An interesting letter crossed my inbox this week:

“I heard that last week in Montgomery, a state legislator told the Forestry Association that the local hospital in Alex City would close if the September 18th referendum does not pass,” the author wrote.

“I’ve now seen that the CEO of Coosa Valley Medical Center in Sylacauga said that if the amendment fails, many regional hospitals, including his, may face severe cuts and possibly close. Please find out if our hospital will cut services or close if the amendment fails. The nearest hospital is already several miles from my home. I’m very concerned about having a place nearby to go when my family or I have an emergency.”

The thought of losing access to health care – of losing a local hospital – is a frightening one, and one that lawmakers are hoping will spark voters to take action on Sept. 18.

At stake in the special election is an amendment that would allow the state government to “borrow” $197 million from the state’s oil and gas trust fund to balance the 2013 budget. The amendment also would allow the state to “borrow” $145 million from that same fund in 2014 and 2015.

Sen. Bryan Taylor, R-Prattville, talked about the proposal during a recent visit to Troy. Taylor’s a fiscal conservative, a proponent of balanced budgets and spending only within the state’s means. But he’s also a realist.

And, he said, the state just doesn’t have enough money in its General Fund to meet its obligations.

Its “obligations” include things like funding the Department of Corrections, state mental health facilities and the Medicaid program, which supplements medical care for pregnant women, children, senior citizens and the disabled.

The proposal to tap the oil and gas trust fund is admittedly a stopgap, a “Band-Aid,” he said, which would allow the lawmakers time to delve into the Medicaid funding labyrinth and tackle the heart of the issue.

And after spending more than six months trying to decipher the funding matrix of Medicaid as an aide to Gov. Bob Riley, he’s honest about the situation facing the state. “We have built an elaborate monster at the federal level.”

But that elaborate monster seems far removed from folks here in Pike County, who just want to know if they’re going to have a hospital or be able to put their relative in a nursing home, with the aid of Medicaid.

And that’s where the amendment starts to hit home.

Jennifer Ventress is the chief nursing officer at Troy Regional Medical Center. She’s also a member of a state hospital association task force dealing with the funding issues facing the system. And, she’s on the board of a local nursing home.

And she drives the point home succinctly: “If the Medicaid funding is cut, not only do we lose the state funding, it’s also matched one-to-one on a federal level, so that means we’re losing a significant amount of federal funds coming into our state as well,” she said. “It’s a double hit.”

And it will be felt in places like the nursing home, where most residents rely on Medicaid funding to pay for the cost of care and treatment.

And that’s where the reality of the Sept. 18 amendment hits home.

It’s a natural reaction for fiscal conservatives to balk at the thought of allowing a state government to “borrow” from a trust fund. It even sends shivers down the spine.

But when faced with the harsh realities of releasing criminals back onto the streets, closing mental health facilities and turning away those in need of care, or even slashing funding to provide medical care for the needy and underserved … well, maybe there’s a bit of gray in that black-and-white world.

Senator Taylor summed it up well. There is no “plan B” right now to the amendment. If the voters say no and they don’t allow the Legislature to tap into those reserves, “well, then, we’re going to have to go back and make some really tough decisions: not just where we’re going to trim fat, but where we’re going to cut essential services.”

And that’s a decision no one wants to face.

Stacy G. Graning is publisher of The Messenger. Contact her at stacy.graning@troymessenger.com.