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States to Face Choice in Medicaid Expansion

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By Bill Britt
Alabama Political Reporter

MONTGOMERY—The Supreme Court ruling on the Affordable Care Act has left states with an interesting dilemma. The SCOTUS while upholding the individual mandate and other key provisions of the law struck down the portion that makes the expansion of Medicaid mandatory. The law, as written, offered states a carrot-and-stick to enlarge the pool of Medicaid eligible poor. Under the court ruling the stick was taken away but the carrot remains. Now, the states may opt out of the Medicaid expansion with no penalty for doing so. The current state Medicaid program in Alabama would continue as before.

Republican lawmaker have come out in force against the ACA, Governor Bentley intoning that it is “the worse piece of legislation ever.”

Republican governors, north, south, east and west are standing firm against entertaining Medicaid expansion for now.

Other than being a good campaign strategy for the GOP, the money offered by the Medicaid expansion may prove to be, over time, an offer too good to refuse.

Speaking with several business and medical professionals who are not ready to talk openly about the program, there is a growing sense that far from being an anathema the Medicaid expansion program may very well be a big win for states like Alabama.

Small states like Alabama have built their healthcare system on the foundation of Medicaid, therefore expanding the program means growing the healthcare industry, which means good paying jobs for perhaps over a thousand Alabamians.

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It is a fact that in the state, a reduction in Medicaid would results in fewer hospitals, fewer physicians, almost zero pediatric care and so on until we would reach a positive death spiral of medical services in the state and a public health crisis to paraphrase a few leading health experts.

Today, Alabama receives approximately $3 dollars for every $1 dollar is spends on Medicaid. Alabama’s Medicaid program is $5,005.97 billion program with the state contributing around $620 million dollars. Once those dollars flow into Alabama’s free market economy these funds become more like $7 dollars for every $1 dollar invested. This is not only a big return on investment, if one thinks in the reverse taking those dollars out of the economy could be ruinous amount.

If the state opted into the Medicaid expansion it is estimated that around 350 thousand new people would be added to the Medicaid rolls and by extension more money flows into the state economy.

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It is important to note that these new additions to Medicaid would be very different recipients. Currently there’s no requirement, for example, that states cover single men, no matter how low their incomes. But under the new plan, Medicaid would increase its eligibility limits for all adults male and female to 133 percent of the Federal Poverty Level, representing an annual income of about $14,856 for one person. This would open Medicaid coverage to childless adults, many of them uninsured, as well as families making around $30,000 a year. This is a category of the population not currently served by Medicaid. Most of those added would be healthy individuals between 19 and 40 years of age.

This is a set of the population that uses doctors and hospital rarely.

Yet, when this portion of the population-—who are uninsured, need health services and are treated the cost is passed on to those who do have insurance. Doctors and hospitals have to place the cost somewhere in the system and the burden of treating these uninsured becomes a hidden fee on everyone.

The new pool of Medicaid recipients, some say, would be a plus for hospitals and some physicians who under law must treat these uninsured citizens but receive no money for doing so.

The argument still being drowned out by political speak is that according to medical administrative professional expanding the Medicaid rolls will lower the overall cost of healthcare for everyone.

According to the American Hospital Association, nationally the uninsured left hospitals with $39.3 billion in unpaid bills in 2010.

This is seen as an unsustainable cost for hospitals to absorb or pass along.

However, lawmakers say that Medicaid has become an increasingly costly burden for states, especially during the Great Recession, and that funds to pay for the existing program are hard to find much less finding new dollars for expansion.

Countering the “states are broke” argument is that the federal government will pay 100 percent of the costs of these new beneficiaries from 2014 to 2016 and then phase down its share of the expenses over three years, reaching 90 percent still paid for by the Feds starting in 2020.

It is still unclear as to what any state will decide as to Medicaid expansion, like the first offer of the program in the 1960s there will be resistance but over time all 50 states adopted the federal plan.

The history of Medicaid itself may be an instructive example. It became law in 1965, as part of the same act that created Medicare. By 1972, every state but one had opted into the program. Arizona was the last holdout state but it had some special circumstances.

Because this is an election year, it may be difficult to separate campaign rhetoric from actual policy thinking.

It will be interesting to watch which states ask Washington for wavers giving them more flexibility or time to meet federal standards.  Alabama, for now, stands resistant—-at least in speech—-to any provision of the ACA and has not applied for wavers.

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Governor declares state of emergency ahead of Tropical Storm Zeta

Zeta is currently a tropical storm over the Gulf of Mexico, but it is predicted to make landfall as a category one hurricane.

Brandon Moseley

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A satellite image of Tropical Storm Zeta. (VIA NATIONAL WEATHER SERVICE)

Alabama Gov. Kay Ivey on Tuesday issued a state of emergency as Tropical Storm Zeta approaches the Gulf Coast.

“Ahead of Tropical Storm Zeta’s anticipated landfall Wednesday evening as a Category 1 hurricane, I am issuing a state of emergency effective today at 4:00 p.m.,” Ivey said. “While this storm is not expected to have an impact as large as storms we’ve seen move through the Gulf earlier this year, we want to be in the best place possible to respond to anticipated rain, storm surge and mass power outage. I encourage everyone to remain weather aware and tuned in to their trusted news source as this storm could shift direction or change intensity. We continue to track the path of this storm and will stay in touch with the people of Alabama with any updates.”

Zeta is currently a tropical storm over the Gulf of Mexico, but it is predicted to make landfall as a category one hurricane. The National Hurricane Center is predicting Zeta to make landfall in Mississippi on Wednesday and then proceed toward Alabama, but these storms can and do move.

A more easterly track could prove devastating to the Alabama Gulf Coast as was the case with Hurricane Sally, which shifted course in September, hitting Alabama, though Zeta is expected to be weaker than Sally at landfall.

The storm surge from the Mississippi-Alabama border to Dauphin Island is forecast to be 5 to 8 feet. Mobile Bay to the Alabama-Florida border is expected to have 3 to 5 feet of storm surge and from the border to Navarre, Florida, could experience 2 to 4 feet of storm surge.

Hurricane force winds are a possibility with this storm. Tropical force winds are expected to be an issue for Southern Mississippi and Alabama well inland. There is expected to be heavy rainfall across the state Wednesday night into Thursday morning.

The Baldwin County Emergency Management Agency announced that sandbags are available inside the county commission office at Robertsdale Central Annex (22251 Palmer Street) until 4:30 p.m. Tuesday and from 8 a.m. until 4:30 p.m. Wednesday or while they last.

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Bring any help and shovels you will need. There is a limit of just 25 bags per person. Alabama’s coastal counties are currently under a Tropical Storm Warning, a Storm Surge Warning for Mobile County and a High Rip Current and High Surf Warning.

Congressman Bradley Byrne said, “I just finished up briefings from Alabama EMA, FEMA, and the National Hurricane Center regarding #Zeta. We should not take this storm lightly and should start making preparations right away. After sundown Wednesday, I’d encourage everyone in Southwest Alabama to stay home and off the roads until sunrise Thursday. This storm will have impacts as far north as Montgomery, so those in Washington, Clarke, and Monroe counties will see tropical storm force winds and heavy rain. I’d encourage everyone to charge their phones and other necessary electronics. If you have an emergency during the storm, call 911 and do not try to drive.”

Coastal Alabama is still in the process of recovering from Hurricane Sally which hit the state on Sept. 15.

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Alabama’s COVID-19 hospitalizations surpass 1,000 for first time since August

The 1,001 patients in hospitals with COVID-19 on Tuesday is a 34 percent increase from a month ago.

Eddie Burkhalter

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(APR GRAPHIC/ADPH DATA)

Hospitalizations of COVID-19 patients in Alabama on Monday crossed the 1,000 mark for the first time since Aug. 31 — a sign that Alabama may be headed for another peak in hospitalizations as the state prepares for winter and flu season.

The 1,001 patients in hospitals with COVID-19 on Tuesday is a 34 percent increase from a month ago, and the seven-day average of COVID-19 hospitalizations by day Tuesday was 917, a 21 percent increase from Sept. 27.

“Unfortunately, not surprised but frankly, depressed by our trends,” said Dr. Don Williamson, president of the Alabama Hospital Association and Alabama’s former state health officer, speaking to APR on Tuesday. 

Work is under way to help hospitals prepare for another surge, ensuring there’s enough of therapies like Remdesivir, ventilators and personal protective equipment are in place, Williamson said. 

Alabama on Monday had just 16 percent of the state’s ICU beds available, and since the start of the pandemic, with a few exceptions, Alabama hospitals have had less than 20 percent ICU availability, Williamson said. During the state’s last peak in mid-July, coronavirus patients were using 445 ICU beds, he said, and by Sept, 20 that had dropped to 274, where it hovered ever since.

On Monday, 292 COVID-19 patients were in ICUs, Williamson said.

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Williamson said at the state’s worst point during July, Alabama had just 109 ICU beds available but that “the problem wasn’t beds. It was staff.” Without staff to care for the patients, empty ICU beds would do a patient no good. 

A nurse can typically care for up to six patients, but only three or four COVID-19 patients, who require extra care, Williamson said. And there’s concern that fatigue among hospital staff will again become a challenge. 

“You’re seeing it nationally now, in folks who are going through this second wave. Staff are just exhausted because they’ve seen it before. They know how somehow this is going to turn out for a significant number of patients,” Williamson said.  “And part of it is just the incredible frustration that a lot of this was preventable. 

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As treatment options and the knowledge of how to better care for COVID-19 patients have improved, fewer coronavirus patients are taking up those ICU beds, but they’ve been replaced with people who come to hospitals sicker than before the pandemic.

Williamson said many of them may have put off going to the hospital during the state’s surge, and as a result, find themselves sicker than they would have otherwise been. 

Alabama’s hospitalizations began dropping in the weeks after Gov. Kay Ivey issued a statewide mask order in July, which she has extended twice, but after dipping down as low 703 on Sept. 25, hospitalizations have been rising. 

Williamson said looking at the rate of increase in recent weeks, he predicts the state could again see daily hospitalizations of 1,500 as in July, and said while current hospitalizations for seasonal flu patients are in the single digits, there’s concern that as flu season continues the combination of flu and COVID-19 patients will strain hospital staffing resources and bed space statewide. 

Williamson said from personal observation he is seeing more people not wearing masks, or wearing them improperly, and said the state could dramatically reduce the risk of COVID-19 if the public regularly wore masks and wore them properly.

“The period between Thanksgiving and the first of the year could be really, really problematic, given what we’re now seeing with COVID,” Williamson said. 

Alabama added 1,115 new confirmed and probable coronavirus cases on Tuesday, and the 14-day average of new daily cases hit 1,375. Over the last two weeks, the state added 19,244 cases, although 3,747 were older test results from labs that weren’t properly reporting to the Alabama Department of Public Health.

Alabama’s 14-day positivity rate is at nearly 21 percent, although those older test results skewed the figure higher than it otherwise would have been. Just prior to those older cases being added to the count, however, Alabama’s 14-day average of percent positivity was 15 percent. Public health experts say it needs to be at or below 5 percent of cases are going undetected. 

ADPH reported 26 COVID-19 deaths on Tuesday. Over the last four weeks, ADPH added 391 coronavirus deaths to the state’s total, which stood at 2,892 on Tuesday.

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Agriculture Department providing shelters for livestock evacuating due to Zeta

The Alabama A&M Agribition Center will open effective immediately for livestock that is being evacuated.

Brandon Moseley

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(STOCK PHOTO)

In response to Tropical Storm Zeta, the Alabama Department of Agriculture and Industries has been in contact with partners to provide a temporary sheltering facility for evacuated livestock including horses and cattle.

Animals moving in response to Tropical Storm Zeta will be exempt from a certificate of veterinary inspection.

The Alabama A&M Agribition Center (4925 Moore’s Mill Rd, Huntsville, AL 35811) will open effective immediately for livestock that is being evacuated. The shelter is only equipped to shelter livestock, not pets or companion animals such as dogs or cats.

This facility will be available on a first-come, first-serve basis. To contact the A&M Agribition Center call 256-689-0274. Evacuees will need to bring their own shavings, water buckets, feed, etc.

When evacuating, it is important for livestock owners to be prepared to care for their animals while they are away. Please be sure to bring the following items with you: a current list of all animals, including their records of feeding, vaccinations and tests.

Make sure that you have proof of ownership for all animals. Supplies for temporary identification of your animals, such as plastic neckbands and permanent markers to label your animals with your name, address and telephone number. Handling equipment such as halters and appropriate tools for each kind of animal. Water, feed and buckets as well as tools and supplies needed for sanitation.

For questions or concerns about sheltering livestock during a tropical storm evacuation, please contact ADAI Emergency Programs at 334-240-7279 or by email. The Alabama Cooperative Extension Service has also prepared an article on how to prepare to evacuate a farm.

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There are more than 1.3 million head of cattle and calves on Alabama farms, according to figures released by the Alabama Agriculture Statistics Service. The cattle herd represents an enormous investment for Alabama farm families and is valued at approximately $2.4 billion.

Alabama has nearly 100,000 horses with a total value of over $500 million. Alabama has 57,000 hogs with annual production of $21.4 million a year. Alabama has more than 40,000 sheep and goats.

Farms in Mobile, Baldwin and Escambia counties were hit hard by Hurricane Sally and repairs to barns and fences from that storm are still ongoing.

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Corruption

Prosecution accepts misdemeanor plea in high-profile environmental administrator’s case 

The plea deal came shortly before Jefferson County Circuit Court Judge Stephen C. Wallace was to hear arguments on selective and vindictive prosecution.

Bill Britt

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(STOCK PHOTO)

Almost two years ago, Trump administration EPA Region 4 Administrator Onis “Trey” Glenn III was charged with more than a dozen state felony ethics violations. On Monday, he pleaded guilty to three misdemeanor charges after reaching a plea agreement with the prosecution.

The plea deal came shortly before Jefferson County Circuit Court Judge Stephen C. Wallace was to hear arguments on selective and vindictive prosecution.

According to a statement from the Ethics Commission at the time, Glenn, along with former Alabama Environmental Management Commissioner Scott Phillips, was charged after a Jefferson County grand jury returned indictments against the two on Nov. 9, 2018, according to a statement from the Ethics Commission.

Rather than moving forward with the case, prosecutors dropped the felony charges against Glenn. They opted to reach an agreement to accept a plea on three counts of “unintentional” violations of the ethics code. Glenn received a two-year suspended sentence for his actions.

“In the interest of efficiency, we were pleased to take advantage of the opportunity to resolve this matter,” Glenn’s attorney Matt Hart told APR when reached for comment. “My client pleaded to unintentional, misdemeanor violations of the ethics law, and the matter is concluded.”

Questions surround the prosecution’s decision to settle the case for a confession to minor offensives in such a high profile case. Still, from the beginning, the case was marred by allegations that the Alabama Ethics Commission’s lawyers had mishandled the investigation and indictments.

Indictments against Glenn and Phillips were reported by AL.com even before the pair was arrested or served with the indictments. In AL.com’s report, Ethics Commission Executive Director Tom Albritton said that then-Jefferson County District Attorney Mike Anderton had requested the Ethics Commission help indict the two men.

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As first reported by APR, shortly after Glenn and Phillips’ indictments, Albritton and his team’s actions raised serious questions about the process that led to charges against the two men. APR reported that Albritton and Ethics Commission lawyer Cynthia Propst Raulston approached Anderton, and he did not request help with the case from the commission, as was reported in AL.com.

Later, APR confirmed that the Ethics Commission approached Anderton, contradicting Albritton’s public statement. In a sworn statement given on Feb. 9, 2019, Anderton said it was Ethics Commission lawyers who approached him, as first reported by APR in November of last year.

According to Anderton, in the fall of 2018, Propst Raulston approached him because “she had a case she wanted to present to the Jefferson County Grand Jury.”

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He further states, “I told Ms. Raulston that I would facilitate her appearance before the grand jury but that my office did not have the resources to support her case. I also told her that she would have to prosecute the case herself.”

These and other aberrations came into sharper focus when Hart — the state’s most famous prosecutor of his generation turned defense attorney — began diving into the particulars of the prosecution’s case.

Glenn’s defense argued from the start that procedural process was circumvented when Albritton and Propst Raulston took the complaint directly to a grand jury rather than the Ethics Commission as prescribed by the Legislature.

An ethics commissioner told APR privately that the commission was never informed about a complaint against the two men, nor was the investigation.

According to internal sources, actions taken by Albritton and Propst Raulston created turmoil at the commission and raised a question about who would prosecute the case on the state’s behalf.

During the process, Albritton, Propst Raulston, and other attorneys for the commission asked the attorney general’s office to take over the case; however, according to sources within the office, the AG turned them down after a review found “statutory problems” with how the case against Glenn and Phillips was handled.

In a motion to dismiss, the defense said, “In sum, the Ethics Commission Staff trampled Mr. Glenn’s rights in obtaining the indictment without giving him his required notice and an opportunity to be heard as required by the Alabama Ethics Act, and then after indictment denied him notice as guaranteed by the Grand Jury Secrecy Act and failed to protect his presumption of innocence as required by the Rules of Professional Conduct.”

While not explicitly noted in the motion to dismiss, the relationship between environmental group GASP and the prosecution was a subject that would have been heard in the hearing on selective and vindictive prosecution.

Immediately following Glenn and Phillips’ indictment, GASP posted a celebratory tweet, even taking credit for the indictment.

Former GASP director Stacie Propst is the sister of Ethics Commission lawyer Propst Raulston who presented the case to the Jefferson County grand jury.

While many in the environmental community celebrated Glenn’s indictment, the defense argued the prosecution took an illegal short cut to indict him, which denied Glenn due process and amounted to selective and vindictive prosecution.

Monday’s plea agreement ended the two-year drama without further exposure as to what happened behind the scene. Phillips’s case is still pending.

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