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Gov. Robert Bentley
Is Gov. Robert Bentley nudging closer to expanding Medicaid under the Affordable Care Act?
Listen to what the governor said Tuesday when asked the question.
"You know I wouldn't say nudging toward it," said Bentley. "But we are certainly looking at that; not right now. We are not at that stage right now."
But then the governor added this when asked about remarks he had just made to a group of seniors about the need to improve healthcare in rural areas and how Medicaid expansion might come into play:
"But you know we do have to realistically look at whether we have adequate funding for rural doctors, primary care doctors. They cannot treat a third of their patients and stay in business. It is a business they run," said the governor.
Expanding Medicaid would pump hundreds of millions of mostly federal dollars into what is Alabama's primary health care program for children and the poor and provide more dollars for primary care doctors to serve those patients.
Bentley has for five years been an outspoken critic of the Affordable Care Act. A doctor himself, Bentley has opposed the law at almost every step of the fight to overturn it.
But that legal fight ended this summer when the nation's highest court upheld the law, a fact Bentley noted while speaking to the Alabama Silver-Haired Legislature, a nonpartisan, nonprofit model legislature made up of persons age 60 and older.
"You know for the last few years we've been dealing with the Affordable Care Act," Bentley told the group. "I was personally against the Affordable Care Act. I never called it Obamacare because it's not a person, it was a philosophy.
"But we lost folks. We lost. And we lost in court. So what we have to do now is move past that, take the resources we have available and try to improve the quality of life for the people of Alabama and that's exactly what I'm going to do," added Bentley.
Since becoming governor in early 2011 Bentley has pushed for reforms that he maintains will slow the growth in Medicaid costs and improve care. He has sought to primarily do that by changing Medicaid to a managed care system.
Under the Affordable Care Act (ACA), the federal government pays states most of the cost of expanding Medicaid to cover people earning up to 133 percent of the federal poverty level - about $15,600 for individuals and just over $32,000 for a family of four.
About 1 million Alabamians currently receive some level of medical care and/or benefits from Medicaid. Expanding the program under the ACA is estimated to add somewhere between 160,000 to 300,000 more Alabamians to the program.
Before the U.S Supreme Court upheld the ACA, Bentley had maintained he would not bring in hundreds of thousands to a state program that was broken.
However, about a year ago Bentley talked about the possibility of a block grant program where ACA dollars might be used provided those receiving benefits in the program held a job or are enrolled in job training. Largely a block grant would allow the state to use the dollars with fewer federal restrictions and the state could request proposals from private insurers to provide the expanded coverage.
All of that would require federal approval through waivers. At the time Bentley brought up the possibility of a block grant system no talks with federal officials had started in the process of seeing some waivers from the law.
That has changed. Bentley has been personally involved in negotiations with the Department of Health and Human Services Secretary Sylvia Mathews Burwell about the ACA and waivers the state is seeking from some requirements of the law.
Sources familiar with the talks will only say that a number of options are being discussed by Bentley with Burwell.