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Opinion | Healthcare access was missing from Gov. Ivey’s speech

Expanding healthcare access relies on a funding source. Alabama’s only current option – gambling revenue – could soon be off the table.

Gov. Kay Ivey delivers the 2023 State of the State address. Hal Yeager/Governor's Office

There was a gap in Gov. Kay Ivey’s “state of the state” speech on Tuesday. A life-long gap, in fact. Maybe you noticed it.

It fell in between the time Ivey spoke of how proud she is of Alabama’s total abortion ban – an abomination that nearly 90 percent of the state disagrees with – and when she spoke of future generations just before wrapping up. 

In the middle, there wasn’t so much as a passing mention of healthcare access. 

Ivey said she wants to make children safer. She wants a strong workforce. She wants to help working families make ends meet. She wants to remove burdens from the backs of Alabama’s poorest citizens. She wants children to have a fighting chance. 

Those are all good things. And she was absolutely right to bring them up. 

Yet, somehow, she missed the one thing that could help achieve all of that – access to affordable, quality healthcare. 

It’s no secret that Alabama is struggling mightily in the healthcare department. We have some of the worst health crises in the industrialized world – from our atrocious infant mortality rate to our incredibly high rates of heart disease, diabetes and obesity. 

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And our access to care is becoming increasingly awful. Over the last decade, at least 18 rural hospitals across the state have closed and at least two dozen more are currently listed as in danger of closing. That’s not to mention the steady migration of doctors and nurses out of the state. More than half the counties in Alabama do not currently have a practicing pediatrician. 

Now, to be fair to Ivey, it’s not hard to understand why healthcare access wasn’t included in her speech. 

It’s a hard topic with basically one solution: Expand Medicaid. 

It’s something that should have happened years ago. Something that was refused only because the Black, Democratic president proposed it. 

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And so now, we actually do have a dilemma on our hands. Because where before, we could rely on the federal government to cover the first five years of costs at 100 percent, and we had time to watch the benefits of the expansion grow to the point that they would pay for the expansion, now we have to start footing a small portion of the bill from the start. And that small portion is millions of dollars annually. 

Even if we don’t officially expand Medicaid, there has to be some program or initiative that provides Alabamians, especially in rural areas, with more access to care and provides doctors and medical personnel with adequate compensation for providing that care. Any such program is going to cost tens of millions annually, if not hundreds of millions. 

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Which brings us to another thing that wasn’t mentioned in Ivey’s speech: Gambling. 

The only viable source for funding expansion of medical services. 

And we’re about to blow it – again. 

On Sunday, the Wall Street Journal reported that there is a new federal government push to vastly expand the gaming rights of federally recognized Native American tribes. That expansion includes allowing tribes to offer online gaming and also allowing tribes – and this is the most important aspect for Alabama – significantly more flexibility in taking non-reservation lands into trust. Those lands would not have to be tied to the reservation and would be eligible for the tribes to use for gambling locations. 

If those proposals from the Bureau of Indian Affairs are approved, that’s a wrap for meaningful, lucrative gambling legislation in Alabama. 

Let me explain. 

Currently, there is an odd situation in this state where our only federally recognized tribe – the Poarch Band of Creek Indians – is essentially land locked. (It’s a bit more complicated than that and we could split legal hairs on this, but that’s basically the state of things.) They are tied by federal regulations to only certain lands that they were able to take into trust because of historical ties to those lands. (What, you thought they chose Wetumpka and Atmore for casino locations because they liked not being around a lot of people?)

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As such, the Poarch Creeks, along with other traditional casino owners, are engaged in negotiations with the state on a very lucrative deal – a comprehensive gaming and lottery package that would generate just under a billion dollars annually. 

The reason the Poarch Creeks are currently engaged in this negotiation – or, at least, one of the bigger reasons – is that it would allow them to expand their gaming operations in this state. A very lucrative prospect. 

However, it’s important to remember one thing: The Poarch Creeks currently have a monopoly on electronic bingo gambling in Alabama, thanks to our absurd laws and even more absurd Supreme Court. For that monopoly, the Poarch Creeks pay absolutely zero in taxes on that gambling. 

So, let’s say that a new law comes floating down from the heavens that allows the Poarch Creeks to take new lands into trust. Let’s say the Poarch Creeks take advantage of that and simply add a couple of new resort casinos in desirable areas. And suddenly they have their Alabama expansion, yet it’s tax free. 

Well, let me just put it like this: At that point, would you keep trying to negotiate with Alabama lawmakers or would you instead spend that time swimming in your pool of money?

As it stands, Poarch Creek officials are still willing to commit to the comprehensive gaming plan that was proposed in the previous two legislative sessions. In addition to creating more than 12,000 jobs, that plan would pump enough money into the state annually to support a college scholarship program, expand health care services and likely make childcare more affordable for working mothers. 

But the opportunity, quite clearly, will not last.

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Josh Moon is an investigative reporter and featured columnist at the Alabama Political Reporter with years of political reporting experience in Alabama. You can email him at [email protected] or follow him on Twitter.

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