By Lee Hedgepeth
Alabama Political Reporter
Chairman of the Alabama House of Representatives Ways and Means General Fund Committee, Representative Steve Clouse, R-Ozark, has recently told media outlets that he favors the expansion of Medicaid under the Patient Protection and Affordable Care Act, more widely known as Obamacare, as long as Alabama’s share of funding for the expansion does not exceed ten percent of the its total cost.
Until now, Rep. Clouse, like nearly all Republican members of the Alabama Legislature, has opposed Medicaid expansion, citing unforeseen costs and increased government dependency.
Under the Affordable Care Act, the Federal government is required by law to fully fund the expansion of Medicaid in states until 2017. Then, their obligation would taper to 95 percent of total costs, leaving Alabama with a five percent funding burden, which would gradually increase to around ten percent in 2020, at which point the federally government would no longer, under today’s law, be required to fund the program.
Despite the gradual increase in cost to the State beginning in 2017, however, research from the University of Alabama in Birmingham and further review by the University of Alabama conclude that given the increased demand in the health care market that would occur, tax revenue form the program would top $1 billion, bring 30,700 to the state, and provide access to health care for 300,000 uninsured Alabamians.
One of the “good things” the Supreme Court did in their ruling on the Affordable Care Act, Representative Clouse told Capitol Journal’s Don Dailey, is that “you can come in and you can come out,” pointing to the fact that states do not necessarily have to keep the Medicaid program in its expanded form after their cost burden tops ten percent.
“We can’t get a firm answer from the Federal government,” he said, alluding to unsure funding obligations for the State after 2020.
For now, though, the Ozark Republican thinks the expansion is a good idea.
“I can see us as we’re going forward probably maybe moving into the expansion of Medicaid,” Clouse told Dailey. “I can see a movement probably next year.”
When asked whether he thought that an expansion next year, after the 2014 election cycle had ended, was a political move on the part of lawmakers, Representative Clouse was rather candid:
“Some of it is,” he said bluntly. “After the elections are over, cooler heads may prevail on this.”
At one point in the interview, elaborating on his favoring expansion, Clouse came back to the issues at hand, saying that not expanding Medicaid would be a “double whammy” for hospitals throughout the State, because the ACA reduces reimbursements that the Federal government expects to be paid for through the expansion.
He also – somewhat surprisingly – credited the Affordable Health Care (and himself) for saving Alabamians $10 million form the General Fund Budget by abolishing a program under which Alabama was required to subsidize health insurance for those who had exhausted their previous policies due to situation such as those with preexisting conditions. That subsidy program is now unnecessary given that such situations are covered under Obamacare, a label Clouse did not assign the President’s signature legislation during the interview.
Before, Clouse explained, “The states had to provide that… We had to help subsidize it. Now, with the ACA, they can go into the health exchange… that will save us some money there.”
Clouse said, however, that he has not approached Governor Bentley about his position. Bentley has long been opposed to the expansion, making the fight against “government dependency” one of the themes of this year’s State of the State address to the Alabama Legislature. “He is standing firm on that,” Clouse said.
As chair of the House Ways and Means General Fund Committee, Rep. Clouse is in the single best position to legislate on Medicaid possible. The committee appropriates the general fund budget, which includes all Medicaid expenses.
Representative Clouse, who was elected to the House in 1994, is facing Democrat Dr. Jennifer Marsden in the November election. Dr. Marsden, who has consistently supported expanding Medicaid, is a retired Army Major, was educated at Harvard University, earned a medical degree at the University of Pittsburgh, and is a family physician. She is the first woman ever to run for the seat representing Alabama House District 93.