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Medicaid Referendum and Medicaid Expansion Two Completely Separate Issues

Susan Britt

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By Susan Britt
Alabama Political Reporter

By coincidence the subjects of Medicaid expansion and of funding of Medicaid with money from the Alabama Trust Fund monies are being discussed by state leaders at the same time leaving many people confused that they are one in the same. The only similarity they possess is the timeframe of the discussions. The two issues are vastly different but are only connected because they effect the same agency, Medicaid.

The constitutional amendment on the ballot in September will help fund the already existing Medicaid needs for the next three years, according to proponents, giving Alabama legislators the time to find a revenue solution.

Without the CA, Medicaid could potentially see a reduction of nursing homes, loss of healthcare providers who accept Medicaid, loss of jobs in medical fields, closing of rural hospitals, further reductions in provider payments and overall loss of services for Alabamians who depend on the program for their healthcare.

In April, Dr. Don Williamson took over the reins of Alabama’s Medicaid Agency. After which he identified that Alabama Medicaid needs $603 million to fund the state’s portion for fiscal year 2013. The General Fund was prepared to provide only $418 million leaving a shortfall of $184 million.

The Governor and legislators passed a proposed constitutional amendment to be voted on in a special election on September 18 asking Alabama’s voters to approve taking the shortfall from the Alabama Trust Fund (ATF). If passed the amendment will allow another two years of General Fund shortfalls to also be funded by the ATF.

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The ATF is a fund that was set up as a savings account that pools royalties from Alabama’s oil and gas proceeds. One of the main contentions of the CA is that there is no plan to pay back the funds, however, it is estimated that the fund will replenish itself with only a few years.

Should the CA fail, it is speculated that the Legislature will be called into special session to try to find an alternative solution to fund the existing Medicaid needs.

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The Medicaid Expansion discussions are a direct result of the the Supreme Court upholding portions of the Patient Protection and Affordable Care Act. While the court upheld the individual mandate and the healthcare exchanges, it left the expansion of Medicaid up to the individual states as an option.

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The individual mandate (which says citizens must be covered by some sort of healthcare insurance or face a federally imposed penalty in the way of a tax) remains because that has a role in what happens to individuals who need Medicaid. The healthcare exchanges remain because individuals are going to be driven to the exchange to purchase insurance to comply with the individual mandate.

Currently Medicaid covers pregnant women and children up to 6 years old at 133 percent of the federal poverty level. It also covers children from age 6 until their 19 birthday at 100 percent of the poverty level. The elderly in nursing homes are covered at 300 percent of the poverty level as are the disabled. But for childless adults, for parents whose children may be covered but they are not, and makes more than 11 percent of the federal poverty level, they are not eligible.

According to Dr. Don Williamson, interim Director of Medicaid, who spoke at the Tuesday Joint Legislative Committee on Medicaid Policy meeting, “With the Medicaid expansion to 133 percent of the poverty level for children less than 19 years of age remains mandatory [by the ACA] and begins January 1, 2014. For Alabama, that means is that by 2014, the 25,000 children who are currently in AllKids (between 100 and 133 percent of the poverty level) will be moved to Medicaid as part of the expansion.”

The big gap that remains is childless adults and parents. If Medicaid chooses not to expand then individuals below 100 percent of the poverty level will not be eligible for a subsidy through the health insurance exchange. Subsidies are available only to people between 100 percent and 400 percent of the federal poverty level. This will leave many people vulnerable because they do not qualify for a subsidy but yet will be responsible for the penalty. However, since the Secretary of Health has the authority to waive the penalty in certain instances.

“If you do not expand Medicaid, you are not making it worse. You are not taking people who have to buy insurance then making insurance not available and then taxing them,” said Williamson.

The ACA proposes for the years 2015-2016 to provide the expansion program will be 100 percent federally funded, 2017 Alabama will match at 5 percent, in 2018 at 6 percent match, in 2019 a 7 percent match and then in 2020 the match tops out at 10 percent. After that, 90 percent of the program will be federally funded with a 10 percent match from Alabama.

Williamson estimates that Alabama will spend $64 million over the next 6 years to take care of existing Medicaid eligibles that will come to the program even if it doesn’t expand Medicaid. “That only generates $173 million in federal funding. If expanded, it will swell to over $250 million over 6 years,” said Williamson.

If expanded he estimates it would increase from between $406-$440 million in new state dollars which will generate between $10.1-$10.8 billion new federal dollars.

“If we could go to 100 percent of the poverty level we could cover 355,000 of the 420,000 that might otherwise go in at under 133 percent. More than three-quarters of people that we could potentially add are below the poverty level. If we could simply get to the poverty level it would make a big difference and potentially cost us less,” said Williamson.

The Joint Legislative Committee on Medicaid Policy is currently considering the matter and will reconvene on September 12, 2012 to continue discussion.

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Crime

Inmate assault injures two St. Clair prison correctional officers

The assaults happened at approximately 7:30 p.m. and both officers were taken to a local hospital and treated for those non-life-threatening injuries.

Eddie Burkhalter

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(STOCK PHOTO)

Two correctional officers at St. Clair Correctional Facility were injured in an inmate-on-officer assault on Monday, the Alabama Department of Corrections confirmed to APR.

Among the two officers who sustained non-life-threatening injuries was a basic correctional officer (BCO), a position created in May 2019, who are not Alabama Peace Officers Standards and Training Commission (APOST) certified and who have some limitations on working directly with inmates without correctional officers present.

The other officer injured was a full correctional officer, Alabama Department of Corrections spokeswoman Samantha Rose told APR in a message Friday. The assaults happened at approximately 7:30 p.m. and both officers were taken to a local hospital and treated for those non-life-threatening injuries and subsequently released, according to Rose.

“The ADOC condemns all violence in its facilities, and the actions taken by the inmate against ADOC staff are being thoroughly investigated,” Rose said. “As the investigation into this incident is ongoing, we cannot provide additional detail at this time. More information will be available upon the conclusion of our investigation.”

The ADOC created the new basic correctional officer position to bolster the state’s woefully understaffed prisons. The creation of the position was also at the suggestion of experts ordered by a federal court to study the department’s staffing problems, ADOC attorneys wrote to the court in a filing in 2019.

The ongoing lawsuit is over the state’s handling of mental health in prisons.

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The Southern Poverty Law Center and the Alabama Disability Advocacy Program filed the 2014 suit arguing the state was indifferent to the health of inmates dying by suicide in greater and greater numbers.

Attorneys for the plaintiffs in June argued that ADOC was far behind on the court-ordered hiring new additional officers. It has been more than two years since U.S. District Judge Myron Thompson ordered the Alabama Department of Corrections to hire an additional 2,000 correctional officers by 2022.

U.S. District Judge Myron Thompson in a previous opinion wrote that prison understaffing “has been a persistent, systemic problem that leaves many ADOC facilities incredibly dangerous and out of control.”

“Taken together, ADOC’s low correctional-staffing level, in the context of its severely overcrowded prisons, creates a substantial risk of serious harm to mentally ill prisoners, including continued pain and suffering, decompensation, self-injury, and suicide,” Thompson’s previous opinion continued.

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The SPLC in court filings late last year expressed concern over the use of basic correctional officers in Alabama’s overcrowded and understaffed prisons. ADOC attorneys have argued to the court, however, that BCO’s are adequately trained to do their jobs and are needed for the department to hire the necessary number of officers per the court’s timeline.

In a court filing on Thursday, attorneys for the plaintiffs asked the court not to again delay site visits to Alabama prisons by two experts who are tasked by the court to determine which positions should be filled by correctional officers and which by BCO’s and which by another new position, called cubical correctional officers, who are to have no direct interaction with inmates.

Those visits were to begin in May, but both parties in the suit agree to wait due to the COVID-19 pandemic and the threat it posed to the experts, who are particularly vulnerable to the disease due to “age and other factors,” according to court records.

Both parties again agreed to postpone those visits in June for those same reasons, those records show. ADOC seeks a third extension but attorneys for the plaintiffs argue that the experts can visit the prisons while keeping themselves, prison staff and inmates safe from harm of COVID-19 and that thousands of employees and contractors enter Alabama prisons daily.

The plaintiff’s attorneys argue in the court filing that the expert guidance is needed because ADOC wishes to use BCO’s and cubical correctional officers to comply with the court-ordered hiring of additional staff by Feb. 20, 2022.

“Ensuring adequate staffing is of upmost importance to address the constitutional violations underlying mental health care within ADOC,” the plaintiffs’ attorneys wrote to the court Thursday.

ADOC in May was employing 494 BCO’s, a 57 percent increase in the number of BCO’s employed in Oct. 2019, according to ADOC’s staffing numbers. The number of correctional officers working in Alabama prisons fell by two percent during that time, dropping from 1,319 to 1,287.

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Elections

Slow absentee voting in Tuscaloosa sparks outrage, possible legal action

Among the issues were incredibly long lines that left some voters waiting more than five hours and an inefficient process that managed to take in fewer than 100 absentee ballots in six hours. 

Josh Moon

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(STOCK PHOTO)

Long lines and slow absentee ballot processing in Tuscaloosa County have left voters outraged and incumbent Sen. Doug Jones’s campaign threatening legal action. 

On Wednesday, Jones’s campaign attorney, Adam Plant, sent a letter to Tuscaloosa County Circuit Clerk Magaria Bobo, outlining a number of issues with ongoing absentee voting and promising to take legal action if Bobo doesn’t improve the process on the final day, Friday. Among the issues documented by Plant were incredibly long lines that left some voters waiting more than five hours and an inefficient process that managed to take in fewer than 100 absentee ballots in six hours. 

Additionally, Plant noted that Bobo has hired her family members to help process absentee ballots and at least one family member had made disparaging remarks on social media about voters. 

“You and those acting on your behalf are suppressing the vote of qualified Alabama voters,” Plant wrote in the letter. “If you are unable or unwilling to execute your duties competently, and allow Tuscaloosa voters to exercise their voting rights without undue burdens, we will take further action.”

In an interview with the Montgomery Advertiser on Wednesday, Bobo noted that her office had received more than 13,000 requests for absentee ballots — a remarkable uptick from the 3,000 or so her office usually receives — and there had been problems in managing that number of ballots while also adhering to social distancing guidelines within the office. 

However, as Plant’s letter notes, the massive increase in absentee ballots for this election shouldn’t have been a surprise. Also, Secretary of State John Merrill had made additional funds available to absentee managers to facilitate hiring extra staff, purchasing additional computers and staying open for longer hours to accommodate the anticipated increase. 

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In a press release on Wednesday, the Alabama Democratic Party criticized Bobo and her family members, and the release included screenshots of Facebook posts from Bobo’s daughter lashing out at voters who complained about the long wait times. 

“No voter should have to wait in line for hours to exercise their rights,” said ADP executive director Wade Perry. “We should leverage every tool we have to make voting easier, not harder. Also, it should go without saying that election workers should not insult the very people they are employed to serve. If Ms. Bobo is incapable of processing voters quickly, someone else needs to do the job.”

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Elections

Jones campaign calls Tuberville a “coward” after no-show at Auburn forum

“Tuberville is hiding because he knows that on every front — policy, experience, character, competence — he loses to Doug Jones. Hands down,” Jones’s campaign said.

Brandon Moseley

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Sen. Doug Jones, left, and Senate candidate Tommy Tuberville, right.

There are only four days left before election day, and incumbent Democratic Sen. Doug Jones’s re-election campaign is slamming Republican challenger Tommy Tuberville, accusing him of “hiding” and calling him a “coward.”

On Wednesday, Jones addressed an Auburn University forum. Tuberville did not attend.

“Tonight, the College Democrats and College Republicans at Auburn University co-hosted a debate between Doug Jones and Tommy Tuberville, offering students a chance to ask the candidates about the issues that matter most to Alabama,” the Jones campaign said in an email to supporters. “But Tuberville never showed up – he’s too scared to face Doug… even on his own home turf. Tuberville has repeatedly refused to debate Doug Jones. He’s consistently refused to be interviewed by the press. He’s refused to tell Alabama the truth about who and what they’re voting for – and it’s clear why.”

“Tuberville is hiding because he knows that on every front — policy, experience, character, competence — he loses to Doug Jones. Hands down,” the campaign continued. “If he won’t tell the truth, we will. Tuberville expects to win this race off of his blind allegiance to the President and his party affiliation. But Alabamians know better.”

“People deserve to know who they’re really voting for if they vote for Tuberville: someone who … won’t protect our health care, doesn’t believe in science, has no idea what the Voting Rights Act is, and doesn’t care about the lives and livelihoods of Alabamians,” the Jones campaign concluded. “Alabama will never elect a coward. Pitch in now and help us spread the truth about the man hiding behind the ballot.”

“I am disappointed that Tommy Tuberville is not here,” Jones said. “I think it is important that people see two candidates side by side answering the same questions.”

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Tuberville meanwhile is canvassing the state, speaking to rallies and Republican groups to turn out the Republican vote for himself and President Donald Trump. Tuberville spoke at Freedom Fest in Madison County on Thursday and at the Trump Truck Parade rally in Phenix City.

“It’s time Alabama had a U.S. senator who represents our conservative beliefs and traditional values,” Tuberville said in Phenix City. “It’s time Alabama had a U.S. senator who supports the Second Amendment, the right to life, and putting God back in the classroom.”

Polling consistently shows Tuberville with a commanding lead over Jones. Real Clear Politics lists the race on their current board as a likely Republican win. FiveThirtyEight’s election model gives Tuberville a 79 percent chance of defeating Jones.

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Elections

Tuberville says election is about “the American dream”

“It is not about me. It is not about Biden or Jones. It is about the American dream. They are trying to take it away from us,” Tuberville claimed.

Brandon Moseley

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Republican Senate candidate Tommy Tuberville (TUBERVILLE CAMPAIGN)

Thursday, Tommy Tuberville spoke at Freedom Fest asking Madison County voters to support him and re-elect Donald J. Trump Tuesday.

The former Auburn University head football Coach told the estimated crowd of 350 that, “It is great to be here. This has been a lot of fun for me. Two years ago, my wife and I started to pray on whether or not to run. When we decided to run, she said don’t come back until you win.”

“This is a very serious election,” Tuberville said. “This is not about Donald Trump. It is not about me. It is not about Biden or Jones. It is about the American dream. They are trying to take it away from us.”

“I always told my players this: this country gives you the opportunity to fail and if you fail you get back up and try again,” Tuberville said. “When I was growing up in Arkansas I wanted to be a college football coach. People in high school laughed at me for it and people in college. It takes perseverance.”

Tuberville said that this country gives you the opportunity to succeed, more so than any other country in the world. Most of the rest of the world is socialist.

Tuberville warned that the other side is trying to turn America into a socialist country.

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“We are not going to let them ruin this country,” Tuberville vowed.

The 2020 Madison County GOP Freedom Fest was held at the brand new Toyota Field, the new home of the Huntsville Trash Pandas minor league baseball team.

Tuberville praised President Trump whom “I have gotten to know through all of this and we have become friends. He never slows down; and he is sharp as a tack.”

Tuberville said that the President once called him at 2:30 in the morning, “He said sleep is overrated.”

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To protect the American dream we need to vote on Tuesday to keep the Senate and get Donald Trump re-elected.”

Tuberville said that he has spoken with, “A lot of people who as nervous as I am about Tuesday.” Coach Tuberville, who is being outspent, urged the crowd to ignore all of the television ads by his opponent, incumbent Senator Doug Jones (D).

Tuberville vowed to defend the Second Amendment if elected, “They ain’t getting my guns….or your guns.”

“We need to get God back in our schools and teach values again,” Tuberville stated. “The other side does not talk about values and morals.”

We are not going to allow them to tear down our country,” Tuberville said. “God will not allow them.”

“We are going to get God back in our country like it is supposed to be,” Tuberville said.

Coach Tuberville was introduced to the crowd by State Senator Clay Scofield (R-Guntersville).

Scofield said that he “is ready to send Doug Jones back to California.”

“Yes I know he is actually from here; but he sure votes like California. He certainly doesn’t vote like the vast majority of the people of Alabama want him to vote.”

Scofield called Tuberville is “A fighter” who will stand up for the values of the people of Alabama.

Congressman Mo Brooks (R-Huntsville) said, “This is the most important election of my lifetime.”

“Do we believe in freedom and liberty or do we believe in socialism?” Brooks said. “We need to beat them like a drum.”

The general election is on Tuesday. You must bring a valid photo ID with you to your assigned polling place in order to participate.

Secretary of State John H. Merrill predicted that the state would have record participation on Tuesday.

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