By Dr. Marsha Raulerson
Shame on us. The lottery is no way to finance the Medicaid program that provides health insurance for more than a million Alabamians — with more than half of them children. Our legislators adjourned last spring after approving a budget that shortchanged the Medicaid program by $85 million dollars along with a loss of approximately $160 million additional Federal matching dollars. Cuts to the program started Aug. 1 with our pediatricians and family practice doctors the first to bear the brunt of the inadequate budget. Office visits now pay about 60 percent of the Medicare rate. The payment for vaccines dropped a whopping 60 percent, now paying only $8 per vaccine which is 31 percent of the Medicare rate. By the way, who thinks it is easier to give an adult a shot than it is to give one to a child with anxious parents?
The doctors who care for more than 550,000 of our children have had to cut staff, cut their hours, curtail efforts to attract more primary care doctors to our state and give up the vaccine program that is vital to public health. Some are planning to close their practice and move to another state. Hit especially hard are physicians serving families in our rural areas where it is not unusual for 70 percent of their patients to have Medicaid insurance. They can no longer afford to keep their doors open.
Benefitting from Medicaid
Who in our state will suffer from this loss of health care? Everyone. Both of our children’s hospitals depend on Medicaid funding as do all of our rural hospitals. Even when you have the very best private insurance, if the closest hospital is 90 miles away will you survive an acute serious illness or accidental injury? If a family member has a premature baby, will the Newborn Intensive Care Unit (NICU) have adequate funding for the state-of-the art care we have now? If we lose primary care doctors to other states who will be there for you? Most of us have benefitted from Medicaid without realizing it — an elderly family member in a nursing home; a family member with a premature newborn graduate of the NICU; a cousin who received maternity care with Medicaid; an employee who couldn’t afford family insurance whose children have Medicaid; children of our hairdresser, housekeeper, dry cleaner, lawn service provider; the waitress in our favorite restaurant; the lady in our Sunday School class whose grandchildren have Medicaid insurance — even family members of our elected officials.
Alabama already had a bare-bones Medicaid program that provides vital services to our seniors in nursing homes, more than half of our pregnant women, the disabled and a majority of our children. We had made steady progress in reducing the number of uninsured children to about 4 percent — the result has been a decrease in the child death rate, a very low rate of unvaccinated children at risk for serious diseases, better birth outcomes with fewer low-birth weight babies, a decrease in teen pregnancy and a drop in hospitalizations for children.
My Medicaid patients include a young woman who was valedictorian of her class and headed to Auburn University with a full scholarship to become a pediatrician; two adorable little boys with Autism whose mom had to quit her job to care for them; a high school student with sickle cell disease who has suffered serious complications but is doing well and wants to own his own business; a toddler born with cancer who is disease-free after intensive care at USA Women’s and Children’s Hospital; two precious sisters whose mom is in prison now living with grandparents; a child born to a family with private insurance who had a major illness requiring intermittent intensive care for two years with that care paid for by Medicaid; a college graduate and former homecoming queen who had major surgery as a newborn and received care through Medicaid until recently (she now has a good job and private insurance); twins whose mom works full time at a child care center but has no insurance; a child with cerebral palsy cared for by his great-grandmother; a teenager with Type 2 diabetes who has worked hard to successfully control her weight; three children who live with their grandmother after their mom died in a car crash on her way to work; a bright young boy who weighed 2 pounds at birth, spent 6 months in the NICU — paid for by Medicaid — but whose mom has finished college and now works for the Department of Human Resources and has private insurance; and a 13-year-old in foster care who suffered severe child abuse.
The future of our children
So why the shortfall? Many of our elected officials ran campaigns on “no new taxes.” They are concerned about being re-elected if they vote for any tax. It is time for Christians in Alabama to let the legislators know that they will still vote for them if a new tax funds health care. A lottery is not the lesser of two evils — increased gambling won’t give our state a healthier future for our children.
Gov. Robert Bentley and the Alabama Legislature should use this special session to look at other alternative revenue raising opportunities to ensure stable Medicaid funding including new taxes. After all you have only one chance to get it right — you have only one childhood.
EDITOR’S NOTE — Dr. Marsha Raulerson has practiced pediatrics in Brewton since 1981. She has been president of the Medical Association of the State of Alabama, the Alabama Chapter of the American Academy of Pediatrics and Voices for Alabama’s Children. She is a board member for the Children’s First Foundation.
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