MONTGOMERY, Ala. (AP) — NN:
Alabama's Republican leaders have made it clear they won't be expanding the Medicaid government insurance program any time soon.
But that doesn't mean that there isn't an election-year fight over a key provision of President Barack Obama's health care overhaul.
When he addressed legislators last week, Republican Gov. Robert Bentley restated his opposition to expanding Medicaid. He said it's too expensive and would breed dependency on government.
Democrats say the governor is being short-sighted.
They note that some parts of the law will cost hospitals money they get for treating the uninsured. It's foolish, they say, to not expand Medicaid to make up the loss.
Hospital executives, meanwhile, have launched a campaign to convince local civic and business leaders that expansion is the right move.
Alabama's Republican leaders have made it clear they won't be expanding the Medicaid government insurance program any time soon. But that doesn't mean that there isn't an election-year fight over a key provision of President Barack Obama's health care overhaul.
Republican Gov. Robert Bentley used his annual legislative address to frame his refusal of federal money for more Medicaid coverage as a principled stand against a profligate White House and an expanding welfare state.
"The money the federal government is spending with wild abandon is not 'federal' dollars; those are your dollars," the governor told lawmakers and a statewide television audience last week. "If states do not stand firm and say 'no more,' there will be no one left to stop the out-of-control spending in Washington."
Widening Medicaid insurance rolls, a joint federal-state insurance pool for low-income Americans, was an anchor of the law Obama signed in 2010. But the U.S. Supreme Court ruled that states could decide whether to participate. The feds have agreed to pay for all new coverage through 2016 for everyone with household income up to 138 percent of the federal poverty rate — $15,420 a year for an individual or $31,812 for a family of four. States eventually would have to pay 10 percent of coverage costs for the new Medicaid recipients.
Besides fiscal considerations, Bentley argued that adding an estimated 300,000 Alabamians to the program would speed "a downward spiral of dependence" in American society. He added an argument familiar to Alabama governors: states' rights. "It's OK to question the federal government. ... The 10th amendment to our great constitution gives us that authority," Bentley said.
Each line of opposition drew enthusiastic applause with the Old House Chamber filled by the Republicans who dominate every branch of state government. Yet Democrats, even as an overwhelming minority, pushed back, accusing Bentley of putting easy politics above good policy as he faces a re-election campaign.
Sen. Billy Beasley, D-Clayton, said he was "disappointed in the governor." Beasley and his fellow Democrats contend that Medicaid expansion makes sense from an economic, health care and moral perspective. And, they add, it would be more irresponsible to deny the state's health care system a new cash flow when separate provisions of the new law promise to cut hospital revenues.
"This would support thousands of jobs around the state," Beasley said. "Instead, the governor wants basically to threaten hospitals and communities with the serious consequences of doing nothing."
Those consequences involve something called "uncompensated care payments" that hospitals get as part of the Medicaid program. Those payments, which like the rest of Medicaid come from state and federal money, are intended to help hospitals cover their losses for treating uninsured patients in emergency situations, as required by law.
The original 2010 law called for curtailing those payments while increasing Medicaid spending. The idea was that having more people with insurance — both through Medicaid expansion and the private policies sold on new insurance exchanges — would mean better care and fewer expensive emergency room visits and hospital admissions by uninsured patients. And hospitals would get paid for the admissions that were still necessary.
"The governor knows all of that," said Senate Minority Leader Vivian Davis Figures, D-Mobile.
Figures, meanwhile, said she appreciated Bentley's emphasis on the moral imperative to prioritize opportunity over simple aid. But, she said, "You don't do that by pulling the rug out from under people." She noted that many of the would-be new Medicaid beneficiaries work, they just don't have jobs with access to health insurance.
Sen. Roger Bedford, D-Russellville, is sponsoring a bill to require the state to enlarge its Medicaid program. Republicans in recent years have denied a committee hearing for similar measures, which have no chance of passing even if there is a hearing.
Republicans have their own symbolic legislation. House Bill 147 by Rep. Barry Moore, R-Enterprise, would declare the federal law "null and void" in Alabama. Despite the U.S. Supreme Court's 2012 ruling upholding nearly all of the law, Moore's proposal essentially declares the act unconstitutional. It states: "The (Alabama) Legislature has the absolute and sovereign authority to interpose and refuse to enforce the provisions of the ... Act that exceed the authority of Congress."
Moore's Democratic colleague, Rep. Joe Hubbard of Montgomery, mocked the proposal on social media. "If my memory of eight grade history serves," he wrote on Facebook, "South Carolina tried nullification in the 1830s. It failed ultimately led to a civil war."
The rhetoric leaves the hospital industry treading lightly.
The Alabama Hospital Association has endorsed Medicaid expansion. But lobbyist Dane Howard said they aren't pushing Bedford's bill or any other. Instead, Howard said, hospital executives around the state have essentially formed a speaker's bureau and a lobbying shop to present civic clubs and business leaders a picture of what would happen at individual hospitals if they lose "uncompensated care payments" without getting new revenue from more Medicaid patients. The idea is for community leaders to embrace expansion and then pressure local legislators on their own.
"When you look at the options here, there really isn't a choice long-term," Howard said. "The most powerful thing we can do is have legislators hear directly from people back home about what this means in their community."
Follow Barrow on Twitter @BillBarrowAP.