By Bill Britt
Alabama Political Reporter
MONTGOMERY — “I will tell you right now, Medicaid absolutely has to be funded or we will have a medical crisis within the state,” warns Dr. Greg Bouska, president of the Alabama State Society of Anesthesiologists.
Bouska and thousands of medical doctors across the state understand the cost of Medicaid but they also know full well the price that will be paid if it is not funded.
“We are going to have a public health crisis if Medicaid is not properly fund,” reiterates Bouska.
According to Dr. Don Williamson who is heading Governor Bentley’s Medicaid Task Force this is not a “Chicken Little” scenario. Williams and a growing choir of medical and business professionals are warning that if Medicaid fails in Alabama, the ripple effects will make the current fiscal crisis look like a minor blip on a heart monitor before full cardiac arrest.
Coosa Valley Medical Center in Sylacauga is the area’s most modern acute-care hospital, it is also the largest employer in the area.
“An organization of our size—which is midsize medical facility—is a part of daily life in our community,” says Hospital CEO, Glenn C. Sisk.
Sisk, a veteran hospital executive, says he is concerned about the situation facing the state’s Medicaid program and the effect it will have on the healthcare infrastructure of Alabama.
“Alabama’s hospitals are on very fragile footing economically,” said Sisk. “A recent survey found that the average margin for hospitals is one percent.”
In the last year St. Vincent’s Health System opened a new $32 million, 40-bed facility in St. Clair County.
St. Vincent’s Chief Executive Officer, John O’Neil is concerned what will happen to the new facility and all hospitals around the state, if today’s constitutional amendment (CA) to fund Medicaid should fail.
O’Neil is also concerned about how the failure of the CA could affect the state’s fragile recovery.
“We have some major momentum going in the state with Airbus and all the governor is doing, we certainly don’t want to slow down this recovery,” O’Neil said.
“This is not a message we want to broadcast around the world, that Alabama’s broke,” said O’Neil. “We are not broke, we have a problem that can be fixed. We have a short-term solution which is the constitutional amendment and we need to use it.”
O’Neil admits that the borrowing the funds from the gas and oil trust may have not been the best choice “but it gives us an opportunity to fund Medicaid while working toward better solution for the future.”
He says that underfunding the program by $200 million dollars which would cause “a major crisis within the state.”
“This would mean having to immediately go to proration, gut the Medicaid program, which would result in cutting and closing necessary services,” says O’Neil.
Such warnings from the Governor, business and health leaders are predicting a dire outcome if funding is not made available.
T. Michael Harrington, MD, president of Medical Association of the State of Alabama is one of the many that have made this prediction. Their accretions are based on facts not political hyperbole and political posturing.
“The money is there,” Dr. Harrington says. “Taking out 5.8 percent per year out of an $2.5 billions savings account is not unreasonable for a situation—that if you don’t fix it is grave.”
Harrington says, “I am firmly convinced our Medicaid program in Alabama is not a luxury. It is a safety net not a hammock.”
Huntsville Hospital Health Systems is only rivaled in size by the UAB Health Systems, leading this massive healthcare provider is CEO David Spillers.
“At our core hospital in Madison we see around, 50,000 in-patients a year and 160,000 in the emergency department,” says Spillers. Of that number, Medicaid recipients account for approximately 30 percent of those patients seen in the ER and around 15 percent of the hospitals in-patients received treatment through Medicaid.
Spillers who spent 18 years in healthcare management in Ashville, North Carolina, before choosing to move to Huntsville, says he loves Alabama, but wishes it paid better for healthcare services.
It is often pointed out that Alabama hospitals are the most efficiently run in the country, to that Spillers immediately replies, “And the worse paid.” He further explains, “When you are paid the least you have to be efficient if you want to stay in business, you figure out how to get real efficient.”
“We are historically a low-tax state, states with more money, tended to spend more on social services. We don’t have the tax base so the money is not there,” said Spillers. “Some will tell you that the reason we are consistently ranked at the bottom with regards to the health of our citizens, is because we don’t spend the money on their healthcare.”
The September 18 vote will determine if the state can fund even its meager Medicaid pro- gram and its overcrowded prison system.
“The biggest problem is there is no plan B, there is only one options right now,” says Spillers. “So, if this plan fails and we are looking at a 20 percent across the board proration. In our area, the ones I am responsible for, it means I have to find an additional $15 to $20 million dollars.”
Spillers says the only way to meet the challenges–that would be imposed by not funding Medicaid through the constitutional amendment–is to “look at what programs can be cut and what services will no longer be offered.”
He does not mean services only offered to Medicaid recipients but service offered to all patients.
“There is no way to see 15 or 20 percent taken away and keep doing what we are doing now,” states Spillers. “We already lose money on the services we provide to those on Medicaid.”
“People need to understand and accept that we have the most value-oriented, cost-effective, minimal entitlement program in the country.” These are the words of Stanley K. Hammack, chief executive officer of University of South Alabama Health Systems referring to Alabama’s Medicaid program.
“We’ve got the most stringent eligibility requirements of any state in the nation when it comes to Medicaid,” Hammack, a veteran administrator, recently said. “There is not this vast number of people out there receiving Medicaid benefits. It is those vulnerable groups: children, expectant mothers, the aged, blind and disabled. And basically, the aged, blind and disabled are two-thirds of the expenditures.”
Everyday in the media people are bombarded with the idea that government spending is out of control and that a vast number of Americans are leaching on systems like Medicaid.
According to Hammack, this is not the case in Alabama,“In Alabama we have the least number of people enrolled and we spend the least on them. So, we are basically doing the minimum standards of what is required by Medicaid.”
This message has been spoken by Governor Bentley, Public Health Officer Dr. Don Williamson and countless others, yet, Medicaid in Alabama is still painted by some as this gross entitlement program.
“The providers [of Medicaid] are not overpaid in fact they are underpaid,” says Hammack. “Several of the providers, specifically hospitals, are covering their own way or at least a big portion of it.”
He also points out that Alabama is the only state that provides zero funding for hospitals as a part of Medicaid.
Over the last several months health professionals have spoken out about the dire need to fund Medicaid, it is now time for a vote.