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

MONTGOMERY, AL (WSFA) - You would think that with its first medical doctor serving as governor inalmost 200 years, Alabama would be making tremendous progress toward becoming ahealthy 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 verywell either.

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

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

Minnesota had the nation's best-performing healthcare system, according to theCommonwealth funding rankings, with Massachusetts, Vermont, and New Hampshiretied 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 abroad-based one that relies on 42 different measurements that take into accounteverything from insurance coverage (one area in which Alabama is about in themiddle among the states) to avoidable hospital stays to death rates that can beaffected by health care. 
The Commonwealth report  shows a disturbing gap between Deep South statessuch as Alabama and the rest of the nation.
Of the 12 states at the bottom of the ranking, nine are Deep Southstates. 
In an editorial in the Journal of the American Medical Association, theCommonwealth Fund's Douglas McCarthy and David Radley wrote:  "Thefindings are sobering in their portrayal of a geographic divide among statehealth systems."

However, they wrote that no state is making widespread progressdespite "the substantial and increasing resources devoted to healthcare in the United States."

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

[ON THE WEB: Commonwealth Report Card]

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

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

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

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

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

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

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

That refusal by Bentley and the Legislature to consider expanding Medicaid isdenying health coverage to more than 300,000 Alabamians, despite the fact thatAlabama taxpayers are still having to pay their share of the cost of theAffordable Care Act.
Bentley is the first medical doctor to serve as governor of Alabama since itsfirst governor, William Wyatt Bibb, left office in 1820.  In fairness toBentley, many of the criteria used by the Commonwealth Fund reflect data from2012 or earlier. Bentley took office in January 2011.
Still, you would expect a governor who also is a physician to recognize howmuch ground Alabama needs to gain in health care to match the rest of thenation.  If he does not want to use the hundreds of millions of dollarsthat the Affordable Care Act would provide, then he needs to come up with hisown plan to find similar resources to address this issue.

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


KenHare is a veteran Alabama newspaper editorial writer and editorial page editorwho now writes a regular column for WSFA's web site. Email him at

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