MONTGOMERY — Alabama's involvement in the Medicaid expansion clause of the federal Affordable Care Act may not be dead yet.

A Montgomery lawmaker and chair of Gov. Robert Bentley's Medicaid study commission said Monday he can see a scenario in which Alabama expands the system under the federal act that many refer to as Obamacare.

Besides providing healthcare for about 300,000 more uninsured Alabamians, the expansion could pump $4 billion to $6 billion a year into the state's economy, Rep. Greg Wren, R-Montgomery, said.

"That's one reason you've seen so many governors in the last month say, ‘We can't turn our back on the economics of what this does for our state,'" Wren said. "Alabama will be no different."

But significant changes would have to be made to the act.

Wren said several pieces of legislation to reorganize the current Medicaid system, which already provides coverage to about 900,000 low-income and disabled residents statewide, will likely be introduced this week.

One would put a cap on how many of the state's general fund dollars go toward Medicaid each year. This year, the state will spend about $615 million on Medicaid, which is more than any other non-education agency receives each year.

Last week, the Alabama House passed a bill aimed at cracking down on Medicaid abuse and fraud.

Changes

Meanwhile, the commission has suggested to Bentley that the state turn the system from a fee-for-service model to a managed-care model. Proponents say that's a less expensive option that is better for patients' overall care.

Wren said that once Medicaid is reformed with the cap and with a "patient-centered" model of care, the expansion could be possible in 2014.

"What we're doing will be the flashpoint of being able to look at expanding Medicaid," he said.

Bentley has said repeatedly in recent months that he will not expand a broken system.

Asked Monday if there is a scenario in which the system could be expanded in 2014, Bentley's spokeswoman, Jennifer Ardis, said she couldn't answer that question.

"It is hard to talk about hypotheticals because you can't do that until the current system we have is fixed and isn't broken," she said.

The changes being proposed to Medicaid are separate from the possible expansion and are largely economic. Lawmakers were told last week Medicaid would need about $743 million in 2014, but interim director Dr. Don Williamson said he could make budget cuts to get there. For 2015, there would be nothing left to cut.

"After 2014, there is no money left," he said.

Priority

Sen. Greg Reed, R-Jasper, vice chair of the Permanent Joint Legislative Committee on Medicaid Policy and member of the governor's Medicaid Advisory Commission, said Monday that fixing the current Medicaid system is the priority.

"Once we have a new model, it gives the governor more information to make the decision he may have to make in regards of expansion," Reed said.

Under the Affordable Care Act, states can opt in or out of the expansion, with the federal government picking up the tab for the first three years.

States would have to pay larger percentages of the increased cost each year after that, leading opponents to say that it will cost the state money in the long run.

Democrats

Democrats in the Alabama Senate have made campaigning for the expansion their only priority this legislative session because they say it'll be an economic boom for the state.

Contrary to other estimated, Democrats say expansion would bring in $20 billion in new economic activity and almost $1 billion in state tax revenues during six years.

Rep. Marcel Black, D-Tuscumbia, said expanding Medicaid is a "no brainer."

"A lot of other Republican governors, after making such a show of not wanting to do it, are changing their minds because they've seen the benefits," he said.

Black said he's seen the estimates for monetary impact in Alabama, "and even if they're half true, you'd want to jump on it."

Jim Carnes of the advocacy group Arise Alabama said Monday his organization is an advocate of the expansion.

"We feel like the governor made a good call for structural reform for Medicaid," Carnes said. "As great as the prospects are for Medicaid expansion, it just makes sense to strengthen the system we have now before bringing in a huge new population.

"We think (the recommended changes) provide the assurances that he was looking for that we will have a sound system that can accommodate the expansion."

Commission member Rep. Ed Henry, R-Hartselle, said that the state's current focus in on changing Medicaid. Not adding more people to it.

"Once we get the mess straightened out, we can look at what an expansion might mean," Henry said. "The feds say it's free money, but there are arguments on both sides that are compelling."

Mary Sell can be reached at mary.sell@TimesDaiy.com.