Panel looks at pros, cons of expanding Medicaid in light of Obama's re-election

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Brian Lyman

With the Affordable Care Act all but certain to be fully implemented following Obama’s re-election, a state committee studying the future of the state’s Medicaid program Thursday morning took a “post-mortem” of the election and what it means for health care in the state.
The meeting, scheduled months in advance, came as lawmakers face big decisions and pressing deadlines on the implementation of the federal health care law. Gov. Robert Bentley has not yet said if he will opt into an expansion of Medicaid eligibility offered by the ACA that will be funded by the federal government for the first three years.
“By definition, Medicaid is going to expand if we do nothing,” said Rep. Greg Wren, R-Montgomery, a co-chair of the Permanent Joint Legislative Committee on Medicaid. “As planners and legislators, we have to anticipate what’s going to happen on the Medicaid piece.”
Nearly 1 million Alabamians are enrolled in Medicaid; nearly half of its beneficiaries are children.
After 2017, states would pay a growing share of the expansion, though the federal government still would bear most of the costs. By 2020, states would have to pay about 10 percent of the expansion. Alabama lawmakers, however, have argued that Alabama’s tight General Fund budget, which pays for Medicaid, would make any additional funding difficult.
The Medicaid expansion would cover all able-bodied adults between the ages of 19 and 65 who make 133 percent or less of the poverty level — $30,567 for a family of four.
If the state opted out of the expansion, those individuals might be able to obtain insurance through a health insurance exchange, a place where customers can price private insurance plans and apply for subsidies. But Joy Wilson, director of health care policy for the National Conference of State Legislatures, told the committee by phone that that would be a significantly larger expense.
Wren said after the meeting that those new costs likely would be borne by small businesses, adding that the Medicaid expansion was something the state should look into.

The state also faces a Nov. 16 deadline to tell the Department of Health and Human Services whether they want to set up a state-run health insurance exchange, allow the federal government to design the program or opt for a mixture of the two. Although the state is unlikely to be able to provide a blueprint of a state insurance exchange by a week from Friday, Wilson and other committee members expressed concerns that HHS had not given a blueprint for a federally run exchange.
“We don’t really have much information on how the federal exchanges are going to work, and how that cooperative agreement will work,” she said.
Wilson also told committee members there was a process for opting for a federally run exchange and then transitioning it to one run by the state.
An advisory HHS sent to states in August said states looking to run their own exchanges or participate in a state-federal partnership would have to submit a “complete Exchange Blueprint” by Nov. 16. Without a blueprint, HHS may offer a “conditional approval” that could mean the federal government running an exchange until the state’s plan was ready.