Ken Hare In Depth: Bronner 'puts the hay down' on Medicaid expansion

MONTGOMERY, AL (WSFA) - There's a colorful Alabama political adage that says a successful public figure needs to be able to "put the hay down where the goats can get it." Few current public figures do that better than state retirement system chief David Bronner, as he showed recently when he spoke publicly about the need for Alabama to expand Medicaid.

Bronner was speaking to the Tuscaloosa Rotary Club. As an old reporter, I can tell you that civic club speeches seldom produce news worth writing about. But the chances of getting a hot news story go up dramatically when Bronner is at the lectern.

According to the Tuscaloosa News,  Bronner, chief executive officer of the Retirement Systems of Alabama, said that those governors who have refused to go along with the expansion of Medicaid in their states are "idiots."  Now that's putting the hay down.

Bronner did not specify which governors he believes deserve that label, but so far Alabama Republican Gov. Robert Bentley has resisted expanding Medicaid in this state as part of the national Affordable Care Act.

Bentley has said that the state cannot afford now to expand a "broken system." He has proposed, and the Legislature has approved, reforms of the current Medicaid system in Alabama, and those reforms currently are being put in place. As far as I know to date, Bentley has not completely ruled out an expansion of Medicaid at some point in the future if those reforms prove successful, but neither has he embraced that possibility publicly.

As I have noted in several previous columns, the math is clear: Alabama could provide health coverage to more than 300,000 additional citizens of modest incomes with the federal government paying 100 percent of the cost in the first three years and 90 percent or more after that.

"To turn it down makes no sense whatsoever to me. It is irresponsible," Bronner told the Rotarians.

Bronner emphasized that expanding Medicaid in Alabama would provide a huge boost to the state's economy. "As money comes in, it creates jobs," he said.

Economists estimate that such an expansion -- which, remember, would be paid for almost entirely with federal dollars -- would have a $20 billion economic impact in Alabama.  One study suggests that infusion of money could create 12,000 new jobs by 2016.

"The governor will use (the recruitment of) Airbus as a key for his re-election," Bronner said, referring to the airplane facility now under construction near Mobile. "That is great. It is 1,000 jobs."

Bronner also noted, according to the Tuscaloosa News, that expansion of Medicaid in Alabama would save money in the long run as those who are denied Medicaid will seek care at hospitals if injured or seriously ill.

That comment by Bronner reflects findings in a study by the Rand Corporation that looked at the 14 states -- including Alabama -- that have said to date they would not expand the Medicaid program to cover citizens up to 138 percent of the poverty level.

Rand researchers found that the 14 states collectively will spend $1 billion more on uncompensated care in 2016 than they would if Medicaid is expanded. Those 14 state governments also would pass up $8.4 billion annually in federal payments and an additional 3.6 million people will be left uninsured.

As I noted in an earlier column,  if Alabama's political leaders choose not to take advantage of the federal money available to expand Medicaid, it does not mean that the status quo will remain in place for Medicaid funding in the state. The Affordable Care Act assumes that states will see a reduction in the number of uninsured patients because of Medicaid expansion. So the act reduces current payments made to the states -- largely to hospitals -- for uncompensated medical care for uninsured patients.

The report concludes that if a state chooses not to expand Medicaid, the changes "could shift the cost for uncompensated care from the federal government to states, localities, and hospitals."

Bronner emphasized that even though the economic benefits of expansion are clear, the principal reason the state should expand Medicaid is that it would provide health care coverage to as many as 330,000 Alabamians living just over the poverty level.

That's something that Gov. Bentley, a physician in private life, should understand. Alabamians should hope that once he feels the Medicaid reforms are having an impact, Bentley will move to take advantage of the economic and public health benefits of expanding Medicaid in the state and that legislators will not block it from happening.


Another story in the news that falls into the crowded category of "elected officials who just don't seem to get it" involves the failure of Congress to avoid a doubling of interest rates on federally subsidized student loans.

A majority of both Democrats and Republicans in Congress were on record as supporting legislation that would keep the interest rate from automatically doubling from 3.4 percent interest to 6.8 percent on subsidized Stafford loans, which account for almost one-fourth of all direct federal borrowing.

But in a column on April 10, I raised the possibility that despite such bipartisan agreement, members of Congress might not  act before the July 1 deadline. Sadly, they did not.

Preventing the increase was crucial because even under the old rate, student loans would have generated more than $36 billion in revenue for the federal government in 2013 above the cost of the program. That pushes up the already high cost of college for students who have to rely on loans. In Alabama, that is a majority of those who attend college.

Already about 54 percent of recent college graduates in Alabama leave college in debt, which ranks 33rd in the nation. And those in Alabama who have debt owe an average of $25,192, which ranks 22nd in the nation.

It is a sad commentary on the state of Congress that partisanship prevents lawmakers from acting even on those issues where both sides agree action is needed.

Members of Congress need put aside partisan bickering and find a way to make the Stafford student loan program revenue neutral.

Ken Hare was a longtime Alabama newspaper editorial writer and editorial page editor who now writes a regular column for WSFA's web site. Email him at

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