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Alabamians wonder what happens after Obamacare is repealed

Chip Brownlee | The Trace

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Chip Brownlee
Alabama Political Reporter

OPELIKA — In Opelika, Alabama, there is a small office, tucked away on the second floor of a law practice along the small town’s main street. There’s no sign on the front door indicating its placement, and most wouldn’t know it’s there.

The office belongs to Hannah Duncan, a recent graduate of Auburn University who works as a health care navigator for EnrollAlabama, an organization that helps sign low- and middle-income Alabamians up for health insurance coverage through the federal health insurance exchange set up by President Barack Obama’s 2010 health care law.

Most people probably think of it as “Obamacare.”

Since she began working for EnrollAlabama, Duncan has helped dozens of people sign up for bronze, silver and gold health care plans provided on the exchange by Blue Cross and Blue Shield of Alabama. Many of those people had cancer and chronic pain, what are known as pre-existing conditions, and would have been discriminated against with higher premiums or no coverage at all before the ACA’s implementation in 2011.

One couple with cancer came to EnrollAlabama’s Opelika office for help signing up. Their household had been paying high premiums with plans that still left them without what they needed. Large deductibles, many doctors visits, lab work, imaging and the treatment needed for the cancer diagnosis left the family in distress.

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Through the health care marketplace, Duncan found the couple a better health insurance plan for a lower price thanks to a lower premium and the family’s eligibility for a cost-sharing reduction subsidy. It covered lab work, diagnostic imaging and had good copays, which were absent in their previous plan.

The plan through the marketplace, Duncan said, allowed the family to begin treating their cancer without going bankrupt. And they weren’t the only two people in Alabama who have gained coverage under Obama’s health care law. Since 2010, 215,000 more people got health insurance in Alabama, which pushed the State’s uninsured rate down 4.5 percentage points from 14.6 percent in 2010 to 10.1 percent in 2015.

“It doesn’t even have to be that dramatic,” Duncan said. “Even the people who come to me after just having found out that this is an option for them are important.”

165,534 people in Alabama got their coverage through the Federal exchange.

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Not everything is sunny in Alabama

But even with higher insured rates and better plans even for people who still get their insurance through an employer, not everyone is happy with the health care law — or the price they pay for their health insurance.

And not everything went as according to plan with the implementation of the law, either. In 2012, the Supreme Court punched a hole in Obama’s signature law by allowing states to opt-out of Medicaid Expansion. The expansion was intended to cover individuals who didn’t previously qualify for Medicaid but wouldn’t make enough to qualify for marketplace subsidies.

Despite a lower average increase in premiums from 2010–2015 than the decade before, a lack of competition, a lack of rate-plan choices and increasing premiums for some Obamacare plans in Alabama still have many wondering if the Affordable Care Act is really that affordable.

In 2016, Blue Cross and Blue Shield of Alabama announced a 36 percent hike in premiums for some Silver rate plans on the Federal exchange. The year before BCBS increased prices for some plans more than 20 percent.

Humana and UnitedHealth, two other insurance companies who previously offered select plans in some counties in Alabama, announced last year that they would be pulling out of the Alabama health care exchange, leaving BCBS — a company facing a class-action lawsuit over anticompetitive conduct — as the sole provider.

For years, the State, which has long been dominated by BCBS, has been ranked by the American Medical Association as having the least competitive health insurance market in the US.

Problems and solutions, maybe

One of the main rallying cries from politicians on the right over the past eight years was a call to repeal the law. The US House, which came under Republican control in the 2010 mid-term elections, has voted more than 60 times to repeal, tweak or revamp the law. Dissatisfaction with the law reached a fever pitch during the 2016 president election as then-candidate Donald Trump promised to repeal what he called a “disaster.”

With the President-elect’s inauguration on the steps of the US Capitol Friday, the likelihood of an Obamacare repeal, or at least a revamp, is imminent. But what comes next has many in Alabama, including some on the right, anxious.

Trump has promised to repeal the law but keep many of its most popular provisions, including allowing young adults to stay on their parents’ plans until age 26 and protecting those with pre-existing conditions.

Last week, Trump took it one step further, advocating “insurance for everybody.” It’s hard to hammer down exactly what Trump’s plan is for health insurance, but it’s unlikely that a Republican congress would support any type of universal coverage — making a full or partial repeal far more likely.

On Thursday, Gov. Robert Bentley sent a letter to U.S. House Majority Leader Kevin McCarthy outlining his suggested changes for the Affordable Care Act. In the letter, he asked for more “patient-oriented solutions” and latitude for the states if changes are made to Medicaid funding. But even Bentley seemed concerned about a swift repeal with no replacement, which could cause up to 200,000 Alabamians to lose health coverage.

“Consumer choice also is vital,” Bentley said. “Repealing the Affordable Care Act without a clear replacement could raise concerns among insurers nationwide and cause some to withdraw from the market, limiting consumer choice.”

Duncan, who is finishing up a busy season of the ACA’s open-enrollment period, has hope that legislators may improve the law instead of scrapping health care for millions of people outright.

“My outlook is positive because that’s who I am as a person,” Duncan said. “I don’t want to jump to conclusions before I have full details. My hope is that our representatives and our government will take into account the number of people this has helped and the number of people this will affect if it is to be repealed.”

Several Republican lawmakers have outlined plans that would provide a replacement for the Affordable Care Act if it were to be repealed including Rep. Tom Price, R-Ga., who is Trump’s pick for health secretary. His plan would offer tax credits for health coverage, instead of direct subsidies and a federal exchange, and would encourage health savings accounts.

Sen. Susan Collins, R-Maine, has rejected the idea of repealing Obamacare without any replacement and instead has supported her own plan that would keep many of the popular provisions and repeal other unpopular provisions like the individual and employer mandate.

“My concern with the repeal and delay plan is that the Obamacare exchanges, already on very shaky financial grounds, would go into a death spiral, as consumers would face uncertainty and insurers would have no basis for pricing their policies,” Collins said on the floor of the Senate.

All of Alabama’s congression delegation, save Alabama’s sole Democrat Rep. Terri Sewell, support repealing Obamacare. Duncan, and others who fear many may lose their coverage, hope legislators consider the gains made under the health care law.

“It has absolutely helped people who didn’t have access to the kind of insurance that, for instance, I was used to growing up because both of my parents were employed,” Duncan said. “It was an eye-opening experience for me starting out because the number of people who had not had access to proper health care was just mindblowing to me. Regardless of how much experience you’ve had, you’re always näive to certain situations.”

No Medicaid expansion in the Yellowhammer State

No singular surrounding the health care law has been more heated here in Alabama than the debate over whether the State should expand its Medicaid coverage as initially prescribed by the law.

Lee County, the home of Auburn University and its surrounding technological hub, boasts per capita average incomes and median incomes higher than the Alabama average and lower unemployment rates, but many people still live in poverty.

Twenty-one percent of Lee County residents, more than 1-in-5 people, live at or below the poverty line, according to the U.S. Census Bureau. That rate is higher than the Statewide poverty rate of 18.5 percent and much higher than the nationwide rate of 13.5 percent.

Medicaid Commissioner Stephanie Azar and Gov. Robert Bentley discuss RCO implementation at the State Capitol.

Medicaid Commissioner Stephanie Azar and Gov. Robert Bentley discuss RCO implementation at the State Capitol.

In Duncan’s Lee County coverage area, there are also many people still without health insurance. More than 13.4 percent of people are uninsured, as compared to the State’s uninsured rate of 10.1 percent and the nationwide uninsured rate of 10.5 percent.

Many of the 10 percent who still don’t have insurance are low-income individuals who “fall through the cracks” because of the State’s choice not to expand Medicaid. Here, it’s hard to qualify for Medicaid: You have to be elderly, disabled, pregnant, taking care of an elderly parent or raising children.

Many low-income families who make too much and all childless adults, no matter how poor, don’t qualify for Medicaid, but they also don’t make enough money to qualify for the ACA’s subsidies, either, leaving more than 139,000 Alabamians without any affordable options for health care.

Bentley and others have said that the State, which already faces near-annual crises over its beleaguered General Fund, can’t afford to pay for the 300,000–400,000 new enrollees who could get Medicaid coverage if the State expanded it, even with funding from the Federal government.

The Federal government would have paid the full cost of the expansion from 2013–2017. From 2017–2020, the Federal funding would have gradually taper to just above 90 percent funding for the cost of the expansion. The State would have been responsible for 10 percent of the expansion after 2020.

Just last year, the Legislature had to resort to using money from a settlement with BP Oil over the 2011 Deepwater Horizon Oilspill to balance an $84 million shortfall in the State Medicaid budget.

In Bentley’s letter to U.S. House Republican leadership, he requested any Obamacare replacement plan include provisions that would allow states to reduce Medicaid benefits and enrollment, to impose premiums on low-income beneficiaries or reduce Medicaid spending in other ways to match any Federal cuts.

Duncan bemoaned the State’s decision to opt-out of the expansion.

“People hear great things from their friends and family members about this low premium, and sometimes they don’t understand why they can’t benefit,” Duncan said. “It seems so obvious sometimes that we could be helping more people.”

Chip Brownlee is a former political reporter, online content manager and webmaster at the Alabama Political Reporter. He is now a reporter at The Trace, a non-profit newsroom covering guns in America.

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Tuberville calls for term limits, balanced budget and lobbying reform

Tuberville has also made a major media buy across the state to trumpet this message.

Brandon Moseley

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Republican Senate candidate Tommy Tuberville (TUBERVILLE CAMPAIGN)

Senate candidate Tommy Tuberville’s campaign began emphasizing key structural reforms that the Republican nominee hopes to advance if elected to the U.S. Senate including congressional term limits, withholding lawmakers’ paychecks unless a balanced budget is passed and a ban on former officials becoming lobbyists.

“Only an outsider like me can help President Trump drain the Swamp, and any of the proposals outlined in this ad will begin the process of pulling the plug,” Tuberville said in a statement. “Doug Jones has had his chance, and he failed our state, so now it’s time to elect a senator who will work to fundamentally change the way that Washington operates.”

Tuberville has also made a major media buy across the state to trumpet this message.

“You know Washington politicians could learn a lot from the folks in small town Alabama, but Doug Jones … he’s too liberal to teach them,” Tuberville added.

Polls consistently show that term limits are popular with people across both political parties, but the U.S. Supreme Court has ruled that imposing term limits would be adding a qualification to be a member of Congress and that can only be done by constitutional amendment.

It is an unspoken truth that when Americans send someone to Congress they never come back. They either keep getting re-elected like Alabama’s own Sen. Richard Shelby, who is in his sixth term in the Senate after four terms in the U.S. House of Representatives. On the other hand, they may become lobbyists getting paid to influence their colleagues on behalf of corporations, foreign governments or some well funded non-government organization.

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Tuberville said he would ban that practice.

A balanced budget amendment almost passed in the 1980s and again in the 1990s.

Since that failure, Congress has increasingly passed bigger and bigger budget deficits. The U.S. government borrowed more money during the eight years of President George W. Bush’s presidency than the government had borrowed in the first 224 years of the country combined.

President Barack Obama followed and the TARP program propped up the post-Great Recession economy. Rather than cutting the deficit, President Donald Trump invested billions in the military and a tax cut without cutting domestic spending. The 2020 coronavirus crisis has further grown the budget.

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The government has borrowed trillions to prop up the economy and provide stimulus while investing billions into medical research and treating the virus victims. Congress is currently debating a fifth stimulus package that would add more to the deficit.

Both a balanced budget amendment and a term limits amendment would have to be ratified by the states if passed by Congress. Tuberville is challenging incumbent Sen. Doug Jones, D-Alabama.

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House passes General Fund Budget

Brandon Moseley

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By Brandon Moseley
Alabama Political Reporter

The Alabama House of Representatives passed the state General Fund Budget on Tuesday.

The General Fund Budget for the 2019 fiscal year is Senate Bill 178. It is sponsored by Sen. Trip Pittman, R-Montrose. State Rep. Steve Clouse, R-Ozark, carried the budget on the House floor. Clouse chairs the House Ways and Means General Fund Committee.

Clouse said, “Last year we monetized the BP settlement money and held over $97 million to this year.”

Clouse said that the state is still trying to come up with a solution to the federal lawsuit over the state prisons. The Governor’s Office has made some progress after she took over from Gov. Robert Bentley. The supplemental we just passed added $30 million to prisons.

The budget adds $50 million to the Department of Corrections.

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Clouse said that the budget increased the money for prisons by $55,680,000 and includes $4.8 million to buy the privately-owned prison facility in Perry County.

Clouse said that the budget raises funding for the judicial system and raises the appropriation for the Forensic Sciences to $11.7 million.

The House passed a committee substitute so the Senate is either going to have to concur with the changes made by the House or a conference committee will have to be appointed. Clouse told reporters that he hoped that it did not have to go to conference.

Clouse said that the budget had added $860,000 to hire more Juvenile Probation Officers. After talking to officials with the court system that was cut in half in the amendment. The amendment also includes some wording the arbiters in the court lawsuit think we need.

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The state General Fund Budget, SB178, passed 98-1.

Both budgets have now passed the Alabama House of Representatives.

The 2019 fiscal year begins on Oct. 1, 2018.

In addition to the SGF, the House also passed a supplemental appropriation for the current 2018 budget year. SB175 is also sponsored by Pittman and was carried by Clouse on the floor of the House.

SB175 includes $30 million in additional 2018 money for the Department of Corrections. The Departmental Emergency Fund, the Examiners of Public Accounts, the Insurance Department and Forensic Sciences received additional money.

Clouse said, “We knew dealing with the federal lawsuit was going to be expensive. We are adding $80 million to the Department of Corrections.”

State Representative Johnny Mack Morrow, R-Red Bay, said that state Department of Forensics was cut from $14 million to $9 million. “Why are we adding money for DA and courts if we don’t have money for forensics to provide evidence? if there is any agency in law enforcement or the court system that should be funded it is Forensics.”

The supplemental 2018 appropriation passed 80 to 1.

The House also passed SB203. It was sponsored by Pittman and was carried in the House by State Rep. Ken Johnson, R-Moulton. It raises securities and registration fees for agents and investment advisors. It increases the filing fees for certain management investment companies. Johnson said that those fees had not been adjusted since 2009.

The House also passed SB176, which is an annual appropriation for the Coalition Against Domestic Violence. The bill requires that the agency have an operations plan, audited financial statement, and quarterly and end of year reports. SB176 is sponsored by Pittman and was carried on the House floor by State Rep. Elaine Beech, D-Chatham.

The House passed Senate Bill 185 which gives state employees a cost of living increase in the 2019 budget beginning on October 1. It was sponsored by Sen. Clyde Chambliss, R-Prattville and was being carried on the House floor by state Rep. Dimitri Polizos, R-Montgomery.

Polizos said that this was the first raise for non-education state employees in nine years. It is a 3 percent raise.

SB185 passed 101-0.

Senate Bill 215 gives retired state employees a one time bonus check. SB215 is sponsored by Senator Gerald Dial, R-Lineville, and was carried on the House floor by state Rep. Kerry Rich, R-Guntersville.

Rich said that retired employees will get a bonus $1  for every month that they worked for the state. For employees who retired with 25 years of service that will be a $300 one time bonus. A 20-year retiree would get $240 and a 35-year employee would get $420.

SB215 passed the House 87-0.

The House passed Senate Bill 231, which is the appropriation bill increase amount to the Emergency Forest Fire and Insect and Disease Fund. SB231 is sponsored by Sen. Steve Livingston, R-Scottsboro, and was carried on the House floor by state Rep. Kyle South, R-Fayette.

State Rep. Elaine Beech, D-Chathom, said, “Thank you for bringing this bill my district is full of trees and you never know when a forest fire will hit.

SB231 passed 87-2.

The state of Alabama is unique among the states in that most of the money is earmarked for specific purposes allowing the Legislature little year-to-year flexibility in moving funds around.

The SGF includes appropriations for the Alabama Medicaid Agency, the courts, the Alabama Law Enforcement Agency, the Alabama Department of Corrections, mental health, and most state agencies that are no education related. The Alabama Department of Transportation gets their funding mostly from state fuel taxes.

The Legislature also gives ALEA a portion of the gas taxes. K-12 education, the two year college system, and all the universities get their state support from the education trust fund (ETF) budget. There are also billions of dollars in revenue that are earmarked for a variety of purposes that does not show up in the SGF or ETF budgets.

Examples of that include the Public Service Commission, which collects utility taxes from the industries that it regulates. The PSC is supported entirely by its own revenue streams and contributes $13 million to the SGF. The Secretary of State’s Office is entirely funded by its corporate filing and other fees and gets no SGF appropriation.

Clouse warned reporters that part of the reason this budget had so much money was due to the BP oil spill settlement that provided money for the 2018 budget and $97 million for the 2019 budget. Clouse said they elected to make a $13 million repayment to the Alabama Trust fund that was not due until 2020 but that is all that was held over for 2020.

Clouse predicted that the Legislature will have to make some hard decisions about revenue in next year’s session.

 

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Day Care bill delayed for second time on Senate floor, may be back Thursday

Sam Mattison

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By Samuel Mattison
Alabama Political Reporter

The day care bill, which would license certain day care centers in Alabama, was once again delayed on the state Senate floor after one lawmaker requested more information.

Its brief appearance Tuesday ended with state Sen. Gerald Dial, R-Lineville, saying a compromise had not yet been worked out with the bill’s detractors.

Alabama’s Senate has been hesitant to act on the legislation because of complaints of state Sen. Shay Shelnutt, R-Trussville, who has been an opponent of the bill since its introduction last year. The bill’s delay on Tuesday marks the second time its been taken off the Senate’s agenda.

The bill has had a rocky time in this year’s session, but the bill’s sponsor state Rep. Pebblin Warren, D-Tuskegee, said she is still confident about its passage out of the Legislature.

Warren, D-Tuskegee, filed the bill this session with the support of influential lawmakers including Gov. Kay Ivey, who told reporters last year that she though all day cares should be licensed.

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Mainly sparked by the death of 5-year-old boy in the care of a unlicensed day care worker, the bill had great momentum coming into this year’ session.

Despite the growing support from lawmakers, Religious groups had concerns that the bill would increase state-sponsored reach into religious day cares in churches and non-profit groups.

Spearheading the dissenters was Alabama Citizens Action Program, a conservative religious-based PAC.

Warren, proponents, and ALCAP announced a compromise to the bill while it was still in the Alabama House.

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Announced by ALCAP originally, the new bill was a weaker version in that it did not require that all day cares in the state be regulated. Instead, religious-based day cares would only need to be registered if they received federal funds. At a Senate committee meeting in February, Warren said a similar requirement was about to come from federal law in Congress.

The bill moved through the House in a overwhelming vote in favor of the proposal and passed unanimously out of a Senate committee a few weeks ago.

Warren, speaking to reporters after its passage from the House, said she was unsure if the bill would encounter resistance in the upper chamber.

It was the Senate that killed the daycare bill last year amid a cramped last day where senators took the bill off the floor. The bill may face similar complications this year, as lawmakers seem to be preparing to adjourn within a few weeks.

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Fantasy sports bill fails on Senate floor

Sam Mattison

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By Samuel Mattison
Alabama Political Reporter

Would-be Fantasy Sports players in Alabama will have to wait to legally play in the state following a Senate vote on Tuesday.

The Alabama Senate decisively killed a bill to exempt fantasy sports from the state’s prohibition on gambling.

Not even entertaining a debate on the Senate floor, the proposal was killed during a vote for the Budget Isolation Resolution, which is usually a formality vote preluding a debate.

Fantasy sports are contests where participants select players from real teams to compete on fantasy teams using the real-world players’ stats.

Since 2016, the practice has been illegal in Alabama following a legal decision by the Attorney General’s Office that categorized it as gambling.

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The bill’s sponsor, state Sen. Paul Sanford, R-Huntsville, predicted the bill’s failure during a committee meeting two weeks ago, where the bill passed unanimously.

Sen. Paul Sanford speaks to reporters after a Senate Committee meeting on Feb. 28, 2018. (Samuel Mattison/APR)

Speaking to reporter’s after the committee meeting, Sanford said the decision to file the bill was mainly a philosophical belief that the practice shouldn’t be illegal.

Sanford, a fantasy sports player before its ban, said that fantasy sports are a way to bring people closer together and not a means to win money. The Huntsville senator is not seeking re-election.

The bill’s failure in the Senate follows its trajectory last year too. A similar version of the bill, also sponsored by Sanford, failed in the Senate during the final days of the 2017 Legislative Session.

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Since Sanford is retiring, it is unclear if the bill will even come back next session, or if it will even have a Senate sponsor.

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