Last Sunday I wrote about the Alabama struggle to balance the budget. I pointed out that due to 100 years of budgetary sleight of hand, we found ourselves voting to take money out of an inviolable trust in order to “prevent the mass release of prisoners” and also provide funding to Medicaid allowing us to continue the program. The vote passed by a 2 to 1 margin, in part because the turnout was below 20% and in part (it is speculated) because the bulk of those who turned out worked in or around the healthcare field (don’t know how the prisoners voted).

Now that the program has been saved, the damage control begins. In an editorial in the local “paper” (soon to go to 3 days a week in paper form so I guess it will soon be the local “web feed”) found here, the politicians have promised to “make it right.” Per them:

Unlike the out-of-control federal government that’s adding nearly $4 billion a day to our $16 trillion national debt, we believe state government should live within its means — without raising taxes on Alabama families and businesses. Next session, expect to see an aggressive push to pass a strong agenda of government reforms that will continue building the foundation for a more conservative, fiscally-responsible state government.

I will take this opportunity to remind them that the Affordable Care Act will provide them with an opportunity to move over 350,000 Alabamians from the roles of uninsured to insured via Medicaid expansion at no cost to the state for 3 years. These Alabamians (per Kaiser Family Foundation) tend to be from working families and unable to afford family coverage, allow themselves to get sicker (thus creating a drain on the system), and have trouble making ends meet as a consequence of medical bills. I will also remind our policy makers that, as Kaiser also points out to conservative politicians considering opting out,

“Part of the legislation actually involves the federal government pulling away some dollars called DISH, or disproportionate share funding, that went to safety net hospitals, primarily who see a lot of uninsured,” he reasoned.

Dr. Adler points out that, when the Affordable Care Act is fully in place, that money – DISH money – goes away.

The DSH money is part of what is being used to fund the Alabama Medicaid Fund so when it goes away, there will be no do-over. . I guess we’ll see just what fiscal responsibility means.

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