medicaid-cartoonThis is the 50th anniversary of the March on Washington and, closer to home, the 16th Street Church bombing.  When I was growing up, though I was too young to remember them, these events were recent to my parents. We learned about the civil rights struggles in school and I would ask my parents for their interpretation of the events. I have also done quite a bit of reading since about the brave individuals who gave up their freedom and their lives for the ability to vote and would encourage you to do the same (a good place to start would be here and here).

I still remember the conversation I had with my parents about the struggles of African Americans in Louisiana to exercise their voting rights. First, there was the struggle to register. There were parishes in Louisiana that would move the voting registration “office” to an unregistered location in the middle of a swamp. Once you got a boat to get there, there were two tests you had to pass if you were African American in order to complete the registration. One was the “literacy test” (found here) that wasn’t passable by anyone (white folks got a bye) and the other was the poll tax. The test wasn’t necessarily the payment of the tax (they were typically a nominal fee) but the challenge was to find and present the correct piece of paper on voting day (once again, whites were given a bye). The intent was to not eliminate all Black voters but to reduce the numbers such that they were not a factor in the elections.

Just as  the loss of key provisions of the voting rights act is worrisome to those of us who believe in universal suffrage,  there is a health care parallel here in Alabama that is also worrisome. The comment period has recently expired on a change by Alabama Medicaid to Rule No. 560-X-16-.20. Quantity Limitations that will now go into effect.

So what, you say…

This rule determines how Alabama spends its Medicaid money on eligible individuals. Alabama is one of the thirteen states not considering an expansion of services, no way, no how. Consequently, they are also looking for ways to reduce costs to existing recipients. This is in part because they anticipate folks currently eligible but not enrolled will be sent for enrollment by the exchange. I would imagine in Montgomery the initially considered moving their Medicaid enrollment offices to the swamp They also likely considered a literacy test.

They have settled on the equivalent of a poll tax. The new rule is going to  limit the number of most kinds of prescriptions to five in a month. The client will be able to get 90 days worth of a chronic illness prescription and in the two months that the filled prescription is in effect, the client can turn in another 5. The with it, engaged, patient who only has chronic illnesses can thus have 15 different medications. Sounds reasonable, similar to how presenting a receipt to vote can seem reasonable to a person who has a stable life situation. 

My patients who are chronically ill also tend to have problems with health literacy and other life struggles. Making sure that the 4 blood pressure medications (oh, let’s change that one) the diabetes medication (no, I said once a day, not twice a day) and the inhaler (no THAT one is for controlling the asthma and you need to take it every day, the OTHER one is for rescue) are taken in the correct order is one thing. Now we are going to need to track WHEN they can be filled as well (I would LIKE to increase the Norvasc but it isn’t due until September and I’m refilling these meds today).

I am hopeful that the intent is to save money and prove to Alabamians that as the lowest taxed state we can make without new taxes. The effect, I’m afraid, will be the premature deaths of Medicaid recipients with chronic illnesses.  I hope this is not the intent.