Name:   copperline - Subject:   Insurance for Everyone Date:   6/26/2017 2:56:57 PM

Here is a policy analysis I just got yesterday from a friend.   She is a Pediatrician and senior staff member at Children’s Hospital here in Birmingham.

It reads:

“This is a long so buckle up: Alabama gets about a 2:1 match on its Medicaid dollars, which the ACA repeal bill proposed in the US Senate will cut into a block grant.  This does not include the Medicaid expansion under PPACA because Alabama did not participate in the Medicaid expansion.  This is existing care that we’ve had well before 2010, do there is no “Obamacare” discussion to be had here.  This is something that existed before 2010 and will only change if the current proposal passes.

In 2015, Alabama Medicaid was 32% state-funded and 68% federal-funded.  More than a million Alabamians are Medicaid recipients; about 535,800 of them are children (0-18 yrs old) and another 16,000 are pregnant women.   This means that about half of Alabama kids under age 18 are Medicaid recipients by my back- of- the- napkin math.   Able-bodied adults without kids rarely qualify for Medicaid, and if you’re the parent of a kid who is a Medicaid beneficiary,  you can only get coverage from Medicaid if you make 18% of the Federal  poverty level  (about $3600/year for a family of three).   Kids are only eligible if they are from a family whose income is less than $2957 a month for a family of four (about $35,000 per year).

From 2008-2016, the portion of Alabama kids living in poverty increased by 27%.  According to the Annie E. Casey Foundation, in 2014, 375,000 Alabama kids (18 & under) received Supplementary Security Income (SSI), cash public assistance income, or Food Stamps/SNAP in the previous12 months.   That’s about 1/3 of Alabama kids.   Between 2010-2014, 192,000 Alabama kids lived in census tracts with poverty rates of 30% or more.   We have a poverty problem and Medicaid plays a big role in keeping poverty from killing Alabamians more quickly.   Medicaid helps make healthcare available to rural Alabamians---especially kids who need pediatricians.   So, if this bill passes and the Alabama legislature does not change the way we fund Medicaid, you’ll  likely see doctor’s offices close, wait times increase, and fewer people with access to healthcare.   We already have the 4^th worst infant mortality rate in the country (8.7 deaths per 1000), which means we lost 517 infants in 2014.   Expect that to get worse with less care available.   I’m not even going to get into what this will do for Nursing homes and Assisted Living facilities that care for our senior saints or the disabled---about 31% of Alabama Medicaid recipients are elderly, blind or disabled.   In 2015, at least ¼ of the people in 57 out of 67 counties are eligible for Medicaid.

Alabama Medicaid makes up between 14-16% of the combined state budget, and is expected to consume more proportionately as time goes on.   In the General Fund budget, we already spend approximately 60% of the budget on two items:  Medicaid and corrections.   This means the Legislature and the people of Alabama would need to increase funding to provide the same level of care as our existing bare-bones program, or cut that bare-bones program back further so fewer people are covered (or there’s less coverage offered for the same number of people or more……remember, poverty is increasing in Alabama)   Spoiler alert:   They won’t change it because they are too scared to raise tax revenue and because there is a structural flaw in the way our State Government is set up.

The result will be anti-family and anti-life.   It will reduce opportunities for human flourishing in the State of Alabama.  So, feel however you want about the Affordable Care Act, Medicaid, the Trump-Ryan repeal bill…. Reducing the tax burden on people who make more than $250,000 per year and on medical device companies, and all the elements of the 1/6 of the American economy this will affect.  

But know the stakes for your neighbors when you formulate your opinions.”