EDITOR'S NOTE: This report is the first in a three-part series on the problems facing Medicaid, and perhaps most importantly, a look at what lies ahead including an expansion of the program under the federal healthcare law.
Why should you should care about Medicaid? Your tax dollars, both state and federal, pay for a huge group of people in the state who have no other way to get health insurance.
Alabama's healthcare system has increased in size by more than the growth of the state's population over the past 10 years and at a cost that's simply unsustainable.
"How come you rent instead of trying to buy a house?" is the question we posed recently while visiting with Alexander City resident Treasure Schutz. "Because we're in bankruptcy," she explained. "We had to file bankruptcy when I lost my job, and we almost lost our car."
Schutz and her family are some of the people who benefit from Medicaid. Her children: Kyle, Parker, Peyton and Colton, were all delivered on Medicaid and are currently covered by the program.
"It's comforting, but at the same time I wish that I was able to pay for their healthcare," the mom explained. "But it is very comforting knowing they're covered should anything happen."
Someone who has Medicaid's struggles always on his mind nowadays is Dr. Don Williamson, Alabama's Public Health Officer. Dr. Williamson has been working on changes to the program for about a year.
"You've got to fix how we enroll patients. You've got to simultaneously fix how we coordinate the care that we currently have on the system," he explains.
Alabama does have an opportunity to get a major injection of funds in the form of an expansion under the federal healthcare law by extending coverage to more than 300,000 Alabamians without any kind of insurance. The only thing Alabama would have to pay for in the first three years would be about $40 million in administrative costs. The federal government would cover the rest of the roughly $2 billion tab.
But Alabama would have to pay, eventually. By 2020 Alabama would be on the hook for about $700 million. The total payoff would be about $11 billion in new dollars coming in to Alabama's healthcare marketplace, and that decision to expand or not is one that's left to the states.
To this point, 15 states have outright rejected increasing the sizes of their Medicaid programs with Alabama being one of them. And the state's governor, Dr. Robert Bentley, has a unique view of the landscape as a practicing physician who served Medicaid patients for more than 30 years.
"We saw everyone. I never discriminated against any patient because of what type of insurance or if they didn't have insurance" Governor Bentley recalls of his practice. "In fact, I had a lot of patients who paid me with maple syrup or soragum syrup."
Dr. Bentley says because of one-time cash injected before he took office, the financial issues with Alabama's Medicaid agency never garnered attention. "We had plenty of money. All of this was hidden. All of the difficulties with Medicaid were hidden because of stimulus dollars. So we really didn't think much about it at that time."
Treasure Schutz, with her kids all on Medicaid, would be eligible for the expansion. She says she would love the coverage for she and her husband but also adds the issue of expansion needs to be handled delicately. "I don't say that it's a no brainer, but I do there think there needs to be very strict guidelines as to who gets it."
Deciding to expand the program hasn't been entirely partisan, either. Numerous conservative Republican governors like New Jersey's Chris Christie and Ohio's John Kasich have each taken steps to open up their programs.
In our next report: More of some of the possible economic benefits and pitfalls of expansion.
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