Alabama simply can’t afford expanded Medicaid

Last month the committee appointed by Governor Robert Bentley to study the state’s health care situation issued a report that essentially recommended that a costly yet key ingredient of Obamacare be brought to Alabama – the much-debated Medicaid expansion.
Members of the Alabama Health Care Improvement Task Force made a noticeable effort to distance their recommendations from that central tenant of Obamacare, probably because the overall law remains so unpopular. Their report states that we should pursue an Alabama-driven solution that “reflects Alabama’s values and meets Alabama’s needs,” but the framework is basically the same.
Under most proposals, Alabama would increase the pool of those eligible for Medicaid, which is the government’s free health care program for the poor, to those low-income adults earning up to 138 percent of the poverty level, or about $16,000 per year. That would close the so called “Medicaid Gap” by providing insurance for the estimated 290,000 Alabamians who earn too much to qualify for Medicaid yet too little to afford government-subsidized private insurance.
That sounds nice, except that we know that free health care isn’t really free.
Estimates show the move could immediately cost Alabama taxpayers $40 million a year, but that’s only thanks to the federal government’s offer to pay the lion’s share for the first three years. After that, Uncle Sam starts walking away and Alabama would be stuck paying about $100 million in 2018, then $222 million in 2020, and who knows how much more of an increase after that. Nothing grows like a government program.
As financial decisions go, this one seems pretty simple: Alabama cannot afford the expansion because we’re broke … or at least that’s what we’ve heard all year.
“Folks, we just don’t have enough money in the state of Alabama,” Bentley recently said to a group of Republican leaders who opposed his tax increase package.
Just a few months ago, before the cost of a Medicaid expansion was even part of the calculation, Bentley painted a dark and dismal picture of the state’s budget.  
If we didn’t raise hundreds of millions in new tax dollars, he said the Huntsville lab of the Alabama Department of Forensic Sciences would shut down, forcing the Montgomery location to do north Alabama autopsies. He claimed that 17,000 children from working-poor families would lose access to subsidized child care in Alabama, and that their parents might lose their jobs and turn to welfare.
There was talk about reducing mental health care treatments, closing courts, and even setting prisoners free. “You might not care about prisoners,” Bentley warned, “but when you have them in your basement, you’re going to care.”
We were also told that 400 adults in need of day care would have to go to nursing homes and 30,000 children will be without food stamps. Bentley then said the state might have to close a majority of its parks, and decrease the number of game wardens.
“We’re not trying to cry wolf,” Bentley promised.
Really? So if our state budget is really doing that bad, then what’s all this talk about creating a new program that could cost Alabama more than a half-a-billion dollars over the next 5-6 years?
The governor’s spokeswoman said he hasn’t taken a position on the task force’s recommendation, but it’d be very surprising for a governor-appointed panel to unanimously recommend something that the governor didn’t at least look favorably upon.
Meanwhile, one of the task force members, Sen. Gerald Dial, R-Lineville, has been urging the panel’s members to advocate for the expansion to their local representatives.
“We can’t sell it from Montgomery” Dial said.
You can’t pay for it from Montgomery, either. Even his own estimates indicate that Alabamians would need to fork over an additional $400 million to $700 million over several years. “Somebody is going to have to pay some more taxes,” Dial said.
Even though this year’s scare tactics didn’t work so well (most proved to be exaggerations), we should brace ourselves for a double-douse of guilt-laden tactics during the coming months.
And the answer should be the same: we’re Taxed Enough Already.

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