If Medicaid expansion was a relocating company

Josh Moon, Montgomery Advertiser - May 23, 2015

I made a mistake.

That's right, I screwed up. And I did so several times over the last few years.

I've written about Alabama's ignorant refusal of Medicaid expansion and participation in President Obama's health care reform (Obamacare).

That wasn't the mistake. I still believe all that I wrote, and I think each passing day proves how stupid and petty such a refusal is.

The mistake I made — and to be fair, I wasn't alone in this — was in how I presented the idea of Medicaid expansion.

Silly me, I forgot who my audience was and is, what they valued and the buzzwords to which they respond best.

It took an email from a reader — a guy who works closely with a health insurance provider in this state — to make it clear just how badly I messed up. The idea he recommended for selling Medicaid expansion, and the one I should have used, went like this:

"Someone should make this pitch to Gov. (Robert) Bentley: Governor, XYZ Company is considering relocating and Alabama is on the list," he wrote.

He then went on to lay out the details of what XYZ would bring to the table.

Over the next 10 years, he said, this company anticipates hiring 40,000 Alabamians, with most of them earning a salary between $31,000 and $48,000.

During that time, the businesses and offshoots of XYZ will also add more than $30 billion to the state economy.

That's 6,000 more jobs than Hyundai, all of its suppliers and all of its indirect employment opportunities have created over the last 10 years.

When all the costs, such as training, site preparation, tax breaks and other incentives, are added up, Alabama paid about $252 million to get Hyundai here (a bargain compared to the $1 billion in incentives wasted on Thyssen Krupp.) Unlike them, XYZ is going to do the opposite. It's going to pay your citizens for the privilege of doing business in the state.

In addition to providing full coverage health insurance to all of those 40,000 employees, XYZ will also provide health insurance to every citizen in the state who earns less than $16,000 per year or less than about $33,000 for a family of four.

It will pay 100 percent of the costs for insuring roughly 300,000 people for three years and then cover 90 percent of the costs forever.

If you doubt the ability of XYZ to live up to such a claim, I suggest you take a look at Kentucky, where a Democratic governor ignored the dire warnings of Republicans and made this deal.

Over the last year, Kentucky enrolled around 375,000 people through Medicaid expansion. A recent study of the expansion by Deloitte Consulting and the University of Louisville now shows the state taking in more than $30 billion and creating more than 40,000 jobs in just six years.

Kentucky's state budget, through added revenue and cost savings, will enjoy an $820 million gain during that span.

And it gets better.

In the as-conservative-as-Alabama state of Utah, there is a new push to expand Medicaid. It is coming from law enforcement.

Last week, Salt Lake City's police chief told state lawmakers that Medicaid expansion in Obamacare significantly aided mental health patients' care. A study from a non-profit group showed that many of the state's murders and accidental deaths might be prevented if such care was implemented.

That should be of particular interest in this state, where a once lauded mental health system has been all but defunded and our local jails have become de facto mental health wards, minus the doctors and trained medical staff.

Imagine: a company locating here that wasn't looking for a handout, wasn't looking to exploit the union-free, cheap labor and wasn't interested in only bettering its bottom line. Instead, it provides good jobs, helps the poorest citizens lead healthier lives and cuts crime.

That's Medicaid expansion under Obamacare.

And that's the pitch I should've made long ago.

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