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Alabama Medicaid Expansion: A Healthcare Provider’s Alternative Perspective

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By Senator William M. “Billy”  Beasley (D-Clayton)

As a rural pharmacist who runs a small business, I am a part of the healthcare delivery system. I dispense prescriptions to people in all walks of life, race, creed and colors. I serve those covered under Medicare, Medicaid and private insurance. I know what people go through to make sure they have the drugs they need. Many of them juggle payments for bills and food for their families with paying for the drugs and procedures they need. The expansion of Medicaid in our state would mostly cover those who work hard and pay their taxes, but are not provided insurance through their jobs, and cannot afford to buy single policy coverage. Please do not trick yourself into thinking that everyone comes from the same background and circumstances as you do.

It is time for straight talk about political implications hurting the people of the state of Alabama. I am referring to the recent decision by Gov. Bentley to not accept the federal funding to expand Medicaid under the Patient Protection and Affordable Care Act – colloquially known as “Obamacare.”

The reason for government is to help those caught in the web of circumstances beyond their control. While the PPACA’s main thrust is cost control, and to prevent people from being punished for things beyond their control – being a woman, or having a pre-existing condition – it is also an economic boon to states which have not seen budget shortfalls like this since The Great Depression.

In a study conducted by The University of Alabama Birmingham School of Public Health David Becker and Michael Morrisey, both healthcare economists say the state could see a $1 Billion boon in new tax revenue.

Under the federal law, dubbed Obamacare, the federal government will cover 100 percent of health care expenditures from 2014 through 2016. During these first years of the program, Alabama would be responsible for a share of the administrative costs of the expansion. The federal matching rate declines after 2016, falling to gradually to 90 percent in 2020. As a result, the annual costs to the state increase from $39 million in 2014 to $222 million in 2020 for a total over the years of $771 million.

The federal expenditure during that time would be an additional $11.7 billion more on Medicaid in the state.

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“While this is a substantial increase in federal spending, it is new income flowing into Alabama,” Becker said, in the UAB press release. “Moreover, when physicians, hospital employees, pharmacists and other employees in the health care sector receive these new dollars, they spend them on gasoline and groceries and clothes. This second-round spending generates additional economic activity.”

Read that last part again. The federal government will give us $11.7 Billion while the state’s share is $771 million. Just the increased economic activity will bring in $1 billion in taxes. They say there’s no such thing as a free lunch, and while we all pay federal income taxes, we should also all get something back from it. I hear Republicans whine every day about federal funding for studies to protect horned frogs, or for National Public Radio.  Here is a chance for federal money to make a direct impact on the health and welfare of our citizens while injecting money into our economy, and we’re turning it down?

After riding a wave of discontent and fear resulting from the drawn out debate and fear-mongering over what is contained in the PPACA/”Obamacare” legislation, my esteemed Republican colleagues hold all levers of governance in our state and make moves in lockstep to stifle dissenting voices and ideas.

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They also seek to curry favor with the Tea Party – a group of nihilist know-nothings who will not be satisfied until our entire system of governance is burned down, and all incumbents are removed from office. To let the decisions of our state and the impact on our economy be affected by such a group is insanity bordering on criminality.

I believe in my heart that Robert Bentley is a good man. We served together in the state House of Representatives for 8 years before I moved up to the Senate, and he became our Governor. He is also a medical doctor bound by the strictures of The Hippocratic Oath. It would seem to me that he would want to expand coverage to all of our states’ citizens if doing so was economically feasible. So either the decision is raw political calculation – The Governor doesn’t want a Tea Party challenger to his re-election campaign in 2014, hard-heartedness, or incompetence.

At the recent hearings on fixing Medicaid, it was revealed that in addition to an unknown $80 million hole in the Medicaid Budget during FY 2013, the State Medicaid Agency has said they do not have the infrastructure in place to accept the money, or to disburse it to the people who would be covered. A state agency not tracking it’s budget and unable to perform the service for which it was created should be a major scandal – but it seems no one wants to upset the Republicans’ apple cart.

In September, the leadership of the Senate, House and the Governor put forth an Amendment to allow the citizens to vote on transferring $437M from the Alabama Oil and Gas Trust Fund – a fund established to keep the state’s money from Oil and Gas deposits in the Gulf of Mexico. The purpose of this amendment was to shore up the budgets of Medicaid and Corrections. The citizens passed this Amendment, and I campaigned for it and personally voted for it. It is the right thing to do to shore up our state Medicaid funds, especially considering Alabama has the least amount of Medicaid coverage allowable by law. It seems to me that some of that money could go toward fixing the infrastructure needed to accept this vital money.

As a small town pharmacist and independent businessman, I see every day that healthcare affects all aspects of Alabama life. It affects every citizen, every region, and every county, city and town. Giving working people basic health care coverage while pumping money all across our state at a 90% Federal-10% state match is a no brainer. I hope those with their hands on the levers of power have a change of heart.

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Opinion | Former Sen. Brewbaker supports Montgomery tax referendum 

If we want Montgomery to change for the better, we are all going to have to start living in our community rather than off of it.

Dick L. Brewbaker

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(STOCK PHOTO)

I am in full support of the property tax referendum on the ballot this November. That may surprise some people because I have been critical of the performance of the Montgomery County Public School System in the past.

Until recently, student performance has generally been poor, financial management has been historically problematic, and there have been real and persistent problems with transparency. New Board leadership has worked hard to address these issues in a real way, but there is still work to be done.

However, whether we are talking about cars or public education, there is such a thing as trying to buy too cheap. Montgomery has been paying the legal minimum in property tax support for decades. It shouldn’t come as a huge surprise to anyone that our schools’ quality reflects our financial commitment to them.

Yes, it’s true that more money isn’t always the answer, but it’s also true that money is part of the answer. Sometimes the bare minimum isn’t enough, and this is one of those times.

Most people who vote on this referendum will not have children currently attending MPS. If you are one of those people, vote yes anyway.

Our public school population is declining because many young couples with children are leaving our city because they know their children can get a better education elsewhere.

This loss of young parents will eventually kill this city. We have got to turn the schools around before Montgomery’s tax base is eroded beyond repair. Whether you have kids in the system or not, if you care about your local tax burden or the value of your property, it’s time to vote ‘yes.’

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Need another reason to vote yes? Ok, here’s one:  Montgomery will eventually lose both our USAF bases if we don’t show the Air Force we are serious about improving our failing schools. Already less than half of the airmen stationed in Montgomery bring their families with them.

Many military families view MPS as so low quality that they won’t subject their children to them. If we don’t fix our schools, sooner or later we will lose Maxwell and Gunter. If you don’t believe that would be an economic nightmare for our city, ask around.

At the end of the day, passing this referendum is not only a vote to help children succeed, but also a vote to save the city in which we all live. It’s ok to be hopeful, it’s ok to be optimistic even about the future of Montgomery and its schools.

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If we want Montgomery to change for the better, we are all going to have to start living in our community rather than off of it.

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Opinion | FEMA’s Hurricane Sally response

So, how has FEMA performed in responding to Hurricane Sally? So far, pretty darn well.

Bradley Byrne

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Gov. Kay Ivey took a tour of the damage from Hurricane Sally on the gulf coast Friday September 18, 2020. (Governor's Office/Hal Yeager)

Most people in Alabama have heard of FEMA, the Federal Emergency Management Administration. Its name is a little misleading because emergencies by their nature aren’t so much managed as responded to, often after the fact. You can’t manage a tornado or an earthquake, for example, but you can and should respond to it.

Hurricanes are facts of life down here and nearly every part of our state, not just the coast, have been affected in some way by at least one. We can prepare for hurricanes and guard against the worst consequences and that starts with each of us as individuals, family members and citizens doing our part to be prepared to protect and take care of ourselves, family members and neighbors. Alabamians are actually pretty good at doing that.

But, there is also a role for governments at all levels. Local governments actually play the most important public role because they are closest to the people of their areas and have the first responders already employed and trained to take care of the needs of local residents during the period running up to, during, and in the immediate aftermath of the storm. State governments manage the preparations before the storm and provide the support local governments need afterward to do their jobs. The federal government supports the state and local efforts, which typically means providing the lion’s share of the money needed, anywhere from 75 percent to 90 percent of the costs. So there’s not one emergency management agency involved in responding to hurricanes but three, corresponding to each level of government.

The day before Hurricane Sally hit, I was individually briefed by the Director of the National Hurricane Center Ken Graham, FEMA Administrator Pete Gaynor and Coast Guard officials. That same day I went to the White House and made sure we had a good line of communication in case we needed help, which looked likely at the time. I have to say, the White House was immediately responsive and has continued to be so.

How has FEMA handled the federal response to Hurricane Sally? When the state of Alabama requested a pre-storm disaster declaration, which triggers federal financial support for preparations and response during the storm, FEMA and the White House gave the okay in just a few hours. On that day before when I spoke with the White House, I asked them to send FEMA Administrator Gaynor to my district as soon as possible once the storm cleared to see the damage and meet with local officials. He came three days after the storm and spent several hours touring the damage with me and meeting with local leaders. When the state of Alabama requested a post-storm declaration, triggering federal financial support for public and individual assistance, FEMA and the White House responded affirmatively in less than 48 hours – record time.

Public assistance is federal financial support for the costs to state and local governments as a result of a storm. This includes water bottles and meals ready to eat for locally requested points of distribution, debris removal and cleanup costs (think of the large tandem trucks picking up debris piled up on the right of way), as well as the costs to repair damage to public buildings and infrastructure like roads and bridges, and in the case of Sally damage to the Port of Mobile.

Individual assistance, as the label states, goes to individuals affected by the storm. Private assistance won’t pay something you have insurance for, but it does pay for a variety of losses, particularly having to do with an individual’s home. So far 60,000 Alabamans have applied for individual assistance and already FEMA has approved $42 million. If you haven’t applied for individual assistance there’s still time for you to do so online at DisasterAssistance.gov, or if you need help in applying call FEMA’s Helpline at 1-800-621-3362. If you have applied for individual assistance and have been denied, appeal the decision because frequently the denial is simply because the applicant didn’t include all the needed information.

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Many people were flooded by Sally and over 3,000 of them have made claims to the National Flood Insurance Program. Over $16 million has already been paid out on those claims. The Small Business Administration has approved over a thousand home loans to people with storm losses, totaling over $40 million, and many more loan applications are still pending.

So, how has FEMA performed in responding to Hurricane Sally? So far, pretty darn well. I want to thank FEMA Administrator Gaynor for coming down here so quickly after the storm and for FEMA’s quick and positive responses to all our requests. And I want to thank President Trump for his concern and quick response to Alabama’s requests for disaster declarations. Hurricane Sally was a brutal experience for us in Alabama, but FEMA’s response shows that government can do good things, helping people and communities when they really need it.

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Opinion | An inspirational pick

Many progressives, it seems, claim to believe in the power of women, but only for women who think and talk like they do.

Govs. Kay Ivey, Kristi Noem and Kim Reynolds

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President Donald Trump, left, and his Supreme Court nominee, Judge Amy Coney Barrett. (WHITE HOUSE PHOTO)

A century ago, the Suffragettes finally succeeded in winning the right to vote for women. They would be thrilled to see the nomination of a woman so uniquely qualified to serve on the U.S. Supreme Court as Judge Amy Coney Barrett, were they alive today. It’s easy to imagine them storming the streets of America and urging that Judge Barrett be confirmed, and by a wide margin.

After all, the four female justices nominated before her were confirmed with lopsided votes by the U.S. Senate: 99-0 for Justice Sandra Day O’Connor, 68-31 for Justice Sonia Sotomayor, 63-37 for Justice Elena Kagan and 96-3 for the late Justice Ruth Bader Ginsburg.

Sadly, it speaks to the times in which we are living that Judge Barrett’s vote by the Senate will most likely come down to a tight vote, with nearly every Democrat opposing her nomination.

As governors who are either the first or second females to be elected in our respective states, we are rightfully proud to see diversity expand among the highest levels of government. Notably, however, our support for Judge Barrett hinges not on her being a female, but rather her superior intellect, unflappable composure and impeccable integrity, all which combine to make her eminently qualified in every way. 

Regretfully, we know – as do many others – that the climb for women into the upper echelon of American leadership has always been a bit steeper. After all, when was the last time a man’s haircut, the color of his tie or suit or the number of children in his family were scrutinized as part of the public discourse?

It is bittersweet that Judge Barrett followed her father’s advice that she could do anything her male counterparts could do, only better, and yet, sadly, millions of women appear to oppose her nomination simply because she interprets the law as-written, rather than siding with them on every issue. Is this the new standard for qualification?  

Many progressives, it seems, claim to believe in the power of women, but only for women who think and talk like they do.

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We applaud President Trump for choosing Judge Amy Coney Barrett for service on our nation’s highest court; she may well be one of the most qualified, extraordinary picks during the past century, and we urge the United States Senate to confirm her nomination in short order.

We especially like the direct answers Judge Barrett provided to two of the Senate Judiciary Committee members who questioned her last week. 

When Sen. Chris Coons, D-Delaware, suggested that Judge Barrett would vote in the same manner as the late Justice Antonin Scalia, a conservative for whom she had clerked earlier in her career, she calmly responded, “I assure you I have my own mind.” 

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And when the Committee’s ranking Democrat, Sen. Dianne Feinstein, D-California, asked her whether she believed that Medicare was unconstitutional, she cited the “Ginsburg Rule,” so named for the late justice she will be following, of providing “no hints, no previews, no forecasts.”

Perhaps one of the most powerful witnesses to speak in support of Judge Barrett was her former law student at Notre Dame, Laura Wolk. 

Ms. Wolk is totally blind, but before pursuing the “impossible dream” of becoming the first blind law clerk at the Supreme Court last year, she was struggling with her classwork as a first-year law student, fearful of failing. 

Laura recalled, “Judge Barrett leaned forward and looked at me intently. ‘Laura,’ she said, with the same measured conviction that we have seen displayed throughout her entire nomination process, ‘this is no longer your problem. It’s my problem.’”

Ms. Wolk went on to say that Judge Barrett helped her see a pathway to success.  She said the Judge will “serve this country with distinction not only because of her intellectual prowess, but also because of her compassionate heart and her years of treating others as equals deserving of complete respect.”

When Judge Barrett raises her right hand to take the oath to “administer justice without respect to persons” and to “support and defend the Constitution of the United States,” it will be a win-win for every female – young and old alike during the past 100 years – who has dreamed of seeing women advance to the top positions of our government. 

Moreover, it will be a signal to every little girl – and boy – that the most qualified individual will get the job.

Governors Kay Ivey of Alabama, Kristi Noem of South Dakota and Kim Reynolds of Iowa authored this column.

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Opinion | Hearings give public opportunity to weigh in on coal ash plans

ADEM will make sure the closure and cleanup of the coal ash sites will be done in a way that will protect the state’s land and water resources now and in the future.

Lance LeFleur

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The mission of the Alabama Department of Environmental Management is to ensure for all Alabamians “a safe, healthful and productive environment.” It’s a mission that ADEM and its nearly 600 employees take very seriously.

Ensuring a safe, healthful and productive environment means more than simply being the environmental cop, though that certainly is part of ADEM’s job. When the Alabama Legislature passed legislation in 1982 that led to the creation of ADEM, lawmakers’ intent was for the agency to promote public health and well-being.

The term “healthful” in ADEM’s mission statement speaks directly to that. ADEM’s work is to contribute to the health of Alabama’s environment and the health of all Alabamians.

An example of that work is managing the process that will determine how coal combustion residuals (CCR) – or coal ash – are dealt with in a safe and effective manner. Managing CCR promotes a healthful environment by protecting our land and water.

On Oct. 20, ADEM will hold the first of a series of public hearings on permits drafted by ADEM to require electric utilities to safely close unlined coal ash ponds at their power plants and remediate any contaminated groundwater. The hearings, and the comment periods leading up to them, give the public the chance to provide ADEM input on the requirements in the draft permits.

To understand how we got to this point today, let’s go back to Dec. 22, 2008, in Kingston, Tenn. On that frigid night, the containment dike surrounding massive ponds holding decades worth of CCR produced by the coal-burning TVA power plant collapsed, spilling more than a billion gallons of coal ash sludge into the Emory River and onto 300 acres of land.

That spill drew the attention of regulators and the nation to the issue of coal ash storage, for which there was little regulation at the time. It also started the U.S. Environmental Protection Agency on the road to adopting a federal CCR rule, which took effect in 2015. The Alabama Environmental Management Commission approved a state CCR rule in 2018, patterned after the EPA rule.

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The rules address two primary issues: closing coal ash ponds to avoid threats of spills into waterways or onto land, and preventing and cleaning up groundwater contamination from arsenic, mercury, lead and other hazardous elements that may leach from the coal ash.

Both the EPA and state rules give the electric utility operators two options in closing the ash ponds. One allowable method is to excavate the millions of tons of coal ash and either move the coal ash to a lined landfill or find an approved beneficial use for the ash. The other is to cap in place, where an impervious cover, or cap, is placed over the ash impoundment. Both methods have been used successfully for decades to close some of the most contaminated sites in the nation.

It must be emphasized that the closure method selection is made by the utilities, as allowed by both federal and state rules. Alabama Power, TVA and PowerSouth all elected to utilize the cap-in-place option.

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The permits will also set out the steps to be taken to clean up contaminated groundwater caused by the coal ash ponds. ADEM’s job, in its environmental oversight role, is to ensure the closure and groundwater remediation plans proposed by the utilities and included in the permits meet federal and state standards and protect both waterways and groundwater. The permits provide for regular monitoring to confirm the closure and cleanup plans are being implemented as required. If necessary, the plans will be adjusted to ensure the intended results are being achieved.

Currently, ADEM has scheduled public hearings on the permits for three Alabama Power plants. The first is Oct. 20 for Plant Miller in Jefferson County, followed by Oct. 22 for Plant Greene County and Oct. 29 for Plant Gadsden in Etowah County. Permits for the other five sites in Alabama are in development, and hearings will be scheduled when they are complete.

The purpose of these hearings is to allow the public, including nearby residents, environmental groups and others, opportunities to weigh in on the proposed permits. This past summer, Alabama Power, TVA and PowerSouth held informational meetings in the communities where their affected plants are located to explain their proposed groundwater cleanup plans(including the CCR unit closure component) and answer residents’ questions.

The draft permits, the hearings’ dates, locations and times and other information are available on ADEM’s website, www.adem.alabama.gov. The public can also mail or email comments related to the permits, including the closure plans and groundwater remediation plans, directly to ADEM during the proposed permits’ 35-day minimum comment periods, which will run one week past the date of the public hearings. Those comments will be considered in the decisions to issue the permits, and ADEM will provide a response to each issue raised.

For maximum protection of the environment, ADEM encouraged the power companies to go beyond the minimum requirements of the state and federal CCR rules. ADEM’s scientists and engineers who analyzed the plans through an exhaustive review and revision process determined the final plans provide the environmental protections Alabamians expect and deserve. But we want to hear from the public.

Certainly, there are pros and cons of each option in closing the coal ash ponds. The daunting task of cleaning up contaminated groundwater will be undertaken regardless of which closure method is utilized. As one opinion writer recently said, there is no easy answer to the coal ash problem. But this is a matter we cannot duck. We must deal with our coal combustion residuals – by EPA requirement and for the sake of our environment.

Here’s what you can count on from your state agency charged with protecting your environment. ADEM will make sure the closure and cleanup of the coal ash sites will be done in a way that will protect the state’s land and water resources now and in the future.

Ensuring that is our mission.

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