Medicaid cuts: life and death

State legislators are used to making people mad. They’re used to being at the center of ideological controversies. What they are not used to is recognizing that they hold the power of life and death over Alabama residents.
Dr. Don Williamson, director of the Alabama Department of Public Health, brought the brutal truth home last week in discussing the impact of a House budget that would make drastic cuts to Medicaid. The cuts, Williamson said, may end dialysis for the poorest Alabamians.
“As a doctor I know exactly what happens if you don’t give dialysis to people,” Williamson said. “They are dead in two weeks.”
This fiscal year, the state’s Medicaid budget was cut by $68 million. The fiscal 2013 House budget passed last week cuts funding to most state agencies by approximately $340 million, a nearly 20 percent decrease. Medicaid would see its state funding slashed by $175 million — 30 percent — which would also reduce federal funding for the program.
Williamson estimated total cuts to the program, if the House budget is approved, of $720 million.
Elimination of dialysis, adult pharmacy services and hospice care are likely because the federal government does not mandate the programs.
Expected cuts in Medicaid reimbursements will reduce the number of doctors willing to accept Medicaid patients. Without access to physicians, minor ailments can become life-threatening ones.
These cuts come despite the fact that Medicaid expenditures per enrollee in Alabama are the second lowest in the nation, and that the federal government matches every Alabama dollar with $2.18.
It’s easy to blame the governor and Legislature for the unfolding tragedy. They know the state needs more revenue, but lack the leadership to propose tax increases.
The ultimate blame, though, falls on voters. Our elected representatives are convinced — maybe rightly — that we will vote them out of office if they raise taxes in a state with the lowest tax burden in the nation. They believe that we will rebel even if the tax increase merely eliminates deductions that favor the wealthy or preferential tax treatment for corporate landowners.
If they have misjudged the voters of Alabama, we need to let them know. If they are correct in their assessment of our values, then the blame falls squarely on us.


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Filed under Alabama politics, Health care, Tax reform

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