This campaign has been as educational for me as it has been exciting. Many experts from all areas in healthcare have volunteered their knowledge and advice on how to improve our healthcare plan, and because there’s always more to be learned by listening than by talking, I have heard them, and I feel that it’s time to incorporate these great ideas into an updated plan.
For example, expanding Medicaid remains my central focus. Not only will it mean that up to 330,000 additional Alabamians will receive health insurance coverage that they cannot afford on their own, including 200,000 people who are already working in jobs but don’t have health benefits, it will also act as an enormous economic stimulus.
In the first six years alone, expansion will create $28 billion in increased business activity in Alabama, add $17 billion to the state's gross domestic product, and increase the wages of Alabama workers by $10 billion. It will also create 30,000 new, high-paying jobs, and save our rural hospitals, which are major employers in counties where they exist – all while producing advances in areas like precision medicine, genomics, and telemedicine.
These projections are consistent with the actual experiences of states that have already expanded Medicaid. A recent study by Louisiana shows that the infusion of $1.85 billion in additional federal Medicaid funds created and supported almost 19,200 jobs and substantially increased state and local tax receipts. Kentucky found that the net difference in the economy between expanding Medicaid and not expanding Medicaid was a positive $919.1 million. Pennsylvania grew by 15,500 jobs. Montana (with 21% of Alabama’s population) grew by 5,000 jobs, and Maine (27% of Alabama’s population) grew by 6,000 jobs.
But in addition, Alabama must develop and implement an actual, substantive, and effective Statewide Healthcare Plan.
This Plan must include articulated priorities and plans to improve in areas such as prenatal and perinatal care, geriatrics, oral health, mental health, and chronic health issues. Preventative medicine must become a point of emphasis, because it’s more effective and cost efficient to keep people heathy.
The state’s current statewide health “plan” is ad hoc and ineffective, and a new plan with defined objectives developed with measurable outcomes, that’s reviewed and updated annually, will facilitate the coordination and proper distribution of healthcare resources.
We must be innovative and forward thinking to bring solutions to our healthcare system.
We desperately need to improve the number and availability of primary care physicians.
The skyrocketing costs of a medical education often burdens new doctors with heavy debt, driving many into more lucrative medical specialization. Because specialists cannot make a living in rural areas, doctors become concentrated in metropolitan areas. While we do need specialists, primary and family care physicians are the frontline guardians of our health.
By putting the right programs in place, such as more tuition assistance in return for practicing primary care in underserved areas, we can put more primary care physicians in places they are needed most.
With special training in obstetrics, pediatrics, geriatrics, and psychiatry, these primary care doctors can improve outcomes for pregnant women, newborns, children, the elderly, chronic health problems, and people with mental health disorders, especially in rural areas. Expanded rural training programs like those at UAB and UA College of Community Health should be incorporated into the statewide plan.
We must also focus on basic barriers to healthcare like emergency and non-emergency transportation, nutrition, and availability of prescription medicine. In short, we must make changes within the healthcare system so that we treat the whole person.
Oral health is increasingly recognized as a key to overall good general health. Dental problems are the number one reason children in Alabama miss school. We must protect critical access to hospital dental care for very young and special needs patients. The Medicaid reimbursement schedule for dental care is 19 years old, forcing dentists to subsidize much of the care they provide, which is an unsustainable model.
We must engage in discussions with dentists and other stakeholders to develop recommendations and funding to ensure Medicaid-eligible, special needs adults have access to preventive and restorative dental services after they turn 21, and that Medicaid eligible pregnant mothers have access to oral health services and education that can reduce the potential for premature births and improve the long-term oral health of their newborns.
Mental health treatment must be better incorporated into medical clinics and primary care centers. Too many who suffer from mental health disorders are left to fend for themselves in a labyrinth that poorly coordinates mental health care into overall health care.
By eliminating regulatory barriers, providing combined physical and mental health care, and including social workers and other professionals to facilitate coordinated care, we will see improved results. Reimbursements to health providers, including psychiatrists must be designed to reward improved care instead of merely rewarding the volume of cases.
Addressing the following issues and factors must be meaningfully incorporated into our planning process:
Access to Care
Mental Health and Substance Abuse
Poor Pregnancy Outcomes
Nutrition and Physical Activity
Child Abuse and Neglect
Injury and Violence Prevention
Through collaboration and cooperation among various groups of health providers, experts in public health, healthcare consumers, and state agencies, we can develop an effective and meaningful Statewide Health Plan.
As your governor, just as now, I will continue to learn and listen to the experts so we can build a better Alabama.