Category Archives: Alabama Legislative Session 2015

Lend Me Your Ear(mark) and I’ll Sing You a Song? Governor Bentley’s Budget Plan Puts State Mental Illness Care at Risk

As most of my Alabama readers know, our legislature ended the session with no solution to our budget shortfall. We simply do not raise enough money in tax revenue to run the most basic functions of the state. On August 3, our legislature meets in special session to try and solve what couldn’t be solved for months this spring.

Governor Bentley has now released the details of his plan. There is a bit of actual revenue raising, but much of his answer appears to be shuffling money from one insufficient fund to another.

Most alarming is the proposed un-earmarking of nearly $200 million intended for the Special Mental Health Trust Fund—a substantial part of the Department of Mental Health’s budget. Otherwise, the Department depends on General Fund appropriations, which have steadily declined over recent years—the earmarked money is the only secure element. The outcome of poor funding has been dismal, with ever-longer waiting lists for life-saving services. Shane Watkins died this year, because when he needed hospitalization for his severe schizophrenia, there were no beds. Current funding is not acceptable. Level funding for 2016 would not be a victory. Now our governor wants to put mental health funding at even more risk.

Here is an example of the deleted earmarks: “…shall be deposited in the State Treasury to the credit of a special fund which shall be designated the Alabama Special Mental Health Fund and shall be used only for mental health purposes, including the prevention of mental illness, the care and treatment of the mentally ill and the mentally deficient and the acquisition, equipment, operation and maintenance of facilities for mental health purposes.”

Supposedly, we are to believe that money will be taken and then somehow returned afterwards in the subsequent budget process, with a leap of faith reminiscent of the Flying Wallendas. But if these funds are needed to make up a deficit in the General Fund to begin with, how will they be given back? Where will the money come from? If there is money to return to the Department of Mental Health, then why take it away at all? Removing an earmark to solve a General Fund shortfall only makes sense if the earmark is going to an over-funded area. I am not an accountant—I never in my life took a finance class. I still think I can recognize tomfoolery when it is this blatant.

I am aware that our state has an incredible number of earmarks, and I know analysts have said this is a problem. At the same time, I can see why we need them in a state which refuses to fund basic functions on a reliable basis in the annual budget. It’s the Ulysses strategy—we lash our legislators to the budget mast before they pass the Sirens singing at them to drown us in the bathtub.

I strongly recommend that Alabama voters contact their legislators now and advise against un-earmarking these critical funds. Tell them we don’t want circus acts performed with our money.

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Filed under Alabama Legislative Session 2015, mental health

Alabama Legislators Want “Blood on the Floor”: Especially the Blood of Children and Grandparents

Well. I heard from a very credible source yesterday that our state legislators are not playing chicken with the budget this time. You know, it seems like every year they expect us to display panic and beg them to fund essential programs– it is so predictable it is almost like we have a set script. We get tired of it, but at the same time we think jeez, if we don’t play our assigned role, maybe they will do the bad thing.

This year may be different, if my source is correct. Their plan this time is to go ahead and pass a severely cut budget, which the governor will refuse to sign, and then override him. Then when there is “blood on the floor” (and I quote), they expect us to come screaming to them to pass taxes and re-fund the state. They do not feel they have support from their base, otherwise.

I don’t know. From my perspective, we already have blood on the floor. People in this state have been bleeding all over the floor for a long time, and it hasn’t mattered so far as the budget. The only blood I think the legislators care about is corporate blood and their own, so maybe the point is that business will begin fleeing the state once Medicaid is defunct and all the people in nursing homes have to move in with their families or be dumped on the street.

Getting even a level budget for mental health would not be a win, because there is major blood on the floor with our current budget. Getting the expected cut to Medicaid ($320 million, taking the federal match into account) would make the floor downright slippery. The cuts to doctors will be so sharp, around 40% cut to payments already well below private insurance rates, that I have personally heard several pediatricians say their plan would be to immediately drop Medicaid. Most practices have overhead in the range of 60 to 75%, so that 40% is at least the entire salary of the physician. There will not be enough of us left to see those suddenly doctor-less kids, even if we worked 24-7 without sleep. The 2 Children’s hospitals will close, because they depend on Medicaid money to fund their specialists. And good luck trying to get programs like that rebuilt to their current level of excellence, once they are gone. It takes decades.

Who will be affected first? The elderly in nursing homes. Children (guess they should take more personal responsibility). Because people of color are disproportionately affected by poverty, this is also a racist move. Some advocates are making a case by reminding legislators and voters that middle class elderly are in nursing homes using Medicaid funds, and that there are more poor white kids than black ones. Why should that even be said, as if poor elderly and black kids matter less? Only a racist and classist audience would need to be told such things.

I asked it there is anything at all we can do to stop this disaster, and my source told me we need to call our legislators. I’m going to add that you really need to talk to your neighbors, co-workers, etc and explain what is about to happen. Because legislators have told me previously that although phone and email contacts matter, they also use their in-house polling results, which are secret. They call their base on a regular basis to check in, and I am betting they are getting the no new taxes response from those voters.

If our legislators were ethical, they would be calling those voters not to ask their opinion but to persuade them– they would be pulling out the stops to stop the bleeding. They would stop putting forward bills that they know will cause us to waste tons of money defending federal lawsuits. The fact that they aren’t doing so says a lot.

I remember the last time this type of cut was proposed, and the legislators came up with a Hail Mary to borrow money for Medicaid– I had prominent progressive friends telling me that I was just playing the game by begging for votes to save the program– that I should let things play out, let the blood flow, call their bluff. So it isn’t just conservatives who are the problem. I do not believe an ethical person who understands these are not numbers– they are human beings– would promote such an idea. We all have our preferred ideas of where the funds should come from, and y’all, we do not have strength in numbers to bicker over that right now. If we do, we will surely lose the farm. I can say that a lottery would come too late and is not a solution for the current funding gap, which could begin as early as June. Otherwise, I’d support whatever taxes they are willing to pass, even though I’d prefer to stop corporate subsidies first.

My source says the fed will not likely permit our Medicaid program to be cut so much without responding. We could be taken into some kind of Medicaid custody. But… the kicker is that they can’t MAKE us write a check, so this is different from school integration. They can put key decision-makers in jail, they can withhold federal funding as leverage, but they can’t issue money from the state, raise our taxes for us, etc.

All that said, I would still call your legislators. I would tell them that level funding is not enough for mental health and that it is killing people as we speak, because of waiting times. And if you happen to have a job opportunity out of state, you might want to strongly consider it, especially if you have children. I’m going to stay as long as I can, but I do have a disabled adult family member who depends on both Medicaid and me, so there will be a limit. I don’t know how long my employer will be able to keep me, if well over my entire salary is defunded. Feel free to share all or part of this post if you think it will help.


Filed under Alabama Legislative Session 2015, Alabama Politics, Children's Issues, Medicaid