Brian Lyman

Montgomery Advertiser

Compared to the six-month battle in 2015 over the General Fund budget, this year’s struggle went fast.

But the budget that passed concerns health care officials, who say that in giving Medicaid less than what it asked for, it could create problems for primary care providers and hospitals in the state.

The Legislature Tuesday overrode Gov. Robert Bentley’s veto of the General Fund budget, putting the $1.8 billion budget into effect. The Senate voted 22 to 10 to pass the budget over Bentley’s objections about Medicaid and Corrections funding. The House voted 71 to 24 for override a few hours later.

“This body overwhelmingly passed the General Fund budget,” Senate President Pro Tem Del Marsh, R-Anniston, said before the Senate vote. “I do not see this body raising taxes or raiding education.”

The Montgomery delegation mostly supported the override. In the Senate, Sen. Dick Brewbaker, R-Montgomery voted to override the governor’s veto. Senate Minority Leader Quinton Ross, D-Montgomery, voted against it. In the House, Republican Reps. Reed Ingram of Pike Road; Dimitri Polizos of Montgomery and Chris Sells of Greenville voted to override, as did Montgomery Democrats Alvin Holmes, John Knight and Thad McClammy. Rep. Kelvin Lawrence, D-Selma, voted against the override.

The 2017 General Fund budget, which goes into effect Oct. 1, level funds most state agencies and provides small funding increases for Medicaid and Corrections. Medicaid would get $15 million more, while Corrections would get $13.2 million.

The budget also increases the allocation for state employee insurance from $825 per employee per month to $850. That could ease – but not eliminate – expected out-of-pocket cost increases expected in the General Fund budget.

Medicaid funding proved the main argument over the budget. The agency said it needed an increase from $685 million to $785 million to maintain services and begin implementation of regional care organizations (RCOs), which would move Medicaid to a managed care program with the hope of arresting costs.

In his veto message, Bentley said Alabama Medicaid focuses its efforts on “those most in need – our low-income children, pregnant women, the elderly and people with disabilities.”

“The proposed appropriation would fall short of what Medicaid would need to maintain reimbursement rates to primary care physicians, dentists, and other health-care professionals, who care for the over one million Alabamians covered by Medicaid," the veto message said.

Medicaid says it would have to reduce cut physician reimbursements and services like eyeglasses and out-patient dialysis under the budget. Danne Howard, executive vice president and chief policy officer for the Alabama Hospital Association, said losing primary care reimbursements could drive more people to emergency rooms for primary care treatment.

“It adds an increased burden to already struggling bottom lines,” she said. “It won’t take long to take its toll.”

Bentley has threatened to call the Legislature back into session over Medicaid funding. But Marsh said Tuesday evening he did not expect the attitude of the Senate to change on the subject.

"We're open to listening to our constituents," he said. "Right now, I think they expect us to live within our means, which we've done."

Republican legislators in both chambers have said they don’t want Medicaid’s needs taking money from other state agencies’ priorities. Medicaid consumes about 38 percent of the General Fund budget, and legislators have resisted efforts to add revenues to the troubled budget.

Sen. Trip Pittman, R-Montrose, said during the Senate debate that he hoped the passage of the budget would focus attention on the problems in it.

“I can stand up here and tell you comfortably I’ve tried to raise revenue,” he said, adding “I’m only one of 35.”

Sen. Rodger Smitherman, D-Birmingham, said he “couldn’t believe” the proposed funding for Medicaid.

“They sent you down here to do what’s right . . . they felt that they didn’t have to pick up the phone and tell you to save Medicaid," he said.