Newspaper in Alabama, a similar state in many ways, gives its readers a look at Kentucky's embrace of Obamacare

The latest newspaper to look at Kentucky's embrace of Obamacare is in Alabama, a state that offers almost a mirror image of Kentucky: another Southern state with a very high poverty rate and very low health outcomes.

"Politically, both are deeply conservative, and both are home to wide expanses of rural poverty," writes Tim Lockette of The Anniston Star. But Alabama's approach to Obamacare "couldn't be more different," because it has rejected Medicaid expansion and a state-run insurance exchange.

The difference in Obamacare outcomes really is as stark as it looks, Douglas Scutchfield, a professor of health services research at the University of Kentucky, told Lockette. Scutchfield, who taught in Alabama for years, said that in demographic terms, "The only real difference is that most of your uninsured folks are black, and most of our uninsured folks are white. We have the Appalachians, you have the Black Belt." In politics, the states' governors have made a big difference.

While Democratic Gov. Steve Beshear expanded Medicaid and set up an exchange, Republican Gov. Robert Bentley and other state officials rejected both the Medicaid expansion and an exchange, citing costs.

Bentley cited the state's struggle to even cover the new enrollees that had been added since the Great Recession. Some Kentuckians are concerned about how the state will pay for its expansion. The federal government will pay all the cost of care for the newly eligible from 2014 through 2016, when the state will increasingly pick up part of the tab, rising to 10 percent by 2020. Beshear, citing a study, has said the expansion will expand the state's health-care industry enough to pay for it, and make the state more attractive to employers in the long run.

Bentley told Lockette that Alabama could not have had success with its own exchange because there is basically one major insurance company in Alabama, Blue Cross Blue Shield. But Alabama could have had more competition if the state had set up a nonprofit, cooperative insurance company, which Kentucky did.

"In Kentucky, everybody has an option," Cara Stewart, a fellow at the Kentucky Equal Justice Center, told Lockette. "Unless you're undocumented or in jail, there's something for you," she said.

Still, Stewart "said she?s run into difficulty working with people who already have employer-provided insurance, but want to switch to the exchanges to cover family members," Lockette report. Also, "The Kentucky system has refused to recognize some enrollees because they don?t have a credit history, health care advocates say." (Read more)

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