The Alabama Nursing Home Association is proud of the fact that at least one nursing home is available in every county in the state. But if the budget referendum taking place tomorrow fails that effort could be in danger. John Matson is a spokesman for the Alabama Nursing Home Association. He says a vote of "no" tomorrow could spell deep cuts on the horizon.
“From what we’ve been told and that’s all we really can go off of; the numbers that we’re given by government officials. We’re told that Medicaid is looking at somewhere between a 15 to 17 percent cut so we just have to assume that nursing homes along with everyone else will be cut by 15, 17 percent and we know that a cut at that level is not sustainable for most of our membership.”
Almost seventy percent of nursing home residents in Alabama have their care paid for by Medicaid. Matson says that not all nursing homes would be affected equally by Medicaid cuts though.
“Obviously your more rural nursing homes will run a higher percentage of Medicaid some have 80 or 90 percent of their residents on Medicaid so a cut of up to 17 percent would have a much more drastic effect on that rural nursing home then it would say in a nursing home in a big city where they may only have 40 to 50 percent of the residents on Medicaid. So you would look at possibly more rural nursing homes closing than urban.”
That loss of access to care is not only a concern for nursing homes, but the entire Medicaid system. Dr. Don Williamson as chair of the Medicaid transition team is charged with making the dollars stretch to make the budget work.
“I have enormous concerns about what happens to health care in Alabama, what happens to public health in Alabama, what happens to mental health, DHR, all the general fund agencies,” says Williamson. “If the constitutional amendment isn’t passed and if additional funds aren’t found than I think we’re facing a train wreck.”
Williamson adds if the amendment passes, the budget still faces a 30 million dollar deficit, which he claims is manageable. On the other hand if the amendment fails, the system could face the thirty million dollars in red ink—plus additional cuts from the state. That proration could balloon that financial hole to one hundred and ten million dollars. But wait it gets worse.
“Because of the way we use multiplying dollars in the system through things called certified public expenditures and provider taxes it’s probably a shortfall of closer to 500 million dollars,” says Williamson.
To hear Dr. Williamson and many of the supporters of the amendment tell it the obvious answer is to pass the amendment and help bridge the gap until lawmakers implement true reform. Specifically the measure would take $145.8 million out of a state trust fund a year for the next three years and use it to balance the state General Fund budget. Kathryn Byrd is president of the League of Women Voters of Alabama. Her big concern is how the ballot item is worded.
“The precise language is proposing an amendment to the constitution of Alabama of 1901 to provide adequate funding for the state general fund budget. To prevent the mass release of prisoners from Alabama prisons and to protect critical health services to the Alabama children, elderly and mothers by transferring monies…funds from the Alabama Trust fund to the state General Fund.”
Byrd says opponents call that language alarmist. And, so do opponents like House Minority Leader Craig Ford.
“I think it’s very political in nature that the Republicans have only decided to fix it for three years which gets them past the next 2014 election cycle,” Ford says. “We want a permanent fix. We’re all for Medicaid; they’ve ran around the state and touted about how they cut a billion dollars out of the budget but then they turned around six months later and they are asking the voters of Alabama to let them borrow almost 450 million dollars out of the savings account.”
Ford adds if you don’t think it’s political in nature just look at the date the vote on the amendment takes place. The fact that it’s on September 18th and not November 6th should raise a red flag.
“Why could we not wait 40 more days to have this election and save the taxpayers three million dollars is what the cost of this election is,” says Ford. “Well they say the fiscal year starts on October 1st. Well cut back for 35 days to find out if we’re going to have money or not because according to the Governor if it fails we’re going to have to cut back anyways.”
And that’s what Ford thinks is going to happen. That the bill will fail and then legislators will have to get serious about other options.
“The Governor should call us a special session in two days thereafter and try to reach across party lines. We’ve offered a dollar cigarette tax which would bring in 238 million, a lottery needs to be discussed again and also closing all these corporate tax loopholes for out state corporations doing business in Alabama that aren’t paying their fair share which is hurting our small businesses.”
Whether you vote yes or no both sides of the issue say this is an important issue that impacts all Alabamians. Serious ramifications are in store for all state agencies if a fix can’t be found through this vote or a special session of the legislature. For now the decision lies in the hands of voters.