By Bill Britt
Alabama Political Reporter
MONTGOMERY—While the political battle is still being waged over the politics of the Affordable Care Act, one Alabama State representative is mining for clarity and hard data.
“We are continuing to drill into the Supreme Court ruling and doing a lot of analysis on it and the Medicaid expansion piece,” says, Representative Greg Wren (R-Montgomery).
Wren is considered by most as Alabama’s leading authority on the ACA.
Wren is the National Chairman of NCSL’s Healthcare Reform Committee, a national bipartisan group of state legislators that is focusing on protecting the individual states, with state specific plans with regards to the Affordable Care Act.
“We are doing a thorough evaluation of full supreme court decisions so that we understand its full implications,” Wren joked. “Unlike the press reporting in the first few moments of the Court’s ruling, we are determined to get it right.”
Wren says that because in his opinion the Chief Justice’s specific reference to a code section as too penalties there are some questions that will be clarification.
A portion of the Roberts opinion, which was joined by Justices Stephen Breyer and Elena Kagan, said that the federal government had gone too far when imposing requirements on states as a condition of accepting federal dollars to expand Medicaid. In his opinion Roberts said that “in this case the financial ‘inducement’ Congress has chosen … is a gun to the head.” The Roberts ruling struck down the mandate that states expand Medicaid to more citizens.
Wren explained that the section Justice Roberts referenced when striking down the Medicaid expansion mandate was talking about expansion on Medicaid for adults.
“The question then arises, what does this mean for pregnant woman and children?” asks Wren.
The way the opinion is written there is a lack of clarity as to if the expansion portion of the ruling —that had the penalty—only applies to adults and not pregnant woman and children.
“This would greatly affect Alabama were half the live births are covered by Medicaid,” said Wren, “This is a serious question mark. This could add tens of thousands of people onto the Medicaid rolls in Alabama.”
Wren and other lawmakers are grappling with the details of the ruling and the subsequent implementation of Medicaid.
“We can’t sit around gazing into the crystal ball anymore,” says Wren. “The crystal ball got it wrong.”
Wren is referencing those in Alabama, including the governor, who had hoped the Supreme Court would overturn Medicaid.
Wren says that the state must be prepared and no longer engage in wishful thinking.
Many are still pinning their hopes on a Romney presidency overturning the Patient Protection and Affordable Care Act (ACA), but no serious constitutional scholars and policy wonks see an easy road to total repeal of the ACA, even if the Republicans win the presidential election.
“We must have hard data to make good choices,” says Wren.
Wren and company are working tirelessly to gather the necessary facts to enable the state government to make the best choices for the state.
“As a legislature we will have to look at multiple scenarios, concerning the option to expand Medicaid,” Wren said.
The group at which Wren sits at the helm is mining all of the data to present states like Alabama with a clearer picture of choices in considering Medicaid’s expansion.
“There is an interesting paradox in play here with the enhanced federal matching funds for Medicaid,” said Wren.
In the original ACA the government had offered state a carrot and a stick to expand Medicaid. The stick was taken away but the inducements to expand the program remain.
“I am not arguing for or against expanding Medicaid,” said Wren, “I just want to have the facts, so we know what we are looking at.”
If a state choses to expand Medicaid, between 2014 and 2019 the federal government will provide 100 percent funding decreasing to 90 percent funding over that six year period ostensibly expanding the program with a massive infusion of federal dollars.
The initial data gathered thus far shows that the federal dollars flowing into Alabama would be around $8 billion dollars. Alabama’s portion of the match money would be around $500 million.
“Obviously I understand the problem of where are we going to get $500 million,” said Wren, “but this is a huge return on investment.”
Wren points out that in a small state like Alabama, where the entire medical infrastructure is built on Medicaid dollars, this would be an enormous boost to the system.
“Look at the provider community that is not getting anything from the uninsured population over that six year period,” said Wren, “Then you add some 9 to 10 billion in new dollars infusion. In the health care community, that would be massive.”
Wren continues, “It would be easy to say, ‘no way are we going to let the feds tell us what to do,’ and I’m there. However, if you take a deep breath and take a step back and look at the return on investment and see how that money infuses itself into the system, then maybe you take two step back and two deep breaths and say let’s not be too knee jerk, because of the political reaction to this idea.”
Wren says this is why he and others are working hard to gather all the facts, “so that we will be armed with good information to make the best decisions for Alabama and its people.”
He says that in the next ten days he will be ready to start submitting the research and hopes that he can work together with the governor and the legislative body to look at all Alabama’s options.
“We can take this information as a template and lay it against the existing Alabama plan, then ask the questions,” says Wren, “Then we put some dollar signs behind each one of them from launch out to a ten year projection on Medicaid and then make decisions.”
Wren says he believes we are going to have to be, “intellectually honest on these decisions by letting fact based evidence drive the discussion and not wholesale politics.”