Brenlee Treadwell was understandably fussy.
Friday morning was the 8-month-old infant’s 11th visit to a doctor in her short life — the latest being a checkup at the Purohit Pediatric Clinic in Anniston for a head cold she’d developed a few days earlier.
Brenlee’s mother, Katelyn Treadwell, 25, of Wedowee has had medical problems of her own lately and so has been unable to work and get health insurance for her and her daughter. Kaye Heard, Brenlee’s grandmother, doesn’t have the money to cover medical costs either.
“If it wasn’t for Medicaid, there’s no way we could get her medical attention,” Heard said as she held her squirmy granddaughter.
Brenlee is one of about 1 million clients of Alabama Medicaid, a joint state-and-federal program that provides health care coverage to the state’s poorest, mainly children and the disabled. More than a week ago, the Alabama Legislature approved a budget that was short $85 million that Medicaid officials say will be needed to keep their program’s services operating at current levels. Some medical professionals say the insufficient funding could cause a chain reaction, starting with less money to cover Medicaid patients and ending with closed clinics and fewer services at hospitals because of insufficient payments.
Among the cuts Medicaid officials are considering: eliminating adult prescription drug coverage to save around $50 million. Other services on the potential chopping block are coverage for outpatient dialysis and prosthetics. Primary care physicians payment cuts are also a possibility.
Senate and House leaders have said there was no interest in finding the extra $85 million to pay for the program and that the Legislature should live within its means.
“I don’t want to see anyone do without anything they need,” said Jim Downey, owner of Downey Drugs in Anniston. “But if the state has to make cuts on the prescription drug program, there probably will not be people getting as much of any of the medications they’re getting at the present time.”
Jack Nevills, owner of Artificial Limb and Brace Center in Anniston, said he knew about the proposed cuts and that any significant reduction could affect his business and his clients.
“We see quite a few people on Medicaid,” Nevills said. “This could impact a lot of people.”
Andrew Conkling, an Arab native and a board member for Dialysis Patient Citizens, a Washington D.C.-based nonprofit that advocates for dialysis patients, said a loss of outpatient dialysis would be devastating for the Alabamians who use it.
“What that really means is patients would have to go into a hospital or not go at all,” said Conkling, who was born with one functioning kidney and needs dialysis to live. “And if you miss just two or three treatments in a row, that’s the end for you.”
Dr. Naresh Purohit of Purohit Pediatric Clinic said about 80 percent of the patients in his Anniston office use Medicaid. Meanwhile around 95 percent of patients in his Roanoke clinic have Medicaid coverage, Purohit said.
Purohit said Medicaid payments to health care providers are already lower than those from private insurance, so the only way he stays in the black is by treating high volumes of patients. All of his patients and staff could suffer, Purohit said, from a reduction in patients served or reduced payments because of Medicaid cuts.
“Across the board, even another 5 or 10 percent cut from what we get now means closing the doors and laying off employees,” Purohit said.
A domino effect
Louis Bass, CEO of Regional Medical Center in Anniston, said his hospital already loses money off of the Medicaid program.
“Medicaid as a payer is not a profitable line of business,” Bass said. “It doesn’t cover all the cost.”
Bass said a large portion of RMC’s patients use Medicaid. More than half the babies born at RMC are covered by Medicaid, he said. Also, more than 20 percent of the patients who visit RMC’s emergency room annually are on Medicaid, he said.
If Medicaid payments are reduced, that means the hospital has to pay more to cover the care for those patients, Bass said.
“We will survive even these cuts, but we will look different than we do today,” Bass said. “Can we provide all the services we have now … can we continue our clinics in Piedmont, Roanoke and Talladega? That’s what we’ll have to look at.”
Bass added that if Medicaid payments get too low, then that makes it harder to recruit physicians to the area and it makes it harder to keep clinics open. And if clinics close or physicians move away because they can’t make money, then the poor patients they once treated will show up in the RMC emergency room, further straining the hospital and driving up costs, he said.
“The Legislature has put Alabama on notice that a strong health care system is something we can do without,” said Jim Carnes, policy director for Alabama Arise, a nonprofit that advocates for people in poverty.
Carnes said a loss of Medicaid affects everyone in the state, not just Medicaid patients. Some state hospitals, particularly those in rural areas, already operate on thin margins and could be in danger of closing if Medicaid is cut too much, Carnes said.
“In a way, we’re all on Medicaid because we all rely on hospitals,” Carnes said. “We’re concerned about the lives that will be directly affected and the direction Alabama will be heading in … this is no way to run a state.”
Beverly Bearden of Oxford brought her 16-year-old granddaughter Lexi Bearden to the Purohit Pediatric Clinic in Anniston on Friday morning to check her out for a bout of dizziness she’d felt earlier in the day. Bearden gained custody of her granddaughter when she was in the first grade and has had to rely solely on Medicaid to pay for her medical care.
“My husband and I have really good insurance because my husband was in the military, but we can’t put her on our insurance — they won’t cover her unless she’s adopted,” Bearden said. “So the only kind of insurance we can get for her is Medicaid.”
And Medicaid is the reason Bearden still takes her daughter to a pediatric clinic.
“A lot of people say, ‘Well, why don’t you take her to an urgent care clinic?’” Bearden said. “Well, a lot of those don’t take Medicaid.”