirement was coercive, and that expanding Medicaid eligibility would be a choice for individual states to make.
Why would cash-strapped states choose to pay for adding more patients to Medicaid rolls? Because they wouldn’t have to; not for the next three years, anyway. Under the terms of the ACA, Uncle Sam pays 100 percent of a state’s costs for expanding Medicaid eligibility in 2014, 2015 and 2016. After that, the federal share will drop gradually over the next four years, bottoming out to a 90/10 federal/state split in 2020 and thereafter.
Would that be an unsustainable burden for Alabama’s budget? According to a Commonwealth Fund scenario cited by Yann Ranalvo in the Birmingham Business Journal, in 2022 the state will likely pay less in Medicaid expenditures than on corporate welfare incentives to attract new businesses to Alabama ($246 million versus $343 million).
[A momentary digression: we have learned in recent weeks about major plant closings in the rural towns of Courtland and Boaz that threaten the viability of those municipalities even as they cause the loss of 2,000 probably irreplaceable jobs. In this “business-friendly” administration anxious to spend lavishly to lure out-of-state corporations, where are the state incentives to help retain businesses we already have?]
Those effusive about “job creators” might view Medicaid expansion in a different light, were they to read a new survey, conducted by UAB’s Center for Business and Economic Research, stating that the state could grow 30,700 new jobs during the next six years of expansion.
The governor was quick to call BS (Bentley Skepticism), characterizing UAB’s meticulous computations as “bogus.” “The jobs are already there. You’re not creating new jobs,” Mike Cason of The Birmingham News reported him saying November 27. “You’re not creating new people by bringing this money in.”
[Another digression: I’m no doctor, but I’m pretty sure that’s not how new people are ever created, though Governor Bentley’s confusion about reproductive methodology could be explained by another statement he made that day. “You don’t produce a new doctor in a year,” he said. “I went to school 24 years to become a doctor.” If it really took him that long, maybe we need to find out if he got his M.D. degree from the University of Phoenix Online.]
In fact, the UAB study predicted that new jobs would be created not just in healthcare, but also in retail, finance, tech services and other sectors of the economy, and you don’t need a university study to comprehend that more jobs mean more revenue for government coffers.
The Dermatologist-in-Chief appears unlikely to make the smart move on Medicaid, given his intransigence toward the ACA. “I really think that what we need to do is to repeal the act completely and bring together those who are involved whether medical, insurance companies, but also stakeholders like individuals,” Mr. Bentley opaquely declared to AlabamaNews.net in Montgomery last month.
If our governor does not issue an executive order to expand Medicaid eligibility for his constituents by New Year’s Day, when the ACA kicks in nationwide, he turns his back on as many as 300,000 impoverished Alabamians who will otherwise have no chance of getting healthcare coverage, even as he refuses the $1.5 billion that would pay for the expansion in the first place.
There is another potential cost of inaction. A study by the decidedly un-bogus New England Journal of Medicine, parsed by the Center for American Progress, estimates that our governor could save 550 lives per year by expanding Medicaid coverage to the least of us in Alabama.
Before he took an inaugural oath, Robert Bentley took the Hippocratic Oath. Interestingly, it doesn’t include the phrase, “First, do no harm.” A more accurate translation of the ancient Greek affirmation mandates this behavior for a physician toward the sick: “I will keep them from harm and injustice.” There could be no more important prescription this month for our governor, the doctor.