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Fri, Nov 20, 2015 at 06:00 AM

Governor’s task force recommends expanding Medicaid

A task force appointed by Gov. Robert Bentley today recommended that the governor and the Legislature find a way to provide health insurance for Alabamians without coverage.

The Alabama Health Care Improvement Task Force approved a recommendation that said the biggest obstacle in improving health is the “coverage gap that makes health insurance inaccessible to hundreds of thousands of Alabamians.”

The majority of that group are working people who earn too much to qualify for Medicaid but don’t have private insurance, according to the Task Force statement.

It said expansion could provide coverage to about 290,000 Alabamians, including 185,000 who are working.

The recommendation does not specifically call for Medicaid expansion under the Affordable Care Act. But a two-page statement attached to the recommendation describes benefits that would come with expansion.

The Task Force recommended that the governor and the Legislature “move forward at the earliest opportunity to close Alabama’s health coverage gap with an Alabama-driven solution.”

The task force, which has more than 30 members, approved the recommendation on a voice vote with no opposition.

For several years, Bentley has been an opponent of expanding Medicaid under the Affordable Care Act.

In the last year, the governor has said his administration might pursue a way to cover more people through an Alabama-specific plan. He has sounded increasingly more open to the idea in recent weeks.

Jennifer Ardis, spokeswoman for the governor, indicated the governor has not taken a position on today’s recommendation by the task force.

“The governor appreciates the hard work of the task force, which is made up of health care experts across Alabama,” Ardis said. “He looks forward to working with the Legislature to review the recommendations.”

Sen. Gerald Dial, R-Lineville, a task force member, said Medicaid expansion is critical for rural areas like his east Alabama district.

But Dial told his fellow task force members that expansion will come with a price tag. States will have to begin paying 5 percent of the cost of expanded coverage in 2018 and 10 percent in 2020.

Dial said it’s realistic to expect Alabama to need an additional $400 million to $700 million over several years.

“Somebody is going to have to pay some more taxes,” Dial said.

Dial urged members of the task force to speak one-on-one with legislators in their districts to build support for expansion and the funds needed to pay for it.

“We can’t sell it from Montgomery,” Dial said.

The task force discussed but did not vote on a proposal to recommend to the Legislature a cigarette tax increase of 75 cents a pack to help pay for expansion.

Lawmakers raised the cigarette tax 25 cents a pack this year to help cover the General Fund appropriation for Medicaid. Dial said passing that bill was “like pulling teeth.”

There was some disagreement about how much new funding would be needed.

The task force’s two-page statement attached to the recommendation, which task force members called the “white paper,” said that expansion could be a net gain for the state budget, based on what’s happened in other states.

That’s partly because some mental health services, public health services, senior services and others that are now provided with state dollars would be mostly paid for with federal dollars after expansion, according to the paper.

The paper cited a 2015 policy brief by the UAB School of Public Health that said Medicaid expansion would produce new revenues to health care providers that would result in $1.2 billion per year in new income.

That would generate tax revenues that could offset most or all of the state’s share of the cost, the paper said.

Dr. John Waits, a family practice physician in Centreville and a task force member, said Medicaid expansion would not only help the uninsured but would improve the economy by creating jobs and providing for a healthier workforce.

“It keeps hospitals open,” Waits said. “It keeps doctors able to go to underserved areas.”