Legislators vote to slash $156M from Medicaid

The Alabama House of Representatives got two bites at a budgetary apple Wednesday. The second ripped a big chunk out of the state’s Medicaid program.

After three hours of debate, the lower chamber voted 46 to 45 to reject a $156 million cut to the state’s Medicaid program, a controversial move that not even the mover of the proposal seemed to agree with.

But some minutes later, House Majority Leader Micky Hammon, R-Decatur, moved reconsideration of the vote. On the second try, the move to cut Medicaid passed 46 to 44, thanks to votes from members who had been absent on the first ballot and a switch by Rep. Ritchie Whorton, R-Owens Cross Roads, from no to yes.

A second vote led to passage of a General Fund budget that cuts $228 million from the General Fund, including the Medicaid reduction. The vote was 53 to 40.

Both legislators and officials say the cut could mean the end of the Medicaid program in Alabama. It would not only hurt some 1 million Alabamians who qualify for the program, but force the closings of rural hospitals and devastate nursing homes and pediatric practices.

But House Ways and Means General Fund committee chairman Steve Clouse, R-Ozark, said he believed the drastic move would spur negotiations.

“We’ve got some serious issues with provider taxes that nursing homes pay and hospital pay, they all need to come to the table,” he said after the vote. “We’ve got to find a solution to this Medicaid budget that’s growing out of control.”

‘That will never happen’

Whatever the solutions are in the Senate, Medicaid cuts might not be among them.

“That will never happen up here,” said Sen. Gerald Dial, R-Lineville, Wednesday afternoon. “We will go home without a budget before we do that.”

Senate President Pro Tem Del Marsh, R-Anniston said the cut was “very unlikely” to pass.

"That money represents a lot more money to the state of Alabama because of the federal match," he said. "I'm all about not expanding Medicaid, but I'm not going to take a position right now that we cut it to that point."

It may be easier to figure out what the Senate won’t do with the General Fund than what it will. Republicans in the deliberative body remain divided on the best way to address a shortfall of at least $204 million in the budget. Senate Finance and Taxation General Fund chairman Arthur Orr, R-Decatur, said Wednesday afternoon the chances of passing a budget in the current session were “less than 50 percent, and declining.”

“We’ll do the best we can,” he said. “We’re still searching for a solution.”

Senate leaders have proposed moving $225 million in use tax from the education budget to the General Fund as a way of filling the deficit. But Senate President Pro Tem Del Marsh, R-Anniston, has indicated that replacing the money is not a priority, a feeling not universally shared.

At the same time, finding any budget idea the GOP in the upper chamber can agree on has fruitless so far.

"With every idea, there are five or six senators opposed to it," said Sen. Slade Blackwell, R-Montevallo.

Frustration and cutting

Republicans noted throughout the debate that Medicaid has consumed an ever-larger part of the General Fund over the years. Currently, the program takes in about a third of General Fund allocations.

But Clouse also said the program serves as the “foundation” of Alabama's health care. About 20 percent of the state’s residents qualify for Medicaid. More than half are children, and 53 percent of pregnant women, get Medicaid coverage. Pediatric services -- ranging from doctors offices’ to Childrens Hospital in Birmingham -- count on the program to keep the doors open. A majority of Alabamians in nursing homes receive some kind of Medicaid.

The cut came out of the House Ways and Means General Fund committee Tuesday after members rejected an increase to the state cigarette tax, a key component of a $173 million House Republican plan to balance the General Fund budget. Following the vote, Clouse said it was time to debate Medicaid, saying both Alabamians and legislators saw it as an entitlement program without understanding the benefits of the program.

“People, constituents, providers all over the state, they need to hear about what Medicaid actually does to be the foundation of health care in the state,” Clouse said Wednesday.

That debate occurred Wednesday afternoon, as Democrats and a handful of Republicans expressed staunch opposition. Rep. John Knight, D-Montgomery, brought two signs to the podium to express his belief that the cut would be disastrous in Alabama.

The Legislative Black Caucus says it will not vote for taxes unless Medicaid expansion and long-term budget reform are part of the budget proposals. Knight also defended his no vote on the cigarette tax.

“How can you justify an increase in taxes on consumers in state and not address the loopholes in the state?” he said. “There’s something unconscionable about that.”

Rep. April Weaver, R-Alabaster, a health care administrator, also defended Medicaid at the podium.

“If anyone thinks this is an entitlement, come see me,” she said. “It is health care infrastructure in this state.”

Clouse did not disagree with any of the speakers, and no one during the debate spoke up for the cut. Many Democrats argued that the state needed to expand Medicaid, a major priority of the party and something most Republicans oppose. Rep. Oliver Robinson, D-Birmingham, said the state was leaving money on the table.

“We have literally let other states have our money because we have this thought that anything our president does is wrong,” he said.

Following the vote, Knight said in a statement that the vote “effectively terminates” Medicaid in Alabama.

“Today, an unconscionable choice was made to gamble with the lives of men, women and children across this state to balance the General Fund Budget on the backs of our state’s most vulnerable citizens,” the statement said.

Alabama Arise, an organization that lobbies on poverty issues, also criticized the vote.

“A budget is more than a balance sheet,” Jim Carnes, policy director for the organization, said in a statement. “It’s a statement of our values. And the Alabama House’s decision today to gut Medicaid sent a stark message to a million Alabamians: Your health coverage doesn’t matter.”

Clouse did open the possibility of a second special session focused on Medicaid.

“That would be my idea, to just have it and let these other agencies know, ‘OK, you’re OK to start Oct. 1,” he said. “They need to realize you’re OK right now. This debate needs to be about Medicaid.”

Some Democrats seemed open to the idea.

“Call another session on Medicaid, and do it damn quick,” said Rep. John Rogers, D-Birmingham.

Corrections, the state Law Enforcement Agency and the departments of Mental Health and Human Resources are effectively level-funded. Other agencies would see a range of cuts to their budgets.

The Senate could take up the budget as early as Friday.

“They’ve been sitting up there with not much to do as far as the budget goes because revenue measures have to start in the House,” Clouse said. “We’re not going to have those revenue measures, so let’s see what their solutions are.”