State health officer: Expand Medicaid, improve health

Dr. Don Williamson was direct when asked how to improve Alabama's health.

“I would expand Medicaid,” Williamson, the State Health Officer, said at a meeting of the Alabama Health Improvement Task Force Wednesday afternoon. “It’s that simple.”

But Williamson, a 20-year veteran of Alabama state government leaving in November to head the Alabama Hospital Association, pointed out after the meeting that the state’s health care politics aren’t simple.

“To expand the number people to be covered, you need the money for match,” Williamson said after the meeting. “You’ve got to have legislative support for that. And rule revisions. You’ve got to have rule revisions that are going to have to go through Legislative Council . . . you can’t cover the working poor without a consensus. Not only of the executive branch, but of the legislative branch.”

Still, the comments represented the first time a high-ranking state official, one who worked with Gov. Robert Bentley on changes to Medicaid delivery, openly discussed advantages of opting into the Affordable Care Act’s expansion option.

Eligibility for Medicaid in Alabama is limited to children and pregnant women. Childless adults almost never qualify, and parents of children on Medicaid can receive benefits only if they make 18 percent of the poverty level -- $4,368 a year in a household of four. Under the ACA, Medicaid eligibility would expand to those making 138 percent of the poverty line -- $16,243 a year for an individual, and $33,465 for a family of four.

According to the Kaiser Family Foundation, about 176,000 Alabamians fall into a “coverage gap,” where they make too much money to qualify for Medicaid, and too little to qualify for subsidies offered in the federal insurance exchange.

Alabama Republicans oppose Medicaid expansion, saying the state cannot afford it. The Senate passed a resolution in April expressing opposition to the idea.

Bentley, who refused to consider the proposal for most of his first term, said last December he was open to a block grant program with a work requirement. The Center for Medicare and Medicaid Services (CMS), which oversees both program, has rejected similar programs from other states, and health care advocates say most of those in the coverage gap have jobs.

Bentley said Tuesday talks were continuing with CMS.

“We haven’t agreed yet on everything,” he said. “That’s just some preliminary talks we’re working on right now.”

Williamson also voiced frustration with the limited benefits given to Medicaid recipients in the program. In particular, Williamson said he was “bothered” that the state did not cover adult dental care, insulin pumps or BRCA tests that identify a woman’s likelihood of developing breast or ovarian cancer.

“Blue Cross does that,” he said. “We ought to be able to do that.” Williamson also noted that Alabama covers about 35 percent more people than Mississippi, but pays 35 percent less.

By most measures, Alabama needs healthier outcomes. The state has a high infant mortality rate and the highest rate of diabetes in the nation, according to America’s Health Rankings, run by the United Health Foundation. Alabama also tends to rank high for obesity rates.

Williamson in the past has spoken about his broad support for access to health insurance, which he repeated on Tuesday after his Medicaid expansion comments.

“I am absolutely convinced people with access to health care have better outcomes,” he said. “I think people who have insurance do better. That’s what Don Williamson, the state health officer would do. I understand the politics.”