September 18th Referendum

Voters in Alabama will go to the polls next Tuesday to vote on a referendum state leaders say is vital to the financial health of the state. The vote would authorize moving money from the Alabama Trust Fund to shore up the state’s general fund budget. That budget supports many services from child protection to prisons. But if the referendum does not pass, one of the biggest programs to feel the effects is Medicaid, as WBHM’s Andrew Yeager reports.


It’s lunchtime at the Arlington Rehabilitation and Healthcare Center in Birmingham’s West End. A caravan of wheelchairs trickles into the dining hall.

“How you doing Miss Terry? Good. Come on in.”

As residents position themselves around the tables, staff members pull trays from a rolling metal cart and deliver food.

“You have corn, mixed vegetables, chicken and you have a yeast roll, okay?”

Ettrude Yvonne Williams spends a lot of time at Arlington. Her husband is a resident. He’s in the early stages of Alzheimer’s disease.

“He still is able to think a little on his own. He has a few cognitive problems. But he knows you when he sees you and he still knows the family.”

It’s too much for Williams to take care of her husband at home. So he’s been in a facility for three years. She’s a retired teaching assistant from the Birmingham City Schools, living on a fixed income. The way she’s able to cover her husband’s care is Medicaid.

“Without the Medicaid, I could not afford to have him here or at any other facility for that matter.”

When Williams thinks about the upcoming referendum and its potential effects on Medicaid, she worries.

“Oh boy, I don’t know what I’ll do.”

Here’s what has Williams and healthcare professionals concerned.

When state lawmakers passed the general fund budget this year, they counted on voters approving a transfer of $146 million a year for three years from the Alabama Trust Fund. It’s kind of like a savings account. That money would go to the general fund budget. Without that money, the state would have to further cut to non-education spending.

Now Medicaid provides medical care to low-income people, pregnant women and children. While it’s a federal program, it’s jointly funded with each state. So in Alabama, without this referendum passing Medicaid’s projected shortfall is $100 million.

It’s not a happy thought for Kevin Ball, administrator of the Arlington center, where about 2/3 of residents are on Medicaid. He says the referendum failing means “Armageddon.”

“Reduction of service. Reduction of staff. Reduction of the care that can be provided. The quality.”

“There is no obvious place, no easy place to save money.”

State Health Officer Don Williamson oversees the Medicaid program. He says Alabama already has among the strictest eligibility requirements in the county. There are few optional services to cut.

“It we eliminated all pharmaceuticals for all adults. It we eliminated dialysis. Those are optional services. Optional for Medicaid. Not obviously optional for the patient.”

He says further cuts could mean a federal lawsuit over noncompliance.

The referendum has garnered wide support. A political action committee formed to push for “yes” votes. It has significant backing from the Alabama Nursing Home Association. Other groups include the Alabama Education Association, The Business Council of Alabama and Alabama Arise – which advocates for low-income people. These are groups that don’t always find themselves on the same side.

Republican Governor Robert Bentley is an outspoken supporter, but few political leaders openly oppose the referendum.

State Representative Phil Williams doesn’t plan to vote for it. The Huntsville Republican says it’s “gentle opposition.” He’s not actively campaigning. He’s not anti-Medicaid. Williams just doesn’t believe the Alabama Trust Fund should be used for a budget shortfall. Because while that fund is like a savings account, it also earns interest. The interest goes to support all those non-education programs. Less money in the account could mean less money in interest for the state to draw on in the future.

“So I feel a certain responsibility to those who came before me to not eat the seed corn.”

Williams says the governor should call a special session so lawmakers can cut what he calls “luxury items” in order to fill the gaps. He points to the Forever Wild land conservation program or certain economic development incentives.

Despite powerful political groups backing the referendum, Williams believes turnout will be low and most Alabamians won’t be supportive.

“I just think people are going to say no. We’re tired of the bailouts. We’re tired of no solutions.”

Governor Bentley hasn’t said if he would call a special session, should the referendum fail. He has said he would not propose a tax increase. For now, the decision is in voters hands, leaving people depended on Medicaid nervously watching.

~ Andrew Yeager, September 12, 2012