Jim Carnes: With federal health care threats looming, Alabama needs a doctor

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If Gov. Robert Bentley still wants to be the doctor for Alabama, he has a good opportunity to prove it before Jan. 6. That’s the deadline that U.S. House Majority Leader Kevin McCarthy has given governors to respond to his letter asking them how best to “give all patients a fair shot at quality, affordable health care.”

House Republicans already have laid out a vision of health care that falls far short of fair, high-quality and affordable. With their party set to take the White House next month, nothing stands in the way of their repealing the Affordable Care Act (ACA) as early as January.

GOP lawmakers used to speak of “repeal and replace,” but the “replace” part is proving difficult. The “Better Way” plan they announced in June would strip Medicaid coverage from millions of low-wage workers, increase out-of-pocket health costs for many middle-income Americans and allow insurance companies to charge more to older enrollees and people with pre-existing conditions.

But let’s take McCarthy at his word: If he does want advice, Bentley should offer some.

The first point we urge the governor to make is that “repeal and replace” cannot mean “repeal and delay.” There’s something deceptively reasonable-sounding about pushing the effective date for repeal a couple of years down the road. After all, don’t ACA supporters want to delay the big changes as long as possible?

Don’t be fooled: A ticking time bomb will not preserve the status quo. Once insurance companies see an end date looming for the ACA Marketplace, they lose their ability to plan ahead and likely will bail out of the Marketplace early. That would cost 195,000 Alabamians their coverage and disrupt the entire health insurance market.

A second point is that converting Medicaid to a federal block grant – as many House Republicans favor – would be a disaster for Alabama. Medicaid is now a federal-state partnership that serves anyone who meets eligibility standards. Medicaid covers one in five Alabamians, almost all of whom are children, seniors, pregnant women, or people with disabilities. Alabama contributes only about 30 percent of its Medicaid program’s funding, with federal money covering the remaining 70 percent.

Changing Medicaid to a block grant would limit Alabama’s federal Medicaid allocation to a fixed amount each year, regardless of the state contribution. Any cost increases would be borne by the state alone, with no 70-30 federal match.

A Medicaid block grant would jeopardize health coverage for hundreds of thousands of Alabama children and seniors. It would leave our state’s Medicaid program with no protections against population growth or greater need during economic downturns or health emergencies. And it would imperil the Medicaid regional care organizations (RCOs) that Bentley has heralded as a way to save money and keep patients healthier by focusing on preventive care and early intervention.

A related proposal to enact a per capita (or per-enrollee) cap on Medicaid funding would allow for enrollment growth, but it also would severely limit the program’s ability to respond to changing needs or pay for promising new treatments in the future. The cap also could open the door for new eligibility restrictions that would deprive more Alabamians of health coverage.

Bentley is reconsidering his previous support for a Medicaid block grant, one of his aides told the Alabama Health Care Improvement Task Force this week, and he should be commended for that. We also hope Bentley recognizes the similar risks that a per-enrollee cap in Medicaid would pose for Alabamians, and that he will convey his concerns about both proposals to McCarthy.

The holidays and the start of a new year are a time to reflect on what we’ve accomplished and what we hope to achieve in the year ahead. If the governor wants his legacy to be a healthier, stronger Alabama, he should stand against imminent threats to Medicaid and the insurance market and give Congress a strong prescription by Jan. 6.

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Jim Carnes is policy director of Arise Citizens’ Policy Project, a nonprofit, nonpartisan coalition of congregations, organizations and individuals promoting public policies to improve the lives of low-income Alabamians. Email: jim@alarise.org.

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