When Gov. Robert Bentley and Alabama Medicaid Director Stephanie Azar on Thursday outlined medical services that will likely be cut to the poorest of Alabama’s poor next year, local pharmacist David Darby was in Montgomery and listening intently.

Earlier this week, Bentley vetoed the General Fund budget, which provides approximately $85 million less than the Medicaid Agency says it needs to operate this year. Both houses of the legislature voted Wednesday to override the veto, so the budget stands.

And that means deep cuts into medical services for the poorest of the state’s poor. With roughly 1 million clients in Alabama, Medicaid is a joint state-and-federal health care program. More than half the program’s clients are children; the income requirements are strict enough that very few non-disabled, childless adults qualify.

Because the federal government matches the state’s contributions to the health care program, the total cut is approximately $300 million.

Eliminating adult prescription drug coverage would save around $50 million ($323 million in total cuts including federal dollars), Azbar said. Other cuts, such as an end to outpatient dialysis or prosthetics, would save much smaller sums.

Darby, who is a member of the Alabama Pharmacy Association board, said there’s no logic in that.

“Why would you pay for primary care, if the patient can’t get the medications needed to treat the problem?” he said. “Just so you’ll know what you’ll die from if you can’t be treated?”

One consideration on the table, he said, is to move drug coverage to a preferred provider contract with a retail chain like Walmart or CVS.

“One proposal is for Walmart to be the exclusive provider of pharmacy services in Alabama,” Darby said. “All these people from Opp, Florala would have to come to Andalusia to get a prescription filled. We’re already dealing with poorest of the poor, and you add transportation costs.

“They said under the contract, they would bus people from their homes to Walmart,” Darby said. “Think about that over in the Black Belt, where there are no Walmarts.”

Darby said he believes the governor is trying to drum up support from local communities to pressure the legislature to support Medicaid. Bentley previously said he would call a Special Session of the legislature to address funding for Medicaid. However, many legislators said they think voters want government to live within its means, so they won’t support any effort to raise revenue for the ailing health care program.

“We asked the governor today about a special session,” Darby said late Wednesday. “He said he sees no point now. Someone asked ‘What would change your mind?’ He said, ‘Legislators hearts are going to have to change.’ ”

Darby said he doesn’t think the Medicaid Agency is bluffing.

“They’re talking about cutting outpatient dialysis. There are patients who would die quickly without it. We’re talking about really sick people.

“It is ridiculous it has come to this,” he said. “When the members of the legislature ran for office, they knew they would have to make hard choices. They decided not to make hard choice, and they gave those decisions to Medicaid.”

Darby said he believes the cuts will have huge and negative impacts on the rural areas of the state.

“This will set rural Alabama back even more,” he said, adding that doctors, pharmacies and even hospitals in places like Andalusia will be affected.