Sept. 10, 2012

Sept. 18 vote will affect local health care facilities

By SCOTT WRIGHT

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CENTRE — Officials at Cherokee Medical Center and Cherokee County Health and Rehabilitation Center are hopeful Alabama voters will vote “yes” Sept. 18 on a plan to avoid drastic cuts in a variety of state services, including an expected 17 percent cut in Medicaid funding.

Gov. Robert Bentley has voiced tepid support for the plan, which would transfer $437 million from the Alabama Trust Fund to the state General Fund over the next three years. The Trust Fund contains around $2.3 billion from the state's royalties from offshore gas drilling leases on the Alabama coast.

“I'm going to trust that it will pass,” Bentley said of the referendum last month. “But if it doesn't we will get through this.”
State Health Officer Dr. Donald Williamson, on the other hand, has not been noncommittal about the future, should the amendment fail. Earlier this year, Williamson said the state's current level of funding for Medicaid services, around $605 million, is already at a bare minimum.

Williamson said without money from the Trust Fund the state's Medicaid program will face a $100 million shortfall, jeopardizing programs that provide medicine to poor patients and pay doctors who see Medicaid patients – as do many in Cherokee County.
“Further cuts would endanger our ability to protect the health of Alabama residents,” Williamson told the Associated Press earlier this year.

Former Republican gubernatorial candidate Tim James has led opposition to the amendment, which was placed on the ballot by a state Legislature dominated by his own party.

“It's not Republican,” James said last week. “And it's not what is best for Alabama taxpayers.”

Last week, Alabama House Minority Leader Craig Ford (D-Gadsden) also spoke out in opposition to the amendment.
“When you’re put in a leadership position like the Republican Party is, they need to make decisions and not pass the buck to the voters,” Ford said. “We need to have real leadership. This problem can be funded by other measures besides raiding the trust fund.”

Like Gov. Bentley, state Sen. Phil Williams (R-Rainbow City) also grudgingly supports passage of the amendment.

“I support the Sept. 18 referendum,” Williams said in a statement sent to The Post on Friday. “I recognize that what it comes down to right now is jobs and quality of life for many of my constituents that would be drastically affected if the referendum does not pass. I voted for it in the Senate and I stand by that vote. I would add that we are cutting government spending in a major way, and more streamlining is coming. We simply cannot reduce the size of government to a sufficient level by the end of this fiscal year, but with over $635 million already cut, and millions more coming, we are going to have a savings of $1 billion by the time we are through. In the short term, this referendum gets us through.”
Cherokee Medical Center CEO Patrick Trammell said literature, mostly in favor of the amendment's passage, has been flooding his in box.

“I am seeing some really strong proponents for this, and from my position I am trying to be realistic about what it accomplishes for hospitals, for physicians, for Medicaid funding,” Trammell told The Post. “The Medicaid funding is the piece that interests us.”
A political action committee called “Keep Alabama Working” has created a website to promote passage of the amendment. The website claims that if the vote fails, over 10,400 jobs will be lost, including 1,185 corrections officers. The website also warns that “many of our rural hospitals and nursing homes would be forced to close their doors,” “doctors will have no choice but to close or move out of state,” and “every Alabamian's access to health care will be limited.”

Cherokee County Health and Rehabilitation Center Administrator Cindy Cline said if the amendment doesn’t pass there could be an abundance of uncertainty for employees and residents at her facility.

“Seventy percent of our nursing home residents are on Medicaid, and a cut of up to 17 percent is a massive amount of money,” said Cline, whose facility is home to around 180 elderly residents and patients. “We have been looking at some contingency plans in some different areas if the amendment fails. None of them are good options.”
Trammell said he doesn't know the future viability of rural hospitals across Alabama if the amendment fails, other than his own.

“I can only talk about my shop,” he said. “As far as alternative means of funding go, there aren't any. But we're going to be here and we're going to treat whoever walks in the door.”

Trammell admits the prospect of maintaining the hospital's current level of care will be a challenge without the already minimal level of funding the facility receives from Medicaid.
“Medicaid has never been funded appropriately for the care hospitals provide,” Trammell said. “We are underwater on most of what we treat, Medicaid-wise. It's a tough situation, and it's never been great. Now we're talking about the possibility of it getting worse? That would be rough on us.”

Cline said she hopes everyone who goes to the polls on Sept. 18 understands the impact their vote could have on the future of health care for the elderly and underprivileged children in Cherokee County and around the state.

“It's not just that you lose your Medicaid funding from the state,” Cline said. “When you have Medicaid, you get matching funds from the federal government, as well. So you're not really losing just a dollar, you might be losing up to three dollars in funding.”

Even if the vote is successful, Trammell said he doesn't consider the amendment to be a “silver bullet” for Alabama's Medicaid funding problems.

“Anything that is going to address the Medicaid funding problem we have in Alabama has to be positive for providers at the front line treating patients – primary care physicians, surgeons, nurse practitioners, and hospitals,” Trammell said. “I think it is a step in the right direction, but I don't think this and two more things could take us where we need to be on Medicaid funding in Alabama. And I don't know what plan B is if this referendum doesn't pass.”

Cline said she hopes people who understand the possible impact of the amendment's failure will make it a point to head to the polls on Sept. 18—and take a few friends with them.
“I think it's such an important issue that we can't be complacent,” she said. “If every person who is concerned about this will talk to ten family members and friends, and then encourage them to talk to ten more, then this can't help but pass. But we have to get folks out to vote.”