The national health care reform act has been signed into law. It requires individuals to have health coverage and calls for their employers to offer insurance; it also requires states to expand their Medicaid programs to cover all people under age 65 with incomes up to 133 percent of the national poverty level.
Those over 65 are already covered by the federal Medicare program.
The new law’s requirements are being challenged in court and the outcome is uncertain. Nevertheless the health care reform debate highlights two important issues facing Alabama.
The first is that many Alabamians lack adequate access to health care. About 475,000 adult Alabamians have no health insurance, according to the Census Bureau. Increased coverage will mean greater demand for medical services. The state already has shortages of doctors and nurses. One of every five Alabamians — 888,000 people — live in a designated “health professional shortage area.”
Both of the state’s medical schools have telemedicine programs to overcome geographic barriers, and they offer rural medicine scholarships; the nursing profession also has proposals to increase the availability of nurse practitioners. Still providing adequate numbers of medical treatment professionals already is a big challenge in Alabama, and health care reform will add to it.
The second issue for Alabama is how to pay for Medicaid, which even now consumes 30 percent of the state’s general fund budget. The program is financing about $5 billion of medical care this year, and federal funds pay for a large percentage of it.
However, Alabama struggles each year to pay its matching share and operates a program at the minimum levels allowed by federal law.
More than 835,000 people are currently eligible for Medicaid, and about 240,000 uninsured adults fall within the income levels proposed for Medicaid expansion. Where will the state get additional dollars for Medicaid?
Alabama is one of several states that are disadvantaged by inaccuracies in the Medicaid matching formula, which ignores the number of poor residents, the capacity to tax and the cost of medical care in a state. The U.S. Government Accountability Office, the investigative arm of Congress, has documented these flaws and their implications in several studies.
Alabama’s congressional delegation has never made this an issue of concern, but now the stakes are much higher.
EDITOR’S NOTE — Jim Williams is executive director for the nonprofit, nonpartisan Public Affairs Research Council of Alabama.
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