Gov. Bentley says Alabama won't set up exchange, expand Medicaid

Gov. Bentley says Alabama won't set up exchange, expand Medicaid

By Kim Chandler | kchandler@al.com The Birmingham News 
on November 13, 2012 at 1:38 PM,

BIRMINGHAM, Alabama -- Gov. Robert Bentley, in a show of continued resistance to the Affordable Care Act,  said this afternoon that he will not set up a state health care exchange and he will not expand Medicaid under the federal healthcare overhaul.

"I will not set up a state exchange in Alabama," Bentley said during a speech to the Birmingham Business Alliance.

States have a Friday deadline to inform the  U.S. Department of Health and Human Services  if they plan to set up a state-run exchange, essentially a marketplace for people and businesses to shop for insurance. If states don't set up their own exchange, either alone or in federal partnership, then the federal government will step in and design it.

Bentley said he has been in communication with other governors  -- including peers in Texas, Florida andLouisiana -- about the exchange decision.  He expected multiple governors to show a united front of resistance to the Affordable Care Act.

"If we stand together, I do believe Congress is going to have to look at this again," Bentley said. 

Bentley said he expected other governors to announce similar decisions. 

"That will send a clear signal to all of our elected leaders in Washington that the health care bill should be changed," Bentley said.

Bentley questioned the constitutionality of the federal government stepping in and setting up essentially a state agency through a federally designed exchange.  Oklahoma has filed a lawsuit alleging that it is unlawful for the federal government to establish an exchange within a state, Bentley noted.

"We believe the federally facilitated system they will try to set up, we believe that is unconstitutional," Bentley said.

Bentley said a state study commission had estimated previously that a state exchange would cost up to $50 million annually to operate. He said the state cannot afford that. The commission estimated that the cost to operate an exchange in 2015 would range between $34 million and $49.6 million.

The exchanges -- whether run by the state or the federal government --  are supposed to be in place by 2014.

Bentley said he will also refuse to expand Medicaid as it currently exists under the Affordable Care Act. The expansion would have been paid for almost entirely by the federal government, but Bentley questioned the long-term cost to both the state and nation.

"I will not expand Medicaid as it exists under the current structure because it is broken," Bentley said." We just cannot afford it. The people of America cannot afford it."

Bentley, who is a doctor,  said his decision to resist the Affordable Care Act was based on a difference of philosophy, not politics.

"It is, in my opinion, truly the worst piece of legislation that has ever been passed in my lifetime," Bentley said of the ACA.

Senate Minority Leader, Roger Bedford, D-Russellville, criticized the governor's decision on both the exchange and Medicaid expansion.

"It's a total shame. It's a complete failure of leadership by the Republican supermajority. What this means is Washington will run Alabama's healthcare system not Alabama," Bedford said.

Bedford said the state should also grab an opportunity to expand Medicaid with the federal government picking up most of the tab.

"There are 350,000 people that could get preventive care rather than showing up in an emergency room,"Bedford said.

Speaker of the House Mike Hubbard, R-Auburn, said he applauded Bentley's "principled stand against Obamacare." Hubbard said implementing the Affordable Care Act would bloat government and putAlabama on a path to "fiscal disaster."

"The governor is in discussions with roughly two dozen of his counterparts in other states to coalesce against Obamacare and push back against its mandates. It's my hope that this coalition can send a wake-up call to Washington and reverse the dangerous trend of liberal policies and directives that Obama and Congressional Democrats are pushing so hard to implement," Hubbard said.

An advocacy group for low-income families expressed disappointment in Bentley's decisions.

"We're disappointed that the governor would close these doors for now. We think Alabamians deserve as good a deal from healthcare reform as folks in other states are getting, " Jim Carnes, communications director for Arise Citizens' Policy Project.

In Alabama about 351,000 people, including 244,804 previously uninsured,  would  join Medicaid under an expansion, according to 2010 estimates from the Henry J. Kaiser Family Foundation.

The suggested expansion would open Medicaid to adults younger than 65 with an income of less than 133 percent of the federal poverty level, which would be $14,856 for individuals and $30,657 for a family of four. The federal government would pay 100 percent of the cost of services for new enrollees for the first three years, but that eventually would drop to 90 percent.

 "This offers us the opportunity to get hundreds of thousands who have no healthcare into preventive care. These are working people. They work in industries we all utilize every day -- restaurants, construction," Carnes said.

Bentley said people had assumed that after the election, the ACA could not be stopped.

"They're wrong," Bentley said.

He said the two key portions of the law are the Medicaid expansion and the exchanges.

"If we have a large enough number of states who refuse to do it, it is going to be very difficult for them," Bentley said