The Opelika-Auburn News asked Representative Bentley some questions about the problems that will be facing Alabama during the next 4 years. Below is his answer for fixing the problem:

Alabama figures to be millions in the hole with upcoming Medicaid costs. What do you propose this state does to keep itself from what could be an economic disaster once stimulus funds expire?

To reduce fraud in Medicaid, which is a joint state-federal program, I will implement electronic medical records for patients. This will improve health care, reduce costs, and provide more data for the state to use in Medicaid fraud investigations. I will also bar any health care provider guilty of fraud from participating in the states Medicaid system.

As I have detailed in the past, it probably won’t be that easy. I hope that Dr Bentley talks to Commisioner Steckel should he be elected. In a recent interview published in Governing Magazine she did not mention Medicaid fraud as our biggest problem.

Steckel’s primary concern centers on the bill’s cost – and on states’ loss of discretion. States currently enjoy considerable leeway in determining who qualifies for Medicaid. While certain populations, such as the disabled and institutionalized, and low-income pregnant women with children, must be covered, states are free to set eligibility levels for low-income families at an extremely low threshold – and states in the south and west generally have. Maine, Minnesota and New Jersey have been more generous: They cover working parents who earn up to (or even slightly more than) 200 percent of the federal poverty level. A few have even gone further. Arizona, Massachusetts, New York and Vermont have received permission from the federal government to offer coverage to the poorest childless adults.

Health reform ends that discretion. Instead, all states will be required to expand eligibility to at least 100 percent of the federal poverty level for childless adults. The scope of this expansion is huge. According to the Kaiser Family Foundation, Medicaid funded services for 59 million people in 2008. Expanding access to adults earning up to 100 percent of the federal poverty level would add another 10 million to 14 million people to the program. That worries Steckel.

“We are already seeing about 5,000 new [Medicaid] recipients every month,” Steckel says, and while most of the new enrollees are low-cost children, “it’s still an added cost to the budget.” Worse, given the fact that it typically takes a year after job growth resumes for people to leave Medicaid, it’s a cost that shows no sign of diminishing anytime soon. Steckel estimates that the cost of Medicaid expansion could approach $400 million. In a state Medicaid budget of $1.2 billion, that’s a big figure.

Some states similar to Alabama are looking forward to the new health care environment and the opportunities it will bring. I would encourage Dr Bentley to look beyond partisan rhetoric and seek out real answers to improve the health of our citizens.  I hope he remembers learning primum non nocere in medical school.

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