Alabama Governor Bentley signs Executive Order No.4 Creating Alabama Health Care Improvement Task Force

Yesterday, Monday, April 6, 2015, Alabama Governor Robert J. Bentley, MD signed Executive Order No.4 creating a 38-member “Alabama Health Care Improvement Task Force.”

Though the unspoken ostensible purpose of the task force is to likely make recommendations to the Governor for the expansion of Medicaid in Alabama, it’s being couched to the less-than-observant (or less-than-smart, take your pick), as a home-grown alternative to the big bad wolf of D.C. known as “ObamaCare.”

Again, for the benefit of the uneducated, in addition to decreasing fraud, waste and abuse, increasing efficiency, eliminating discrimination against women, children & people with “pre-existing” conditions, mandating numerous improvements to the quality of the delivery of healthcare from all states in order to receive payment (performance-based payment), the Patient Protection and Affordable Care Act (sometimes abbreviated as ACA, though popularly known as “ObamaCare”), contains a provision encouraging (but not requiring – that decision was made the U.S. Supreme Court) the state’s governors to expand Medicaid for their impoverished residents. The law provides for 100% payment for so doing, then gradually declines to 90%.

Governors in Kentucky and Arkansas have decided to Expand Medicaid in their states, and are already enjoying savings.

Currently, Alabama’s matching portion (the %age it pays to purchase Medicaid) is 32.4%; so to expand Medicaid, and have it ALL paid for, and then to pay a LOWER rate than is presently being paid is one of the smartest fiscal decisions the state could make.

Already, the Governors of Kentucky and Arkansas – both well-known Republican strongholds, with opposition to the ACA – have expanded Medicaid in their states, and are already reaping the rewards.

Here’s a chart showing the compensation plan to the states:

ACA (ObamaCare) Federal Matching for Medicaid Expansion

As the Government Accountability Office (GAO) has stated, “The federal government will assume 100 percent of the Medicaid costs of covering newly eligible individuals for the first three years that the expansion is in effect (2014-2016). Federal support will then phase down slightly over the following several years, and by 2020 (and for all subsequent years), the federal government will pay 90 percent of the costs of covering these individuals.  According to CBO, between 2014 and 2022, the federal government will pay $931 billion of the cost of the Medicaid expansion, while states will pay roughly $73 billion, or 7 percent.

The U.S. Government Accountability Office (GAO) wrote in GAO-12-821, Published Aug 1, 2012, that “Medicaid—a joint federal-state program that finances health care for certain categories of low-income individuals—must be expanded to non-elderly individuals with incomes at or below 133 percent of the federal poverty level (FPL) beginning on January 1, 2014. Through this expansion, states will provide Medicaid coverage to eligible low-income parents and childless adults. PPACA also requires the establishment of American Health Benefit Exchanges (referred to as exchanges)—marketplaces where eligible individuals can purchase private health insurance in each state.”

According to the United States Census Bureau, Alabama’s Poverty Rate for the years 2009-2013 is 18.6%, while the U.S. national average is 15.4%.

Given the state’s 2014 population estimate – 4.89 Million – that’s 901,984 people.

Put another way, combine Jefferson & Madison counties’ population & subtract 10%.

California’s poverty rate is lower – 15.9%, as is Montana’s – 15.2%.
Michigan – 16.8%
Maine – 13.6%
Florida – 16.3%

Alabama Governor Dr. Robert J. Bentley, MD, seen here with select members, signs Executive Order No. 4 creating the “Alabama Health Care Improvement Task Force.”
Note the Confederate flag on the FAR RIGHT.

There was at least one odd thing about the signing event, and it was that there apparently remains a Confederate flag positioned alongside Alabama’s state flag… which is disturbingly odd if you think about it – especially given the fact that some decades ago in the 1970’s, State Representative Alvin Holmes climbed up to the Capitol dome and removed the Confederate flag. In the three decades following, he and other lawmakers attempted several times to remove the Confederate flag which had been flying ABOVE the United States and Alabama state flags (a clear violation of the Public Law which is the United States Flag Code & protocol) and were arrested. One such occasion was in February, 1988 when he and 13 other lawmakers were arrested while attempting to remove it. Naturally, a flap ensued (Please, please laugh!), and a civil lawsuit ensued. (Again, please laugh!) Holmes eventually sued then-governor Guy Hunt to have the flag removed, and won in 1993.

Hunt was Alabama’s first Republican governor since Reconstruction (that’d be the post-Civil War period for the unaware), and up to that point, his only elected political experience was being a Probate Judge in Cullman County. His election was a most unexpected political turnover, and resulted from a question of “crossover” votes in a primary race pitting then Alabama Attorney General Charles Graddick in a runoff with Lieutenant Governor Bill Baxley, both Democrats, as the party’s gubernatorial candidate. Charlie Graddick won by a slim margin, and Baxley sued alleging that Graddick had encouraged Republicans to “cross over” (against party rules, but not illegal) and vote in the Democratic primary. The fracas wound up before the state Supreme Court, and the justices ruled for Baxley. Later, the Alabama Republican party removed a legally unenforceable so-called “loyalty pledge” from their party ballots.

Voters were so enraged by the ordeal, they decided to cast their ballots for Guy Hunt, who was the dark horse in the race.

Hunt, who was also a Primitive Baptist preacher, was also later convicted of violating the state ethics law by using the state jet for private, personal use to go to preaching meetings in which he was the guest preacher. He died January 30, 2009.

Friends, it MUST be understood that, at least in Alabama, many GOP/Republicans are in cahoots with old-school racists – pure and simple. And there’s no escaping that most wretched, and horrific period in our nation’s and Alabama’s state history… or the pall which it continues to cast over the state, and the putrid stench that remains from it’s rotted, decaying flesh. Oddly enough, some proudly wear that effluvium as if it were a coveted aromatic fragrance such as Chanel N°5‎ Eau de Parfum.

Even though it took Governor Bentley 5 years to do so, it should be noted that the frequent operative phrase in Alabama politics is “better late, than never” – which, of course, is apparently why Robert Bentley was re-elected as governor.

Naturally, it took no time for right-wing-extremist partisans such as the Yellowhammer News website to begin spewing their nonsensical ignorant, vitriolic diatribes against his actions as was evidenced by Elizabeth Beshears headline “Bentley packs Healthcare Task Force with Democrats, Medicaid expansion advocates.”

To be certain, from the get-go, I have called out Governor Bentley on his track record of lies and failures, although -again- partisans in the Grand Old Party of Stupid would hear nothing of it.

If you have any gumption about you at all, or are even the least bit curious, the enumeration of those items may be found here from this entry dated Monday, October 13, 2014:
Alabama Governor Bentley Broke 20 Promises From 2010 Campaign

The image appearing here, and following is the page on Healthcare Reform from Robert Bentley’s 2010 gubernatorial campaign website in which then-candidate & state representative from Tuscaloosa Dr. Robert J. Bentley, MD made his promises – presumably the ones which got him elected – and which remain exceedingly (if not wholly) unfulfilled. Oh… the items of interest are EXCLUSIVELY the ones appearing under the heading Alabama-Specific Healthcare Solutions. The reason why, of course, is that Bentley, the legislature and every state official is impotent to change Federal Law. They must act within the confines of Federal Law – NOT outside.

From Dr. Robert Bentley’s 2010 gubernatorial campaign website:

Affordable & Accessible Health Care

o As a physician running for Governor, I am in a unique position to understand health care issues, and to protect Alabama from the unwarranted and unnecessary federal intrusion into our personal health care choices;

o I started laying the groundwork for Alabama’s rejection of Obamacare by pre-filing a Constitutional Amendment on October 13, 2009 which will prohibit any person, employer, or health care provider from being compelled to participate in any health care system. It also codifies Alabama’s 10th Amendment rights over this issue;

o I have real-world solutions that will result in affordable and accessible health care for all Alabamians without bankrupting our nation or pushing us closer toward a government-controlled, single-payer system.

 

National Solutions to Reduce Costs in America’s Health Care System

As Governor, I will work with other conservative Governors to encourage Congress to pass federal legislation to drive down prices by increasing competition, while working within a capitalist framework. Those provisions include:

A. Portability of Insurance across State Lines. There is no valid reason why Alabamians should be prohibited from purchasing health insurance policies from companies in other States. By allowing the people of Alabama to have access to all of the country’s health insurance products, competition would increase and cause health insurance premiums to decline.

B. Tax Deductibility for the Self-Employed. Unemployed individuals and those who work for small businesses that do not provide health benefits should be allowed the same 100% tax deduction for health insurance costs that corporations receive.

C. Meaningful Tort Reform. As a physician, I can attest to the fact that the practice of defensive medicine is a strong factor in the rising costs of medical care in America. Meaningful tort reform legislation to end lawsuit abuse against the medical profession is necessary to make any significant impact on the costs of health care. Establishing a cap of $250,000 on non-economic damages would end the practice of ordering unnecessary, expensive tests simply to avoid lawsuits. It would also significantly reduce the role of trial lawyers in our medical system.

D. Change Medicaid Awards. Currently, Medicaid dollars are allocated to the States on a match basis, meaning the federal government matches whatever each state spends. This should change immediately to a system that allocates Medicaid dollars based on need so that States with the most urgent needs would receive the most funds. For example, if Alabama has 5% of the nation’s impoverished individuals, Alabama should receive 5 % of federal Medicaid money regardless of how much money the state allocates for health care for the needy.

E. Medicare Payments to Medical Professionals. Any increase in federal Medicare spending should be directed to Medicare to increase payments to hospitals and primary care physicians.

 

Alabama-Specific Health Care Solutions

We do not need to wait for the federal government to act. There are solutions that we can enact in Alabama to increase the affordability of health care without the need to raise taxes or borrow from future generations. These are:

A. Establish a Statewide Insurance Exchange. A state insurance exchange would encourage more companies to write health insurance policies for Alabamians. It will also increase competition among insurance companies, which will drive down costs for Alabamians.

B. Tax Incentives. We must encourage health insurance companies from all over the country to write policies in Alabama. By offering tax incentives to companies that provide health insurance to Alabamians, more companies would do business in our state, which would increase health care access.

C. Health Savings Accounts. Establishing Health Savings Accounts (HSAs) in Alabama will add a much-needed consumer element to medicine. Much like an IRA, HSAs allow individuals to contribute pre-tax finds into an account explicitly dedicated to pay for medical costs. Coupling these accounts with high deductable insurance policies will save Alabamians millions of dollars.

D. Tax Deductions. Alabamians who pay their own insurance premiums should be able to deduct 100% of the premium costs on their Alabama Income Taxes.

E. Electronic Medical Records. We should immediately adopt a Statewide, interconnected electronic medical records system tailored for each medical specialty.

F. Individual Ownership of Medical Records. Each Alabamian should be allowed to own their personal medical records in an electronic format. This will allow patients to keep their records on a portable keychain-sized flash drive to bring with them to any doctor they visit. This will allow quick, accurate sharing of information between a patient’s doctors and reduce the need for repetitive testing, which in turn will reduce costs.

G. Prescription Transfers. By encouraging the electronic transfer of prescriptions from the physician to the pharmacist, errors and prescription abuse can be drastically reduced.

H. Tax credits for Indigent Care. There are many doctors who treat indigent patients for no pay. These healthcare providers should receive tax credits, and special emphasis should be given to doctors who are required to treat the uninsured as a result of working on a hospital staff.

I. Mandate cost savings education. All medical students should receive special training on reducing health care costs during the final year of school and during their residencies.

J. More primary care physicians. Obamacare will drive good doctors away from the practice of medicine. That is the exact opposite of what we need in Alabama and across the United States. We should encourage training more primary care physicians, not fewer. To accomplish this goal, we should dedicate 25% of each Alabama medical school class to students who will enter family medicine, internal medicine, pediatrics, OB-GYN, or general surgery. Furthermore, we should award $40,000 per year scholarships to each of student who pursues primary care. Upon completion of their medical training, those students will be required to provide full-time medical service for four years in a medically underserved area of Alabama. This will produce an additional 60 primary care physicians a year. However, Alabama needs at least 100 doctors per year to meet existing and projected needs. The additional 40 primary care doctors will be trained through a new Alabama Medical Education Consortium program. This program will be known as the Alabama Health Service Corps. We also should establish similar programs for nurse practitioners, nurses, physician assistants, and other ancillary health care providers.

In Alabama, we have an advantage that few other States have in fighting the left-wing agenda on health care. By having a physician in the Governor’s Office, we will have a knowledgeable, committed, conservative voice to ensure that Alabama remains an “Obamacare Free Zone.”