Governor Bentley announced today that the state of Alabama would not be participating in the Insurance Exchanges. The state had received $9.5 million in federal grants to study various approaches to the exchange but in the end has decided to leave the establishment to the federal government:

In a statement, Bentley said he would not authorize a state-based exchange that would create a tax burden of between $34 million to $49.6 million on the people of Alabama. The decision will put the federal government in charge of creating an exchange for Alabama.

Modeled on a Massachusetts experiment, setting these up would be a difficult thing to pull off:

“They need to have toll-free 800 numbers you can call,on-the-ground navigator and other assistance programs to help people,” she says. “[They need] hold-their-hand help people in languages they can understand.”

“These exchanges are expensive bureaucracies,” Kaeding said. “They’re going to cost states an estimated $10 million to $100 million per year, and they will be financed through a tax increase on health insurance premiums — a tax increase that will almost surely be passed along to taxpayers.”

I am concerned, however, that the exchanges are being thrown in by our Governor with the Medicaid expansion:

Bentley said he will also refuse to expand Medicaid 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.

According to the statements in the paper, this has more to do with philosophy than the additional $100 million a year it would cost the state to provide the additional coverage for the 350,000 that would be newly covered:

Bentley said people had assumed that after the election, people assumed the ACA could not be stopped. “They’re wrong,” Bentley said.  Bentley, who is a doctor,  said his decision to resist the Affordable Care Act was based on a difference of philosophy and not politics.

Given that the two are unrelated and the resources traditionally used by poor people (as I discussed here) are being moved into Medicaid, I hope he will reconsider the latter.