There is an immediate crisis happening in Alabama: Medicaid and the entire health delivery system in our state is a “house of cards.” Sitting at the base is Medicaid itself, and if it falters, the entire system falls.
Without adequate state funding for Medicaid, hospitals across Alabama will close, and many Alabamians – including the insured – will be denied access to the healthcare they need. That’s why the legislature created Regional Care Organizations (also known as RCOs) to reform and help bring down the costs of a struggling Medicaid system.
The federal government has offered to give Alabama hundreds of millions of dollars to implement the RCOs, but in order to qualify we must pony up the match. The federal government will continue to give us those funds for five years, but the legislature hasn’t even figured out how to fund Medicaid properly this year.
This is not simply a problem of “just cut some more.” Alabama already runs the leanest Medicaid program in the country with the toughest qualification guidelines. Medicaid needs $60 million to provide the same level of federally-required services for next year. Medicaid needs an additional $60 million to finish implementing the RCOs that will save hundreds of millions in the years to come.
There is obviously no appetite from either legislators or voters for new taxes. Some legislators support combining the Education and General Fund budgets, but that is not a responsible solution. So far I have not seen any plan that will rescue Medicaid, especially from those who oppose my solution.
I have heard the Governor will veto the General Fund budget as passed by the Senate, and I suspect the legislature may well override that veto. But I believe whether we override or not, the Governor will call a special session to address Medicaid.
Unless we solve Medicaid, we will continue to have budget fights in Montgomery. It is time to step forward with a solution that the people of Alabama have already said they want to happen: an up-or-down vote on a lottery.
Representative Alan Harper and I have introduced lottery bills that would provide sufficient revenue to the state to fund Medicaid for the next five years and likely beyond. It will allow us to get the full drawdown from the federal government for the RCO reform, and enough to help with the prison crisis, as well.
Senate Bill 19, my clean lottery proposal, will generate $285 to $300 million, according to the nonpartisan Legislative Fiscal Office. There is another bill in the Senate Tourism committee that allows only Power Ball-type lotteries, however it only produces one-fifth of what I propose.
My bill sits quietly in committee, and I have asked Chairman Pro Tem Del Marsh not to bring it to a committee vote until I know there is sufficient support for a floor vote in the Senate. Quite a few senators have indicated support for the bill as it is written, but not enough.
Unfortunately, a group of senators wants to substitute a casino bill for my clean lottery bill, perhaps even a bill that includes both casinos and lotteries. This would mean certain death for the solution that could fix both Medicaid and prisons.
These senators are saying if we can’t have casinos we would rather have nothing. But the fact is, casino gambling is not going to pass the Senate. It is not going to happen. By taking the position “casinos + lottery or nothing,” we get nothing. We get a vetoed budget, we get a special session, and the state ends up right where we started – broke and without a long-term solution.
There are other senators who fear what their voters back home will think of them for voting for a lottery and some legislators object that we are taking advantage of the poor. Whatever objections may be raised to a lottery, from polling data I have seen and from conversations I have had with voters in my district, it is clear the people of Alabama want to vote on the issue.
If you are concerned about the poor, let’s look at where the proceeds from a lottery will go. It will insure the viability of Medicaid, which serves pregnant women, children, and the disabled. Folks who buy lottery tickets come from all socio-economic backgrounds, but the beneficiaries will be those who need our help the most.
By any yardstick, the General Fund needs an injection of new revenue. Medicaid’s costs grow every year. Alabama’s prisons are crumbling, and our roads and bridges badly need repair. Further, if the Senate decides to direct the proceeds from the lottery to the General Fund, pressure will be taken off the Education Trust Fund and momentum to combine the budgets will be halted.
Please take a close look my lottery proposal, SB19. Call your legislator and ask him or her to stand up, take a position, and allow the people of Alabama to vote on a lottery.
Jim McClendon (R-Springville) is a retired optometrist and represents Alabama Senate District 11, which includes St. Clair, Shelby, and Talladega Counties. He served in the Navy Medical Service Corps in Vietnam.