A RAND Corp. analysis out this week looked at the consequences of Alabama and 13 other states rejecting expansion of Medicaid as part of the Affordable Care Act. The results are depressing: Less federal cash ($8.4 billion); more losses in uncompensated care ($1 billion); and more uninsured residents in those 14 states (3.6 million).
Those are powerful reasons for Alabama to expand Medicaid, which over the next 10 years would bring in $14 billion to the state while costing us about $1 billion. In the process, 300,000 uninsured Alabamians would gain coverage.
In rejecting expansion last year, Bentley said the state “simply cannot afford it.” It’s also worth noting that Bentley, a physician, opposes Obamacare on ideological grounds.
Alabama’s governor isn’t alone on this count. Plenty of his fellow Republican governors treat Obamacare as if it’s toxic. However, bucking this trend is a small subset. Gov. Jan Brewer of Arizona famously wagged her finger at President Barack Obama last year. Gov. John Kasich of Ohio is a former Republican congressman who once had his own program on Fox News.
Along with Michigan Gov. Rick Snyder, these Republican governors are pressing to expand their states’ Medicaid programs and in the process collect millions of federal dollars. The feds pick up the total bill for the first three years; the states’ share will max out at 10 percent in 2020. Not that this this is easy. These governors are battling fellow Republican lawmakers in their state legislatures.
While noting she “ never liked” Obamacare, Brewer nonetheless has said, “But, we don’t cut off our nose to spite our face.”
Translation: Leaving this much money on the table is costly — to the finances of a state, to the well-being of poor residents and to the reputation of any politician whose fierce opposition to expanding health-insurance to more Americans will be judged harshly by history.
With this at stake, Brewer and others are making a bet. They can loudly gripe about the Affordable Care Act of 2010 while at the same time rake in all that distasteful federal cash. They realize their constituents will happily play this game of cognitive dissonance.
A recent Joint Center for Political and Economic Studies poll found Alabama residents are already doing it. More Alabamians (41 percent) had an unfavorable view of Obamacare than had a favorable view of it (35 percent). Meanwhile, 64 percent supported expanding Medicaid, the very policy enabled by Obamacare. Too bad, Alabama’s governor was unwilling to follow suit.