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Opinion | Alabama should wait and watch before considering Medicaid expansion

J. Pepper Bryars

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If only Alabama’s leaders had a magical Medicaid “Choose Your Own Adventure” book, so they could flip ahead and see the different outcomes we could expect by expanding the government insurance program that was originally designed for the poor and disabled.

Would it end in a stronger economy, more jobs and a vibrant system of rural hospitals?

“Medicaid expansion remains an economic development opportunity without equal,” said David Becker, an economics professor at UAB, in an Al.com article.

Or would it bankrupt our already cash-strapped state budget and further sink our country into unsustainable levels of national debt?

“When you expand Medicaid, the administrative costs and the cost of expansion will eventually swamp the state,” warned U.S. Rep. Gary Palmer, R-Hoover, during an interview on the Matt & Aunie Show on Talk 99.5 FM in Birmingham. “It has in other states. Illinois is about to go bankrupt.”

Each side makes a strong case, but the truth seems hidden behind a fog of experts, statistics and forecasts that confuse more than clarify.

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The Economic Impact

A UAB study conducted by Becker and paid for by the Alabama Hospital Association found that even when Alabama starts paying 10 percent of the expansion’s costs, the move would create thousands of new jobs and generate $2.7 billion a year in economic activity. Becker wrote that the expense would be “almost entirely offset” by new tax revenue and state spending reductions on current Medicaid enrollees and other health programs.

And another study funded by the same association concluded that “state savings and other economic gains from expansion could be reinvested in the health care system in Alabama, including to support expansion and other state priorities.”

But critics say those predictions are extremely unrealistic and point to how widely off the mark such estimates have been elsewhere.

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States that expanded Medicaid have signed up more than twice as many “able-bodied adults” than expected and per-person costs have exceeded original estimates by a whopping 76 percent, according to a 2018 report by the Foundation for Government Accountability. This led to cost overruns of 157 percent, the report showed, with Medicaid now accounting for one of every three state budget dollars.

Many expect the same overruns in Alabama, which would exacerbate our already challenging budget.

“We will have to find $250 million more in the state general fund every year, even when revenues decline in recessions,” said Daniel Sutter, an economics professor and director of the Manuel H. Johnson Center for Political Economy at Troy University, in an email. “Alabama’s perennial budget crisis is due largely to having to pay for Medicaid every year. Medicaid expansion makes this pressure worse.”

Hospital Closures

Supporters of Medicaid expansion most often mention that 12 Alabama hospitals have closed this decade, with many being in rural areas possibly leaving residents without critical care nearby. Expanding the program, they contend, may have saved those hospitals, and could still save many that are at risk.

“Those are critical dollars for us as our hospitals currently spend more than $500 million each year in care for which they receive no reimbursement,” said Owen Bailey, chairman of the board of the Alabama Hospital Association and CEO of USA Health, in a press release. “Providing insurance through Medicaid expansion is vital to maintain access to care for everyone.”

While an influx of Medicaid cash would help these hospitals in the short term, it’s unclear if it solves the underlying problems that created their instability in the first place.

Hospitals are losing money and closing for a variety of reasons, according to The New York Times — shrinking rural populations, hospital mergers, consolidated services, regulatory burdens, low reimbursement rates, and a decrease in hospital care due to outpatient services and speedier care that requires less hospital time.

Officials at one Kansas hospital that closed in 2015 told The Times that additional Medicaid funds would have been significant but probably would not have helped them survive in the long run.

Meanwhile, help could come from elsewhere. The federal agency that oversees Medicare recently announced that its “tweaking” the formula used to reimburse hospitals in Alabama, a move that AL.com noted could increase payments to rural hospitals.

A way forward

When economists are arguing vastly different forecasts and outcomes, it’s often helpful to fall back to a few simple yet immutable conservative principles. Chief among them is the principle of prudence, which basically says we shouldn’t rush big decisions – decisions that have long-term consequences and that cannot easily be reversed, if at all.

Medicaid expansion is clearly one of those decisions.

And even without that magical Medicaid “Choose Your Own Adventure” book, there have already been unexpected plot twists, and clear deathtraps, for other states who decided to expand the program.

Alabama should wait and watch to see if the promises, or the fears, are realized.

We should also patiently observe states taking alternate story-lines through Medicaid waiverspartial Medicaid expansion requests, and block grant plans.

Otherwise, if Alabama takes the bait and expands Medicaid, we might turn the final page only to see that ominous yet sadly predictable word.

Bankrupt.

J. Pepper Bryars is a senior fellow at the Alabama Policy Institute. Follow him on Twitter at @jpepperbryars.

 

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Opinion | Let the head coach lead the team: Vote no on Amendment 2

“As the 34th chief justice of the Alabama Supreme Court and an Alabama justice for over 15 years, I strongly urge you to vote ‘no’ on Amendment 2,” Chief Justice Tom Parker writes.

Tom Parker

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Alabama Supreme Court Chief Justice Tom Parker

Down the ballot from the presidential race are several proposed constitutional amendments, but one of them does not deserve your vote. Statewide Amendment 2 contains a “Trojan horse” that would disrupt the Alabama court system from the top-down and overthrow an important part of the Alabama Constitution.

As the 34th chief justice of the Alabama Supreme Court and an Alabama justice for over 15 years, I strongly urge you to vote “no” on Amendment 2.

Just what would this amendment do? Amendment 2 would strip from the chief justice the important power to appoint his own administrative director of courts (ADC) — the second-in-command of the whole judicial branch of government since the ratification of the Judicial Article in 1973 — and would instead give that power to the eight associates justices of the Supreme Court.

Amendment 2 would give the ADC a long 10-year term and make it much more difficult to remove him or her, instead of serving at the discretion of the chief justice as they do now.

This strange scenario is like Nick Saban and Gus Malzahn having their assistant coaches selected for them by the athletic departments at Alabama and Auburn, and then being told they have to keep those assistant coaches for 10 years! Such a bizarre scheme would totally undermine the ability of the head coach to effectively lead the offense, defense, special teams and all departments of their program — and, if necessary, fire underperforming coaches.

That’s not good leadership in football, and it’s not good government for Alabama. It’s a losing game plan.

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The direct relationship and accountability between a head football coach and his assistant coaches are crucial to the successful execution of the head coach’s process and vision.

In the same way, the ADC, under the direct leadership of the chief justice who appoints him, directs the day-to-day administration of Alabama’s Unified Judicial System, which includes all the circuit and district judges, personnel and equipment throughout the state of Alabama.

The ADC is one of the most important positions in the Alabama court system, because the ADC is the linchpin between the chief justice and the trial courts throughout the state. The ADC provides direct accountability and feedback to the chief justice so that he can make necessary and sometimes quick “game-time decisions” that affect all courts.

The ADC is the singular “assistant coach” carrying out the leadership and direction of the judicial “head coach.”

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This is exactly how the framers of the Judicial Article of the Alabama Constitution intended it. Article VI, Section 149 makes the chief justice “the administrative head of the judicial system” with the power to appoint the ADC “to assist [the chief justice] with his administrative tasks.”

But Amendment 2 flips the constitutional order and destroys that close accountability between the chief justice and the ADC. Instead, it gives the appointment power to the eight associate justices who, ironically, are not elected with the authority to lead the administration of the judicial branch of government.

To put it in the context of another branch of government, it would be like letting the governor’s cabinet select her chief of staff for her. How strange would it be for the elected head of the executive branch to be unable to choose her top in-house official? And then to be told to work with this person for the rest of her term! This is what Amendment 2 would do to the leadership dynamics of the judicial branch.

Since you did me the great honor of electing me as chief justice two years ago, I have experienced first-hand just how demanding it is to run the day-to-day operations of our entire judicial system. I take seriously that responsibility to lead the court system, as does the ADC.

But my ability to lead this branch, and the ability of future chief justices, would be severely hampered if Amendment 2 passed. Mind you, the chief justice would still be the elected administrative head under the Constitution, but their second-in-command would be picked by a political process and given a longer term of office than even the chief justice’s 6-year term.

Supporters of Amendment 2 claim that letting the associate justices pick the ADC would lead to “stability” and “longevity” in that position. That’s the problem! The amendment would make the ADC nearly unaccountable to the chief justice that he is supposed to assist — and for a cushy 10-year term, regardless of how poorly he is doing the job.

The ADC should carry the football for the chief justice the people have elected, and it is entirely appropriate that both positions follow the desires of the people who elect the head of the branch.

Vote no on Amendment 2 and let the head coach lead the courts as the people have elected him to.

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Opinion | We’re just hours from Election Day. Do you have a plan to vote?

“Alabama’s working people deserve better, and on Nov. 3, we have the opportunity to make it truly great.”

Bren Riley

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(STOCK PHOTO)

We are just hours away from the most anticipated election in America’s modern history. On Nov. 3, Alabama voters will have the opportunity to elect pro-worker candidates up and down the ballot.

As president of the Alabama AFL-CIO, the state’s largest labor federation, our choice in August to endorse Joe Biden for president and Sen. Doug Jones for re-election in the United States Senate could not have been more clear. Our country is facing a crisis on three major fronts: a public health pandemic, an economic free fall and long-standing structural racism. Here in Alabama, working people’s hopes and aspirations are intertwined with the outcome of this election.

Alabamians, your vote is essential. We need to elect leaders who will serve us, not themselves. We have suffered for far too long and simply cannot afford to sit this one out.

Across the country, more than 80 million Americans have already voted — a number which exceeds half of the number of votes counted during the entire 2016 presidential election. Unfortunately, Alabama does not offer an early voting period. Instead, we’re breaking ground with a record 200,000 absentee ballot requests.

According to Secretary of State John Merrill, by the time all votes are counted, an estimated 68 and 75 percent of Alabama voters will have cast their ballots. While these numbers are groundbreaking compared to past election cycles, I know they could be even higher.

We are down to the wire, and if you do not have a plan to vote yet, you must make one now.

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The deadline to request an absentee ballot was Thursday, Oct. 29. If you have received your ballot but have not cast it yet, it must be postmarked no later than Nov. 1. Your ballot can also be hand-delivered to an absentee election manager by close of business on Nov. 2.

Not sure where to go? Check here on the Secretary of State website for a list of addresses, sorted by county.

If you mailed your absentee ballot, but want to check its status, you can track it here.

If you choose to vote in-person on Nov. 3, make sure you wear a face mask and bring a valid, state-issued photo ID. If you need to check your polling location, do so here.

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If you still do not have a plan to vote, make one as soon as possible that is safe and best for you here.

And if you have any other questions, you can always call the Alabama Democratic Party’s Voter Protection Hotline at 833-468-6832.

With so much at stake in this election, every vote counts. Both Jones and Biden have proven time and time again that they are willing to work with anyone to save lives and livelihoods.

Alabama’s working people deserve better, and on Nov. 3, we have the opportunity to make it truly great.

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Opinion | COVID-19: Living in a state of alert

We will resort to our survival mode and exhibit moods and behaviors that are very much like those of individuals who have experienced trauma such as battle or extreme loss.

Lynn Beshear

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(STOCK PHOTO)

Borrowing a phrase from a recent communication by the National Council for Behavioral Health: as a result of COVID-19 everyone is living in a state of alert.” The effect of that on human beings is that we will resort to our survival mode and exhibit moods and behaviors that are very much like those of individuals who have experienced trauma such as battle or extreme loss.

Indeed, individuals on the Gulf coast and the west coast have experienced recent extreme losses of property, lives and livelihood due to Hurricane Sally and rampant fires, further compounding the impact on them of the COVID pandemic. In short, many in our state and country are in the midst of a mental health crisis. This is not a personality defect or sign of weakness. It does not just affect one type of person. We all can experience mental and emotional health issues.

So, what can we do? First, recognize that everyone is having these experiences to some degree. What we have learned about a major crisis is there are predictable emotional highs and lows as our state, country and the world move through the six stages of a disaster: pre-disaster, impact, heroic, honeymoon, disillusionment and reconstruction. If there is any good news about this situation it is that critical conversations are taking place in homes and workplaces. Individuals from all walks of life feel freer to share their feelings and fears, to listen to each other and to act decisively.

On the other hand, we know millions of Americans and Alabamians are suffering tremendously. According to a June 2020 Centers for Disease Control poll, forty percent of adults reported struggling with mental health or substance use issues since March. For frontline healthcare workers and first responders, the impact of COVID-19 and the resulting increasedcritical care workload, is immense. Providing those levels of care has led to stress, anxiety, fear, substance use, suicidal thoughts and other mental health issues that for many individuals has resulted in a state of PTSD. This is true for individuals and families, regardless of direct care-giving involvement.

How can we improve mental health for ourselves, our family, coworkers and friends?

First, start the conversation. Everyone needs to feel they are “seen” and fully informed of options. Don’t hide your own feelings or genuine concern for those of others. Look for common experiences, while sharing useful and accurate information. In the work environment, a buddy system could be a vital strategy to ensure that no one is further isolated.

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Warmlines, such as Wings Across Alabama’s phone line [1-844-999-4647] are there for anyone to call. Peer support is offered through dozens of organizations by trained peer specialists who have been successful in recovery. They help others to stay engaged in the recovery process and reduce the likelihood of relapse.

Alabama’s nineteen local mental health authorities and other mental health related organizations around the state offer direct services. Providers have implemented innovative ways to serve individuals through telehealth therapy, virtual group meetings, and drive-throughs for medication or information.

What can we do today is to turn our worries into action? Do not wait to seek help or help someone else. Create a mental health safety plan for yourself or family and friends about whom you may be concerned. Take breaks from social media but stayhealthily connected with friends and family.

To further expand accessibility to care, Alabama is transforming the approach to prevention and early intervention regarding mental health. From initiatives like the First Episode Psychosis program, the School-Based Mental Health Collaborative and ourIndividual Placement and Support-Supported Employmentprogram, to the Stepping Up Initiative’s goal to reduce the number of individuals with mental illness in jails, the Alabama Department of Mental Health is creating preventive and restorative programs for recovery.

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Remember that behavioral health is essential health. Prevention works. Treatment is effective, And, people can and do recover from mental and/or substance use disorders. Most of all, we must be kind to each other; it is good for our own mental health.

To find resources and assistance for mental health services visit: www.mh.alabama.gov

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Opinion | Air superiority then, space superiority now: the Battle of Britain 80 years hence

The United States and her friends cannot allow a country that is utterly opposed to freedom to control space.

Will Sellers

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(VIA WIKIMEDIA COMMONS)

Eighty years ago this week, hurricane season ended when the Royal Air Force won the Battle of Britain by stopping the Nazi war machine at the edge of the English Channel.  Before the summer of 1940, Hitler had derided Great Britain as a nation of shopkeepers. Göring’s seemingly superior Luftwaffe pilots were outdone by the young British RAF, aided by friendly forces—not the least of which was a squadron of Polish pilots. They had shown the world that the Nazi juggernaut could be countered through perseverance, aided by the novel design of quick and lethal airplanes: the spitfire and hurricane.

Churchill named this battle when he declared after Dunkirk that with the conclusion of the Battle of France, the Battle of Britain would begin. Unlike past battles, the critical objective was as amorphous as it was strategic: the achievement of air superiority. It was a testament to the fact that warfare had changed forever, tilting the scales in favor of technology over brute strength.

Even Hitler and his retinue of yes-men knew that subjugating Britain would require a risky and complex invasion. The English Channel, though relatively narrow at some points, served as a giant moat that required amphibious landings on slow-moving vessels, which would be vulnerable to attack from above. Nazi control of the air would be the key to a successful invasion. With proper preparations for a seaborne invasion many months out, Göring pushed for an air campaign, and Hitler approved.

The Luftwaffe’s first objective was to destroy RAF airfields, but Luftwaffe planes were not designed for this mission, and their pilots—though experienced—were no match for the RAF’s pilots in spitfires and hurricanes. These planes had unmatched maneuverability, and home-field advantage played an equally important role. The British had a superior early warning radar system that enabled them to plot the likely flight path of incoming enemies and to scramble their gassed and fully loaded planes efficiently. Over Britain, each downed German represented not only a lost airplane but also a lost pilot. Maintaining air superiority was a fight for survival, and the British pilots knew that the fate of freedom for their island, and perhaps for civilization, rested on their shoulders. They turned the tide of the war in fighting, as Churchill noted, “undaunted by the odds, unwearied in their constant challenge and mortal danger.”

While the concept of air superiority was initially academic, the Battle of Britain proved it critical to modern military success. Since then, the need for air superiority has remained unquestioned. A country might not win with air superiority, but failure was guaranteed without it. The use of airpower to master the skies has been the first order of business in every major conflict since World War II. Even today, with the development of defensive missile shields and the capability of intercepting incoming aircraft and missiles, air superiority is and will remain a critical objective in any conflict. But air superiority is starting to give way to space superiority.

As we become more and more dependent on satellites, and as human activity in space becomes less of a novelty, controlling space will be critical not only for commercial and economic success, but also for global stability and the defense of our nation. The nation that controls space will control the destiny of the entire world. To be dominant in space is to be dominant period, and the dominating nation will have the final say over many aspects of our lives.

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Those who would object to the militarization of space do not understand, or refuse to see, today’s reality. The activities of the Chinese Communist Party (CCP) in space are similar to those of the nations who sought to control the sea in the 19th century and the air in the 20th century. At present, these activities are largely unchecked by other nations and international organizations.

There was a time when the United Nations was capable of limiting space to peaceful means. Similar to the control of nuclear weapons, the United Nations provided a means of achieving an international consensus that limiting weapons in space was beneficial for all nations. But, as with any large organization attempting to achieve consensus among diverse groups, the only real agreement among nations became the lowest common denominator. Thus, UN limits on the militarization of space are limited, weak, and ineffective.

This void of international leadership is being filled by a resurgent Communist China, intent on achieving world domination—a long-term national goal. With few international limitations, the CCP is seeking space superiority to impose its ideas on the world and thereby supplant civilization’s shared liberal principles. The UN has been aggressively helpless or simply unable to check China’s dreams of space superiority. While the CCP has yet to obtain the domination it seeks, it is clearly on track with covert military missions, like developing its own GPS system that would aid in obtaining space superiority.

The United States cannot let this happen. Students of history know that many of the great and terrible military conflicts could have been prevented or mitigated with proper foresight and preparation. Unless the United States acts soon to check CCP aggression in space, we may have extremely limited choices in the future.

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Our new Space Force must explain the seriousness of this threat and develop strategic plans to protect space from the domination of any one country. This grand effort will require allies who not only understand the threat, but who are financially able to join with the United States to dominate space for peaceful purposes. The free world’s shared cultural and civic traditions could form the basis for ensuring that space can never be dominated by one country.

During World War I and in the following decades, Churchill stressed the importance of developing radar, the tank, and the airplane. Without these developments, the Battle of Britain would have ended much differently. As we celebrate the 80th anniversary of victory at the Battle of Britain, and as we understand the strategic necessity of air superiority in protecting the island nation from foreign invasion, we should recognize the strategic necessity of space superiority today.

The United States and her friends cannot allow a country that is utterly opposed to freedom to control space and, in turn, Earth. The free world must develop space first and create enforceable laws to allow space to be an extension of the liberty we currently enjoy. In order to do that, we must overhaul our outdated legal regime concerning the development and deployment of space technologies, support the private development of space properly, and remove the bureaucratic barriers hindering important breakthroughs. We must not surrender space to totalitarians who would use it to subjugate free peoples around the globe. If we heed the call to action and engage in this new endeavor, we can ensure that the limitless possibilities of space are secured for future generations.

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