One of the advantages of living in Alabama (state motto: “We dare to defend our rights” which sounds much less like an angry, red faced person yelling when translated into Latin: Audemus jura nostra defendere) is that others are always more than happy to come here and help us defend our rights. The most recent came in the form of a “essay” from a rights defender in the Arkansas legislature (%uninsured before Obamacare 22%, % after 12%). Senator Bryan King (with help form the Alabama Policy Institute) examined Arkansas’ efforts and has issued a strong warning to us Alabamians. He dared us, at least as much as he could on, to defend our rights. In his assessment, Arkansas did not do so with the following consequences:

1) Arkansas’ leadership was misled into thinking that they were being allowed through waivers to do something state-based, flexible, or innovative, which was, in Senator King’s eyes, untrue. He provides some examples of innovative things Arkansas was not allowed to do. They were not able to make healthcare access a privilege that came only through hard work, for example. They were unable to place burdensome restrictions on Medicaid recipients to force them to chose between medication and food. They were not allowed to arbitrarily identify certain segments of the population as unworthy of health care and deny it to them. This alone—not being able to deny the unworthy access to healthcare—is reason enough to defend our rights.

2) Arkansans are now dis-incented to work. Senator King points out that many Arkansans are sitting around sucking up free health care because if they make over 133 of poverty they will have to pay “thousands” for healthcare (Senator King must not have read the guidelines for premium assistance and cost sharing under ACA, which provides health care very inexpensively to the working poor). Better to spend time in the doctor’s office, I suppose. Keeping those deadbeats out of my office and into a low-paying job with no health coverage is something we should certainly want to continue as a state.

3) We are threatening Arkansas’ safety net for the truly needy. This argument goes something like the way lifeboats are filled on a sinking ship: the Medicaid net is mighty frail, and if more childless adults are added, it will break and all the women and children will fall into the ocean, um, that is, the uninsured void. As Arkansas now manages to get only half of her children vaccinated, the safety net their may actually already be a little frayed. But, none the less, we should aspire to be better (worse?) than Arkansas and decline the expansion. No sense in keeping folks HPV-negative for free, is there?

4) Arkansas opted to not go with the traditional expansion, which cost them more money. This is, per Senator King, is a reason not to expand at all. If we can’t go in a Cadillac, let’s not go at all.

5) Provision of healthcare to the poor already costs states a lot of money (the Senator points out that it is 35% of Alabama’s general fund, not pointing out that the bulk of that money is a provider’s tax that would not be collected if not for Medicaid). Per the Senator, this is a deal breaker.

Governor Bentley has recently appointed a “task force” to identify ways “real ways to make health care accessible and affordable to everyone while also combating the shortage of primary care physicians in 65 or the state’s 67 counties.” I suspect this article was targeted at the members of the task force. Expanding Medicaid would be an important tool to accomplish the governor’s charge. In addition, it would bring 30,700 jobs into the state, shore up the rural (and urban) hospitals, and provide currently uninsured citizens citizens access via the same provider network current Medicaid recipients receive care. Our 15% uninsurance rate post-Obamacare would be reduced to about 7% if we were to accept the expansion. Yeah, but you say, where does that money come from? Obamacare, as expertly explained by Dr David Bronner, takes the money states were already getting to take care of their poor (disproportionate share funds) and moves it into the Medicaid expansion program. If you don’t take the expansion, you no longer get those funds. In our case, the $14 million/year that used to come to us is going somewhere else.

Fittingly, the state motto was taken from  the poem “What constitutes a State?” written about the Gordon Riots in England. Adopted by Alabama in 1939, the rest of the line is as follows:

Men, who their duties know,

But know their rights, and, knowing, dare maintain,

Prevent the long-aimed blow,

And crush the tyrant while they rend the chain:

Wonder in this case, if our elected officials choose to deny Alabamians access to healthcare, who the tyrant is?