3 weeks ago

Alabama should wait and watch before considering Medicaid expansion

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.

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.

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 storylines 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.

51 mins ago

Alabama House Dems unanimously vote against anti-infanticide bill

MONTGOMERY — The Alabama House of Representatives on Tuesday night passed State Rep. Ginny Shaver’s (R-Leesburg) anti-infanticide bill, with Democrats in the chamber unanimously opposing the measure.

HB 491 would safeguard against infanticide by requiring a doctor to administer the same level of medical care to a child born alive after an abortion attempt as they would any other child.

The “born-alive” bill was introduced by Shaver after the publicized rise of support for infanticide amongst national Democrats, especially following in the wake of statements by policymakers in New York and Virginia.

Shaver has said, “There is no such thing as post-birth abortion. Think about those three words. That’s infanticide.”

657

“That’s what it is and what my bill does is in this situation where a child survives an abortion attempt and is born alive, it would require a physician to exercise the same reasonable care to preserve the life of the child that is born alive,” she continued. “When this happens, if there is any sign of breathing or any other sign of life … there would then exist a doctor-patient relationship between the doctor and the child so that he would be required to exercise the same degree of physical skill and care to make an effort to reasonably preserve the life and health of that child.”

House Majority Leader Nathaniel Ledbetter (R-Rainsville) was the sole original cosponsor of Shaver’s bill. He has been a strong pro-life voice throughout his time in office, including this legislative session.

Democrats filibustered the bill on Tuesday. Cloture had to be invoked shortly before the day’s business had to end at midnight on Tuesday.

The final vote on the bill as substituted was 66-18. No Republicans voted against HB 491, while only one Democrat, State Rep. Juandalynn Givan (D-Birmingham), voted for the legislation. It was immediately unclear if Givan accidentally vote “yay,” as she spoke passionately in opposition to the bill on the floor several times.

This came after the official Twitter account for the Alabama House Democratic Caucus claimed the anti-infanticide bill equals “criminalizing doctors who attempt to help women make their own choice with their own body.”

To be clear, HB 491 only deals with children born alive pursuant to an abortion attempt. The bill has nothing to do with a woman’s “right” to an abortion, as Shaver said on the floor.

“I really do not see the controversy in this issue,” Shaver emphasized. “I do not see how anyone with a conscience could oppose rendering aid to a child born-alive.”

Senator Doug Jones (D-AL) in recent days has called Republican state legislators “callous” and “extreme” for their pro-life views.

HB 491 mandates, “A living human child born alive after an abortion or premature birth is entitled to the same rights, powers, and privileges as are granted by the laws of this state to any other child born alive after the normal gestation period.”

State Rep. John Rogers (D-Birmingham) has said that Jones called him to say he agreed with Rogers’ viral abortion comments.

During Tuesday’s debate, State Rep. Barbara Boyd (D-Anniston) worried that opposing infanticide would cause economic boycotts of the state of Alabama. This came after Boyd claimed last week said that dyslexia does not exist.

Rogers called HB 491 “about the most ridiculous thing I’ve heard in my life.”

The bill now goes to the Senate.

If HB 491 becomes law, it shall be officially known as “Gianna’s Law,” named after a survivor of an attempted abortion who is now 42-years-old and travels the world telling her story. Shaver has met the woman (Gianna Jessen) and called her an inspiration.

State Rep. Merika Coleman (D-Birmingham) said a baby born-alive after an attempted abortion is not “a person.” Coleman asserted such a baby would still be a “fetus” and would not deserve the chance to live. She referred to the mother as “the host,” seemingly implying that the unborn baby is a parasite using that analogy.

Rep. Barbara Drummond (D-Mobile) said she does not see a difference between the born-alive/anti-infanticide HB 491 and the near-total abortion ban of HB 314, which was signed into law last week by Governor Kay Ivey.

Update 6:00 a.m.

Givan intended to vote “nay.”

Sean Ross is a staff writer for Yellowhammer News. You can follow him on Twitter @sean_yhn

12 hours ago

GoFundMe raising money for fallen Auburn PD officer William Buechner

A GoFundMe has been established in memory of Auburn Police Department Officer William Buechner, who was shot and killed in the line of duty late Sunday night.

A representative of the fundraising platform has confirmed its authenticity to Yellowhammer News. The GoFundMe will establish a memorial fund to assist Buechner’s family.

While the initial goal was set at $10,000, the campaign has already blown through that benchmark in less than 24 hours, raising over $20,500 as of 5:00 p.m. on Tuesday.

62

Buechner leaves behind a wife (Sara) and two children, including a one-year-old daughter.

In addition to raising funds, prayers are also being requested for the family.

Governor Kay Ivey on Monday ordered flags in Alabama to be flown at half-staff until sunset on Saturday to honor Buechner.

Sean Ross is a staff writer for Yellowhammer News. You can follow him on Twitter @sean_yhn

13 hours ago

Randall Woodfin: Alabama abortion ban could end two tech companies bids to locate in Birmingham

Since passage and being signed into law by Gov. Kay Ivey, the fallout from the new abortion ban has been harsh for many in Alabama.

Opponents of the law warned passage would not only impact Alabama’s reputation, but it could also threaten economic development opportunities for Alabama.

On Tuesday, Birmingham Mayor Randall Woodfin claimed that in fact was the case.

90

Birmingham FOX affiliate WBRC reported that the abortion ban could be the reason two tech firms could take a pass on locating in Birmingham.

Woodfin did not disclose the name of the firms.

Yellowhammer News reached out to the Birmingham mayor’s office and the Birmingham Business Alliance, which functions as the metropolitan area’s chamber of commerce, about the merits of the report and is still awaiting a response.

@Jeff_Poor is a graduate of Auburn University, the editor of Breitbart TV and host of “The Jeff Poor Show” from 2-5 p.m. on WVNN in Huntsville.

14 hours ago

‘Party of no?’ Democrats block lottery bill in Alabama House, end best chance of Medicaid expansion

MONTGOMERY — SB 220, State Sen. Greg Albritton’s (R-Atmore) clean paper-only lottery bill, failed on a procedural vote in the Alabama House of Representatives on Tuesday, essentially killing the bill.

Democrats joined with hardline conservatives to stop the bill from even getting fully debated on the floor in a 53-36 vote, with one abstention. Fifty-four affirmative votes were needed (60% of those voting) on the procedural motion, meaning the lottery failed by a single vote.

Political observers were quick to note that Democrats have been pushing a lottery for the past two decades, campaigning on the right of the people of Alabama to vote via referendum on the issue. However, on Tuesday, Democrats stood in the way of that becoming reality.

The bill had been passed by the Senate but seems to be dead in the House. Observers believe this was the best chance a lottery had of getting to a referendum this quadrennium and for the foreseeable future.

499

State Rep. Steve Clouse (R-Ozark) carried the bill in the House. He presented a substitute during a committee meeting last week that changed the revenue distribution in the bill so that 75% of funds would flow to the state general fund, while 25% would go to the Education Trust Fund. The committee adopted the substitute unanimously during that previous meeting. On advancing the bill itself, the only two “nay” votes in committee were Democrats.

The bill passed beforehand by the Senate did not allow for any revenue to benefit education.

Senate President Pro Tem Del Marsh (R-Anniston) has said that lottery money benefitting the general fund would protect the education fund.

The general fund has obligations that are expected to grow significantly in coming years, including Medicaid and the corrections system.

Despite the fact that the House Minority Caucus, i.e. the House Democrats, have said Medicaid expansion is their number one priority, killing the lottery bill on Tuesday ended their best chance of achieving that goal.

House Minority Leader Anthony Daniels (D-Huntsville) had a conversation with Marsh recently in which Marsh told Daniels Medicaid expansion was not possible right now because of a lack of general fund revenue to fund the expansion. However, Marsh added to Daniels that lottery revenues bolstering the general fund could make Medicaid expansion a realistic option.

On Tuesday, Democrats complained that SB 220 would not raise the maximum amount of money possible because it did not expand other forms of gaming, like slot machines, or legalize existing electronic bingo operations in places like Greene County or Macon County.

Clouse expressed that his bill would raise more revenue than the alternative, which of course is not having a lottery at all. SB 220 was projected to generate $167 million in revenue for the state annually once the lottery got fully operational.

Procedurally, SB 220 could be brought back up by the House if Democrats stop blocking the lottery legislation.

Update 4:50 p.m.:

Proponents of the lottery in the House will likely attempt the procedural motion again on Tuesday night. Only one attempt at reconsideration is allowed by the chamber’s rules.

It is important to note that 63 votes would be needed for final passage, even if the 60% of those voting threshold is met on the procedural vote.

Update 8:15 p.m.:

Clouse told reporters the lottery will not come back up on Tuesday.

State Rep. Terri Collins (R-Decatur) told Yellowhammer News that she intends to bring an amendment to the lottery legislation to make the revenue be split equally between education and the General Fund.

Daniels told Yellowhammer News that giving more of the revenue to the Education Trust Fund would not win over his party’s votes, saying their opposition is “much broader than that.”

Sean Ross is a staff writer for Yellowhammer News. You can follow him on Twitter @sean_yhn

14 hours ago

‘Real and painful consequences’: Ala. Secretary of Commerce, Toyota head ‘profoundly disappointed’ by Trump trade action

President Donald Trump has now concurred with a Department of Commerce Section 232 report that deemed imports of automobiles and automobile parts as a “national security threat,” with the president’s determination seriously worrying Alabama’s automobile manufacturing industry and economic development leaders.

The Department of Commerce report, delivered to Trump on February 17, concluded that imports of automobiles and certain automobile parts threaten to impair the national security of the United States. On Friday, Trump announced that he has completed his review of the report and agrees with its conclusion.

The president has ordered U.S. Trade Representative Robert Lighthizer to open a negotiation process with affected countries like Japan and, if agreements are not reached within 180 days, tariffs could be instituted on auto and auto parts imports from those countries.

Focusing on Japanese automobile manufacturers alone, Alabama is home to a Honda manufacturing facility in Lincoln, and the under-construction Mazda-Toyota joint venture in Huntsville features two Japanese auto giants.

In a statement on Tuesday, Akio Toyoda, who is president of Toyota and chairman of the Japan Automobile Manufacturers Association (JAMA) emphasized that he “is profoundly disappointed by President Trump’s announcement.”

649

Speaking on behalf of JAMA, Toyoda said, “We are dismayed to hear a message suggesting that our long-time contributions of investment and employment in the United States are not welcomed. As Chairman, I am deeply saddened by this decision.”

“For JAMA member companies, providing the best possible vehicle options for our customers is our top priority. We now have 24 manufacturing plants, 45 research-and-development/design centers, and 39 distribution centers in 28 states, and have cumulatively invested approximately $51 billion in manufacturing facilities alone,” he outlined. “It is also important to remember that, even during the Great Recession, JAMA member companies made great efforts to maintain employment, and currently we provide more than 93,000 direct American jobs. According to a new study, a total of over 1.6 million jobs (including intermediate and spin-off jobs) in the U.S. are supported by Japanese automakers. These numbers speak for themselves about JAMA member companies’ long history of local contributions and commitment as U.S. corporate citizens, and we are certain that neither imported vehicles and parts nor our American operations ‘threaten to impair’ the U.S. national security.”

Toyoda also warned that potential moves like tariffs down the line from the United States could have major consequences for places with large auto industries like Alabama.

“Any trade restrictive measures would deliver a serious blow to the U.S. auto industry and economy, as it would not only disadvantage U.S. consumers, but also adversely affect the global competitiveness of U.S.-produced vehicles and suppress company investments in the U.S,” Toyoda advised.

He continued, “We believe that free and fair trade as well as a competitive business environment based on international rules support the global competitiveness of the U.S. auto industry, leading to consumer benefits and sustained growth of the U.S. economy.”

“JAMA member companies strongly hope that President Trump understands our desire to further contribute to the U.S. economy and employment and that the dialogue between the governments of Japan and the U.S. leads to an outcome that supports the development of the auto industries and economies of both nations,” Toyoda concluded.

In a statement to Yellowhammer News, Alabama Secretary of Commerce Greg Canfield said “the U.S. Department of Commerce’s Section 232 findings… set the stage for tariffs that threaten to seriously disrupt the operations of” the state’s auto manufacturing operations “and put Alabama jobs on the line.”

Canfield explained, “Automakers based in Europe and Japan have made profound contributions to Alabama’s economy through significant investment and job creation that has enriched families and communities. Mercedes-Benz opened a manufacturing facility in Alabama 22 years ago; today, that complex has seen nearly $6 billion in investment and is home to thousands of jobs. Between them, Honda and Toyota have invested well over $3 billion in their Alabama manufacturing operations and employ more than 5,000 people in Alabama. Toyota and Mazda are currently investing another $1.6 billion to open an auto assembly plant in Alabama with 4,000 new jobs. Auto suppliers for these automakers have also invested heavily in operations in Alabama — and they continue to do so.”

“Over the years, Alabama has formed strong partnerships with these automotive companies,” he added. “We’ve also made many lasting friendships with industry leaders, including Akio Toyoda, president of Toyota Motor Corp., who personally came to Alabama’s capital to announce the Mazda Toyota Manufacturing USA assembly plant in 2018, and the top leadership at Honda and Mercedes.”

“We regret to see these relationships imperiled by the U.S. Department of Commerce’s Section 232 findings that set the stage for tariffs that threaten to seriously disrupt the operations of these Alabama manufacturing operations and put Alabama jobs on the line. We will continue to work to help the Trump administration understand that these proposed tariffs will have real and painful consequences for many hard-working Alabamians and companies that have established roots in our state,” Canfield concluded.

Sean Ross is a staff writer for Yellowhammer News. You can follow him on Twitter @sean_yhn