More than 1 million Alabamians now enrolled in Medicaid

By Johnny Kampis | Watchdog.org

CULLMAN, Ala. — The Yellowhammer State’s Medicaid enrollment now tops 1 million.

The Alabama Medicaid Agency reports the numbers spiked by 30,000 during the first quarter of 2014 as Obamacare begin taking effect.

Although Alabama is one of the states declining to expand Medicaid under the Affordable Care Act, what officials called the “woodwork effect” may be coming true — that is, people are applying for Obamacare and discovering they were eligible for Medicaid all along.

The boost in enrollment to 1,020,000 Alabama residents also includes about 100,000 women who receive free birth control through Medicaid.

The total enrollment represents more than 20 percent of the state’s 4.8 million residents.

Cameron Smith, policy analyst at the free-market think tank Alabama Policy Institute, said he doesn’t see the 1 million enrollment as a “magic number,” since the state’s Medicaid-eligible population already has been over that figure for some time.

“It’s a matter of people making use of the services that are there,” he told Alabama Watchdog.org.

In Alabama, residents must have an income of 16 percent of the federal poverty level of $23,800 (for a family of four) to qualify for Medicaid, one of the most stringent requirements in the country.

ACA expands the eligibility to 133 percent of the federal poverty level, or $31,720, for states taking part, but only about half are. Although the federal government will pay 100 percent of the costs of expansion through 2016, some of the burden begins shifting to the states in 2017, with participating states paying 10 percent by 2020.

Smith said the larger issue for Alabama is the fact so many of the state’s residents can qualify for Medicaid, even at those tight requirements. It speaks to a larger issue of a lack of quality jobs in the state, he said.

“It’s an economics thing,” he told Watchdog. “It’s a narrative we should be very concerned about, Medicaid or not.”

Those states like Alabama that declined to sign up cite three major reasons: they can’t afford even part of the additional costs, Congress and the White House aren’t the best at keeping promises and money doesn’t grow on trees – i.e. that federal tax money is coming from each state’s residents in the first place.

Cost is a big part of it in Alabama, as 35 percent of the state’s general fund budget pays for the service now, compared to 18 percent a decade ago. Legislators agreed to borrow $400 million form the state’s trust fund in 2011 to make up a shortfall in the general fund caused by the growing number of enrollees, spurred by the housing market crash in 2008.

About 220,000 enrollees have been added in just the past five years. About 300,000 more would join if Alabama reversed course and agreed to implement the federal Medicaid expansion plan.

Gov. Robert Bentley has made Medicaid reform one of his administration’s top priorities, and he spoke disdainfully of the expansion and Obamacare during his 2014 State of the State address:

“The federal government has said they will give us money to expand. But how can we believe the federal government will keep its word? The anything but Affordable Care Act has done nothing to gain our trust.

First, they told us we could keep our doctor — that turned out not to be true. Next, they told us we could keep our policy — that’s not true. Then they told us our premiums would not go up — nothing could be further from the truth. Now they are telling us we’ll get free money to expand Medicaid.

Ladies and gentlemen, nothing is free. The money the federal government is spending with wild abandon is not federal dollars — those are your dollars, your hard-earned tax dollars. There is no difference between federal money and your money.”

Contact Johnny Kampis at johnny@missouriwatchdog.org