When Governor Robert Bentley took office, I had high hopes that a doctor in the Governor’s Mansion would mean improvements for Alabama’s health care. He had worked in the health care system, knew the pitfalls of Medicaid and Medicare, and would be able to see reform as a provider, patient and policy-maker.

I have been a staunch supporter of Medicaid expansion under the Affordable Care Act — it will provide care for 300,000 Alabamians and bring in billions to stimulate our economy and protect rural hospitals. Governor Bentley, though, was adamant about not expanding a broken system. He wanted to implement reforms to fix Medicaid before we talked about expansion.

In 2012, Bentley set up a Health Care Task Force to figure out how best to reform Medicaid. The task force recommended and Bentley established new Regional Care Organizations, which Bentley called “progress in the way the Alabama Medicaid Agency operates, making it more effective and efficient.” According to the governor’s office, “Alabama could receive up to $748 million in federal money over five years to help start and improve its RCO program.”

This sweeping reform for Medicaid was set to go into effect October 1, 2016, but it looks like we’re going back to the drawing board. In yet another chapter of the ongoing power struggle between Republican legislators and Governor Bentley, the legislature has proposed a budget that under-funds Medicaid by $100 million, which will cost the state the ability to implement these RCOs and the $748 million in federal grants to set them up.

To recap this Medicaid boondoggle: we are letting an estimated 600 people per year die due to lack of care coverage, preventing 300,000 Alabamians from obtaining affordable health care, allowing our rural hospitals to go bankrupt and now we’re going to roll back the clock on the reforms that would have made our broken system just a little less broken.

The Republicans have a super-majority in the Legislature. They control every statewide constitutional office. They have the ability to do exactly what they want, yet time and again we see that they aren’t ready or able to lead.

Medicaid is the state’s largest General Fund budget item, so we have no choice but to address the issue of Medicaid funding. Yet the Republicans are taking two steps backwards for every step forward because they don’t know how to think strategically or lead effectively. I’ll support reforming a broken system, but I won’t support feel-good legislation that never actually goes into effect. This bungled Medicaid budget is making it more and more clear: we’re out of options. It’s time to expand Medicaid any way we can get it.