HUGE Medicaid Crisis Looms in Alabama

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Critics Say More People Are Going to Die Needlessly Due to Legislative Inaction

Watch this shocking video to see what legislators are saying about the inevitability of many people dying due to the budget shortfall.

By Glynn Wilson –

MONTGOMERY, Ala. — More sick babies, old folks and poor people are just going to have to die. Sorry. When it comes to a constitutional mandate to balance the budget, by god, tough choices have to be made.


A portrait of Governor Robert Bentley hangs in the old Alabama Capitol: Glynn Wilson

That is, hint, hint, unless thousands of people come out of the woodwork and surround the Capitol grounds and let the politicians hear from them. Inside, what some news wires used to call “lawmakers,” openly admit they are not hearing from Medicaid recipients or their advocates. Their phones are ringing off the hook, however, from people willing to offer campaign contributions for passage of a bill that would create a special, shiny new tax credit for anyone willing to refurbish old plantation mansions.

That’s the New South Alabama style.

That’s the message coming out of the state capital from mostly white Republican men this month in what some critics are calling the new Republican “Death Panel.”

That’s what they come up with when trying to forge public policy to fit the desires of ignorant, conservative constituents — fueled into a hateful budget cutting rage by commentators on talk radio, Fox News and the right-wing tea party blogs.

Even the conservative doctor governor now ensconced in a titillating alleged sex scandal that apparently doesn’t really involve sex — just an embarrassing tidbit of early phone “sexting” which just happened to get recorded apparently by his now ex-wife — had the gall to veto the budget that cut another $85 million for the state Medicaid agency. It seems now the governor who campaigned and got reelected on a promise to refuse a billion dollars a year from the Obama administration for his people’s health care under the Affordable Care Act seems to have more heart than state Senators like Trip Pittman, chairman of the joint House and Senate committee charged with figuring how to gut the social service agency even more.

As our previous reporting shows, estimates indicate that as many as 3,669 people have already died in the state over the past three years due to the state’s refusal to expand Medicaid with federal health care dollars. That’s about 1,223 people a year. How many more must die?

In a presentation to the committee state Medicaid Commissioner Stephanie Azar explained why the agency asked for an additional $100 million this year. The budget proposed by the Legislature gave them a mere $15 million increase for a program that had already been denied about $3 billion in federal money so the Republicans running for office could make political points in the last election cycle.

In a true bit of political demagoguery, legislators have been quoted as saying the agency, which accounts for about 38 percent of the General Fund budget, is guilty of “cannibalizing” other state agencies in its needs to help the young, old, poor and sick. That accounts for about one-fifth or a little more than 20 percent of the state’s population.

Everybody admits the program is critical for the state’s health care system, especially without the federal money the state turned down. All hospitals and most doctors, especially pediatricians, depend on Medicaid to stay in business. There are already stricter eligibility requirements than most states, and most states took the federal money to expand Medicaid and cover almost all their citizens with some level of health care.

There seems to be a debate still in Alabama about whether “able-bodied” people who COULD work are living off the “gov’ment,” although the debate doesn’t seem to involve the poor job market in many parts of the state. How are they going to work if there are no jobs? A man or a woman of working age who is not physically or mentally disabled can only qualify for Medicaid benefits if they have a child under 19 who is eligible and they report an income of less than $2,892 a year. Yes, you heard that right. The threshold is $2,892 a year.

The poverty line pay rate for a family of four in the state is considered to be $23,834 a year. The number who fall below that line is 883,371. A little more than 1 million of Alabama’s 4,716,105 residents qualified for Medicaie for this fiscal year, which began in June.

The goal of the new Medicaid hearings seemed unclear even to the mainstream media reporters and bloggers who cover the State House. The Republicans who control both the House and especially the Senate have indicated no willingness to reconsider the 2017 General Fund budget, approved earlier in April over the governor’s veto.

Pittman, who has been busted for ethical problems in the past for accepting a $639,000 contract to lay boom in Mobile Bay while he was involved in oversight of how to spend Baldwin County’s share of the BP oil spill disaster money, was put on the spot Wednesday (see video). But in the end, he predicted some level of Medicaid cuts would survive the session, mainly because he is hearing more from people who want the old house tax credit than those who want to see Medicaid fully funded.

“At some point these impacts have to be felt,” he said, quoting Republican Senator Del Marsh of Anniston. “Some of these cuts will be made. Those impacts will have to be felt, and people will react to what ultimately happens.”

Cuts already mentioned include outpatient dialysis for kidney disease, meaning many clinics would close, as well as hospice care and even reimbursements for prescription drugs for seniors. The state would also cut a small supplement to primary care physicians, meaning many of them, especially in rural areas, would change their practices to stop taking Medicaid patients — or even give up on Alabama and move to another state to practice medicine.

“If we were to cut any of these providers . . . we would have the possibility that some of these providers would close,” Azar testified before the committee on Wednesday.

Before the hearing, in a press briefing called by Alabama Arise and a coalition of other non-profit groups, Troy pediatrician Nola Ernest said half the doctors polled in a survey said if Medicaid is not fully funded, they would either stop treating Medicaid patients or move to another state (see video).

After the hearing, Azar said the governor had not yet decided what cuts to make to fit the new budget. So there may still be time to lobby Governor Robert Bentley to do the right thing. The Legislature may not listen to him, but maybe it’s worth a try?

Azar’s presentation, which is now available online, showed how two-thirds of the $6 billion program is paid for by the federal government from federal taxes. The state only has to come up with 11 percent of the money that serves a little more than a million people, the only thing keeping many of them alive. Hospitals themselves absorb a significant share of costs by charging Medicaid patients less than those with private health insurance.

And no, a majority of those who qualify for and recieve Medicaid services are not black. In fact, 45 percent of them are white.

While there has been a 30 percent increase in eligible Medicaid patients since 2008, Azar showed how the state agency has kept the cost per recipient level over the past 8 years. She debunked the notion out there in some forums that growth in the program is “out of control.”

Furthermore, the state does not determine who is eligible, she said. It is a federal program.

Rather than looking at a billion dollars a year in increases from the feds, the state is losing $73 million in one-time money this year.

In one of the few questions asked by committee members during Azar’s presentation, Decatur Republican Senator Arthur Orr seemed to be searching high and low for some category of individuals the lawmakers could boot from the program, including those who cut grass for a meager living and do not make enough to owe taxes. The yard man’s kids might be eligible for Medicaid. Horror of horrors.

He also pressed to see if the Legislature could do anything about people living in $100,000 homes who “refuse” to work. Nope. Nothing they can do there either. Again, the feds determine eligibility and the value of your home has nothing to do with it. You can even have one car and still qualify. What a shame, especially if a car is essential to get to any jobs in the South, a region where the very idea of mass transit runs tantamount to Communism.

Some people in the crowd and Senator Linda Coleman, a Democrat from Birmingham, pointed out that there are many old people who live in homes they inherited from relatives or paid for in their working lives but do not have adequate retirement income to pay for private health care.

After the hearing, Chairman Pittman faced a small contingent of reporters and bloggers still covering goings on in Montgomery, a dwindling group shrunk from 22 reporters who covered that beat 25 years ago.

He admitted that the federal government pays for most of the program, but used the opportunity to try to make points for the Republicans in the upcoming presidential election by blaming the problem on the feds, an age old tactic in Alabama going at least back to the days of George Wallace.

He made clear that lawmakers want to dig into the requirements of the federal Centers for Medicare and Medicaid Services, including checking people’s net worth like is done for Food Stamps and Welfare recipients. They want to look at certain types of doctors they don’t like, maybe abortion providers? They want to see if they can boot some of those who receive Social Security disability payments, a program “that may be too liberal,” Trippman said, and “not discerning enough on whether somebody is really eligible.”

“There are needy people out there who need help,” he admitted. But they wish they had the power to “ensure that those receiving the services really do need the services. Because there is enough need out there and right now there’s not enough money to be able to cover those.”

When confronted with the question of turning down the federal billions, he claimed taking it would only have been a short term solution.

“When you cover more people you’re not going to save money,” he said, although studies showed that the high paying jobs in the health care industry that would have been funded by the federal subsidies would have more than paid for the increased cost to the state by expanding Medicaid and covering everybody.

“The federal government would have covered those initial costs, but the reality is, the federal government is running trillion dollar deficits,” he said, another issue the Legislature has no control over or even a say so in the process.

He denied playing politics with people’s lives, even though he seemed to acknowledge that some people would just have to die.

“We all die sometime,” he said in response to a reporter’s questions. “We’re all mortal. We all have a finite period of time on earth. I think sometimes we confuse saving lives with extending lives.”

In a state where a “right to life” and saving the unborn children who are victims of abortions is a litmus test issue for anyone running for public office, Pittman complained that “We’re spending more than 40 percent of the money on children in their first year of life.”

He added: “We’re spending a lot of money on the elderly, at the end of life. I think as a society we need to debate and look at all of these things. If not, you’re going to get into rationing.”

He said tough choices have to be made, “and we’re all going to have to come to grips with our mortality. It’s just a fact of life.”

Football season doesn’t start until August, he said, so maybe if the media would just do its job, we can have a real debate on these “real and difficult issues.”

“They’re not going away,” he said. “They have reached critical mass.”

He turned to the national presidential election coming up in November 2016.

“I would argue that of all the issues coming up in this election, health care is the biggest one,” he said. “It is the biggest challenge we face. Attempts have been made, and I at least give the Democrats credit. They are reaching out there and trying to do some things. Mr. (Bernie) Sanders has some plans on what he wants to do.”

Senator Linda Coleman, one of the few African-American women in the Legislature, a Democrat from Birmingham, countered the argument that taking the federal money to expand health care would not have helped with the state budget. She said it would have helped set up the Regional Care Organizations the state is now turning to.

“If we had taken that money when it first came out … we could have already had that taken care of,” Coleman said. “Then we would have been well on our feet to do that. Right now we just cut our noses off to spite our faces. All the other states have taken that money. They’ve taken our money because part of that money was our (federal tax money) but we didn’t take it. And so we’ve backed ourselves into a corner. To me that is very short sighted that you would hurt your people not to take this.”

See This Extra Video

The national mainstream media, including the Washington Post, seems to think the sex scandal involving allegations of an affair between Republican Governor Robert Bentley and a married, female aide not even on the government payroll (see this is not even a gay Republican hypocrite sex scandal or a scandal involved misuse of taxpayer money) has the state so shut down no business is being conducted. But in fact, the Legislature is in session and about to kill thousands of people by cutting Medicaid by another $85 million after the governor and Legislature refused a billion a year from Obamacare, federal money for health care.

© 2016, Glynn Wilson. All rights reserved.

  18 comments for “HUGE Medicaid Crisis Looms in Alabama

  1. April 22, 2016 at 11:18 am

    “WE ALL GOTTA DIE SOMETIME??????” YOU SON OF A B!!!!!!! Why don’t you be the FIRST to stand in line????

    • April 22, 2016 at 11:22 am

      You mean Trip Pittman, right?

    • Sharon
      April 30, 2016 at 7:30 am

      First, take away Pittman’s state funded healthcare and insurance. Let him and his family get buy without insurance. I surely hope Pittman and his family never have a catastrophic illness, nor a long suffering condition/disease. I hope he never has to look into the eyes and face of a sick baby or toddler. I have a dear friend who is also on dialysis. Luckily, she is a nurse and does her treatment in her home. If Medicaid is not funded completely, there should be the biggest march/objections ever in the history of Montgomery. One can go on-line and get the addresses to the congressmen, and US Senators. A letter to Bentley is a must, this is the least one can do.

      • Christine
        May 2, 2016 at 1:14 pm

        Trip Pittman is a Nazi with a eugenics programs. They can get rid of the disabled, the poor and elderly with an override. He said they did it because they were showing the Feds we have to live within our means. Really? I don’t think so. They turned down $457 million in Fed money by not fully funding the program. They are also going to get rid of or reduce prescription drug coverage. People are going to start dying and I hope he is at the top of the list of those being sued in a class action suit so big that AL will never see the light of day. I think we need to personally hold the people who voted to override the veto and not to fully fund Medicaid responsible for what is going to happen here. In the meantime, they are going to build 4 new prisons which, I suppose, will hold all the mentally ill who cannot afford their medication. These Republicans are criminally insane themselves. You would have to be a bit of a sociopath since they have no conscience and apparently no idea of right and wrong to agree to what Pittman is saying. If they had any compassion, empathy or people in their families with anything as discussed above, they wouldn’t be doing this. I think they will find themselves looking for other work the next time we vote.

  2. April 22, 2016 at 1:16 pm

    Trip Pittman, co-opting the Benie Sanders message by saying we’ve seen a transfer of wealth from young to the old on their death beds. Classic Alabama politician. Let’s occupy his driveway. Good idea.

  3. dunder
    April 22, 2016 at 1:33 pm

    The sainted Ronnie Reagan acted swiftly upon entering the White House. He ordered federal bureaucrats to review Social Security disability files and to boot undeserving recipients from the rolls. This was not done to stop healthy cheaters from getting benefits. It was done to perform sacrifices in honor of Reagan’s rightwing ideology. Most of the benefit denials were later deemed mistaken and were reversed–with much suffering caused meanwhile. Senator Pittman’s remarks show he desires a repeat of Reagan’s cruelty. Is the senator hoping for sainthood too?

  4. sharon lyn jones
    April 22, 2016 at 2:56 pm

    my husband would be affected by this cut to medicaid if it goes thru the house…and he would die as a direct result of it…and it wouldn’t take long..he is on dialysis… .please call these bastards….

    • Sharon
      April 30, 2016 at 7:21 am

      We must,(myself included) must write our congressmen who represent our areas. We need to write also to our 2 US senators, Sessions and Shelby.

  5. J Cummings
    April 23, 2016 at 10:01 am

    Welcome to the Republican DEATH PANELS!

    You know, for a Party that INSISTS that every fetus is precious and must come to term, they seem to be pretty CALLOUS about those lives who are POOR- and RESENT ever having to CARE for THOSE lives.

    I guess this DEATH PANEL gets to determine whose live is WORTHY of saving-and THAT is entirely dependent upon HOW MUCH they have in their BANK account (if they have one at all).

    Apparently, in the GOP’s eyes, it is not “we are all in this together”, and “EVERY life is SACRED”, after all.

    Instead it is “every man (woman and child) for themselves”, and if you don’t have the resources, then “hurry up and DIE”, so that the doctors can spend time treating people who are WORTHY of care, like “ME”. After all.. “if doctors aren’t “wasting” their time on Medicaid patients, I won’t have to WAIT so long for MY appointment.”

    THIS from people who FORGET that our doctors will retire or LEAVE the state if they no longer get adequate reimbursement for government provided healthcare. And OUR hospitals WILL CLOSE.

    Not to mention… WWJD?

  6. April 23, 2016 at 1:01 pm

    Now this is another example among many I have provided over the past decade to show how we can do better watchdog journalism on the web. I wish people would study this story and watch the video closely and compare it to anything else out there. Newspaper websites, television news and their websites, blogs, social media, etc. NOBODY, and I mean NOBODY is practicing this kind of journalism.

    There are a very few examples sort of like it in the early 20th century in what journalism historians call “The Mickraking Era.” But this is far better than anything done in print in those days.

    Compare the story to any news site or blog. Compare the tough questioning that happens in the video. Sixty Minutes on CBS used to do something sort of like this, and Michael Moore did something sort of like it with his movies.

    This is the future, or could be if enough people would catch on to it and help fund it. This is what we need to change our political system into something that actually works. Without this, things are only going to get worse. Google or Facebook “Jump On The Bus.”

  7. April 25, 2016 at 3:45 pm

    The problem is, the Alabama Democratic Party is all but dead, and the state’s liberal and progressive population is too busy arguing with each other on old fashioned e-mail lists and Facebook group comments and sharing blog posts about the governor’s sex scandal to do anything effective to stave off this crisis.

    Meanwhile, the trial lawyers and the unions are still playing footsie with the Republicans, doing nothing to help the poor people of this state.

    • Sharon
      April 30, 2016 at 7:53 am

      We have to get your message to more people. I have “shared” this post on my Facebook timeline. I got absolutely no response( as of today). People are detached, apathetic, “doesn’t affect them” and most of my readers are Republicans. Alabama is a red state, and you are right about the democrats. My democrat friends are scared to speak up. People tell me they would “comment” or “like” my post” on Facebook, but they just don’t want to take their republican friends on, the backlash, the fear, the lies………..I can see why so many are apathetic, but it is no excuse. It is time for people to stand up and talk about what is so wrong with the state, and bombard these offices of congressmen with letters. Maybe someone could write a “sample letter” with addresses and names of legislators already on the letter. Then each individual could sign their name, add comments if needed and begin to send these letters to each person in the state congress. And let us not forget Sessions, Shelby, and mammary loving Dr. Death.

  8. April 30, 2016 at 9:41 am

    They could copy and paste my letter and adapt it to their interests and send it.

    Open Letter to Alabama Governor Robert Bentley – Please Fully Fund Medicaid

  9. April 30, 2016 at 9:42 am

    Send me more money for expenses and I’ll go back next week and do more: PayPal

  10. Hand-Truitt Judy
    April 30, 2016 at 1:08 pm

    Here is Alabama Arise’s terrific site that does what you’re suggesting — it gives you a sample letter and links you to your legislators, then you can modify the letter and send it off.

    You can be kept informed by “liking” Alabama Arise on Facebook.

  11. Hand-Truitt Judy
    April 30, 2016 at 1:12 pm

    I was inspired by this article to post this on FB and send as letter-to-the-editor to B’ham News and Montgomery Advertiser:


    Here are my thoughts on the comments about Medicaid that were made by State Sen. Trip Pittman on April 20, along with some thoughts for consideration by exclusionary Christians, including reflections on the experience of the Apostle Paul.

    Below you’ll see I’ve partially transcribed the exchange that took place between Sen. Pittman and reporters, regarding Medicaid in Alabama. I found the interview amazing. The transcription is immediately below, followed by my thoughts about it, and about the Christian church’s role in helping build a society willing to separate people from access to healthcare.

    Pittman: …why do we have certain limitations by CMMS on limiting enrollees, on checking on net worth, on looking at certain caregivers, on looking at the disabled and some of the requirements of SSI disability that we’ve all read and seen and y’all may have done stories on, that sometimes tends to be too liberal and maybe not discerning enough on whether someone is really eligible or not.

    Reporter: It wouldn’t have been a crisis if the state had accepted the Federal millions of dollars.

    Pittman: No, that’s not true. The problems as you’ve seen, the enrollment goes up… the challenge you find with the expansion of Medicaid, the estimates in Alabama is that it would go up 300,000. The states that have expanded, in some cases those estimates were way low. When you cover more people, you’re not going to save money. The Federal government covers those initial costs, but the reality is, the Federal government is running trillion dollar deficits. So I think that most of us in government understand that we do have a responsibility not only to look after State dollars, but also to help our friends in Congress better manage the taxpayer dollars of our constituents at the same time…

    Reporter: You’re playing politics with people’s lives.

    Pittman: No, we’re not playing politics, we’re governing, and governing has costs.

    Reporter: People will die.

    Pittman: Well, you know what, we all die some time… I think that some time we confuse saving lives with extending lives… We’re spending 41% on children in their first year of life, we’re spending a lot of money on the elderly at the end of life…

    Reporter: [Wouldn’t taking the Federal money] provide jobs and thus more income and more tax revenue?

    Pittman: Compared to private sector jobs, compared to productive jobs?

    Reporter: A hospital is not private sector?
    Another reporter: Doctors, physicians, the ones who are threatening to leave the state right now.
    (Pittman did not answer this question.)

    Pittman: Eighty per cent of the costs are for elderly, for people in this state in the last few months of their lives, and then people with chronic illnesses… In this country, the transfer of wealth from working to non-working, for every dollar you’re transferring from working to non-working, you’re transferring seven from young people to old people. That’s a moral debate.

    Do you expect to see any more funding for Medicaid?

    I do not right now. I think Sen. Marsh said it, he said at some point these impacts have to be felt. We’ve had demogoguery in a lot of cases, and maybe reality, back when Gov. Riley tried his tax increase. I remember one of the senators from my district talking about people being kicked out of jails, and Meemaw was going to come home from the nursing home and live with you, and there were all these things that people talked about. The bill failed by two thirds, a lot of those things never came to pass, cuts were made. So I just think there has to be some realism and some of these cuts will be made and those impacts will have to be felt and then people will react to what ultimately happens.


    Sen. Pittman has a particular political philosophy which constrains his thinking and determines his legislative activities, and which is on display in his remarks.

    One of the interesting points in this exchange is Sen. Pittman’s comment that private sector jobs are “productive” jobs, the corollary assumption being that public sector jobs, or apparently any job that is even partially supported by public funds, are by definition non-productive, and that only the for-profit economy is valid. It follows that any spending for the common good is to be reduced to the point of elimination, which of course is the position that Republicans have been turning into policy for years now, to the detriment of all but the super-wealthy — and to their detriment as well, since a life of compassionless oblivion is a sad life.

    The fact that people will die to further this agenda in regard to Medicaid in Alabama is fine with Mr. Pittman. He sleeps well, because, as he says, “we’re not playing politics, we’re governing, and governing has costs.”

    It is interesting, too, that Mr. Pittman is trying to do something he wasn’t elected to do: to “not only to look after State dollars, but also to help our friends in Congress” by using Alabama Republican preferences to thwart to the greatest extent possible any initiative from the Federal level to provide for the common welfare — if it isn’t making private profit, it shouldn’t exist.

    Another phrase he uses is “the transfer of wealth from working to non-working”. What could this mean? The actual transfer of wealth in this nation for the past several decades has been from poor and middle income people to wealthy people, not from working to non-working (although many of the wealthy are indeed non-working). Is he calling infants and the elderly, who he says use most of Medicaid dollars in Alabama, “non-working”? It isn’t enough to divide people by race, now they are attempting to divide adult men and women from their infant children and their elderly parents?

    As for adults of working age who qualify for Medicaid, the article “Huge Medicaid Crisis Looms in Alabama”, which accompanies the video of the interview, published on-line on April 21 by New American Journal, says, “A man or a woman of working age who is not physically or mentally disabled can only qualify for Medicaid benefits if they have a child under 19 who is eligible and they report an income of less than $2,892 a year. Yes, you heard that right. The threshold is $2,892 a year.” There is not a lot of transfer of wealth to the non-working going on here.

    Mr. Pittman says, “In this country… for every dollar you’re transferring from working to non-working, you’re transferring seven from young people to old people.” This promotion of resentment toward the elderly is part of the Republican effort to destroy Social Security. When privatizers want to turn a program that belongs to taxpayers into a privately-owned profit center, first they starve it, then they demonize all who use it or administer it, then it’s theirs.

    The version of Christianity which supports and elects the kind of politician who enacts such an agenda as this, is a blight on this nation. The judgmental, harsh, exclusionary and punishing outlook that is tolerated, promoted, and in some cases preached, in churches is shameful. The children who are being raised in it will spend much of their lives — if they are lucky — trying to deconstruct the faulty map they’ve been given, and to reconstruct one that works.

    I think the story of the Apostle Paul is a wonderful lesson in something miraculous that could happen for exclusionary churchgoers. Paul, a man of devout religious conviction, upholding the laws of the religious authorities of his day and culture, was going about the countryside persecuting, and even helping to execute, followers of Jesus, who had opposed those religious authorities, and who had lately been murdered by the Roman occupiers.

    Apparently Paul had been hearing things about Jesus, or maybe watching the behavior of his followers, and something had been sinking in without his being conscious of it, because one day he had a psychotic break, a major meltdown, that knocked him off the mule he was riding, and caused him to see a blinding light, to hear Jesus’ voice, and to go blind for several days.

    When he came to himself, the main thing that struck him about the new outlook he found himself with, was — there were no insiders and outsiders! Indeed, all were welcome! And beyond that, all had to be welcomed if Jesus’ command to love one another was to be taken seriously. He had changed sides!

    One word to exclusionary Christians — change sides. That’s all you have to do. It’s the most humbling thing you’ll ever do, and the biggest relief you’ll ever feel.

    The realization that God, the Creator of the Universe, is, after all, not judgmental, not harsh, not punishing, and not exclusionary, but is instead (like Jesus, and like Paul after his conversion) all welcoming, all forgiving, and all loving — is the major stepping stone that must fall into place when you’re building a true map of the world. In Christian parlance, this change of heart is called salvation — and all are welcome into the fold.

    Judy Hand-Truitt
    Center Point, AL

  12. April 30, 2016 at 1:39 pm

    Don’t forget to read and share this too. The shorter video is here: Open Letter to Alabama Governor Robert Bentley – Please Fully Fund Medicaid

  13. April 30, 2016 at 1:40 pm

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