Alabama Gov. Robert Bentley's comments about being open to a form of Medicaid expansion expansion have brought reactions ranging from hope to scorn.
Bentley said last week that his administration is exploring the possibility of creating a state-designed program that uses a Medicaid grant to provide private insurance coverage to people at or slightly above the poverty line. Arkansas was the first Southern state to expand Medicaid in the way that some Republicans have found acceptable.
"This would be a totally different program that we are just beginning to look at. It wouldn't be an Arkansas program. It would be an Alabama program. It would be tied to work. I expect able-bodied people to either be working or in work force training if they get this insurance," Bentley said this week.
Critics called Bentley's comments a flip-flop of his previous hard-line stance. Others cheered his words.
Mike Horsley, president of the Alabama Hospital Association, said hospitals appreciate the governor's willingness to explore an Alabama-driven solution to provide additional health coverage.
"There are an estimated 300,000 Alabamians who would greatly benefit from having coverage. We support and encourage any discussions that will create a healthier Alabama, while meeting the unique needs of our state," Horsley said.
Leaders of state tea party groups sent Bentley a letter urging him to promise to never expand Medicaid.
"You campaigned specifically on not expanding Medicaid, and according to recent media reports from multiple outlets, you are now open to expanding it," they wrote Bentley.
"Medicaid expansion by any name including, expansion through a waiver program is still expansion and will cost Alabama taxpayers additional money," read the letter.
Bentley argued this is not a reversal from his previous position. He said he's always favored using federal block grants for Medicaid.
"I'm here to do what is best for the people of Alabama. If I held my finger up in the wind and say, 'Am I going to get criticized for this or that?' I wouldn't make any decisions," Bentley said.
The Affordable Care Act gives states money to help expand Medicaid to cover people up to 138% of the federal poverty level, which is $27,310 for a family of three in 2014. A U.S. Supreme Court ruling made the expansion optional.
The governor said what he is discussing is a block grant.
"They would have to pay a copay. You could index that by what they do make. I think people always ought to pay something, and also I believe it should be tied to work. We're just in the early stages of this right now. And right now, would CMS improve this? No, they wouldn't," Bentley said.
Federal officials have previously rejected Pennsylvania's effort to put a work requirement on recipients in that state's plan. Bentley said he hoped federal officials would reconsider and be more open to states' requirements in the future.