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Governor: It would be “irresponsible” for Alabama to expand Medicaid right now

Chip Brownlee

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Gov. Kay Ivey on Tuesday tamped down discussion about expanding Medicaid in Alabama, saying it would be financially irresponsible to expand the program, which provides health insurance to low-income people, during the COVID-19 pandemic.

“Certainly we’re concerned about the health and welfare of all of our citizens, wherever they may live,” Ivey said. “But at the same time, it would be irresponsible to think about expanding Medicaid just for the sake of expanding Medicaid without having a complete and honest discussion about the source of stable funding to pay the match.”

When Medicaid expansion became an option in 2014, the federal government covered the full cost. Beginning in 2016, funding began dropping from 100 percent. By this year, the federal match rate will level out at 90 percent.

“There is a lot of exploring that has to be done on how you pay for it,” Ivey said. “Right now, we’re focused on keeping everybody healthy and figuring out how we can get our people back to work.”

Federal funding covers most of the costs for those who become newly insured through expansion, but Republican state legislators fear the larger costs would cripple an already tight state budget. Alabama’s constitution has a balanced-budget provision that does not let the state run a budget deficit.

Expanding the program allows states to provide healthcare coverage for all individuals up to 138 percent of the federal poverty rate, which is about $28,000 for a family of three. Proponents have argued that expanding the program would pay for itself through new tax revenues without having to raise any additional taxes.

If Alabama, for example, were to expand Medicaid this year, it would start with a 90 percent reimbursement rate. Several studies estimate that more than 300,000 people would be newly eligible for the health insurance program for lower-income individuals.

Sen. Doug Jones, who has repeatedly urged the state to immediately expand Medicaid to expand health coverage to low-income people, has sponsored bills to up the federal match rate for states that have been late to expand the program.

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“A lot of federal dollars are coming into states right now,” Jones said during a press conference Friday. “Alabama is missing out on a lot of those dollars we would otherwise get because we did not expand Medicaid back six or seven years ago when we had the opportunity.”

Jones pointed to the state’s cash-strapped hospitals as a reason to expand the program. The Alabama Hospital Association has, for years, been lobbying the state government to expand the program.

“We could give our population better health outcomes, but we could also have more federal dollars,” Jones said.

One of Congress’s coronavirus stimulus bills includes billions in aid for hospitals, but hospitals fear it may not be enough.

Rural hospitals across the country, particularly in non-expansion states, are closing at an alarmingly high rate — largely because the Affordable Care Act intended for an influx of money from more people covered by Medicaid. The new money was intended to offset cuts to Medicare reimbursements built into the Affordable Care Act.

About 52 percent of the state’s hospitals had negative total margins before COVID-19, and 75 percent of them had negative operating margins, according to Alabama Hospital Association President Donald Williamson. Canceling elective procedures to prevent the spread of the virus has crippled hospitals’ cash flows, especially the rural hospitals.

“Our hospitals are losing money rapidly because they’re not doing the elective procedures — even hospitals that are not seeing a surge in COVID patients are still operating by not doing elective procedures that make them money,” Jones said. “Expanding Medicaid would help them right now immediately if we could get that plan in place.”

Jones said Friday he is working in the Senate to pass a bill that would give states the incentive to expand the program right now.

“We’ve got to change some things in the state and across this country so that everybody has access to affordable health care,” Jones said. “Medicaid expansion is a big piece of what I’m looking at.”

The discussion around Medicaid expansion has been ongoing since Alabama refused to expand the program in 2014, but it has taken on a new sense of urgency as COVID-19 continues to disproportionately impact vulnerable people in the state. As of April 12, about 53 percent of the state’s verified COVID-19 deaths have been among black people, who make up only about 27 percent of the state’s population.

Black people also more likely to go uninsured and suffer from chronic health problems.

“This is a disease that has worse outcomes in people that already have other social determinants like chronic health problems or issues just related to education and income,” State Health Officer Scott Harris said Tuesday. “So this is a big concern for us in public health. We want to make sure our most vulnerable citizens are the ones that we are protecting, and we’re committed to continue to do that.”

 

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Governor

Legislators briefed on coronavirus crisis

Brandon Moseley and Nicole Jones

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Alabama Gov. Kay Ivey and her team on Thursday briefed state legislators on the latest developments on the coronavirus crisis that has gripped the state for the last ten weeks.

State Public Health Officer Dr. Scott Harris told legislators that the state has 13,058 confirmed cases of coronavirus infection. 528 Alabamians have died from COVID-19 COVID-19 related. More than 250 of those deaths have occurred in nursing homes.

Harris said, “So far, we have been able to fulfill all requests for medication in hospitals.”

Kelly Butler is the Alabama State Finance Director.

“The department is working diligently with each entity to provide aid/reimbursement throughout the state to responsibly use the CARES Act funding,” Butler said.

Butler said that new guidelines that the federal government issued regarding the funding are extremely detailed. Legislators will be given a special form to provide input as to what category or entity they see has the greatest need. Counties and cities will be issued guidelines to know what they can and cannot apply for regarding reimbursements.

Butler said that a website is being worked on to provide updates regarding applying for funds. For now, this information can be found on the governor’s website.

Department of Senior Services Commissioner Jean Brown also addressed legislators. Brown said that GA Foods has placed a successful bid with the Farmers to Families program. The Farmers to Families foods will be sending free foods to Alabama. The delivery of meals will begin after Memorial Day and end on June 30.

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Alabama Department of Corrections Commissioner Jeff Dunn told legislators that 100,000 masks and 2,500 gowns have been produced by ADOC textile factory workers. The staff and inmates have been provided at least 4 masks for their protection. Inmates have also received individual bottles of soap and hand sanitizer provided thanks to community support.

Dunn said that as of May 20, 138 inmates have been tested for the coronavirus, with nine testing positive. One of those inmates has died due to a pre-existing health condition. The other eight have recovered. Each person that has tested positive has been properly quarantined.

Alabama Department of Labor Secretary Fitzgerald Washington briefed the group as well.

Washington said that more than $1 billion has been paid out in unemployment claims and that the department has processed 88 percent of COVID-19 related claims. Washington said that ADOL has paid out more in total benefits in the last three months than in the previous six years combined.

Washington said that unpaid claims are being looked at daily. Over 500,000 claims were filed in the last two months, more than the last two years combined.

Washington said that guidelines relating to issues such as “employees refusing to return to work when applicable” or “employee quits job instead of returning to work” may be addressed on the DOL website.

Washington warned that fraud claims and online scammers acting as ADOL online are happening and that citizens should be aware of such and report any fraudulent activity to ADOL immediately.

State Superintendent Dr. Erick Mackey addressed the group on the plans for the Alabama State Department of Education.

Mackey said that immediate guidance for reopening schools in June will soon be distributed. This would be for students in 7th grade and above. Students 6th grade and below will be able to attend school beginning in July.

Mackey said that the CDC guidelines that were released on Tuesday have not been adopted by ALSDE. Mackey said that some of these guidelines are not reasonable or doable in our state.

CDC issues new guidelines for schools reopening

“There are many moving parts to creating new procedures, etc., so please understand we are taking into consideration that not one size fits all,” Mackey said. “Our local schools will be making the final decisions as to what procedures are put in place for reopening.”

“We hope to issue recommendations to our schools by 19 June regarding reopening for the 2020-2021 school year,” Mackey told legislators. “We will be asking parents and students to implement new safety procedures, but these will be practical and easy to do.”

“We will leave the start date entirely up to each local superintendent,” Mackey continued. “We have asked that they assure they have time to prepare and adjust to the new procedures prior to opening.”

Mackey said that as of now, all school systems will be starting at some point in August. Distance learning for at-risk children is being looked at and there will be some sort of options for those needing this. Special Needs students needing therapies, etc. are also being looked at heavily.

“There are many moving parts to reopening, so we are working diligently to keep every student and every situation in mind,” Mackey said.

Later that afternoon, Ivey held a press conference to unveil the amended Safer At Home Order, which goes into effect at 5 p.m. today. The new orders, which opens many more businesses, will be in effect through 3 July.

 

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Governor

Governor signs both state budgets

Brandon Moseley

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Monday, Alabama Governor Kay Ivey (R) signed the General Fund budget (SGF), the Education Trust Fund (ETF), and the PSCA bond bill.

“I appreciate the hard work of the Legislature during an unprecedented Regular Session,” Gov. Ivey said in a statement. “While we have yet to know the full impact of COVID-19 on our state, these budgets will ensure continuity of government, while being fiscally responsible. There is more work to be done, and I look forward to working with the Legislature in the days ahead.”

Despite the growing economic collapse as a result of the coronavirus crisis; both budgets were record amounts.

“This has been a unprecedented session due to the COVID-19 epidemic which imposed multiple obstacles for our elected officials to overcome,” said Alabama Republican Party Chairman Terry Lathan. “Our Republican leadership and governor managed to forge through passing both the General Fund and Education budgets to see our state through the next year.”

“While there was more belt tightening required than anticipated before the Coronavirus outbreak, Alabama’s economic situation is much better than many other states in the nation – in large part due to the fiscally responsible practices of our Republican supermajority since we gained control of the legislature in 2010,” Lathan continued. “We also are proud to highlight that no proration has occurred since the Alabama GOP takeover along with record breaking education budgets.”

“In fact, the 2021 General Fund Budget is $169 million larger than the previous year and includes funding increases for the Alabama Department of Public Health ($35 million), Alabama Medicaid Agency ($94 million), Alabama Department of Mental Health ($25 million), ALEA ($3 million, specifically for the hiring of additional State Troopers) and the Department of Corrections ($23 million),” Lathan explained. “Additionally, the Education Trust Fund is $91 million more than fiscal year 2020, and includes funding increases for our award winning early childhood education program and Alabama’s public institutions of higher learning (colleges, universities, and community colleges).”

Both Houses of the legislature voted to concur with the Governor’s executive amendment to SB161 a 2020 supplemental appropriations bill directing how $1.9 billion in federal CARES Act money can be spent.

I commend the Alabama Legislature for their cooperation by supporting my Executive Amendment to SB161. This friendly amendment ensures the CARES Act money will be immediately available to the people of Alabama and put to use under the intent of the U.S. Congress and President Trump. Our cities, counties and state, as well as places like our nursing homes, hospitals, schools and colleges have incurred many legitimate expenses because of COVID-19. I thank the members of the Alabama Legislature for supporting this amendment and for ensuring this money helps the people of Alabama who have been harmed by this disease. While no one could have predicted COVID-19, it is easy to conclude this pandemic has touched every aspect of our daily lives. I assure the people of Alabama that we will be with them at every step moving forward. Together, we will recover, and we will get Alabama back on her feet.”

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The coronavirus global pandemic hangs over everything moving forward. Will there be federal aid to make up for lost state revenues? How much will that aid be? When can schools reopen? Will this winter see a resurgence in COVID-19 cases?

“We are confident Alabama will continue to grow its economy – even beyond what we experienced prior to the pandemic,” Lathan said. “Thanks to hard working, determined Alabamians combined with the sound conservative principles our Republican officials use to guide our state. In the end, we are grateful the Republican legislative body and Governor Ivey came together as a team to get the record breaking budgets up and out to Alabama, even with heavy burdens and concerns lingering due to COVID-19 in these unparalleled times.”

Monday was the last day of the 2020 Legislative Session.

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Guest Columnists

Opinion | Alabama House Members answer the call to duty

Mac McCutcheon

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When the Legislature convened its 2020 regular session in February, Alabama enjoyed record-low unemployment and record-high revenues in our state budgets.

Pay raises for educators and state employees were foregone conclusions, unprecedented improvements in mental health services offered to Alabamians were being passed, and new and expanded education programs were on the table.

But as legislators returned to Montgomery from the mandatory COVID-19 shutdown period — a little less than three months removed from the session’s start — an entirely new landscape greeted us.

Our record-high employment numbers have turned into record-high applications for unemployment benefits, and our state revenues have been negatively impacted by an economy gone sour.

But Alabamians have always risen to meet a challenge, and I am confident that the historic economy that our state once enjoyed can be rebuilt and made even stronger.

All of us who serve in the House of Representatives have publicly offered ourselves as leaders in our communities and our state, and as Alabama continues its journey on the path back to normalcy, it is important us to lead the way. We cannot expect average Alabamians to feel safe and confident in returning to work and resuming their jobs if the men and women they elect to represent them in Montgomery are not willing to do the same.

So on May 4, we convened at the Alabama State House to resume the regular session and complete the tasks that remained before us.

Our members came from the Tennessee Valley, the Gulf Coast region, and dozens of cities, towns, and crossroads in between, and we took important steps to safeguard their health in a cramped and aged State House where proper social distancing is difficult at best.

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House members were required to wear face masks in all public areas, and once they entered the building, they proceeded directly to their personal offices to await the gavel to fall each meeting day.

In order to accommodate the House members at safe distances, only a handful were able to sit at their desks in the House Chamber while the others were spread across the spectators’ gallery and an adjacent overflow room and cast voice votes by microphone.

With one exception House Democrats boycotted the session and cited on-going concerns over the potential spread of COVID-19 as their reason, which was certainly their right.

I do want to commend State Rep. Rod Scott, D – Fairfield, the ranking minority member of the education budget-writing committee, for being the lone member of his party to attend the remainder of the session. His input was valuable, and his participation was much appreciated.

In addition, social distancing and health concerns prompted us to take the unusual step of closing access to the State House to the public, lobbyists, and other visitors, but video streaming of every public meeting was made available on the Internet..

Drafting responsible and prudent General Fund and Education Trust Fund budgets that accurately reflect the current economic climate is the Legislature’s only constitutional obligation and became our highest priority.

By approving Alabama’s spending plans now, rather than waiting until later in the year, many local systems avoided unnecessarily pink-slipping their non-tenured teachers, plans for the coming school year could take shape, and state agencies could begin implementing the adjustments in services that COVID-19 will likely demand.

We were also able to craft balanced budgets because budgeting and spending reforms enacted over the past decade have ensued that several hundred million dollars remain accessible and available in times of crisis, so Alabama is better prepared than many other states to weather this economy.

General Fund Chairman Steve Clouse, R – Ozark, and Education Trust Fund Chairman Bill Poole, R – Tuscaloosa, worked hard to assemble budgets that are fiscally-responsible, conservative, and disciplined.

Because of federal mandates and rulings in on-going lawsuits over state prison conditions, General Fund spending increased by 7.5% under the budget that was signed by the governor, but the increase was dramatically less than originally expected when the Legislature first convened in February.

The $7.2 billion Education Trust Fund budget that was approved included new funding for our award-winning “First Class” Pre-Kindergarten program and the reading and literacy initiatives. Additional dollars were also appropriated to help school systems absorb the loss of local revenues due to the Coronavirus.

Lawmakers also approved a $1.25 billion bond issue for school construction, which is the state’s largest capital improvement investment in history and the first in more than a decade. The bond issue will provide money to every city and county K-12 school system and to two- and four-year colleges and was made possible by retiring old debts and taking advantage of today’s historically-low interest rates.

Public officials at all levels of government are often subject to criticism, and I will admit it is often well-deserved, but they should also be recognized for jobs well done.

The men and women who participated in the unusual, extraordinary, and unforgettable final week of the 2020 regular session put their responsibilities ahead of their own health concerns and answered the call to duty. They stood tall when Alabama needed them most.

The members of the House of Representatives are some of the finest people I have ever known, and serving with them reinforces my confidence that Alabama’s best days still remain ahead of us.

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Governor

House speaker says he supports governor’s CARES Act plan

Chip Brownlee

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Alabama House Speaker Mac McCutcheon said Friday that he supports Gov. Kay Ivey’s proposed executive amendment, which would appropriate federal CARES Act funds for responding to the COVID-19 pandemic.

With the speaker’s support, the governor’s amendment has a better chance of passing Alabama’s House of Representatives — whether the same will be true in the Senate is unclear.

“Our goal throughout the budgeting process has been to ensure that Alabama’s share of the federal CARES Act dollars are appropriated in a manner that is open, transparent, and serves the greatest public good,” McCutcheon said in a statement. “I believe that Gov. Ivey’s proposed executive amendment checks all of those boxes.”

The governor and GOP members of the state’s Legislature have been in a public dispute over how and when to spend the $1.9 billion in federal funding provided to Alabama in the federal CARES Act.

The governor on Thursday blocked the legislation that would have limited her ability to quickly distribute the money. If the legislation had been signed into law, it would have required another special session of the Legislature for all of the federal funds to be appropriated through the legislative process.

Ivey has said she wants the emergency funds to be appropriated immediately and through a public and transparent process so the money can get to agencies and Alabamians who need it most. Her executive amendment Thursday effectively blocked the legislation and sent it back to the Legislature with proposed changes.

If the money is not appropriated and spent by the end of the calendar year, it would be reclaimed by the federal government, and Alabama could lose out on hundreds of millions of dollars.

Her amendment would appropriate nearly all of the CARES Act funds the state received immediately. It would be used for the following purposes, according to Ivey’s amendment:

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  • Up to $300 million to reimburse state agencies for COVID-19 expenditures
  • Up to $250 million to reimburse local governments for COVID-19 expenditures
  • Up to $250 million to “support the delivery of healthcare and related services to citizens of Alabama related to” COVID-19
  • Up to $300 million to support citizens, businesses and non-profit and faith-based organizations impacted by COVID-19
  • Up to $53 million for reimbursement of equipment and infrastructure necessary for remote work and public access to functions of state government impacted by COVID-19
  • Up to $300 million for technology and infrastructure for remote instruction and learning
  • Up to $200 million for the Department of Corrections to address COVID-19
  • Up to $10 million for courts to ensure access during COVID-19
  • Up to $5 million to reimburse the State General Fund for previous appropriations to the Alabama Department of Public Health
  • The remaining $118 million could be used for any lawful purpose in line with federal guidance

Both the House and Senate must take up the amendment Monday, the last day of this year’s session, and decide whether to make the changes Ivey proposed. The Legislature could also override Ivey’s amendment and pass the legislation directly into law.

McCutcheon said Friday that he hopes members of the House will be amenable to the amendment.

“It also embraces the balance of power between the legislative and executive branches that is outlined in the 1901 Constitution,” McCutcheon said. “Combatting COVID-19 and repairing the damage it has caused within our state will require the governor and the Legislature to work in a unified and cooperative manner, and for that reason, I am hopeful that our members will be amenable to this amendment.”

The Senate will also need to approve the changes. Senate President Pro Tempore Del Marsh, R-Anniston, has not said whether he supports the governor’s amendment.

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