News Analysis by: John Zippert, Co-Publisher

The Alabama Hospital Association, a statewide trade organization representing 100 hospitals in the state is launching the ALhealthmatters campaign highlighting the importance of expanding Medicaid. The Association says If Alabama expands Medicaid, almost 300,000 uninsured Alabamians would receive health insurance coverage, an estimated 30,000 jobs would be created, and $28 billion in new economic activity would be generated.  Alabama would also save millions of dollars on current state services.  “On average, almost one out of every 10 hospital patients does not have health insurance, resulting in more than $530 million annually in uncompensated care,” said Danne Howard, executive vice president and chief policy officer of the Alabama Hospital Association.  “Currently, 75 percent of Alabama’s hospitals are operating in the red, meaning the dollars they receive for caring for patients are not enough to cover the cost of that care.  Expanding Medicaid would be a significant investment in the state’s fragile health care infrastructure and would help maintain access to care for everyone.” “In Greene County because we are a poor county, one in three patients do not have any insurance, which means we provide an average of $100,000 in uncompensated care per month. Expanding Medicaid under the Affordable Care Act would help people in our county whose earn less than 138% of poverty (approximately $20,000 annual for a family of four) to secure affordable health insurance coverage,” said Dr. Marcia Pugh, Administrator of the Greene County Health System. Howard adds that hospitals and other health care providers are a critical piece of the state’s infrastructure.  “Alabama’s hospitals employ about 90,000 individuals and indirectly support another 96,000 jobs,” she said.  “Not only are they often one of the largest employers in their communities, but hospitals also have a huge economic impact on their local economy.  Statewide, the annual economic impact of Alabama hospitals is nearly $20 billion, not to mention the pivotal role access to quality health care plays in recruiting and keeping new businesses.” The Alabama Hospital Association statement indicates the importance of expanding Medicaid but does not endorse the state’s Democratic political candidates who support Medicaid expansion. Walt Maddox, Democratic candidate for Governor, in the November election, says, “ I will expand Medicaid for Alabama during the first hour of the first day that I am Governor. We will find the resources to pay our part of the costs to pay for this critical life-saving service from our people.” Incumbent Gov. Kay Ivey has not expanded Medicaid and does not intend to because of cost. State Senator Hank Sanders said, “ It is clear that on the one issue of expanding Medicaid, there is a clear distinction between the candidates for Governor on the ballot in November.

Democratic candidate Walt Maddox will expand Medicaid and help save lives in Alabama as well as expand our economy in every county, while Kay Ivey will continue to oppose this program for narrow political reasons.” Since 2010 when Medicaid expansion has been available under the Affordable Care Act, Alabama has lost $7 billion in Federal support under the program. For the first three years of the program, there was no cost to the states to participate. This has increased by 2.5% a year until it reached the maximum 10% this fiscal year. In addition in coming years beginning in 2020, the disproportionate share reimbursement rate payment to rural hospitals will decline because the program assumes coverage for low-income people in the state by Medicaid expansion under the ACA. Rural hospitals in states like Alabama, that have not expanded Medicaid, will begin to take a “double-whammy” for not expanding Medicaid – more patients without insurance coupled with lower reimbursement rates. Howard notes that a recent study showed that hospitals in expansion states were 84 percent less likely to close than hospitals in non-expansion states.  “Alabama has had 12 hospitals close since 2011, and more are on the verge of closing if something doesn’t change,” she added. “Plus, the economic impact in other states has been tremendous; Louisiana has added 19,000 jobs; nearly 50 percent of new enrollees in Ohio have been able to receive mental health and substance abuse treatment, and the state has seen a 17-percent drop in emergency department use; Kentucky has seen an increase in state revenues of $300 million.” The AHA study says, “Investing in the rural health care infrastructure is critical as Alabama works to improve rural prosperity.  Alabama’s rural hospitals are an anchor in their communities‒creating jobs, providing critical care, and supporting other industries.   ​“When a rural hospital closes, other mainstays in the community often follow … local pharmacies, physicians, banks, and grocery stores to name a few. When a rural hospital closes, it’s very difficult to attract new business. “ ​Throughout the next few months, hospitals will be talking with business, civic and government leaders to stress the importance of expanding Medicaid in Alabama and to share quantitative results of the positive impact it is having in other states.  For more information on the impact Medicaid expansion could have in Alabama, visitwww.alhealthmatters.com.