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The closing of another rural hospital renews calls for Medicaid expansion

Chip Brownlee | The Trace

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The announcement that Butler County’s Georgiana Medical Center will close on March 31 of this year has renewed calls for the state to expand Medicaid.

Georgiana Medical Center will become the 13th Alabama hospital to close in eight years, the seventh rural hospital to close. Other rural hospitals that have closed include those in Florala and Elba.

“The rising costs of healthcare coupled with the cuts in reimbursement have made it impractical to maintain financial viability with two hospitals operating in Butler County,” Mike Bruce, CEO of the hospital’s parent company, Ivy Creek, told the Andalusia Star-News. “The partnering of the two organizations is the optimal way to continue to provide overall high-quality healthcare for the residents of Butler County, as well as the surrounding areas.”

Proponents of Medicaid expansion say it would significantly aid rural hospitals in paying their bills.

Rural hospitals across the country, but particularly those in non-expansion states like Alabama, are closing at an alarming rate, largely because an influx of money from more folk covered by Medicaid was intended to offset cuts to Medicare reimbursements built into the Affordable Care Act, President Barack Obama’s 2010 health care law.

With no offset there, hospitals have lost money.

Should Medicaid expansion be on the 2019 legislative agenda? Experts say it has to be

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Nearly 90 percent of the remaining rural hospitals in Alabama are bleeding money — operating at a loss and routinely cutting back on staff and services, according to the Alabama Hospital Association.

“Medicaid expansion is the one thing the state can do to prevent more hospital closures, loss of jobs, and cutbacks on services,” Danne Howard, the association’s chief policy officer, told APR in December.

The association plans to launch a renewed effort early this year to bring the discussion of Medicaid expansion back to the forefront ahead of the 2019 legislative session.

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Sen. Doug Jones, D-Alabama, echoed those calls.

“For years, our rural hospitals have been warning public officials about the financial cliff they faced in large part as a result of unfair Medicare reimbursement rates and the refusal to expand Medicaid in Alabama,” Jones said.

Beginning in 2014, the federal government would have financed 100 percent of the costs for those made newly eligible for Medicaid until 2016.

After that, the federal match phases down to 90 percent by 2020, where it will stay, meaning for every dollar the state spends on new enrollees, it would get $9 in return from the federal government.

“How many more rural health care providers need to close for meaningful action to be taken?” Jones said. “This should be a wake-up call — actually, another wake-up call.  We all have a responsibility to take action — to expand Medicaid, to fight for wage index reform, to find opportunities to lower the cost of health care — and to find common ground to best serve our communities.”

As legislators return to Montgomery in March, they’ll face more uncertainty.

Additional cuts to Disproportionate Share Hospital Payments — a payment mechanism that supports many hospitals with a disproportionate number of low-income, uninsured patients and uncompensated care — could go into effect on Oct. 1, 2019, when the fiscal year 2020 begins.

The bulk of those cuts have been routinely delayed by the Republican-controlled Congress since they were set to take effect in 2014 — mainly because it would negatively hit Republican, non-expansion states.

But with Democrats heading into a majority, it isn’t so certain that those cuts will be delayed again.

Cuts to DSH payments could cost Alabama hospitals between $70 million and $156 million. More than 75 percent of Alabama’s more than 100 hospitals receive DSH payments. Those cuts could severely impact both rural and urban hospitals that care for uninsured, low-income patients. Experts fear those cuts could spur a health care crisis that isn’t just confined to rural hospitals and the areas they serve.

Hospitals like those are barely operating in the black, and it wouldn’t take much to put them in the red.

“If the state has not expanded Medicaid in 2020, as the DSH cuts are scheduled to take effect, that will close a significant number of hospitals,” Howard said. “That will cripple. That will be the straw that the hospitals can’t survive.”

Some Republican lawmakers and officials have privately expressed concern about the DSH cuts. If they’re not delayed again this year, they said, it could force the state’s hand.

Rep. Terri Sewell, D-Alabama, introduced legislation last month to incentivize states to expand Medicaid. It would ensure that states who choose to expand Medicaid going forward get a similar federal match to those who chose to expand Medicaid earlier on.

Sewell’s legislation would allow states that expand Medicaid in the future to receive a 100 percent federal match for the first three years, 95 percent for the fourth year, 94 percent for the fifth year, 93 percent for the sixth year and 90 percent for each year thereafter.

“The writing is on the wall and the facts are clear: premiums and health care costs are higher in states that have not expanded Medicaid. And over 90 percent of rural hospital closures have been in states that did not expand Medicaid before the closure. In my state, approximately 314,000 more Alabamians would be covered under Medicaid expansion. Not doing so is a poor decision,” Sewell said. “And while I can’t force Alabama’s governor to expand Medicaid, I can continue to promote legislation that provides more incentives for her to do so.”

Senate President Pro Tem Del Marsh, R-Anniston, has said recently that expansion will not be on the agenda during this legislative session. He reiterated that statement in an interview with APR in December.

“Among the Republican leadership and Republican caucus, when discussions have been made, there has been no initiative, if you will, to expand Medicaid,” Marsh said. “In fact, the position has been to control the costs of Medicaid and to put pressure on the health care community to find ways to make it more efficient.”

But support for the program is spreading to more conservative areas across the country.

Voters in three deeply red states — Idaho, Nebraska and Utah — approved ballot initiatives in 2018 requiring their state to expand Medicaid, and three other states — Kansas, Wisconsin and Maine — elected Democratic governors who are likely to push for expansion.

Alabama is among fourteen states that haven’t expanded the insurance program for low-income residents. The state’s neighbor to the west, Mississippi, is another one of those states, but that could change this year.

Some Mississippi Republicans appear to be supporting Medicaid expansion — with strings attached mostly aimed at reducing the cost to the state, according to the Clarion-Ledger.

A 2012 economic analysis by the UAB School of Public Health found that expansion would cost the state about $770 million over the first seven years in costs, but could potentially result in $20 billion in economic growth over the same time period.

Though professor David Becker’s report is now six years old, the general takeaways still apply, he told APR in December. “The tax revenues generated from expansion would exceed the cost to the state, and so in that sense, it was just sort of a win-win proposition,” Becker said.

Becker and his partner at UAB recently updated their economic analysis.

Medicaid expansion would provide insurance to 346,000 more Alabamians. It would also spur $2.7 billion to $2.9 billion in annual economic activity, according to the updated study.

 

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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Economy

Alabama Gulf Coast beaches remain closed for now

Brandon Moseley

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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)

Alabama Gov. Kay Ivey announced that beaches will remain closed for now due to ongoing repair and cleanup efforts in the wake of Hurricane Sally.

“Working closely with Gulf Shores Mayor Robert Craft and Orange Beach Mayor Tony Kennon, as well as Commissioner Billy Joe Underwood, the governor has agreed to keep Baldwin County’s beaches closed until Friday, October 2nd,” the governor’s office said in a statement. “This will allow those communities additional time to get their beaches ready for public enjoyment in a safe, responsible manner.”

Mobile County beaches might open earlier than that.

“Likewise, the governor has been in touch with Mayor Jeff Collier, and she is prepared to amend the beach closure order for Mobile County when he signals that Dauphin Island is ready to reopen their beaches,” the governor’s office said in a statement. “At the present time, all Alabama beaches remain closed until further notice.”

Hurricane Sally came ashore near Gulf Shores on Sept. 16 as a category two hurricane with 105 mile per hour winds. Numerous homes, businesses and farms have been destroyed and many more have seen serious damage.

“As of Wednesday night, approx. 37,000 cubic yards of Hurricane Sally debris (equivalent to roughly 1,700 truck loads worth) has been picked up in Orange Beach since Sunday (4 days),” the city of Orange Beach announced. “Kudos to our debris contractor CrowderGulf.”

“I spent Sunday afternoon meeting with senior staff and I believe we will need some time to get our buildings safe for children to return,” said Baldwin County Schools Superintendent Eddie Taylor in a letter to parents. “We live in a very large county. Power may be on in your area and your school may not have any damage, but we cannot open schools unless all schools can open. Our pacing guides, state testing, meal and accountability requirements are based on the system, not individual schools.”

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“We have schools without power and for which we do not expect power until later this week,” Taylor said. “In this new age, we need internet and communications which are currently down so we cannot run any system tests. We have physical damage at our schools including some with standing water, collapsed ceilings and blown out windows. We have debris on our properties and debris blocking our transportation teams from picking up students. All of this must be resolved before we can successfully re-open.”

“If everything goes as planned, I expect we will welcome back students on Wednesday, September 30,” Taylor said. “Prior to returning students to school, we will hold two teacher work days to get our classrooms and our lessons plans back on track.”

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Economy

SNAP replacement benefits coming to three counties hit by Hurricane Sally

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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)

Thousands of SNAP recipients in Mobile, Baldwin and Escambia counties are set to receive automatic replacement benefits as a result of Hurricane Sally, the Alabama Department of Human Resources announced Thursday.

Recipients who received their benefits Sept. 1 through Sept. 16 will receive a replacement of 50 percent of their regular monthly benefit. Those who received supplemental pandemic maximum allotment payments will receive a replacement of 30 percent of those benefits.

The U.S. Department of Agriculture Food and Nutrition Service approved the replacement benefits today at the request of DHR. The benefits are intended to replace food purchased with SNAP that was lost to widespread power outages caused when Hurricane Sally made landfall on Sept. 16.

“Our priority is to remove the very real threat of hunger for the many Alabamians who are struggling from the devastation of Hurricane Sally,” said Alabama DHR Commissioner Nancy Buckner. “The first step toward that goal is to replace the food that so many Alabamians lost to the storm. We are actively working to obtain additional resources to provide much-needed relief for the region as it recovers.”

Hurricane Sally caused over 265,000 households to lose power for at least four hours in Mobile, Baldwin and Escambia counties, where approximately 54,000 households will receive SNAP benefits totaling an estimated $8.5 million.

Those recipients should expect to see the replacement benefits automatically loaded onto their EBT cards next week.

The Food Assistance Division of DHR administers the SNAP program in Alabama.

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More information about the program can be found at dhr.alabama.gov/food-assistance.

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Economy

Unemployment assistance available to workers in Baldwin, Escambia and Mobile Counties

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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)

Alabama Department of Labor Secretary Fitzgerald Washington announced Thursday that workers who became unemployed as a direct result of Hurricane Sally in Baldwin, Escambia and Mobile Counties may qualify for unemployment assistance.

People who live in or worked in these counties and became unemployed due to Hurricane Sally during the period of Sept. 14, 2020, may be eligible for assistance under the Disaster Unemployment Assistance program, which was triggered when President Donald Trump designated the area as a disaster area on Sept. 20, 2020.

“Generally, those who are eligible for state unemployment benefits are not eligible for DUA, but a claimant may qualify if state unemployment compensation benefits are exhausted,” said Washington. “If you believe you are entitled to these benefits, I urge you to file a claim to see if you are eligible.”

People who may be eligible for Disaster Unemployment Assistance include the following:

  • Individuals who no longer have a job, are unable to reach the place of employment, or were scheduled to start work in the major disaster area and the job no longer exists
  • Those who became the breadwinner or major support of the family because the head of household died, or those who cannot work because of an injury incurred during the major disaster

All the previously described circumstances must be as a direct result of the hurricane. Self-employed individuals must provide a copy of their 2019 tax return, business license or Form 1099 within 21 days after applying for DUA benefits.

Claims can be filed through ADOL’s website at labor.alabama.gov or by calling 1-866-234-5382.

The deadline to file a DUA claim is Oct. 28, 2020, for Baldwin, Escambia and Mobile Counties.

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Alabama Farmer’s Federation starts a relief fund for farmers impacted by Sally

Brandon Moseley

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A satellite image of Hurricane Sally. (VIA NATIONAL WEATHER SERVICE)

The Alabama Farmers Federation said Monday that it has established a relief fund to help farmers from across the state whose farms were damaged by Hurricane Sally.

“When disaster strikes, I am always impressed by the people of Alabama and their giving spirits,” said Alabama Farmers Federation President Jimmy Parnell. “As we started receiving photos of damaged crops, barns and equipment, we also started getting questions from people about what they could do to help our farmers, and that’s why we’ve established this fund.”

All the donations to the relief fund are tax-deductible and may be made online or by check payable to Alabama Farmers Agriculture Foundation at P.O. Box 11000, Montgomery, AL 36191. Please include “hurricane relief fund” in the check memo line.

“Most of our farmers had as good a crop as we’ve ever seen, and it was so close to harvest for cotton, soybeans, peanuts and pecans,” Parnell said. “It’s devastating to lose a crop that had so much promise. Our farmers are great people who are assisting each other with cleaning up the damage, and we’re so grateful to everyone across the state who is helping in some way, like donating to the relief fund.”

Hurricane Sally made landfall near Gulf Shores as a category two storm Sept. 16 with maximum sustained winds of 105 mph. Official reports from the National Weather Service show more than 20 inches of rain in Baldwin County.

The combination of heavy rains and high winds damaged crops, structures and equipment from Mobile and Baldwin Counties in the southwest through Russell County in the east.

It has been a difficult few years for farmers.

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While the general economy had been doing well prior to the coronavirus global pandemic, the farmers were caught in the middle of an international trade dispute over tariffs and fair competition.

Chinese retaliation against Americans farm products depressed commodity markets from 2018 through early this year.

When it appeared that the U.S. and China had come to a trade accord in January, the coronavirus hit along with massive disruptions in the supply chain.

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Farm bankruptcies were already up pre-COVID-19. The loss of the 2020 crop could push some already struggling agribusinesses over the brink.

The Alabama Farmers Federation is Alabama’s largest and most influential farmers’ organization.

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