Governor Robert Bentley says that he ready to be a sort of "last man standing" when it comes to his decision so far to not expand Medicaid.
In an interview with WSFA 12 News, Gov. Bentley said, "This is not to punish the poor of this state. This is to try and get a better program and an affordable program for this state and if I'm the only governor. . . If I'm the only governor left with enough forethought and really trying to get things to work right then I'll be the only governor."
Medicaid expansion is an option for states to expand health insurance benefits under the Patient Protection and Affordable Care Act, also known as Obamacare.
The United States Supreme Court upheld the law as a tax last summer but did change a provision that would have made it mandatory for states to expand their Medicaid programs in order to receive billions in federal assistance. The justices on the high court ruled that section unconstitutional and made it optional for states to expand their Medicaid programs.
In Alabama, Medicaid serves a very limited population that consists almost exclusively includes children, pregnant women, and the elderly.
According to a study conducted by economists at UAB Medical Center, Alabama could see a $10 billion impact on the state's Gross Domestic Product (GDP), the goods and services produced by the state. The Hyundai Motors Manufacturing America facility in Montgomery has a $6 billion impact on Alabama's economy and the Airbus assembly line currently under construction is projected to have a nearly $9 billion impact on the state's GDP.
When asked if he viewed the Medicaid expansion as a possible economic development project, Gov. Bentley said he has never thought of it that way because the money for the expansion comes from the federal government.
They can say this is free money coming into the state. It's not free money because we're paying for it and we're $16.6 trillion dollars in debt right now and you add $6 trillion to this debt that we already have and we're going bankrupt" Bentley said.
There is one scenario known as the "Arkansas Model" as a possible avenue for Alabama in expanding Medicaid that the governor won't rule out. It would involve the state applying for waivers and block grants for the state to provide to newly eligible Medicaid patients. Those patients would then use the subsidies to pay for health insurance on an exchange or marketplace.
"I think it's one of those things you want to explore" said Dr. Don Williamson, Alabama's Public Health Officer who has helped to run the Medicaid Agency for the past year. I think it's one of those things you want to ask about from other states."
As a doctor himself, Gov. Robert Bentley says his decision to not expand Medicaid is in the best interests of some Alabamians, but not all, like those without health insurance.
"Some of those people already have health insurance through their job" Gov. Bentley said.
When asked if he was abiding by the oath he took as a doctor to care for and do what's best for all of his patients, Gov. Bentley said, "I do believe that I am doing the best thing for our existing Medicaid patients with this bill we're talking about. I do believe that we will have a much better system."
Lawmakers in the Alabama legislature are considering a measure to overhaul the state's Medicaid program that could pave the way for an expansion in the future.
The governor has described that measure as a "good first step" in the conversation about expanding Medicaid.