July 22, 2012, Birmingham News op-ed
The Supreme Court of the United States made its health care decision. We, as Alabama voters, will make one on Sept. 18. The first is momentus, the second is a Band-Aid, and each has serious implications for Alabama.
In one deft maneuver worthy of Brer Rabbit, Chief Justice John Roberts returned a policy problem to those whose job it is to fix it, preserved the integrity of his court, respected federalism, put Congress on notice and deferred to posterity. His decision will be celebrated and condemned for the rest of the year, and dissected for decades.
The governor and Legislature have asked the people of Alabama to make a withdrawal from their savings account. On Sept. 18, we will vote “yes” or “no” on a constitutional amendment to withdraw $437 million, over three years, from the $2.5 billion Alabama Trust Fund, a 30-year accumulation of oil and gas revenue.
That money will go into the Alabama General Fund, one of two primary state budgets (the other is the Education Trust Fund). Dollars from this transfer are not bound to fund Medicaid, but it is the driver. The fiscal year 2013 Medicaid appropriation is 38 percent of the General Fund budget that sustains corrections, public safety, mental health services and day-to-day state operations.
The proposed withdrawal doesn’t improve cost, quality or access to health care in Alabama. It bends no curve in any direction. It keeps Alabama Medicaid afloat at current spending and service levels.
Drawing from the Alabama Trust Fund is a dip into the seed corn. But, for the Legislature and the governor, that option was more palatable than provoking the teachers union with a serious discussion about the education budget or corporate interests with a review of tax accommodations.
Impact to schools and jobs would have certainly been central to that debate. But so, too, would have powerful lobbies whose constituents derive direct financial benefit from the political hornet nests they maintain.
That left the Alabama Trust Fund a sitting duck.
Architects of the referendum, to their credit, understand the impact of a sudden and precipitous drop in current Medicaid funding. The proposed yearly withdrawal from the Alabama Trust Fund is only 2 percent of the total $6 billion Alabama Medicaid budget. But the program receives two federal dollars for every $1 the state contributes. Reduction of the state contribution puts the $4 billion federal grant at risk.
Opponents of the referendum do not propose anything so Draconian as a disturbance of the status quo. They, instead, point to potential efficiencies inside the Medicaid program.
Nevermind that enrollment eligibility for Alabama’s Medicaid program is among the most stringent in the nation and the scope of services ranks near the bottom among states, even as quality of service is considered in the Top 10 according to consumer groups.
We should, by all means, identify, pilot and claim efficiencies. We’re going to need them as Alabama’s middle class continues to tumble downward toward our threadbare safety net.
In May, as the Legislature was formulating next year’s budget, state Health Officer Don Williamson explained the importance of maintaining current Medicaid funding and services. He described the effect of cuts on recipients, but focused on impact to providers and communities.
Williamson made his plea in the most ideologically neutral terms possible. It’s not politically fashionable in Alabama to speak with too much passion about the disadvantaged. Advocates for the poor are about as welcome in Montgomery as a street-corner preacher at halftime.
But, the case for Medicaid doesn’t rest solely on moral grounds, even in the presence of the well-worn admonition that a society is measured by how it treats its weakest members. Medicaid has long-term benefits that the most ardent economic developer should appreciate.
Forty percent of Alabama children are on Medicaid. One half of Alabama Medicaid recipients are children.
Every dollar we invest in the health of an Alabama child is a direct investment in the future of the state. That investment is every bit as valuable as any money spent on our current public education system, or as an incentive to a company to hire an Alabamian.
Our only hope for maintaining a middle class in Alabama lies with the ability of our children to compete in a global, interdependent and chaotic economy.
They can’t even show up for the game if they are hampered by obesity, addiction and chronic illness. Consistent exposure to a doctor, preventive care, nutrition and exercise counseling, health literacy, access to mental health services and just the ability to function in class are all part of helping our kids become productive and capable adults.
We should approve the keep-the-lights-on transfer punted to the ballot box by state leadership and move on. Cuts to Medicaid are too imminent, and the existing scope of services too fragile, to risk a knee-jerk budget debate this close to the beginning of the fiscal year.
Not to mention, the Supreme Court ruling on the Affordable Care Act has presented the governor and the Legislature with a markedly more complex set of health care policy and budget decisions. This is a time for pragmatism and statesmanship, not drawn sabers and battle flags, or a do-over of next year’s appropriation.
You grow by investment. Yes, in education. Yes, in the business sector. But, just as importantly, we grow when we invest in the well-being of the generation of citizens who will carry us on their backs into the future. Alabama has 1 million reasons to do just that.