Alabama Accepts The Reality Of Obamacare — And Its Federal Funds

Gov. Robert Bentley (R-AL)

While many states are moving slowly to implement the requirements of the Affordable Care Act, Alabama — a red state with a Republican governor — is on track to institute the law’s health insurance exchanges and is increasing spending on its Medicaid program — all the while challenging the constitutionality of the law in court. It’s a more nuanced view of reform that recognizes the practicality of using the law’s new federal dollars to cover its citizens and the need to continue implementing the measure to receive more federal funds. Faced with the choice of money and politics, Alabama is choosing the money. Politico’s Sarah Kliff has the story:

Last week alone, Republican Gov. Robert Bentley issued an executive order to move forward on an Alabama health insurance exchange and lashed out at the state’s Republican-controlled Legislature for attempting to scale back his proposed $247 million increase in Medicaid funding by a mere $7 million. […]

But for as much as Medicaid strains state budgets, it’s also a major contributor. In states with high rates of poverty, like Alabama — where poverty is the third-highest in the nation — the federal government provides as much as three-quarters of the entitlement program’s budget. For every dollar Alabama spends on Medicaid, Washington ponies up $2.80.

State officials are also pushing back against the GOP’s plans to block grant the Medicaid program:

“The idea of a block grant really will not save my program,” Alabama Medicaid Agency Director Bob Mullins told POLITICO in a recent interview. “I’ve already got a minimum program, and if that block grant says I have to maintain that minimum program [with less money], well, obviously, that’s not going to work very well.” […]

Under the current matching-per-enrollee payment system, he said, “If I had 100,000 more people sign up in the next six months, I [would] get more federal drawdown.

“If you give me a block grant, I end up up a creek.”

Many other states continue to accept federal grants while claiming that the law which authorized those funds is unconstitutional. But Alabama stands alone in recognizing the ACA is established law and that any other alternative to it would leave the state with less federal dollars. It’s the kind of argument that should make a lot of sense to Republican governors and maybe even give them political cover to follow Alabam’s lead.