5 months 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.

13 mins ago

On this day in Alabama history: Alabama legislature ratified the 19th Amendment

Sept. 19, 1953

The fight for the right for women to vote officially ended in 1920 when Tennessee became the 36th state to ratify the 19th Amendment to the U.S. Constitution. In Alabama, there was an active suffragist movement, led by the Alabama Equal Suffrage Association, but opposition by some Alabama groups resulted in the Legislature not taking up the amendment, and after Tennessee signed on the issue was moot. Thirty-three years later, the Legislature decided to “record its approval of extending the right of suffrage to women” and officially ratified the 19th Amendment. Although the Alabama Equal Suffrage Association dissolved in 1920, many of its leaders and members joined the newly founded League of Women Voters, which remains active today in Alabama elections.

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52 mins ago

Canfield elected chair of Alabama Commission on Artificial Intelligence, Waggoner vice-chair

The Alabama Commission on Artificial Intelligence (AI) and Associated Technologies recently held its inaugural meeting, at which commission members elected Alabama Department of Commerce Secretary Greg Canfield as chairman and State Senator Jabo Waggoner (R-Vestavia Hills) as vice-chairman.

The commission plans to schedule additional meetings over the next seven months, with all meetings being open to the public.

The members will deliver a report in May to Governor Kay Ivey and the Alabama Legislature, recommending strategies and policies on how AI and other emerging technologies will be of benefit to the Yellowhammer State’s economy.

In a statement on Thursday, Canfield explained the importance of the commission’s work.

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“Artificial intelligence is a powerful, disruptive technology that has the potential to forever change the way we live our lives and how businesses across Alabama operate,” he emphasized.

“It’s critical that we understand how AI will bring about these sweeping changes, and this Commission will help us develop insights into what the future has in store for Alabama’s citizens and businesses,” Canfield concluded.

Waggoner spearheaded the legislative resolution that formed the commission. His leadership has been, and continues to be instrumental, in this process. The powerful chair of the Senate Rules Committee identified the goal of Alabama being on the cutting edge of AI research and job creation in the technology sector.

“We want Alabama to be a leader in AI research, innovation, technology start-ups, and technology jobs,” Waggoner stated. We believe that we are competitive with other states.”

He continued, “The Commission will look at how Alabama is positioned and ready for the opportunities of tomorrow. Those are some of the issues and questions this Commission is going to answer. We will meet with key business groups and different industry sectors to understand the impact of AI and automation on their industries.”

According to Waggoner, the commission will also examine how schools and universities can develop AI-educational programs, and investigate what privacy safeguards might be needed to protect consumers.

“We want Alabama’s education system in a place where we can equip students with AI-relevant skills through engineering and technology classes and apprenticeship programs,” he added. “As we promote innovation and educational readiness, we must also protect the privacy rights of citizens, and examine whether existing state laws are effective in regulating these emerging technologies. There’s a lot of work ahead.”

The commission will be divided up into five sub-committees, focused on the following:

  • state regulations, government oversight, and potential legislative action;
  • education and workforce development;
  • healthcare and medical services;
  • future and evolving industries, economic development, and research;
  • ethics, privacy and security.

The subcommittees will begin their work in mid-October.

State Senator Dan Roberts (R-Mountain Brook) was appointed to the commission by Senate President Pro Tem Del Marsh (R-Anniston). Roberts came away from the body’s initial meeting impressed at the experience and expertise of its membership.

“Artificial intelligence, machine learning, and deep learning are very complex subjects. Thankfully, I think we have some of the finest minds in our state working on this project. The sub committees that have been established will allow every person on the commission to hone in on their particular areas of expertise,” Roberts outlined.

The 25 members of the commission are as follows:

Greg Canfield – Secretary of Commerce (chairman)

Marty Redden – Acting secretary of the Alabama Office of Information Technology

Ivey’s appointees:

1. Dr. Hari Narayanan— Auburn

2. Dr. Gerry Dozier— Auburn

3. Dr. Jeff Carver – UA (Tuscaloosa)

4. Dr. Curt Carver – UAB

5. Dr. Alec Yasinac – USA

6. Dr. John Beck – UAH

7. Dr. James Cimino – UAB

8. Melvin Evans – Hand Arendall

9. Jim McLane – NaphCare

10. Jacob Kosoff – Regions Bank

Lt. Governor Will Ainsworth’s appointees:

Joshua Jones – StrategyWise

Dr. Vicki Karolewics – Wallace State Community College

Speaker of the House Mac McCutcheon’s appointees:

Rep. Kirk Hatcher

Rep. Craig Lipscomb

Marsh’ appointees:

Sen. Jabo Waggoner (Vice-chair)

Sen. Dan Roberts

Non-Voting members appointed by the governor:

J. Michael Hardin – Provost & vice president at Samford University

John Brandt – Southern Company

Leonard Tillman – Balch & Bingham

Mike Rowell – Senior VP & CIO at ALFA Insurance

James Mizell – Senior account executive at Microsoft

Jason Asbury – NXTsoft

Dr. Syed Raza – Jefferson State Community College

An Alabama CEO, also a commission member, said artificial intelligence is on the cusp of transforming every industry.

“Artificial intelligence is rapidly changing every industry, and it is incredibly important for us as a state to think strategically about what that means to our economy,” advised Joshua Jones, CEO of Birmingham-based StrategyWise, an AI and data science consulting firm.

He concluded, “I applaud Senator Waggoner and Secretary Canfield for leading Alabama to be one of the first states to really address these opportunities and changing dynamics systematically. It sends a message to the rest of the U.S. that Alabama is serious about investing in our future, and we’re growing our tech-based ecosystem. For companies that want to leverage all that AI has to offer, we’re going to be prepared with a trained workforce, accommodating public policy, and a strong tech infrastructure.”

Sean Ross is the editor of Yellowhammer News. You can follow him on Twitter @sean_yhn

1 hour ago

Decatur Mayor Tab Bowling open to Tennessee River toll bridge — If that moves freight, freight companies, truckers ‘would just be thrilled to do it’

For decades, traffic headed west from Huntsville and other points toward the Shoals has relied upon the Captain William J. Hudson “Steamboat Bill” Memorial Bridges to cross the Tennessee River into Decatur. Once traffic crosses that bridge, it either heads south on U.S. Highway 31 toward Hartselle and Cullman, or it makes a hard-right 90-degree turn on to U.S. Highway Alternate 72 and heads toward Muscle Shoals, Tuscumbia and Sheffield.

As the manufacturing base in northern Alabama expands, freight traffic is expected to increase at that intersection and make the turn west even more precarious for commuters and commercial traffic.

During an appearance on Huntsville radio’s WVNN on Wednesday, Decatur Mayor Tab Bowling discussed that spot and possible solutions for the future, which could include a tolling component.

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“If you were to go now and sit in the Doubletree Hotel, which is where you’re talking about there where you make that turn to go to the Shoals, and just look at the amount of freight that comes in out of Memphis — Memphis is the distribution hub for America,” Bowling said on Wednesday’s broadcast of “The Jeff Poor Show.” “And that freight that comes out of Memphis, straight down [U.S. Highway Alternate] 72, and then it makes its way across our bridge and goes various routes from there — into Huntsville, Madison, Athens, gets on [Interstate] 65, has different directions it can go from there. But whenever we start producing a thousand cars a day, we have 4,000 employees plus the tiered suppliers who will be there. The amount of freight that will come in to take care of that I believe is going to double.”

Bowling noted the situation at the Hyundai facility near Montgomery as a sign of what is to come and commended Gov. Kay Ivey for the commitment to widen the existing Interstate 565 that connects Decatur and Huntsville.

“We visited the Hyundai facility manufacturing a thousand cars a day just south of Montgomery — just-in-time deliveries: batteries, tires, things of that nature — they receive a truck a minute,” he continued. “You think widening [Interstate] 565 is important? Heck yeah, it’s important. We’re thankful Gov. Ivey is going to get that done for us in the Spring of 2020.”

The Decatur mayor said the completion of a nearby overpass for Alabama Highway 20 remains his current top priority.  Once that is completed, Bowling said exploring the possibility of an alternate route over the Tennessee River would be appropriate.

“We’re working on an overpass on [Alabama] Highway 20 where Apple Lane Farms is,” he said. “That’s Decatur, and that’s a build grant that we received for $14 million from the Federal Highway Department. We’re very thankful for that. A lot of people made that happen. Once that project gets going, then we’ll start working on the other. But we want to be sure we do everything to make sure that project gets going first.”

As for the possibility of using tolls to finance a new bridge, Bowling said he expected that those moving freight would be “thrilled” if it expedited transit and that if it would improve commuter traffic on existing structures, it could be a possibility.

“If that moves freight, I would believe that the freight companies, the truckers would just be thrilled to do it,” Bowling explained. “If we were to take the trucks off of the [U.S.] Highway 31 bridges, I believe that our commuter traffic — it would be a lot easier to make that commute. And so, we’ll see what we can do. We’ll come up with a traffic plan. We’ll do traffic counts. Things to prove it out.”

@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.

3 hours ago

Patriot Flag to be displayed in Mobile on Thursday to honor fallen American heroes

The Patriot Flag will be displayed at the USS Alabama in Mobile on Thursday, September 19.

According to WALA Fox 10, the flag is currently on a national tour intended to honor and thank fallen American men and women who made the ultimate sacrifice for our nation’s freedom and safety.

Measuring 28 by 60.5 feet and weighing 50 pounds, the Patriot Flag’s nationwide journey began on the 15th Anniversary of 9/11 when the flag was displayed at all three locations that were attacked by radical Islamic terrorists. The tour will end in 2021, on the 20th anniversary of the attacks.

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On Thursday, the flag will be unfurled at 3:00 p.m. at Battleship Memorial Park. Mobile Fire-Rescue firefighters will assist.

You can read more about the tour and see photos from previous stops here.

Sean Ross is the editor of Yellowhammer News. You can follow him on Twitter @sean_yhn

3 hours ago

Byrne applauds Trump administration for rescinding WOTUS rule; Says Mobile Baykeeper ‘absolutely wrong’ about environmental threat

Last week, the Trump administration rescinded the Obama-era “Waters of the U.S.” (WOTUS) rule, which broadened the scope of “waters” protected by the Clean Water Act.

The rule faced numerous legal challenges and was decried by farmers as an overreach.

During an appearance on Huntsville radio’s WVNN on Wednesday, U.S. Rep. Bradley Byrne (R-Fairhope), a candidate for the U.S. Senate in 2020, applauded the Trump administration’s decision.

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“There was a power grab by the Obama administration,” Byrne said on “The Jeff Poor Show.” “They wanted to take the traditional understanding about what is the water under the Clean Water Act that the EPA can regulate it and expand it to the point where if a farmer has two or three inches of standing water in their fields, all of a sudden the EPA tells them they can or can’t plant. That’s nonsense.”

“We actually had some legislation previously on it, but the Trump administration has just rescinded that rule,” he continued. “So we have gone back to a more common-sense understanding. I mean, a small pond in your yard is not something that should be regulated by the EPA. Some standing water in a big field is not something that should be regulated by the EPA.”

Byrne cited an AL(dot)com story quoting Mobile Baykeeper’s Casi Callaway decrying the move by the Trump administration and warning the impact that revoking the rule could have on the environment.

“Casi is a friend, but she is absolutely wrong about that,” Byrne remarked. “This is just a common-sense change going back to the way it has been for decades. It has worked fine for decades. I really appreciate the Trump administration making this change. And I understand why farmers and other people in other rural parts of Alabama felt so strongly about it.”

@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.