Ken Hare In Depth: Legislature uses poor children and elderly as pawns

Ken Hare In Depth: Legislature uses poor children and elderly as pawns

MONTGOMERY, AL (WSFA) - It is tempting to write a column that just calls the leadership of the Alabama Legislature ugly names -- heck, make that just about every state legislator. But that would be a waste of time, because after the Legislature's performance on the General Fund budget I imagine many of my readers have been doing that for some time -- and not being constrained by journalistic concerns, they are probably coming up with some doozies.

But you have to wonder about the thought patterns -- if "thought" is the right word -- of those lawmakers in the Alabama House who threatened to essentially cripple Medicaid, which could cause small hospitals to close, grandmas to get kicked out of nursing homes, medical costs to rise for everyone, and tens of thousands of Alabama children and the elderly to lose medical care.

Wait, there's an alternative being discussed: Transfer money from public education to cover the General Fund shortfall, ignoring the fact that public education is already drastically underfunded in Alabama. It is better than Medicaid collapsing, but it still hurts children.

So what are the state legislative leaders thinking? Are they thinking? How can you make sense of what's going on?

Sadly, there is factor that makes it all make sense.

Gambling. I have to suspect that it is all about gambling.

More precisely, it's all about blackmailing Alabamians into supporting an expansion of gambling by creating such dire revenue alternatives that Alabama voters and anti-gambling legislators will feel they have no choice but to support expanded gambling.

It now appears unlikely that the Senate will go along with the House-passed budget that contains a 23 percent cut to Medicaid. Because Alabama already funds its share of Medicaid costs at close to the federal minimum requirements, such a cut could cause the program to lose federal approval, which would cause it to collapse. Even if that did not happen, the loss of 23 percent of its funding most likely would mean the loss of four times that much in federal funding.

Consider this: More than 60 percent of nursing home residents in Alabama are funded by Medicaid. Such a dire cut in Medicaid would cause some -- perhaps many -- rural hospitals to close. Children's Hospital in Birmingham and perhaps the Women's and Children's Hospital in Mobile, which rely heavily on Medicaid funding, would be closed.

William Ferniany, chief executive of the UAB Health System, said the cuts to Medicaid would impact many Alabamians not covered by the program because it supports hospital infrastructure that benefits everyone.

"Alabama's Medicaid program is much more than a health insurance program," he wrote. "It is a vital part of the state's health care delivery system and supports the infrastructure of hospitals, physicians, nursing homes, and pharmacies.  In fact, Alabama Medicaid covers the health care needs of nearly one million Alabamians."

That is about 20 percent of all Alabamians.

That vulnerable 20 percent -- many of them poor children and the elderly -- are being used as pawns by the Legislature, and that is something that no respectable Alabamian should tolerate.

Since the Senate does not appear willing to hit Medicaid as hard as the House, surely senators have an alternative plan, right?

Well, sort of.

Senate President Pro Tem Del Marsh, R-Anniston, has been quoted as saying he supports shifting the state use tax from supporting education to the General Fund budget. But education officials warn that could cause the education budget to be prorated. Marsh said he thought growth in the education budget would offset  any loss in revenue.

Of course, Marsh, who is leading the crusade to expand gambling, would be happy to see casinos and a lottery approved to offset that lost revenue for public schools and colleges.

So if Marsh's proposal doesn't fly, what is the most likely scenario? The House and Senate might pass the same General Fund budget that was passed in the regular session. You know, the one the governor already vetoed to make this special session necessary. Yes, the same one with $200 million in cuts that would hamstring  health care, cause the layoffs of state troopers, close state parks, and gut many more programs crucial to the lives of Alabamians. The one that the governor is likely to veto again, causing another special session for the Legislature to do what it should have done in the regular session.

It is still possible that enough legislators will muster the political courage to pass some of the modest tax increases Bentley has proposed, thus rescuing this special session from total failure. Alabamians should hope so.

But if they don't, it raises the question of whether the state's current crop of legislators -- Republicans and Democrats alike -- have the will to actually govern.

Back to the issue of gambling. Maybe Alabama should expand gambling. As I have written many times before, that depends on the details -- how it will be taxed and regulated, and whether there will be sweetheart deals for gambling interests.

But Alabama voters should not be put in the position of having to choose between expanding gambling and kicking the elderly out of nursing homes and children out of hospitals.


Ken Hare is a longtime newspaper editorial page editor and editorial writer who now writes a regular column for Feedback is appreciated at

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