If you have watched the news lately you might have seen a familiar face to many Alabamians. Gov. Robert Bentley has been making the rounds with local and national media.

News outlets are interested in what Gov. Bentley has to say because he has recently announced that the state of Alabama would not be establishing a health care exchange as is required under the ACA and also would not be expanding the state's Medicaid program. According to Bentley he expects other states to also refuse to set up health insurance exchanges.

Some time back, Legal Ease featured a series of articles dealing with the Patient Protection and Affordable Care Act (ACA), also commonly known as “Obamacare”. At that time we discussed the fact that the federal government cannot force states to participate in certain programs or follow specific guidelines, although the federal government can withhold funds from the state.

To review, under the ACA each state is tasked with establishing its own health insurance exchange. In theory, this exchange is a marketplace for individuals to comparison shop for an insurance policy from competing private insurance companies. This exchange would target people who do not have insurance through the government or an employer.

Another provision increased Medicaid eligibility so that more people could be included on the Medicaid rolls. The state would have to opt in to the Medicaid expansion. Existing Medicaid funds cannot be cut, but if the state opts out, the state is not eligible for additional funding offered under the ACA.

One reason Gov. Bentley has given for not expanding Medicaid is that he thinks the current structure of Medicaid is broken. For that reason, he does not believe it needs to be expanded.

If Alabama expanded its Medicaid program under the ACA, the federal government would pay for 100 percent of the cost of services for the new enrollees for the first three years. After three years, that contribution would drop to 90 percent. That drop of 10 percent could potentially cost the state millions of dollars. Some estimates put Alabama paying more than $100 million a year to continue the new, expanded program. The problem for the state is that it struggles to fund the current Medicaid program.

Gov. Bentley does not believe the state, or the country, can afford to expand Medicaid rolls under the current system.

The ACA authorizes the federal government to set up health insurance exchanges when states refuse. Reportedly, this could be quite costly to the federal government if many states refuse to participate. Will the federal government actually set up the exchanges for Alabama and other states? For now, as far as Alabama is concerned, the ball is in the federal government's court. We will all just have to wait and see what happens.