Ken Hare In Depth: Alabama not a healthy state to call home - Montgomery Alabama news.

Ken Hare In Depth: Alabama not a healthy state to call home

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You would think that with its first medical doctor serving as governor in almost 200 years, Alabama would be making tremendous progress toward becoming a healthy state in which to live. But according to a just-released report card, Alabama is losing ground to other states -- most of which aren't doing very well either.

According to the Commonwealth Fund, a non-profit foundation that promotes health-care access and high quality health care, only five states scored worse than Alabama in a ranking of the quality of state healthcare systems.

Sadly, Alabama scored even worse in the 2014 rankings -- in a tie for 46th among the states and the District of Columbia -- than it did in a similar report issued in 2009, when Alabama was tied for 44th.

Minnesota had the nation's best-performing healthcare system, according to the Commonwealth funding rankings, with Massachusetts, Vermont, and New Hampshire tied for second. Mississippi ranked last, as it did in 2009. Nevada, Louisiana, Oklahoma and Arkansas also finished below Alabama. 
The Commonwealth Fund ranking is particularly interesting because it is a broad-based one that relies on 42 different measurements that take into account everything from insurance coverage (one area in which Alabama is about in the middle among the states) to avoidable hospital stays to death rates that can be affected by health care. 
The Commonwealth report  shows a disturbing gap between Deep South states such as Alabama and the rest of the nation.
Of the 12 states at the bottom of the ranking, nine are Deep South states. 
In an editorial in the Journal of the American Medical Association, the Commonwealth Fund's Douglas McCarthy and David Radley wrote:  "The findings are sobering in their portrayal of a geographic divide among state health systems."

However, they wrote that no state is making widespread progress despite "the substantial and increasing resources devoted to health care in the United States."

Of the 42 criteria ranked by the report card, 34 criteria reflected data in which trends could be determined. In those 34 categories, Alabama showed declines in 16 areas and improvements in only seven areas from the 2009 scorecard to the 2014 scorecard.

[ON THE WEB: Commonwealth Report Card]

Of the entire 42 categories, Alabama ranked among the best states in only one relatively narrow category -- home health patients who showed an improvement in walking or getting around.

But Alabama scored among the bottom half-dozen states in such categories as the mortality rate from causes "amenable to health care" and the percentage of adults who went without health care because of costs.

In their JAMA article, McCarthy and Radley suggested that expanding Medicaid coverage under the Affordable Care Act would be one way for Southern states to help close the healthcare divide. 

"If all states participate in Medicaid expansions, the geographic divide documented by the scorecard might narrow," they wrote. "However, if many states do not, the divide could widen in the future."

They wrote that expanding Medicaid "would benefit the poorest families in these states and reduce the burden of uncompensated care for hospitals and physicians while supporting efforts to improve primary care and lower hospital emergency department use in their communities.

"This could benefit all areas of a state by using resources well and particularly help lower-income areas by supporting a healthier workforce and stimulating economic opportunity," they concluded.

So far, doctor and governor Robert Bentley has turned his back on any such Medicaid expansion in Alabama, despite the fact that the federal government would pay 90 percent or more of the cost. 

That refusal by Bentley and the Legislature to consider expanding Medicaid is denying health coverage to more than 300,000 Alabamians, despite the fact that Alabama taxpayers are still having to pay their share of the cost of the Affordable Care Act.
Bentley is the first medical doctor to serve as governor of Alabama since its first governor, William Wyatt Bibb, left office in 1820.  In fairness to Bentley, many of the criteria used by the Commonwealth Fund reflect data from 2012 or earlier. Bentley took office in January 2011.
Still, you would expect a governor who also is a physician to recognize how much ground Alabama needs to gain in health care to match the rest of the nation.  If he does not want to use the hundreds of millions of dollars that the Affordable Care Act would provide, then he needs to come up with his own plan to find similar resources to address this issue.

That's one place that his responsibilities as governor and as a physician are identical.


Ken Hare is a veteran 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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