A Health Care Q&A With Alabama Governor Robert Bentley

MONTGOMERY, Ala. — Alabama’s Robert Bentley is one of two current governors to have “doctor” on his résumé. Bentley was a dermatologist before he got into politics; Oregon’s John Kitzhaber was an emergency room physician. The two governors agree on one thing: The federal health care law reforms the way we pay for health care, but doesn’t fix the problems with the way we deliver it.

That’s where the similarities end. Kitzhaber, a Democrat, supports the federal health care overhaul passed last year, and is looking to find ways to channel federal dollars toward coordinating care at the local level. Bentley, a Republican, objects to what he calls a “federal takeover” of health care.

As a state senator in 2009, Bentley authored a constitutional amendment designed to block the law’s implementation in Alabama. In his view, health care costs have gone up and quality has gone down as the federal government and insurance companies have taken a larger role in health care. His prescription is to return health care to patients and doctors.

In an interview with Stateline last week (March 10), Bentley elaborated on his health care agenda. His plan emphasizes individual health savings accounts, which he says will lower costs by letting patients decide how they want to spend their health care dollars. He wants to give state tax breaks to businesses that purchase insurance for their employees and state-based incentives to attract more insurance carriers. He’s also proposing greater use of electronic medical records and state scholarships for primary care physicians willing to repay their loans by serving Alabama’s rural communities.

Below is an edited transcript of the interview with Bentley. (Click here to read Stateline’s interview with Kitzhaber.)

Q: How has your experience as a doctor formed your perspective on health care?

A: I’ve had the privilege, or longevity, to have seen it all and I believe I can pinpoint many of the causes of the increased costs of health care and health insurance — which, by the way, are separate. The federal government has attacked the issue by trying to expand health insurance coverage and that’s not really the problem. Just because a person has insurance doesn’t mean they’re getting quality health care.

As the federal government and insurance companies have taken over the practice of medicine, that has lowered the quality of health care because physicians have become employees of either the government or insurance companies.

I personally believe that with the Affordable Care Act, we’ve gone in the wrong direction. We’ve gone further into the area where government will be the single payer of health care eventually.

We should have gone back the other way and let patients and doctors determine how the first dollars are spent. That’s why I love health savings accounts. If you do that, it puts free enterprise and consumerism back into health care.

Q: What are the first steps you plan to take in putting your health care plan in place?

A: We’re looking at a pilot program for health savings accounts, or something similar, for our [state] employees and our teachers.

What we will do is provide front-end money for patients and let them decide whether or not they’re going to spend it. You have to couple that with some sort of high-deductible insurance to take care of what is beyond that amount. If they don’t spend that money, they could either get it as a bonus or save it, like an IRA program, or it could almost be a second retirement.

This is money set aside to encourage decreased utilization of the system by not going to the emergency room. For example, let’s say you’re a teacher and we gave you $1,000 and you could use that in any way you wanted to for health-related expenses. You could use it for the dentist; you could use it to buy glasses. You could use $500 tonight by going to the emergency room or you could wait until tomorrow and go see your family doctor for $50. It’s a carrot rather than a stick.

Q: You’ve long been a proponent of health insurance exchanges, which is one of the first things the federal health care law requires states to get to work on. How does that figure into your plan?

A: We were going to have an exchange whether the Affordable Care Act had passed or not. When I wrote up my plan, that was long before this law was passed. Utah had one and Georgia had one.

Right now in the legislature, we’re looking at how to structure an insurance exchange for the state. We need to establish a loose framework. We probably will not have time to complete it during this session. But if we get the framework in place, by next year we’ll be able to complete it.

Q: President Obama recently announced his support for an amendment to the federal health law that would give states more leeway to come up with their own plans. If it is enacted, would you be interested in seeking such a waiver?

A: I was not aware of that amendment. But I talked with [U.S. Health and Human Services Secretary Kathleen Sebelius] about that exact thing. I told her that we wanted to have accessible and affordable health care in Alabama and we had a lot of ideas that we wanted to put into place. And she told me “we’d be willing to work with you.”

Q: You’ve said the federal government should allow people to purchase insurance across state lines. How do you plan to pursue this?

A: We really should look at health care cooperatives with other states since the federal government will not let us buy insurance across state lines. Let’s say an insurance company is housed in Tennessee. We could form a cooperative with Tennessee. I don’t think the federal government could do a thing about that. It looks to me like they would want to encourage it.

Q: How do you expect Alabama to fare under the Affordable Care Act’s Medicaid expansion?

A: Obviously, we’re going to have a difficult time paying for the proposed Medicaid expansion. I know they’re going to give a higher match for four years, but after that, the match is going to be gone and you’ll have all those people on Medicaid and we’ll have to come up with the money.

Q: What do you think about the idea being discussed in Washington of turning Medicaid into a block grant?

A: I’m for the federal government giving us a block grant and allowing us to come up with our own ideas. I’ve talked to Secretary Sebelius about that.

For example, we have a bill in the legislature to increase from 150 percent to 200 percent the deduction companies can take if they pay for insurance for their employees. The other thing I would like to see is tax credits for physicians that see indigent patients for free. We do it for lawyers right now. It would be a state tax credit, not a lot, but it would provide some payment.

Q: In your plan, you call for a statewide electronic medical records system. You also call for individual ownership of medical records. How would that work?

A: Electronic records can save money and improve care, if it’s done correctly and done simply so that people like me could operate it. I could not operate a complicated system. Now if you’re below the age of 45, you could. It’s got to be common sense, almost age-specific, and it’s got to be accurate.

Ownership of medical records is another thing. Each patient should be allowed to own their own medical records and keep them with them at all times on a portable flash drive. This would allow quick, accurate sharing of information between a patient’s doctors and would decrease the need for repetitive testing. What if you were in an accident and you had the thumb drive with you? They could plug it in and see what you’re allergic to.

Q: How successful do you think your plan will be?

A: There’s no doubt we can come up with a better system. We need the cooperation of physicians, hospitals, and other health care providers. We can do it. It’s a matter of putting our ideas into practice. It’s going to take a while. Not everyone will fit into the same mold. Not every state and not every patient. The plan must be flexible.