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	Name:	copperline -
	Subject:	Glad I was sitting down....
	Date:	1/8/2013 7:08:04 PM

...when I read your post.   Finally, something we can agree on.   People want cuts in govt spending, but not to the programs that affect them.   Absolutely.

Honestly, one of the reasons I am wary of block grant programs is that they give so much discretion to the State. In our case, the State of Alabama does not have a track record of governance that I have a lot of confidence in.   Historically, we haven't elected politicians who are invested in looking after the needs of the people, so often they are ideologues & bible-thumping airbags...and none too savvy about the intricacies of social programs.   Through out our history, Alabama's social safety net programs have had to be mandated by the Feds...otherwise they simply would not have happened.

Currently in Alabama, Medicaid has been poor funded for years. It runs out of money before the end of each year leaving many bills unpaid. Hospitals and MD offices know this, plan on it and many refuse to accept Medicaid because of it. Plus, the Medicaid reimbursement schedule is far less than Medicare and commercial insurers. As a result, Medicaid patients often find themselves using MD's far distant from their homes, imposing extra hardship (and poor compliance with treatment so they stay sick longer). The only good thing I can say about Alabama Medicaid is that more MD's accept it than take people with no insurance at all.

Alabama has already taken the position that it wants the Feds to manage it's Insurance Exchange, and that doesn't give any indication that our legislators are going to take a leadership role when they can punt to the Feds.... avoiding the difficult & complicated choices.     Georgia may collectively have a more sophisticated political leadership, Alabama's is suspect.