|I have recently gotten comments on Left in Alabama that Medicare for All is a no go and I should do something practical instead. I disagree strenuously, and would like to point out that a "both/and" approach is better. Since we are stuck for at least the next couple of years with our fragmented, expensive and disparate system, I have some thoughts on funding Alabama Medicaid while we wait.
I propose a bill for the 2013 session. This one will be a little more complicated-- let's work out some details here and then find a sponsor. Please help me find any possible holes. I expect opposition will prevent it from passing this year, but we could get it on the option list now.
The ACA has penalties for large employers if their employees apply for and qualify for subsidized policies on the Exchange to start in 2014. There is speculation that because the penalties are cheaper than insurance, some people who now have insurance through work will be pushed to buy policies on the Exchange instead.
What's missing? No penalty if employees or their children qualify for Medicaid!
So here's my idea. For any business receiving state or local incentives or tax breaks starting in 2014, there will be penalties if employees and/or dependents qualify for Medicaid (except for disability, because that is federal and we don't want to discourage hiring folks who are disabled). This includes both part and full time workers, as well as seasonal workers.
The penalty will equal the average age adjusted cost to Alabama Medicaid for a nondisabled person, prorated for less than full time workers (employer would pay a half penalty for a halftime worker). Alternatively, the employer may provide insurance coverage with benefits, prescription coverage, provider availability and cost-sharing (deductibles, co-pays, etc) at least as good as Alabama Medicaid. This is crucial to avoid low income families being saddled with unpayable $30 or so co-pays or any plan worse than Medicaid.
The penalty will be assessed quarterly and is earmarked for the state Medicaid budget. The maximum penalty in a year will be no more than the amount of incentive or tax break provided to the employer by state or local government.
What do you think? Those who say corporate incentives are an income generating activity for Alabama have never provided evidence. I suspect but can't prove that some subsidized companies are failing to provide a living wage to all employees. These days, a living wage should allow employees to cover the healthcare needs of their families.
Medicaid is a growing expense to our state, and we need to push for the Expansion to include adults up to 133% of poverty. However, after the first 3 years, we will be on the hook for a significant portion of the cost. A $1 per pack cigarette tax won't cover it, so we need to start now thinking of solutions.
At the same time, my pragmatic friends, please do NOT relegate Medicare for All to the pipe dream file. It is not just practical but inevitable-- and we need to do it before there is no other option. By the time it is a last resort, serious damage could have occurred to our medical infrastructure, and far too much needless suffering and premature death will have happened.
Medicaid is not the best answer-- it keeps the poor in a dual but often inferior system. Too few physicians accept patients with Medicaid. In the meantime though, it does save lives. Let's make employers who benefit from our tax money help pay their way