MONTGOMERY — A Montgomery lawmaker and member of Gov. Robert Bentley's Medicaid study commission said Monday he can see a scenario in which Alabama expands Medicaid under the federal Affordable Care Act.
While providing health care for about 300,000 more uninsured Alabamians, the expansion could pump $4 billion to $6 billion a year into the state economy, said Rep. Greg Wren, R-Montgomery.
"I think that's one reason you've seen so many governors in the last month say, ‘We can't turn our back on the economics of what this does for our state,' " Wren said. "Alabama will be no different."
But significant changes would have to be made. Wren said legislation to reorganize the Medicaid system, which provides coverage to about 900,000 low-income and disabled Alabamians, likely will be introduced this week. One bill would cap how much of the general fund goes to Medicaid each year. This year, the state will spend about $615 million on Medicaid, more than on any other non-education agency.
Last week, the Alabama House passed a bill aimed at cracking down on Medicaid abuse and fraud.
The study commission has suggested to Bentley that the state turn the system from a fee-for-service model to managed care. Proponents said that's a less expensive option better suited for patient care.
Wren said once Medicaid is reformed with the cap and a "patient-centered" model of care, the expansion could be possible in 2014.
"I think what we're doing will be the flashpoint of being able to look at expanding Medicaid," he said.
Bentley repeatedly has said he will not expand "a broken system."
Asked Monday if there is a scenario in which the system could be expanded in 2014, Bentley spokeswoman Jennifer Ardis said, "It is hard to talk about hypotheticals because you can't do that until the current system we have is fixed and isn't broken."
The proposed changes are separate from possible expansion and are largely economic.
Lawmakers were told last week that Medicaid would need about $743 million in 2014, and interim director Dr. Don Williamson said he could trim the budget. But in 2015, nothing would be left to cut.
"After 2014, there is no money left," he said.
Sen. Greg Reed, R-Jasper, vice-chairman of the Permanent Joint Legislative Committee on Medicaid Policy and a member of the governor's Medicaid Advisory Commission, said fixing the Medicaid system is priority No. 1.
"Once we have a new model, it gives the governor more information to make the decision he may have to make in regard to expansion," Reed said.
Under the Affordable Care Act, states can opt in and out of the expansion, with the federal government picking up the tab for the first three years. States would have to pay larger percentages of the increased cost each year after that, leading opponents to say that it will cost the state money in the long run.
Democrats in the Alabama Senate have made campaigning for the expansion their one and only priority this legislative session because they say it'll be an economic boon to the state, bringing in $20 billion in new economic activity and almost $1 billion in state tax revenues during six years.
Rep. Marcel Black, D-Tuscumbia, said expanding Medicaid is a "no-brainer."
"I think a lot of other Republican governors, after making such a show of not wanting to do it, are changing their minds because they've seen the benefits," he said.
Black said he's seen the estimates for monetary impact in Alabama.
"Even if they're half true, you'd want to jump on it," he said.
Jim Carnes, of the advocacy group Arise Alabama, said his organization hopes for an expansion.
"We feel like the governor made a good call for structural reform for Medicaid," Carnes said. "As great as the prospects are for Medicaid expansion, it just makes sense to strengthen the system we have now before bringing in a huge new population.
"We think (the recommended changes) provide the assurances that he was looking for that we will have a sound system that can accommodate the expansion."
Commission member Rep. Ed Henry, R-Hartselle, said the state's current focus is on changing Medicaid, not increasing its rolls.
"Once we get the mess straightened out, we can look at what an expansion might mean," Henry said.
"The feds say it's free money, but there are arguments on both sides that are compelling."
Mary Sell can be reached at email@example.com.
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