It’s an unfortunate fact that many hardworking Alabamians in low-wage, economically essential jobs have no health coverage. As a result, those folks struggle with health problems that reduce their productivity and add stress to their households. These health problems get worse without timely preventive healthcare. Imagine what it would mean to the state’s business community to have a work-force with access to regular health care. Imagine the effect on the state’s education system if all children came to school healthy, ready to learn and prepare for their future.
Hundreds of thousands of Alabamians are caught in the health coverage gap. Working at low-wage jobs that often don’t offer health insurance, these folks earn too much to qualify for Medicaid and too little to afford private insurance. Therein lies the problem – one which creates a very bad situation for all Alabamians – and ignoring it makes no sense.
Fortunately, the Patient Protection and Affordable Care Act passed by Congress bridges this gap by helping states expand Medicaid to people with incomes up to 133% of the federal poverty level, which is just under $15,000 a year for an individual and $31,000 for a family of four. Folks who are uninsured and who earn above this amount and up to 400% of the poverty level will qualify for sliding-scale tax credits to help buy insurance through a state health insurance exchange, or marketplace, which is the healthcare law’s other main tool for expanding coverage.
It appears that lots of folks, including some politicians, don’t really understand Medicaid – its purpose, how it works, or who is covered. Alabama Medicaid has been successful in providing health care for children in low income families, seniors living in nursing homes, and folks with disabilities. The program can build on these successes and make coverage affordable for more working families. Despite the tight limits on direct Medicaid coverage, all Alabamians benefit from the services and facilities that Medicaid funding makes possible. Without Medicaid, many hospitals, doctors’ offices and specialized treatment centers would go out of business. Without Medicaid, hundreds of thousands of Alabamians would have little, if any, access to healthcare.
After months of studying Medicaid programs in other states, the Alabama Medicaid Advisory Commission created by Gov. Robert Bentley voted to recommend expanding an existing care coordination pilot project now operating in four Alabama regions. The Commission is made up of health care providers, insurers, governmental officials and one consumer. The Governor had given the commission a deadline of January 31st to propose reforms that would control costs and improve quality in the program.
Under the Commission’s plan, Alabama Medicaid would divide the state into ten or more regions, using the patient care network (PCN) model to coordinate care tailored to local needs. Jim Carnes, Alabama Citizens’ Policy Project team leader, holds the lone consumer seat on the 33-member coalition. Jim, who is quite knowledgeable on healthcare issues and on Medicaid specifically, had this to say: “We’re pleased with the plan to make Medicaid’s care delivery more effective and efficient while keeping the savings in-state.”
But there is another group working on Medicaid and it appears they are taking a totally different approach. The Legislative Joint Committee on Medicaid Policy, which is also looking at how to improve the programs, will issue a report fairly soon. I read a draft from the committee last month. It concerns me and should concern all Alabamians. In the draft, the committee basically recommends a cap on spending for the Medicaid program. That, in my opinion, is the wrong approach to take and will make matters much worse.
To broaden consumer input on the Medicaid reform process, the group Alabama Arise, an organization that works hard for low-income Alabamians, convened a coalition of 17 groups representing current and potential Medicaid recipients. For a list of coalition members, and to read the principles of consumer-centered Medicaid reform the coalition submitted to the Commission, you can go to arisecitizens.org.
Dr. Don Williamson, Commission chairman and State Health Officer, put a target date for statewide operation of the new structure that came out of the Governor’s Commission for sometime in 2015 if both Gov. Bentley and the Legislature agree on the plan. The Medicaid-run pilots now serve multi-county regions centered in Huntsville, Mobile, Opelika and Tuscaloosa. Significantly, only one member of the Commission voted against the proposal. Patient Care Networks have two inter-related goals:
• Improving health outcomes, and
• Holding down costs.
It should also be noted that Alabama Medicaid, with its 2% to 3% overhead, has the third lowest cost-per-recipient of any state Medicaid program. That has received very little attention by the Medicaid naysayers. As stated above, I find that many folks are confused about exactly who Medicaid serves. I am convinced that the Legislature should adequately fund the Medicaid program. Dr. Williamson has made it very clear that we will face a fiscal disaster in the program very soon if corrective action isn’t taken.
Late in 2012, Gov. Bentley announced that Alabama would not expand Medicaid “under the current structure” to cover everyone up to 133% of federal poverty level. That’s what the Patient Protection and Affordable Care Act encourages states to do. Even though I like and respect Gov. Bentley, I believe that he is wrong on the Medicaid issue. Hopefully, the Governor’s Commission and the Joint Legislative Committee on Medicaid Policy will get together and work to restructure the program in a sensible manner. Then I believe the Governor would approve expansion. To find out more about the Commission’s Medicaid reform study and recommendations, visit Medicaid.alabama.gov, and click on “Newsroom.”
Sources: Arise Citizens’ Policy Project, Associated Press, and The Montgomery Advertiser
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