Governor Robert Bentley has responded to a congressional request to recommend changes to the Affordable Care Act in an effort to improve quality and affordability in health insurance markets and in Medicaid.
Bentley wrote House Majority Leader Kevin McCarthy, R-Calif., and copied U.S. Sens. Richard Shelby and Jeff Sessions, U.S. Reps. Robert Aderholt, R-Haleyville, Mo Brooks, R-Huntsville, Bradley Byrne, R-Montrose, Martha Roby, R-Montgomery, Mike Rogers, R-Saks, and Terri Sewell, D-Birmingham.
He responded to Rep. McCarthy after the presidential election of Donald J. Trump, who seeks repeal of the ACA, known as ObamaCare. President Trump wants to turn Medicaid into a block-grant payment system where states would get lump sums to spend as they wish.
Governor Bentley is cautious, though, on the idea of block grants. “If we don’t have some type of payment per capita, we cannot ask for some type of block grant,” Bentley said.
“States should be given the ability to reduce Medicaid benefits or enrollment, to impose premiums or other skin-in-the-game requirements for beneficiaries, or to reduce Medicaid spending in other ways if needed to match cuts in federal Medicaid revenues that may accompany reforms,” Bentley wrote. “Quality care would remain crucial, but a sustainable balance of revenues and spending also must exist.”
Alabama, with a population of 4.8 million, has more than 1.2 million eligible Medicaid recipients – 26 percent of the population. Taxpayers pay $500 billion a year on the combination state and federal aid program to provide 70 million people with health insurance. Many gain coverage under the Affordable Care Act through Medicaid.
Alabama’s Medicaid payment share strains the stagnant General Fund budget.
Governor Bentley said consumer choice is vital but repealing the Affordable Care Act without a clear replacement could raise concerns among insurers nationwide, and cause some to withdraw from the market, limiting consumer choice.
Governor Bentley recommended eliminating the Small Business Health Options Program (SHOP). Small business markets were relatively stable prior to the implementation of the ACA in 2010. Let small businesses make the decisions as to whether to offer insurance coverage and what type of insurance coverage suits their needs and those of their employees, he recommended.
Governor Bentley said because small business markets were relatively stable prior to the implementation of the ACA in 2010, small businesses should decide whether to offer insurance coverage and what type of insurance coverage. The premium increases experienced now in the small-group market are a direct result of the federal duplication of state regulation and the federal intrusion into the type of insurance plans that may be offered to small businesses and what coverage is required, he said.
Governor Bentley also recommended:
Adjusting, by regulation or law, the Medicare Hospital Area Wage Index to reduce the wide gaps between states in hospital reimbursement rates paid by Medicare;
Stopping scheduled cuts in Medicaid Disproportionate Share Hospital (DSH) payments, cuts that would hurt hospitals that care for many indigent people, especially in states such as Alabama that have not expanded Medicaid under the Affordable Care Act;
Maintaining federal funding for the Children’s Health Insurance Program (CHIP) and maintaining the Federal Medical Assistance Percentage (FMAP) increase now in place;
Ensuring that “people are truly eligible when they enroll in “creditable coverage” plans, whether in an initial enrollment, open enrollment or a special enrollment period, to ensure that late enrollees are identified or the special enrollment period truly applies to the circumstances. Additionally, if an individual appears to be eligible for a public program such as Medicare or Medicaid, he or she should be referred to that program, he said;
Allowing states the flexibility to establish their own Medicaid eligibility rules and grant the power to set co-pay amounts and charge premiums for Medicaid.
Governor Bentley said because of the Legislature’s meeting schedule and the preparation requirements, it could take a minimum of 18 months for insurers to develop plans, rates, forms, and networks, and to meet any other regulatory requirements to replace the ACA. In addition, the state would need 18 months to change Medicaid.