Lawmakers: Medicaid expansion can't happen without funding

MONTGOMERY, Ala. (AP) — Some Republican leaders in Montgomery might have cracked open the door to Medicaid expansion in Alabama, but also say it won't become a reality unless a funding source can be identified.

Republican Gov. Kay Ivey agreed to have discussions with Democrats about expansion and other Democratic caucus priorities, but has made no further commitment.

"The issue for states like Alabama is where is the money going to come from to get it started," said House Ways and Means Chairman Steve Clouse.

Alabama is one of 14 states that have not expanded who is eligible for Medicaid under the Affordable Care Act. An estimated 340,000 Alabamians — many of them previously uninsured — would gain health coverage through expansion. While the federal government would pick up 90 percent of the cost, the state's share would be an estimated $168 million in 2020. However, one study estimated the net cost would drop in subsequent years as the state reaped economic benefits.

Senate President Pro Tem Del Marsh, R-Anniston, said he opposed expansion, saying it's a price tag the state can't afford.

"I just don't see a way to expand Medicaid. I think we need to just keep in under control by creating good economic conditions, keep more people working," Marsh said.

Democratic and Republican leaders met last week after Ivey — during negotiations on an approved gasoline tax increase — agreed to keep an open dialogue on Democratic priorities.

House Speaker Mac McCutcheon told reporters Friday that they are having conversations, but he described them more as "fact-finding" meetings for him.

House Minority Leader Anthony Daniels said Democrats are looking at different options. He said a lottery is one possible funding source. He said Democratic legislators have also had loose conversations about legalized sports betting as a possible revenue source.

"Looking at all the different options, we are not going to take anything off the table," Daniels said.

Rep. Mary Moore, D-Birmingham, said Thursday that expansion is a priority for the Democratic caucus.

"We extend the olive branch to the Republican Party to ask them to dig down in their heart of hearts and understand they have brothers and sisters who are suffering because they do not have any health care," Moore said.

The Alabama Hospital Association this year launched a press for expansion as hospitals financially struggle because of the high number of uninsured patients. Twelve Alabama hospitals have closed since 2011.

Clouse said the conversation on Medicaid has shifted from political — as Republican efforts to repeal the Affordable Care Act were unsuccessful — to more of an "economic-type" discussion.

Clouse said he is among lawmakers who believe it is something the state should continue to "look at."

"I'm in a rural area and I have rural hospitals that are really suffering. ... There will be some political opposition to it just on the fact of being Medicaid and the word expansion. But if I can see a funding source, I can see us moving forward with it if that source can be identified and we can enact it," Clouse said.