City: Referendum is void

City: Referendum is void

Related Documents

Posted: Wednesday, October 8, 2014 9:45 pm | Updated: 10:02 pm, Wed Oct 8, 2014.

A 2010 referendum changing Decatur’s form of government is a “dead letter,” the city argued in a federal court motion last week, because the city failed to obtain preclearance from the U.S. Department of Justice.

The city’s motion seeks to dismiss the lawsuit filed by Gary Voketz on the ground the council-manager form of government — required under state law by the referendum vote — could not be implemented unless the Justice Department ruled it was legal under the Voting Rights Act.

Because the city withdrew its request for such a ruling before the 2012 election, the brief argues, the referendum is void.

“The people of Decatur have a right under the Alabama Constitution to change their form of government,” said Voketz’s attorney, Carl Cole. “The people of Decatur voted to do that, and the leaders of Decatur are fighting tooth and nail to deprive the people of that right.

“I never in a million years thought these guys would undermine state law and hide behind the federal government to do it.”

Voketz has until Oct. 24 to respond to the city’s motion.

In October 2011, the city submitted a plan for changing to a council-manager form of government to the Justice Department for preclearance.

“Preclearance” was a procedure in which the Justice Department ruled in advance that election changes were legal under the Voting Rights Act. In January 2012, before the Justice Department issued a ruling, the city withdrew the submission. At the time it withdrew the request, the City Council passed a resolution stating it had no information that “will justify preclearance of the submitted plan.”

“This withdrawal of the manager-council submission … had the same prohibitory effect as would have had a formal (Justice Department) objection to preclearance,” the city argued in its brief. “As a matter of federal law, the council-manager form of government and method of election were unenforceable.”

The referendum triggered the state Council-Manager Act. Under that law, the city would have to hire a city manager and drop from five to three council districts. One of two at-large council members would serve as the mayor, but the appointed city manager would serve as the chief executive.

According to the city, the drop to three districts would require eliminating a district with a black majority, which the city argued would violate the Voting Rights Act.

The October 2012 city elections — for a mayor and five council members — proceeded as if the referendum had not taken place.

The City Council had another chance to seek Justice Department approval when Mayor Don Kyle, honoring a campaign pledge, requested a council vote to seek preclearance of the change in government from the Justice Department. In a March 2013 meeting, Council President Gary Hammon and Councilman Chuck Ard voted to re-submit the three-district plan to the Justice Department. The resolution failed when councilmen Billy Jackson, Charles Kirby and Roger Anders opposed it.

Last month, the city and Voketz reached a settlement in which Voketz agreed to dismiss the portion of his lawsuit that alleged the mayor and each City Council member are serving illegally, a claim that had blocked the city from borrowing money or issuing bonds since Voketz filed the lawsuit in February. In return for the dismissal, the city agreed to pay Voketz’s attorney fees if he wins the case.

After the settlement, Voketz filed an amended complaint that claims the city is required to hold elections that conform to the Council-Manager Act. Even if the law violates the Voting Rights Act, the complaint said, the court has authority to amend the act to include five districts and thus preserve a black minority in one district.

There is no inconsistency in the city arguing its own failure to obtain preclearance nullified the referendum, according to the city’s attorney, because the city was correct in its judgment that the Justice Department would not have precleared the change to a council-manager form of government.

“It was clearly in violation of the Voting Rights Act,” said George Royer, of Huntsville. “It was withdrawn from preclearance because it was clear there was no way it would not violate the Voting Rights Act, and there was no way it could be precleared. This is not an inconsistent position. If the referendum is unenforceable because it wasn’t precleared, then that’s the end of the case.”

In the city’s brief, Royer argued it was not just the drop from five to three districts that required preclearance. The change from a mayor to a city manager as the chief executive also required Justice Department approval.

It is too late for the city to obtain Justice Department approval. A June 2013 U.S. Supreme Court involving Shelby County ended the preclearance procedure. Moreover, the city argued in its brief, the Council-Manager Act imposed a deadline for implementing the change in government that the city did not meet.

“Because the change to a council-manager form of government did not receive preclearance before its statutory implementation date in 2012, the 2010 referendum now is a dead letter,” the city argued in its brief. “Neither the change to a city manager nor the change in electing council members is enforceable today, as a matter of federal law.”

Royer said the city would be placed in an untenable position if Voketz won the lawsuit and the federal court forced a change to a council-manager form of government, even if the new government had five districts and maintained a black majority in one.

“It would leave the city in the position of having someone else come along who opposes a council-manager form of government and saying, ‘No, you can’t do that, because the council-manager form of government was never precleared,’ ” Royer said. “The city would still be open to subsequent litigation by people who are opposed to the notion of a city manager.

“This motion seeks to resolve that issue once and for all at the outset, so two years down the road you don’t have to confront this issue.”

A decision by the Birmingham federal court would not protect the city, according to the city’s brief, because the court has no authority to preclear election changes under the Voting Rights Act. Only the Justice Department and the U.S. District Court in the District of Columbia had that authority, and it ended with the Supreme Court’s Shelby County decision.

“They now say that because the Council-Manager Act wasn’t implemented in October 2012, it can never be implemented,” Cole said. “They ignore the fact that the reason it wasn’t implemented, and the reason we never had an answer from the Justice Department, was because those same people with a vested interest withdrew it, saying there was no way it could be precleared by the Justice Department.”

Eric Fleischauer can be reached at 256-340-2435 or eric@decaturdaily.com. Follow on Twitter @DD_Fleischauer.

http://www.decaturdaily.com/news/local/city-referendum-is-void/article_0aa317f2-4f5e-11e4-b683-001a4bcf6878.html

Leave a comment

Filed under Uncategorized

Stark numbers, in black and white

Stark numbers, in black and white
By Eric Fleischauer Staff Writer | Posted: Saturday, April 12, 2014 9:30 pm
A recent court filing by the city of Decatur underlines the dramatic disparities between blacks and whites in everything from income and education to home ownership and health.
The study, commissioned by the city as part of its defense to a lawsuit challenging its failure to implement a 2010 referendum requiring a council-manager form of government, suggests a huge racial divide in the quality of life of Decatur citizens.
“We have to confront these numbers,” said Bruce Jones, who as director of Decatur Youth Services works extensively with minority youths, their families and teachers. “We can talk all we want about policies, but finally the disparities shown by these numbers tell us whether we are doing enough.
“The answer is clear. We’re not.”
The data, compiled for the city by demographic and redistricting expert William Cooper, was based primarily on detailed breakdowns compiled by the U.S. Census Bureau in 2010 and 2012. The data shows disparities in nearly every facet of life.
One in five black households — 18.5 percent — in Decatur have annual incomes of less than $10,000, well below the poverty level. One in 16 white households, or 6.4 percent, have incomes this low. The median income for black family households in Decatur is $21,938, compared to $52,725 for white families.
One in three blacks in Decatur are below the poverty level, compared to one in 10 whites. Half of black children — 49.7 percent — live in poverty, compared to 16 percent of white children.
Blacks who are seeking jobs are three times more likely than whites to be unemployed, but even if they get a job, the disparities continue. The $15,952 median earnings level of blacks working full time is barely half the $29,589 annual median earnings of whites in Decatur.
The overlap between skin color and poverty creates hard-to-resolve societal problems, said Kevin Lang, an economics professor at Boston University. Lang, author of the book “Poverty and Discrimination,” is a fellow at Stanford University’s Center for the Study of Poverty and Inequality.
“You’re living in a world in which race is a fairly obvious trait, and it’s correlated with economic disadvantage and the many problems that are associated with that,” Lang said after reviewing the city-commissioned study. “People are going to make inferences based on what they can see. That’s going to make it tougher.
“Birth is not destiny, but it sure helps to choose the right parents.”
Poverty is about more than income, said Thomas Buchanan, lead program coordinator at Decatur Youth Services with a master’s degree in social work. It is also about a culture of poverty that — while necessary for survival — creates nearly insurmountable barriers to entering the middle class.
“The dominant culture (which is almost exclusively white in Decatur) has a monopoly on defining reality,” Buchanan said. “That translates all the way down to things like language and standards of beauty and dress codes. You have to conform to the dominant culture in order to be perceived as successful. People attempt to do that, but without the resources to conform in an effective way. It limits their ability to participate in any significant way in the dominant culture.”
Because that dominant culture controls the hiring process that is the key to ascendancy to the middle class, conformity to its norms is essential.
Buchanan likens the interaction between upper classes and those in poverty to a barrel of crabs.
“If you put crabs in a barrel with one scrap of food, you determine everything about their existence,” Buchanan said. “What you talk about is the fact that the crabs are fighting. But the issue really is not the crabs fighting. The issue is who put the crabs in the barrel.”
As income and wealth statistics make clear, blacks in Decatur have far fewer resources than their white counterparts. Wealth statistics are not available for Decatur, but nationally the average net worth of black households in 2009 was $5,677, compared to white households with a net worth of $113,149. Home ownership is the main form of net worth for most people, and Decatur statistics are available for that. Nearly two-thirds of black households rent their residences, compared to a rental rate of about one-fourth for white households.
If income and net worth are the scrap of food, the barrel is the confinement that is an inherent consequence of poverty.
“The impoverished culture doesn’t have the ability to be as mobile as someone from the upper class or middle class, either in terms of geography or income,” Buchanan said. “Try to move to Huntsville with $20 in your pocket. You just can’t do it.”
So in a perverse experiment where the dominant culture both creates the barrel and determines how much food goes into the barrel, it also judges the behavior of the crabs in their artificial environment.
“The dominant culture creates the situation and defines the reality of what’s happening,” Buchanan said. “Then the dominant culture comes in and says they’re so primitive or so uneducated or uncivilized that they can’t even take care of themselves.”
That judgment has consequences, because it is the dominant culture — through hiring, through the funding of education, through control over access to health care, even through the rules of the economic system — that determines the extent of the resources available and the extent of the confinement.
“If you take those same crabs from the barrel and dump them on the beach, they won’t mess with each other,” Buchanan said. “If you confine people to an area and limit the resources they have to survive, what do they do? It’s not peculiar to black people. You look through history, and how much violence, how many wars, have resulted from limited resources?”
Jones said the numbers are revealing, but fail to communicate the human toll that comes with desperation, a sense of futility and anger.
“Too often I see them internalize that anger,” Jones said. “They self-destruct. They have all these frustrations and see no way to change anything. That’s when you see the alcohol and drugs, and too often the crime.”
Many programs at Decatur Youth Services, including boxing and judo classes, are designed to serve as productive outlets for that frustration.
“These programs provide a safe place for kids to hang out with positive adults who are encouraging them daily,” Jones said. “They also give the kids discipline, an outlet for anger and a sense of self-worth, all the things kids need to grow up healthy, whole and productive.”
It is the nature of poverty, said Sam King, head of King James Communications Alternative School, to be cyclical. The first thing he does when taking in a new student in his GED and vocational program is to conduct a home interview. More often than not, the roots of his student’s problems are found in their environment.
“A challenge I have had is raising their self-esteem,” said King, administrator at Redeeming Love Outreach Ministries. “They have been surrounded by negativity all their lives. Mostly what they know is how to hustle, the wrong way, and they see it as a way of life.”
He recalls visiting one of his students in jail several years ago.
“There were three generations in the same cell,” King said. “My student was in there, his daddy was in there and his granddaddy. And I said to myself, ‘What chance does this kid have in life?’ He ended up doing prison time, because that’s all he knew.”
Reviewing the study showing the stark disparities between whites and blacks in Decatur, he shakes his head at the enormity of the challenge.
“We may have to deal with one category at a time,” King said. “We change it one kid at a time. We as a community need to reach out and help these individuals that are struggling. We won’t always be successful, but as a community we have the resources to change these numbers.”
King shares frustration at a system created by a dominant culture that does not always see the benefit of giving every child a chance at success.
“History has proven that those in financial power will lean toward whatever measures that will keep them in power,” King said. “Those in power can hide behind laws. Those laws may be no more than red tape to deter success, to prevent a change in these disparities.”
But King, like Jones and Buchanan, focuses less on changing the system than helping people cope with it.
“I try to make sure they face the facts. The fact is, you were raised in an impoverished situation. The fact is, you have not completed your education. They have to be held accountable for their actions,” King said. “The system — the educational system, the court system, the police system — has not always been fair to black children.
“One individual can’t fix the system, so what we try to do is work the kid through these systems so they can be successful in life.”
King’s one-on-one approach is essential, said Lang, but slow. Noticeable change requires a system that supports programs of intervention.
“To the extent you want to see a dramatic change in the correlation between race and adult outcomes, when you’re starting with a very strong correlation between economic disadvantage and race, I don’t see how you do that without some programs,” Lang said.
King said Decatur, more than most communities, has the will and the resources to initiate and expand on programs that make a difference.
“Right here in Decatur we need to make plans that work for us,” King said. “We should come together to do it. There are things that we can do. And there’s money in Decatur. Are we willing to invest in our own people? That kind of spirit will help us to crush all kinds of ethnic lines.”
King’s efforts are not always successful. Last week, he said, he spent an evening visiting a former student at the hospital. The student rejected the message of hope and accountability, King said, and he was recovering from two bullet wounds.
Yet King still finds hope in the next generation, and it is a hope rooted partly in biology.
“We have a higher rate of mixed students, where one parent is white and the other is black, than we’ve ever had in our educational system,” King said. “You can’t hate the white man when your children are half white, and vice versa. It is coming to the point where our children are not buying into the hatred that the older generation bought into. God is using another generation to fix things that we procrastinated on and couldn’t fix, to show us that we can come together.”
Eric Fleischauer can be reached at 256-340-2435 or eric@decaturdaily.com. Follow him on Twitter http://www.twitter.com/DD_Fleischauer”>@DD_Fleischauer.

Decatur’s Demographics
Population: 55,996 residents
Blacks: 22 percent
Whites: 63 percent
Hispanic: 12 percent
Other: 3 percent
Source: U.S. Census Bureau, 2012 estimate

http://www.decaturdaily.com/news/article_54337074-c291-11e3-bc1d-001a4bcf6878.html

1 Comment

Filed under Uncategorized

On inequality, Obama is talking to Alabama

You could almost hear the collective groan in deep-red Alabama when President Barack Obama, in his State of the Union address, reminded Americans of what he has long said was one of the nation’s most pressing challenges.

“Today, after four years of economic growth, corporate profits and stock prices have rarely been higher, and those at the top have never done better,” Obama said. “But average wages have barely budged. Inequality has deepened. … Too many Americans are working more than ever just to get by; let alone to get ahead.”

The Alabama groans were expected. For six years, our elected officials have force-fed us a political diet that lacks any substance but the certainty that everything Obama says or does is wrong, and maybe evil.

Alabama’s groans at Obama’s words on the collapsing middle class, however, were misplaced. More than almost any other state, we feel the consequences of a four-decade trend in which the rich — blessed with capital and opportunity — have gotten richer and everyone else has struggled. Like him or not, Obama is fighting for Alabamians when he fights against inequality.

Obama’s description of growing income polarization is accurate. Corporations get it, and many are struggling to cope with it. In Decatur, we recently have lost two retailers that depended on the middle class: Sears and JC Penney. The disposable income of the companies’ traditional customer base is dwindling.

Some retailers, however, are doing great. Never better, thank you. High-end stores like Nordstrom and hotels like Four Seasons are powering ahead, reports the New York Times. The most nimble companies, like G.E. Appliances and Darden restaurants, are pushing high-end brands that appeal to the wealthy customers who still have disposable income.

Forty percent of all personal consumption expenditures in 2012 — up from 27 percent in 1992 — came from the top 5 percent of earners. The bottom 80 percent of earners accounted for only 39 percent of personal consumption expenditures in 2012, down from 47 percent in 1992.

Alabama — with more than one in five living in poverty and with a per capita income that is 42nd in the nation — should be especially disturbed by this trend. In a nation that has the greatest income inequality in the industrialized West, Alabama’s income disparity — its gap between the haves and have-nots — is greater than all but four states. And even corporate America should worry, as it is forced to market its products to an ever-smaller percentage of the population.

If our politicians have new ideas on how to reverse a trend that is undermining our economy and depriving Alabamians of access to capital and opportunity, they should speak up. If all they have to offer is attacks on Obama, they need to get out of the way.

3 Comments

Filed under Alabama politics, Income inequality, obama, Uncategorized

Alabama needs to embrace ACA

This was my response to a friend who opposes the Affordable Care Act. I first sent him this story of what is happening in Kentucky, a state seeing remarkable success with the ACA despite similar demographics. Kentucky, of course, embraced the reforms as a long-overdue way to help its citizens while stimulating its economy and saving its hospitals.

I continued as follows:

Alabama is not working well, which was the state government’s goal. We have not expanded Medicaid — and note that the KY story involved the working poor, who do not have Medicaid in Alabama. The state has done nothing to curb the BCBS monopoly and it refused to create its own anti-monopoly exchange or promote the federal exchange, so BCBS remains the only significant player and controls premiums.

In Decatur we don’t have it quite so bad yet because Huntsville/Decatur Morgan hospitals are trying to provide diagnostic tests and specialized care to the uninsured, usually after a referral from the Free Clinic. (In the Kentucky story, note that diagnostic tests and specialized care were the biggest pre-ACA problems.) In talking to hospital officials, though, it is clear that can’t continue. Decatur Morgan is not breaking even; HH barely is. They are not required to provide MRIs or cancer screens or most cardio tests. All the hospital is required to do is stabilize the patient and send her home. The specialists are not required to see the uninsured patients at all, and fewer and fewer are willing to see them.

When 17% of our population has essentially no access to health care, it is inevitable that the transition will be difficult for everyone — doctors, hospitals, insured patients. Many uninsured have been struggling with untreated illnesses for years, and they will strain the health infrastructure initially. Those who have been previously denied insurance due to preexisting conditions will put upward pressure on premiums for everyone.

The transition also is difficult because the ACA is a major overhaul of a huge and complex system. There are dozens of minor changes that would make it work better, but the U.S. House does not want it to work better.

I avoid saying this publicly, but you’re a friend: For me, it comes down to my acceptance of Christ’s teachings. We have the ability to heal the sick and give them an opportunity to become productive members of society. We have the ability to treat diabetes and prevent its horrific consequences. We have the ability to alleviate painful conditions that ruin the quality of life for thousands of Alabamians. Nobody gets healthcare for the fun of it, so we are not even creating the “dependency” issues that cause our governor such consternation.

ACA has plenty of problems. Its initial rollout, as you mentioned, was a disaster. The pre-ACA status quo, however, was an affront to everything I believe in. While the vote ended up being partisan, ACA was formulated by both parties and numerous experts. Short of a politically untenable single-payer system, it’s our best shot.

20140202-121041.jpg

Leave a comment

Filed under Alabama politics, Health care, Medicaid, Obamacare

The gospel of simple mercy

How can our annual celebration of Christ’s humble birth not jolt us from our year-long exercise in complex self-justification?

Jesus, Christians agree, was the one perfect man. His perfection manifested itself not in the accumulation of riches, but in poverty. His generosity was complete and unconstrained by judgment.

He was the one man with a right to judge, yet his gifts of food and healing and salvation had no conditions attached. He gave to the undeserving based not on their merit, but based on their need.

This man whose perfection we proclaim felt the hunger of the poor, and he fed them. He felt the pain of the sick, and he healed them. He felt the hardness of our souls, and he saved us.

Two thousand years later, we chafe at this man’s simplistic gospel.

His response to hunger was to provide food. Ours is to weave intricate masterpieces of logic: The seeming generosity in paying $1.40 per meal to feed the hungry will really doom them to perpetual hunger. We harm the hungry by giving them sustenance, because our gifts will make them dependent.

When this perfect man confronted illness, his naive response was to offer healing. We come up with elaborate justifications for withholding health care: If all who are sick have access to a cure, our health-care facilities will be overburdened. The cost of healing the impoverished sick will harm the productive potential of the rich, which ultimately will hurt the poor. Universal health care will incentivize unhealthy lifestyles.

We have become enamored of our intellect. With ever-more-elaborate twists of logic, we can prove that food stamps cause hunger and health care causes illness.

And yet on Dec. 25, most of us bow to a man who rejected such logical games. If we were hungry, he gave us food. If we were sick, he healed us. His perfection was simple, but inconvenient. Our imperfection is complex, but convenient.

If we want to pick holes in the Affordable Care Act, we can do so. It is a creation of imperfect humans. If we want to find justifications for whittling away at food stamps and dropping benefits for those who cannot find a job, we can do so.

In the midst of our efforts to construct logical self-justifications for abandoning the poor, however, should we not be jolted each Christmas? Most of us worship a perfect man — the son of a forgiving God — who was both poor and selfless. For him, there was no complexity in goodness. Not one of us deserved his mercy, yet he fed us and healed us and died for us.

Feed the hungry. Heal the sick. As imperfect as we are, we have the power to do both. It’s not convenient, but it’s simple.

Leave a comment

Filed under Conservatism, Health care, Medicaid, Poverty, Religion, Uncategorized

Without Medicaid expansion, indigent care will decline

By Eric Fleischauer
Staff Writer

Without an expansion of Medicaid, care for uninsured Alabamians will not stay the same, the head of the Huntsville Health System said.
It will deteriorate, David Spillers predicts.
Spillers, chief executive officer of a system that includes nine north Alabama hospitals, fears elected officials are assuming public hospitals will continue to provide roughly the same level of care for those without public or private insurance. The same Affordable Care Act that would use federal dollars to foot more than 90 percent of the bill for a Medicaid expansion, however, also reduces funding for hospitals that are struggling to break even.
“I think you will see a lot of hospitals in Alabama who do not make it,” Spillers said. “I’m predicting that 30 hospitals in Alabama are at risk of not being hospitals. There are some in this system that are going to struggle. I’m not going to say who, but there are some that are struggling today and if it gets any worse, it is going to be tough to figure out how they make it.”
In addition to Huntsville Hospital, Huntsville Health System includes Decatur Morgan Hospital, Helen Keller Hospital, Athens-Limestone Hospital and Lawrence Medical Center.
Alabama hospitals receive the lowest reimbursement levels in the nation from Medicare, Medicaid and Blue Cross, Spillers said, which together represent essentially all their revenue.
“The poorer your payment from Medicare, Medicaid and Blue Cross, the harder it is to treat people,” Spillers said. “So when you go to Decatur, when you go to Sheffield, when you go to Florence, those hospitals have horrendous payment from those payers. So there is not any excess that they can take to spend on these poor patients.”
The problem is revenue is dropping, mainly because of cuts in federal Disproportionate Share, or DISH, payments.
DISH payments came about to help offset the costs of hospitals that — either because of demographics or the types of services they provided — treated a disproportionate number of uninsured patients. As originally passed, the Affordable Care Act eliminated the need for DISH payments.
The health-care reform law required all states to provide Medicaid to citizens at or below 138 percent of the poverty level. The law required almost everyone else to purchase insurance. The U.S. Supreme Court upset this balance when it ruled states could opt out of the requirement that they expand Medicaid. Alabama is one of 23 states that has declined to expand Medicaid.
“Alabama has the bare minimum Medicaid system from a coverage perspective that there is,” Spillers said. “So for us, because we are a poor state, there are a lot of people who fall below 138 percent of the federal poverty level. By not expanding Medicaid, that means there are a lot of people who are not going to be insured.”
What that means for Huntsville Health System is that its hospitals will not receive the influx of Medicaid reimbursements for patients it now treats for free, but it still is losing DISH payments.
“The concern about the impact of loss of DISH is a real one,” said State Health Officer Don Williamson, although he said the most dramatic cuts in DISH payments begin in 2016.
Removing revenue from a system that is struggling to break even means programs and services that lose money are at risk.
The problem, Spillers said, is not efficiency.
“For Decatur Morgan, being really, really efficient means breaking even,” Spillers said. “For Helen Keller, being really, really efficient means breaking even. For (Huntsville Hospital), if we are really, really efficient, we can make a little bit of money, which helps fund the things we need to do in the system.”
The level of care Huntsville Health System provides to uninsured patients far exceeds legal requirements, which are set forth in the Emergency Medical Treatment and Labor Act, an unfunded mandate passed in 1986.
“It’s a law that’s widely misunderstood,” said Harold Pollack, a health policy expert and Helen Ross Professor of Social Service Administration at the University of Chicago.
“EMTALA requires the hospital to provide a set of emergency services when you present an acute need,” said Pollack, an executive member of the university’s Center for Health Administration Studies. “It does not require that the care be free and it does not require that you receive many services you need if you have a serious chronic illness or if you need more medical care once your condition is stabilized.”
If elected officials believe the alternative to Medicaid expansion is a continuation of the care hospitals currently provide to uninsured patients, Spillers said, they are failing to understand the increasing pressure to cut all services that lose money and are not legally required.
Spillers provides an example of an uninsured patient who enters the emergency room with undiagnosed cancer.
“Once we find out they have cancer, that is not an emergency from an EMTALA perspective,” Spillers said. “Our job was to triage and get you to the most appropriate care, which was that handoff to the oncologist. Once you’re handed off to that oncologist, you are no longer an emergency patient.”
In a system that only provided the care required by EMTALA, the cancer patient would be facing a death sentence.
“If they need something, the oncologist has the right to say, ‘Sorry, you don’t have money. You don’t get treatment,’ ” Spillers said. “EMTALA does not require the oncologist to do anything. Then the patient goes home until the cancer progresses and he gets sick enough to come back to the emergency room, and then there’s a requirement to treat him.”
To keep people from dying of untreated cancer, Huntsville Hospital leases space in a cancer institute. The uninsured patients are treated at the expense of Huntsville Hospital.
When a surgeon volunteers his time to perform non-emergency surgery — such as for a hernia — on an uninsured patient, Huntsville Health System provides expensive surgical support. It’s an expense the system struggles to afford and one the law does not require.
“If we do nothing and let the DISH dollars fall off the cliff, then you’re going to have fewer hospitals and hospitals less able to take care of the indigent patients,” Williamson said.
The only way to sustain the level of care for uninsured patients, Spillers said, is to inject more money into the system. With DISH payments falling, the most obvious route is to expand Medicaid.
“We don’t have a cost problem; there is no cost to cut,” Spillers said. “We have a revenue problem. With a revenue problem, expanding Medicaid would help. Eventually the state will have to expand Medicaid. Every year we choose not to do it there’s a significant negative economic impact to our state.”
Williamson said the decision on whether to expand Medicaid is not up to him, but to the governor or the Legislature.
“At this point the governor said he’s not going to expand Medicaid,” Williamson said. “My job is to try to give him a Medicaid system that — if he wants to revisit the decision at some point — is as lean and efficient as possible.”
Williamson said the main downside of expanding Medicaid now, before an ongoing reorganization of the state’s system is complete, is that emergency rooms and hospitals could be flooded with an extra 300,000 to 500,000 Alabamians who have no public or private insurance.
Gov. Robert Bentley has raised the same concern. He also has said — even with the federal government picking up 100 percent of the cost of expanded care through 2016 and an amount that gradually drops to 90 percent in 2020 and beyond — the cost to the state would be too high. A spokesman for the governor said the net cost of expansion in Alabama from 2014 through 2020 would total at least $488.5 million.
This year, Alabama taxpayers spent more than $600 million on a Medicaid program for about 930,000 people, according to state Medicaid officials.
“The positive of expansion is you bring in a billion dollars (a year),” Williamson said. “And the data is clear. If you compare a population where people have insurance to a population where people are uninsured, the people with insurance have better health outcomes.” Spillers said he struggles to understand the decision not to expand Medicaid, a move that would inject needed federal funds into the state’s effort to care for the poor.
“The longer we stay out of the expansion, the longer we are going to approach No. 50 in every health category there is,” Spillers said. “We are getting exactly what we’re paying for. We have very poor health outcomes by every indicator. We are in the bottom two or three or four states in the country, but we’re not putting any money into health care. So why would you expect anything different?”
Politics, not rational health policy, is preventing states like Alabama from expanding Medicaid, Pollack said.
“It’s a sad commentary on the polarization of American life and the tenuous commitment we have to caring for the most disadvantaged Americans,” Pollack said. “I do think that eventually every state will take the Medicaid expansion. The challenge we have on both sides is to find a politically dignified path to compromise.”
Williamson said he has personal views on the issue of Medicaid expansion, which he has expressed to the governor, but he believes it is counterproductive to express those views publicly.
“My best role is to work as hard as I can to get the Medicaid program in the best shape we can get it in, so that if a decision is made to expand, two things happen,” Williamson said. “No. 1, that I can assure the taxpayers that we are asking for the least amount of money possible to get the job done. No. 2, that we have organized the system of care in a way that doesn’t simply flood emergency rooms and hospitals because people otherwise don’t have access to care.”
As Spillers waits for what he said is the inevitable Medicaid expansion, he has to figure out what money-losing programs or services to cut as DISH payments drop. He has no announcements to make.
“I can see the headline, ‘Huntsville is going to close this.’ I don’t want to put that out there,” Spillers said. “I can tell you that we are providing services today that this community vitally needs, and they lose tons of money.”

Eric Fleischauer can be reached at 256-340-2435 or eric@decaturdaily.com.

.

http://www.decaturdaily.com/life/health/article_6fa7678a-6a84-11e3-bacb-0019bb30f31a.html

Leave a comment

Filed under Uncategorized

Obama wrong: you can’t keep junk insurance

The horror stories are rampant. In Alabama alone, Blue Cross Blue Shield is canceling 87,000 health insurance policies. Around the nation, people who liked their inexpensive individual insurance plans say they must replace them with a more expensive one because of the Affordable Care Act.

The stories raise two distinct issues, one minor and one major.

One is whether President Barack Obama lied when he said, more than once, “If you like your plan, you can keep it.” This is the minor one.

Certainly Obama was wrong. Maybe he was making a paternalistic assumption that people do not “like” lousy individual insurance policies. Or maybe he was lying; it would hardly be the first time for a U.S. politician. This is a minor issue, because he’s serving his final term as president. His fluctuating poll numbers really don’t much matter.

Distinct from Obama’s motives in making the false statements is whether the fact not all people can keep the cheap individual insurance policies they “like” is a bad thing.

The policies being canceled under Obamacare do not meet even the minimum standards of the law. They fall far short of the excellent “platinum” insurance, fall short of the gold and silver policies, and can’t even meet the minimalist coverage requirements of a bronze policy.

The common gripe is that it’s unfair for one insured to have to pay premiums for a service he will never use; why should a man have to pay premiums for policies that cover maternity care or mammograms? But this is not unique to Obamacare. Men already pay premiums for policies that cover uterine cancer, just as women pay premiums for prostate cancer. It’s called sharing the risk, and it’s the point of insurance.

A recent Consumer Reports investigation looked at a horror story that went viral. A 56-year-old Blue Cross insured told CBS her monthly premium would jump from $91 to $591.

For starters, Consumer Reports concluded her actual premium would only increase to $165 after subsidies.

More importantly, her $91 policy was “junk insurance,” to use Consumer Reports’ term.
The plan she likes was of little benefit even for minor ailments. If she were to require treatment for something major — Consumer Reports used the example of breast cancer — the $91 policy would be all but worthless.

The investigation assumed a $120,000 treatment cost for breast cancer. The policy the woman said she likes because it costs her little in premiums would leave her with a $119,000 bill. The policy that complies with the ACA, while it has a higher premium, would limit her personal expense to $6,300.

Because the woman had an annual income of $30,000, a $119,000 medical bill probably would mean bankruptcy and a shifting of her providers’ unreimbursed costs to the rest of us.
The uproar over the fact that some people with individual insurance will pay more under Obamacare may suggest the president was dishonest.

More importantly, however, the uproar focuses attention on the number of people who have junk insurance that provides little protection for them and almost none to a nation reeling under the burden of unpaid medical bills.

Leave a comment

Filed under Health care, Obama, Obamacare