Essential to Obamacare is Medicaid Expansion – a federal government dependency program for the uninsured, which is administered by states. Since 1980, Medicaid spending has increased nationally by over 1500 percent. Here in Alabama, Medicaid takes up 35% of our General Fund. And under Obamacare, Medicaid would grow even larger – bringing millions more people to a state of dependency on government, and saddling our state and our nation – the taxpayers – with the enormous expense.

Robert Bentley, Governor, State of Alabama “State of the state” 2014

Governor, please get with your finance director and look at the “General Fund budget” again. He should be able to help you correct your facts. The state’s General Fund expenditure you recommended in your budget is indeed $14 billion dollars and Medicaid is $5.7 billion of that. However, I believe you need to qualify that a little:
  • $4.2 billion is from THE FEDERAL GOVERNMENT. We put up matching money (approximately a 1:4 match) to draw it down. For this money the General Fund is essentially a holding account. If we didn’t ask the feds for it, someone else would get it. Alabamians will not get it back in the General Fund, no matter how many hospitals close.
  • This leaves $1.5 billion of Alabamian’s hard earned cash…well, not really. Hospitals, nursing homes, and pharmacies put about $900,000 of the cash they get from patient care and other activities into an account, the Alabama Medicaid Fund, so that we can show it to the feds and they match it. The money in this “provider tax” then goes back to the providers. Alabamians will not see this money in the General Fund if Medicaid goes away. These providers would need to hang on to that money to care for poor people who are uninsured.
  • In actuality, Alabamians put in $650 million dollars from the General Fund for Medicaid.

This is about 10% of the non-dedicated revenues, not 33%. It pays for the health care of 1,000,000 people and brings in 10 times that amount in dollars to pay for care that would otherwise have to be given away or not happen at all. The federal government has already increased our taxes to pay for the 300,000 people who would have been covered in the expansion. We have to at least maintain the current bare-bones Medicaid program, or else give it up completely.

Whose dependency are we trying to break? The 500,000 children who receive Medicaid because their parents are poor and uninsured? The 100,000 Alabamians in nursing homes who have no other resources to pay for their care? The 200,000 mentally ill and otherwise disabled people who can no longer work because their bodies are unable to provide labor that the market wants? The 300,000 uninsured people, most of whom work at low-paying jobs, who are not included in the subsidized insurance market? The rural citizens whose hospital will close without the expansion?
Governor Bentley, I appeal to you as a fellow physician. We received 55% of our income from the federal government before the ACA was passed so we can’t claim not to accept government money. Most of what the ACA does is reformulate the insurance market. This was desperately needed in Alabama where at 87% of the insured market, Blue Cross had no competition. What lesson are you trying to teach to poor people by denying them Medicaid?