By Bill Britt
Alabama Political Reporter
MONTGOMERY—It what may be a bit of supple irony the Robert Johnson blues song “Sweet Home Chicago” played in the Capitol Auditorium as the Alabama Joint Legislative Medicaid Committee took to the stage to discuss the future of Medicaid under an Obama second term.
On whole, the state’s governor and republican legislature had taken a wait-and-see attitude toward implementation of Medicaid expansion and an even more resistant approach to the Affordable Care Act or (ACA).
Now, with the re-election of the man from Chicago, the state’s leaders are in a race to decide the future of the plan in Alabama.
One man who has not been idle is Representative Greg Wren (R-Montgomery), Chairman of the Joint Legislative Medicaid Committee. Wren and his colleagues have been working to explore the options that the state faces going forward.
“I believe the Joint Legislative Medicaid Committee has worked really hard to drill into every aspect of Medicaid from the financing to the delivery system to the payment system,” said Wren. “It is 100 percent certain they we are going to have to reform our Medicaid program which is systemically on life support.”
The committee is confronted with looking at structural changes to the system while also facing the deadlines to opt in or out of the Medicaid expansion being pushed by the federal government.
The expansion of Medicaid has been a major part of President Obama’s healthcare reform. Under the President’s plan around 400,000 Alabamians could be added to the Medicaid rolls over the next three years if the state opt in.
Very few people in state government seem to have an idea on how this could be implemented given the no new tax pledges made by Governor Bentley and the GOP super majority.
Thursday Wren and company looked at new ways in which they can restructure the program to keep it viable, “Medicaid is too important to our healthcare infrastructure and economic infrastructure to allow it to go into the future in the way it has been in the past,” said Wren. “We have legislators working on this everyday non-stop until February.”
Even if Alabama chooses to opt out of the Medicaid expansion the state’s top health officer, Dr. Don Williamson, and acting guide for Medicaid has said that Medicaid would increase in Alabama even if the legislature opts out of the federal program.
State Senator Greg Reed (R-Jasper) Co-Chairman of the Joint Legislative Medicaid Committee said, “According to what we are hearing, we are going to have a $30 to $40 million dollars increase in Medicaid cost facing the general fund in the near future. We have to look at how we provide better care that is cost effective but to do that we are going to have to address the very structure of how Medicaid is funded in Alabama.”
Reed and Wren have been working together with other state’s and experts from around the country to find the right answers for Alabama.
“It is a daunting challenge but when we are dealing with something that effects over a million Alabamians and consumes over 35 percent of our general fund budget, it demands this kind of attention,” said Wren.
During the meeting Senator Viviane Figures (D-Mobile) expressed her dismay that so few women and minorities have been awarded seats on the Medicaid committees and commission in Alabama.
Figures says that while the committee is making progress she has stressed to the Chairman Wren her concerns about the make up of the committee. “The very first day we met, I felt that the Chair and the Co-Chair should have at least been Democrat/Republican, male/female, black/white, because that is what you call inclusion,” said Figures. “When you see this commission, we started out with four Democrats on this committee, now we have three. Representative Scott, Representative Beach and myself.”
Figures also points out that the governor’s new Medicaid lacks a collation that is reflective of the state. “When you look at this Commission that the Governor appointed, I was very disappointed.” said Figures. She says the Governor had “vowed to work with both sides of the aisle and be inclusive.”
However, she points out that, on the governor’s commission, “There are only four women on that 26 member commission.”
She says that women are the ones who deal most often and more directly with the Medicaid system and yet only a handful of women will be making the decision on Medicaid’s future.
“Then when you look at the gender as far as the Legislators are concerned, there are four Legislators on there [The Governor’s commission], two white male Republicans from the House, two white male Republican from the Senate. There is no Democratic representation on the committee and no female representation from the Legislature.”
Figures says she believes, “All sides have to be willing to give a little and take a little.”
Chairman Wren said that he is working in a bi-partisan way and that he understands Figures concerns. Wren says he understands that people are watching how Republicans will reform Medicaid in Alabama and is working to be inclusive.
Wren says he believes that the nature of Medicaid in Alabama fits the needs of the people of the state. “For too long we have taken a template and tried to fit it to Alabama,” said Wren. “We have to look at specifics for Alabama, look at our demographics.”
He says that, “The first person to live to be 130 years old in Alabama has already been born.” He knows that the committee must be “looking at Medicaid for the next thirty to fifty years, anything less than that is intellectually dishonest.
There seems to be a long road ahead of the committee and a short time to travel it, but Wren says he is confident that it will be done.