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Alabama health insurance

Alabama opposes ACA, but governor revives Medicaid expansion talk

If you live in Alabama – or you’re considering moving to the state – you should certainly be aware of the state’s perceived “healthiness.”

There are plenty of factors that might affect your own perception of the state’s attitudes toward providing health coverage and health care. We’ve put together a partial list for your consideration.

Alabama health ratings

The Commonwealth Fund’s Scorecard on State Health System Performance, 2014, rated Alabama 44th among the 50 states and District of Columbia. That means the state has dropped two spots since the 2009 rankings by The Commonwealth Fund.

Take a closer look at Alabama’s measurements.

The most recent edition of America’s Health Rankings (2013 edition) also measured the state’s “healthiness” and ranked Alabama #47 of the 50 states … down two spots from the 2012 assessment. The state’s ranking was hurt by factors that included the prevalence of obesity, low birthweight and high infant mortality.

For yet another look at health indicators that might explain Alabama’s health rating, check out the 2014 listing of Key Health Data About Alabama, compiled by Trust for America’s Health.

Alabama and Obamacare

In 2010, Alabama’s Congressional delegation opposed the health reform law. Senators Jeff Sessions and Richard Shelby both voted no on the law while six Alabama representatives voted no in the House.

At the state level, Gov. Robert Bentley indicated early on that he would support a state-run health insurance exchange, but ultimately sided with the state legislature, which decided to cede exchange control to federal government.

How the ACA could help Alabama

According to figures from The Henry J. Kaiser Family Foundation, an astounding 46 percent of Alabama’s 660,000 uninsured nonelderly residents were eligible for financial assistance under the ACA.

A Gallup survey shows Alabama’s uninsured rate dropping 2.6 points following the ACA’s first open enrollment period. The state’s uninsured rate was 17.7 percent in 2013, and it fell to 15.1 percent by mid-2014.

Alabama enrollment in QHPs

As of April 2014, 97,870 Alabama residents were enrolled in qualified health plans (QHPs). This population includes legal U.S. residents who were uninsured, nongroup purchasers with incomes above Medicaid and CHIP eligibility levels.)

Medicaid expansion and Alabama

Alabama’s opposition to the Affordable Care Act also meant that the state opted to not accept Obamacare’s Medicaid expansion. As a result, 29 percent of Alabama’s uninsured nonelderly population fell into the coverage gap.

Gov. Bentley, however, re-ignited a discussion of Medicaid expansion in late 2014. Bentley said he is interested in tapping into Medicaid expansion funding to expand health insurance coverage, perhaps through a block grant. Expansion opponents and proponents quickly weighed in.

See a full overview of Alabama’s Medicaid and CHIP programs.

Other reform provisions in Alabama

The Affordable Care Act established a federal loan program to encourage the creation of nonprofit, consumer-run health insurance issuers – called Consumer Operated and Oriented Plans (CO-OPs).  By January of 2013, 24 CO-OPs had received loans totaling $1.98 billion. Alabama is not one of the states. See a map of the states receiving CO-OP loans

Does Alabama have a high-risk pool?

Before the ACA reformed the individual health insurance market, coverage was underwritten in nearly every state, including Alabama.  Because pre-existing conditions were a factor in eligibility for coverage, some people were unable to purchase a private plan at all, or were only able to get one that excluded their pre-existing conditions.

The Alabama Health Insurance Plan (AHIP) was created in 1998 to give applicants an option for coverage if they were ineligible to purchase individual health insurance because of their medical history.  But unlike risk pools in many other states, AHIP was only available to applicants who were HIPAA eligible, coming off of a group plan with no more than a 63 day gap in coverage.

Under the ACA, all new health insurance policies became guaranteed issue starting on January 1, 2014. This change largely eliminated the need for high risk pools and MCHA stopped enrolling new members as of January 1, 2014.  In March, the Alabama Senate passed SB 123, allowing AHIP to “cease operations upon allowing current participants enough time to transition out of the plan.”  But the plan website has not yet announced a termination date for existing members.

State-based health reform legislation

Here’s a summary of recent Alabama bills related to healthcare reform: