On the front page of the 25 April Decatur Daily was an article entitled ‘Providers: Medicaid could face more cuts’ (1). This is not really news to most of us, but the potential impact of this action is monstrous. I will have to mostly limit the scope of this paper to the impact of these cuts to the state’s mentally ill that receive Medicaid assistance.
In the article, it states that the House has appropriated ‘$400 million (M) to Medicaid in the 2013 budget, which is about $175 M less than the current year’ (1). Later, Senator Orr of Decatur states that ‘there is without question the need for more state dollars that what was appropriated in the House’ (1), and posits that the Senate appropriation will be between $500 M and $600 M.
In any case, that will still lead to cuts. One of the potential cost saving measures being considered is an ‘across the board pharmacy prescription limit of 1 brand name and 3 generic medications (a TOTAL of 4 medications) for each Medicaid participant. There (would be) no drug class exclusions and no special population exclusions. This would mean that the antipsychotic exclusion for individuals with serious mental illnesses would no longer be part of Medicaid reimbursement…(and that) many (consumers) will be forced to choose (for example) between filling prescriptions for their diabetes medications versus filling prescriptions for their antipsychotics’ (2). I cannot overstate how tragic it would be for this to happen, for those of us who struggle to maintain some stability to have it be endangered by a cut in funding.
To use a personal example, I am dependent on psychoactive medications to function normally, those being lithium (a mood stabilizer) and Wellbutrin (an antidepressant), which are currently covered by Medicaid. Without them, I WILL decompensate, become either manic or severely depressed (neither being preferable to the other), and over time, either end up in a state hospital, the emergency room of a general hospital to ask for a prescription of these drugs to ‘hold me over’, or jail. ALL of these cost more both in terms of money and the cost to society at large (not to mention the trauma to myself) than simply funding the Medicaid program. And it would erase the benefits of years of careful, fragile cultivation of stability, so that I may maintain some semblance of normality and return to the status of a contributing citizen. And my experience would be shared by others numbering in the thousands, if not tens of thousands, state-wide.
The nation’s leading pundit has probably put in best already when he said, “If this is going to be a Christian nation (or state) that doesn’t help the poor, either we have to pretend that Jesus was just as selfish as we are, or we’ve got to acknowledge that He commanded us to love the poor and serve the needy without condition and then admit that we just don’t want to do it. (3)” I take that thought to mean if government cannot prioritize funding to support and protect the least among us, then I submit that it has failed. Failed in their duty to citizens who have little to no other assistance, who depend upon governmental programs literally to survive. A bull-headed stance of ‘no new taxes’ is but cold comfort to those of us who the pending cuts will affect. I implore all of you to consider new sources of income for the state, a new cigarette tax for example, or a new soft drink tax. Or (heaven forbid) actually raising property taxes from the lowest in the nation to merely one of the lowest in the nation. But never forget the human aspect of this kind of legislation, the horrible damage that it may sow, for I assure you, we will not.
John Paul Thornton, MBA/CPSS
Registered lobbyist in the State of Alabama
(1) ‘Providers: Medicaid could face more cuts’, The Decatur Daily, by Mary Sell and Jennifer Edwards, 25 April 2012.
(2) ’2012 Legislative Update’, Dr. Timothy Stone, AL Dept of Mental Health email, 19 April 2012.
(3) ‘Stephen Colbert > Quotes’, http://www.goodreads.com/author/quotes/6649.Stephen_Colbert
‘Balancing the Budget on the Backs of the Mentally Ill’, JP Thornton position paper, 3 April 2012.
‘Supreme Court Hears Challenge to Health Reform: Medicaid and More Hang in the Balance’, The Reporter, Bazelon Center for Mental Health Law, 10 April 10 2012.
’20 Lowest Property Taxes in USA’,