2.3 million Americans would gain health care coverage if 10 states, including Alabama, expanded Medicaid eligibility
Ten states—Alabama, Florida, Georgia, Kansas, Mississippi, South Carolina, Tennessee, Texas, Wisconsin, and Wyoming—have not yet expanded Medicaid eligibility. A new analysis by the Robert Woods Foundation showed that 2.3 million lack health coverage that would have coverage if their state expanded Medicaid. This would cut the number of uninsured nationally by 25%. Expanding Medicaid in those states would cost the federal government. Federal spending on Medicaid in these states would increase by about $24 billion, an increase of 17.5%. Alabama did not expand Medicaid because of the costs to the state general fund (SGF). The authors estimate that Medicaid expansion would cost Alabama and the other nine states $1.5 billion (an increase of 3%). The authors claim, however, that there would also be a variety of additional state savings and new revenue under expansion that researchers did not estimate when they prepared their cost estimates. The authors estimate that Medicaid expansion in Alabama would insure an additional 146,000 people and decrease the number of uninsured Alabamians by 37%. Alabama Today asked the authors for more Alabama-specific information on the cost to the state and federal governments. Matt Buettgens is a senior fellow at the Urban Institute and one of the researchers who prepared the brief. He responded in a written statement. “The difference in federal costs is one of the top-level findings in the summary and is in the press release,” Buettgens wrote. “As far as state costs, there are potential savings and new revenue streams with expansion that would require a detailed analysis of state-specific data that are not public in order to estimate. We note that most states that have conducted such analyses have found that these savings and revenue more than offset state spending on new enrollees.” Alabama Medicaid, as it currently exists, will cost Alabama taxpayers $862,999,999 in the current budget year. That is without expanding it to include another 146,000 people. According to the analysis, the findings include: · Women of reproductive age would see a large reduction in uninsurance (a drop of 31%) compared to older women (a drop of 23.2%) and men (a drop of 22.4%). · Non-Hispanic Black women of reproductive age would see a 51.3% reduction in uninsurance. · Non-Hispanic Black adults would see the largest reduction in the uninsured rate of any racial or ethnic group (43.2% reduction). · Young adults ages 19 to 24, the age group with the highest uninsured rate, with nearly one in five individuals uninsured (19.9%), would see the greatest decrease in the rate of uninsurance (a drop of 32.4%). Katherine Hempstead is the senior policy advisor for the Robert Wood Johnson Foundation. “The coverage gap is perhaps the cruelest loophole in our fragmented coverage system. Expanding Medicaid eligibility in the remaining states would increase health equity and generate health, social, economic, and fiscal benefits throughout the state,” said Hempstead. “We know from studies of other states that expanding Medicaid improves health outcomes for those who gain coverage, disproportionately populations of color, and additionally supports healthcare providers, especially in rural areas, and creates jobs.” “Our analysis shows expanding Medicaid eligibility or implementing Medicaid-like coverage under the president’s budget proposal in the remaining ten non-expansion states would significantly reduce the number of uninsured,” said Buettgens. “Expanding Medicaid eligibility would provide substantial health and economic benefits at little or no cost to state governments.” Originally, the Affordable Care Act required states to expand Medicaid. Alabama and other conservative states challenged that law to the Supreme Court, where the court ruled that the Constitution does not give the federal government the authority to force state governments to expand a program without their consent. States can expand Medicaid eligibility to nonelderly adults with incomes up to 138% of the federal poverty level. Alabama, Florida, Georgia, Kansas, Mississippi, South Carolina, Tennessee, Texas, Wisconsin, and Wyoming have all resisted efforts to expand Medicaid eligibility. Medicaid is already the most expensive single item in the Alabama State General Fund. Any expansion will mean either new sources of revenue for the state or cuts to existing general fund agencies. The federal government has paid for Medicaid expansion almost entirely through deficit spending. Since Medicaid expansion went into effect in 2014. In 2013, the National debt was just $16.7 trillion. The debt has more than doubled since then to $33.7 trillion. Medicare and Medicaid spending is the now most significant contributor to the debt at nearly $1.5 trillion a year. At some point, the federal government will have to reduce spending by over $1.7 trillion a year to balance the federal budget or raise taxes by that amount – current personal federal income tax collections are only $2.1 trillion. To connect with the author of this story or to comment, email brandonmreporter@gmail.com.
Federal government owed nearly $15 million by state
By Steve Wilson | The Center Square Nearly $15 million is owed by Alabama to the federal government because it did not invoice rebates from manufacturers on prescription drugs covered by Medicaid, a report says. Under Medicaid’s outpatient drug rebate requirements that began in 1991, pharmaceutical manufacturers must pay any rebates for those drugs to the states. Each state is required to invoice the manufacturers for the rebates to be eligible for federal reimbursement of drug costs. The Centers for Medicare & Medicaid Services receives a list of covered drugs and prices from the manufacturers and calculates a unit rebate amount for each drug and provides these amounts to the states each quarter. The report by the U.S. Health and Human Services Administration’s Office of Inspector General found that the Alabama Medicaid Agency didn’t invoice manufacturers for rebates for $21 million ($14.9 million federal share) in outpatient drugs. Auditors scrutinized $3.43 billion ($2.44 billion federal share) in Medicaid-reimbursed drug costs from Jan. 1, 2016, through Dec. 31, 2019. Health and Human Services recommended the state refund $14.9 million, work with Medicaid to determine how much it needed to refund the federal government for drugs not invoiced for rebates after Dec. 31, 2019, and tighten its internal controls to ensure all drugs eligible for federal reimbursement have their rebates invoiced with the manufacturers. In a response, the state says it will collect the rebates on its next invoice cycle and will pay the federal share on any rebate it receives. State officials also told the Office of Inspector General that manufacturers would need time to pay the rebate owed and it will comply with the request to tighten internal controls to ensure that rebates are invoiced. Republished with the permission of The Center Square.
Florida leads 22 states with nearly 303,000 losing their Medicaid coverage
According to data from the Kaiser Family Foundation, more than one million people have lost their Medicaid coverage nationally and Florida had the most who are no longer eligible for benefits. According to data from KFF — a nonprofit that focuses on health policy and conducts its research and polling — at least 1.35 million people, spread across 22 states, lost their Medicaid coverage as of Tuesday based on the latest available data. Florida had the most recipients lose eligibility for the Medicaid program, with nearly 303,000 people losing their benefits. Second was Arizona, with 149,000 people disenrolled, according to the KFF Medicaid Enrollment and Unwinding Tracker. The reason was the redetermination process that resumed on March 31 after the COVID-19 pandemic emergency rules ended. These rules expanded the eligibility to receive Medicaid benefits. States are required to check the eligibility of recipients annually, a mandate sidelined by COVID-19 emergency rules. The tracker shows that Florida recipients began losing their coverage in May, while enrollment in Medicaid declined by 234,646 people between April and May. A total of 583,929 enrollees had renewed their coverage by May 2023, however, 302,556 people were disenrolled. Most of those who found themselves suddenly without Medicaid coverage in Florida — 197,367 people — lost their coverage for procedural reasons. This comprised 65% of the total number disenrolled, while the other 35% (105,189 beneficiaries) lost coverage due to ineligibility. Medicaid recipients who lost their coverage in the 22 reporting states vary greatly, with some states now finding enrollees ineligible for continued coverage that was maintained due to the COVID-19 pandemic, as is the case in Idaho, which had a disenrollment rate of 73%. According to a national survey conducted by KFF with Georgetown University Center for Children and Families, the lowest Medicaid disenrollment rates around the U.S. come from states that rely on renewals through ex parte (one-sided) processes. This reduces administrative burdens on the state and the enrollee while streamlining the renewal process. The KFF tracker noted that while Florida’s renewal process was mostly automated, and the state would complete all renewals within 12 to 14 months, less than 50% of renewals were done on an ex parte basis, and the state was not taking any steps towards improving it, partly explaining the state’s high disenrollment rate. Florida has also not adopted Medicaid expansion, nor has it adopted 12-month continuous eligibility for all children in Medicaid and CHIP, according to the tracker. However, 12-month postpartum coverage has been adopted. Republished with the permission of The Center Square.
Millions who rely on Medicaid may be booted from program
If you get health care coverage through Medicaid, you might be at risk of losing that coverage over the next year. Roughly 84 million people are covered by the government-sponsored program, which has grown by 20 million people since January 2020, just before the COVID-19 pandemic hit. But as states begin checking everyone’s eligibility for Medicaid for the first time in three years, as many as 14 million people could lose access to that health care coverage. A look at why so many people may no longer qualify for the Medicaid program over the next year and what you need to know if you’re one of those people who rely on the program. WHAT’S HAPPENING TO MEDICAID? At the beginning of the pandemic, the federal government prohibited states from kicking people off Medicaid, even if they were no longer eligible. Before the pandemic, people would regularly lose their Medicaid coverage if they started making too much money to qualify for the program, gained health care coverage through their employer, or moved into a new state. That all stopped once COVID-19 started spreading across the country. Over the next year, states will be required to start checking the eligibility again of every person who is on Medicaid. People will have to fill out forms to verify their personal information, including address, income, and household size. ___ WHEN MIGHT I LOSE MY COVERAGE? That will vary depending on which state you live in; some states are moving faster than others to check eligibility. Arizona, Arkansas, Florida, Idaho, Iowa, New Hampshire, Ohio, Oklahoma, and West Virginia are among the states that will begin removing ineligible Medicaid recipients as early as April. Other states will start taking that step in May, June, or July. Not everyone will be removed from the program all at once. States plan to verify all recipients’ eligibility over periods of nine months to one year. ___ HOW WILL I BE NOTIFIED IF I’M LOSING COVERAGE? If you rely on Medicaid for care, it’s important to update your contact information, including your home address, phone number, and email, with the state from which you receive benefits. States will mail a renewal form to your home. The federal government also requires states to contact you in another way -– by phone, text message, or email –- to remind you to fill out the form. Even if mailed notices reach the right address, they can be set aside and forgotten, said Kate McEvoy, executive director of the nonprofit National Association of Medicaid Directors. “A text might just grab someone’s attention in a way that would be more accessible,” she said, noting that a quick message also may be less intimidating than a mailed notice. Most states have already used texting for things such as reminding patients to get a COVID-19 vaccine or about upcoming doctor’s visits. But sending mass texts on Medicaid eligibility will be new, McEvoy said. You will have at least 30 days to fill out the form. If you do not fill out the form, states will be able to remove you from Medicaid. ___ WHAT ARE MY OPTIONS IF I’M KICKED OFF MEDICAID? Many people who will no longer qualify for Medicaid coverage can turn to the Affordable Care Act’s marketplace for coverage, where they’ll find health care coverage options that may cost less than $10 a month. But the coverage available on the marketplace will still be vastly different from what’s offered through Medicaid. Out-of-pocket expenses and co-pays are often higher. Also, people will need to check if the insurance plans offered through the marketplace will still cover their doctors. A special enrollment period will open for people who are unenrolled from Medicaid that will start on March 31 and last through July 31, 2024. People who lose Medicaid coverage will have up to 60 days to enroll after losing coverage, according to guidance the Centers for Medicare and Medicaid Services sent to states last month. ___ MY CHILDREN ARE ENROLLED IN MEDICAID. WHAT WILL HAPPEN TO THEIR COVERAGE? More than half of U.S. children receive health care coverage through Medicaid or the Children’s Health Insurance Program. Even if you receive a notice that you’re no longer eligible for Medicaid, it’s likely that your child still qualifies for the program or for health care coverage through CHIP, which covers children whose families make too much money to qualify for Medicaid but don’t earn enough to afford private health insurance. Between 80% and 90% percent of children will still be eligible for those programs, according to estimates from the Georgetown University Health Policy Institute’s Center for Children and Families. “When a parent receives a message that they aren’t eligible anymore, they often assume their child is no longer eligible either,” said Joan Alker, the center’s executive director. “It’s more common to find that the parent is no longer eligible for Medicaid, but the child still is.” Republished with the permission of The Associated Press.
Kay Ivey & 24 governors ask Joe Biden to end COVID public health emergency, cite Medicaid costs
Twenty-five governors signed a letter to President Joe Biden asking him to end the federal public health emergency (PHE) in April, saying Medicaid costs are costing their states millions. States received more money for Medicaid during the PHE but cannot remove anyone from the program’s rolls until either one month before the PHE ends, the month it ends, or the month after it ends, according to Medicaid.gov. Biden extended the PHE to January and has not indicated when it will end. The governors said they assume the PHE will continue at least until April. The governors asked Biden for an indication as to when he would end the PHE. Twenty million people have joined the Medicaid program since the PHE began nearly three years ago, and the states are faced with additional costs, they said. “While the enhanced federal match provides some assistance to blunt the increasing costs due to higher enrollment numbers in our Medicaid programs, states are required to increase our non-federal match to adequately cover all enrollees and cannot disenroll members from the program unless they do so voluntarily,” the governors said in their letter. “Making the situation worse, we know that a considerable number of individuals have returned to employer-sponsored coverage or are receiving coverage through the individual market, and yet states still must still account and pay for their Medicaid enrollment in our non-federal share.” The governors said they have the “tools and information” to protect their citizens against COVID-19. “You recognized this yourself in a 60 Minutes interview in September when you said, ‘The pandemic is over,’” the governors said. “Additionally, the United States Senate passed a bipartisan resolution, 61-37, to terminate the national emergency on November 15, 2022. We agree with both your statement and the Senate’s resolution – it is time we move on from the pandemic and get back to life as normal.” The letter was signed by the governors of New Hampshire, Alabama, Alaska, Arizona, Arkansas, Florida, Georgia, Idaho, Indiana, Iowa, Massachusetts, Mississippi, Missouri, Montana, Nebraska, North Dakota, Ohio, Oklahoma, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, and Wyoming. Republished with the permission of The Center Square.
Justin Bogie: In the aftermath of Roe, Alabama should not rush to fully expand Medicaid
In the wake of the U.S. Supreme Court’s decision to overturn Roe v. Wade, will Alabama lawmakers make a renewed push to expand Medicaid in Alabama? The early indications suggest yes, but lawmakers should be in no rush to take action. Governor Kay Ivey and the Legislature have already expanded Medicaid coverage for new mothers, and full Medicaid expansion would come at a hefty cost to taxpayers. The day after the Supreme Court decision was released, the calls for Medicaid expansion began. Tuscaloosa Mayor Walt Maddox took to Twitter, saying that Medicaid expansion “would make quantum leaps for Alabama’s ability to ensure healthy pregnancies and births. The time must be now.” While not specifically referencing the Roe v. Wade decision, Alabama Arise Executive Director Robyn Hyden published a column renewing the call for Medicaid expansion. Other policymakers have followed suit. The call to expand Medicaid coverage for new mothers in a post-Roe world is understandable. While the specifics of how the decision will impact the number of births in Alabama are unknown, we can assume that the state’s ban on abortions, with limited exceptions, will result in more babies being born. But using the Roe decision as a means to push for full Medicaid expansion is disingenuous at best. Expanding Medicaid would almost certainly improve health outcomes for new mothers and their children. It would also provide relief from the financial burdens of having a child. But the reality that so many pro-Medicaid expansion advocates seem to ignore is that Alabama already expanded Medicaid coverage for new mothers and their children before the Roe decision. During the 2022 regular legislative session, the Legislature enacted a budget that extends Medicaid coverage from six weeks to 12 months for postpartum care. The General Fund budget signed by Governor Kay Ivey included $4 million in funding for the extension of care, and the Alabama Medicaid Agency had previously designated another $4.5 million for the program. As of now, the extension is part of a one-year pilot program, which will allow the Alabama Medicaid Agency to evaluate its cost, how many eligible mothers use the services, and whether it improves health outcomes. If the pilot program is successful, it will almost certainly be extended. This is a much more fiscally responsible and reasonable approach than bowing to the pressure of calls for full-blown Medicaid expansion. The cost of expanding postpartum care is $8.5 million. That could fluctuate based on how many mothers utilize the program over the coming years, but in the scope of a $2.7 billion General Fund budget, the costs to the state are negligible. The same cannot be said for full Medicaid expansion. The Public Affairs Research Council of Alabama (PARCA) recently estimated that full expansion would cost the state over $225 million per year on average. Total expansion costs would rise to $243 million by 2027, and the increases would likely continue thereafter. One common argument in favor of Medicaid expansion is that Alabama will receive more federal Medicaid funding and realize net savings from the expansion. PARCA estimated net savings to be over $1 billion from 2022-2027. Saying that the state will save money is an oversimplification of the issue though. While the state may see a net gain within the Alabama Medicaid Agency, it will be at the cost of other agencies funded by the General Fund budget. If the state expands Medicaid, nearly a quarter of a billion dollars from the General Fund budget will be going towards that by 2027. Most of the federal dollars that the state receives as a result of expansion would go back into the Medicaid program. Apart from potential new tax revenues, they could not be used to pay for Corrections, Mental Health, or other General Fund expenses. The decision to expand Medicaid would have ramifications far outside of the Medicaid budget. Despite the current period of record state revenues, if there is a gap left to be filled, lawmakers might turn to tax increases on the citizens of Alabama to pay the bill. Because of the required state matching funds to expand Medicare, it also means that lawmakers will have less autonomy in making budget decisions. The looming threat of an economic recession could mean less budget flexibility. While the U.S. Supreme Court’s decision to overturn Roe v. Wade may increase the need for postpartum Medicaid coverage, Alabama’s lawmakers have already addressed that issue, extending postpartum coverage from six weeks to 12 months. The Roe decision is not a reason to undertake full Medicaid expansion. Doing so could come at a high cost to Alabamians. Justin Bogie is the Senior Director of Fiscal Policy for the Alabama Policy Institute.
Robyn Hyden: We can’t wait another decade: It’s time for Alabama to expand Medicaid
It’s been a decade of missed opportunity. On June 28, 2012, the U.S. Supreme Court ruled in NFIB v. Sebelius that Alabama and other states were not required to implement the Affordable Care Act fully. The decision declared that states could opt out of expanding Medicaid to provide health coverage to adults who have low incomes and could not otherwise afford insurance. Despite the ruling, a generous offer remained on the table: The federal government would fund Medicaid expansion in its entirety for the first three years and cover 90% of the cost thereafter. Still, Alabama sat by and did little even as 17 of our hospitals have closed since 2010. We watched with no response as more than 300,000 of our friends and neighbors – folks who make too little to afford private insurance but too much to qualify for our bare-bones Medicaid program – struggled to afford needed health treatments or simply went without care. We waited for help to come as major health indicators – including labor force participation rates, maternal mortality rates, substance use disorders, and mental health outcomes – continued to languish. During those ten years, we witnessed 38 of our neighboring states take the deal that we did not. The results speak for themselves. While many of Alabama’s rural hospitals closed, Arkansas expanded Medicaid back in 2014 and retained their rural hospitals and providers. While more than 600 Alabamians die every year due to lack of health coverage, Louisiana expanded Medicaid back in 2016 and saw a reduction in premature deaths. And while Alabama lost out on more than $1 billion in additional tax revenues that would have strengthened our economy and supported our long-term economic success, our federal tax dollars went to fund health care in other expansion states, including Kentucky, Missouri, Oklahoma, and Virginia. The good news is this: A new Medicaid expansion deal is now on the table, and it is even better financially than before. The American Rescue Plan Act offers additional incentives to states that have yet to expand Medicaid to ensure we don’t miss out. With these incentives, Alabama could more than afford to provide coverage for those 300,000 friends and neighbors who are struggling to make ends meet and pay for health care. Evidence is strong that states that build a strong social safety net, including more expansive Medicaid programs, enjoy faster economic recovery from recessions than those that don’t. And these federal funds will provide the most benefit to those most harmed during the COVID-19 recession. Medicaid expansion also will help K-12 schools and universities across Alabama by generating significant increases in income and sales tax revenues – the funding sources most at risk of decline in times of economic instability. When we look back on this moment ten years from now, I’d like for the story of Medicaid expansion to be one of an embraced opportunity. Let us say Alabama’s leaders brought billions of dollars back home to invest in our health care, our economy, and our people. Let us say we weathered the ups and downs of economic instability and came out stronger. And let us say we did it all because of leaders who had the courage, the vision, and the foresight to invest today in the Alabama of 2032. Robyn Hyden is executive director of Alabama Arise, a statewide, member-led nonprofit organization advancing public policies to improve the lives of Alabamians who are marginalized by poverty. Arise’s membership includes faith-based, community, nonprofit, and civic groups, grassroots leaders, and individuals from across Alabama. Email: robyn@alarise.org.
Sweeping new vaccine mandates for 100 million Americans
In his most forceful pandemic actions and words, President Joe Biden on Thursday announced sweeping new federal vaccine requirements affecting as many as 100 million Americans in an all-out effort to increase COVID-19 vaccinations and curb the surging delta variant. Speaking at the White House, Biden sharply criticized the roughly 80 million Americans who are not yet vaccinated, despite months of availability and incentives. “We’ve been patient. But our patience is wearing thin, and your refusal has cost all of us,” he said, all but biting off his words. The unvaccinated minority “can cause a lot of damage, and they are.” The expansive rules mandate that all employers with more than 100 workers require them to be vaccinated or test for the virus weekly, affecting about 80 million Americans. And the roughly 17 million workers at health facilities that receive federal Medicare or Medicaid also will have to be fully vaccinated. Biden is also signing an executive order to require vaccination for employees of the executive branch and contractors who do business with the federal government — with no option to test out. That covers several million more workers. Biden announced the new requirements in a Thursday afternoon address from the White House as part of a new “action plan” to address the latest rise in coronavirus cases and the stagnating pace of COVID-19 shots that has raised doubts among the public over his handling of the pandemic. Just two months ago, Biden prematurely declared the nation’s “independence” from the virus. Now, despite more than 208 million Americans having at least one dose of the vaccines, the U.S. is seeing about 300% more new COVID-19 infections a day, about two-and-a-half times more hospitalizations, and nearly twice the number of deaths compared to the same time last year. “We are in the tough stretch, and it could last for a while,” Biden said of the current state of the pandemic. After months of using promotions to drive the vaccination rate, Biden is taking a much firmer hand, as his aides blamed people who have not yet received shots for the sharp rise in cases that is killing more than 1,000 people per day and imperiling a fragile economic rebound. In addition to the vaccination requirements, Biden moved to double federal fines for airline passengers who refuse to wear masks on flights or to maintain face-covering requirements on federal property in accordance with Centers for Disease Control and Prevention guidelines. Biden announced that the federal government will work to increase the supply of virus tests and that the White House has secured concessions from retailers including Walmart, Amazon, and Kroger to sell at-home testing kits at cost beginning this week. The administration was also sending additional federal support to assist schools in safely operating, including additional funding for testing. And Biden will call for large entertainment venues and arenas to require vaccinations or proof of a negative test for entry. The requirement for large companies to mandate vaccinations or weekly testing for employees will be enacted through a forthcoming rule from the Occupational Safety and Health Administration that carries penalties of $14,000 per violation, an administration official said. The White House did not immediately say when it would take effect but said workers would have sufficient time to get vaccinated. The rule would also require that large companies provide paid time off for vaccination. Meanwhile, the Centers for Medicare & Medicaid Services will extend a vaccination requirement issued earlier this summer — for nursing home staff — to other healthcare settings, including hospitals, home health agencies, and dialysis centers. Separately, the Department of Health and Human Services will require vaccinations in Head Start Programs, as well as schools run by the Department of Defense and Bureau of Indian Education, affecting about 300,000 employees. Biden’s order for executive branch workers and contractors includes exceptions for workers seeking religious or medical exemptions from vaccination, according to Jen Psaki. Federal workers and contractors will have 75 days to get fully vaccinated. Workers who don’t comply will be referred to their agencies’ human resources departments for counseling and discipline, including potential termination. “We would like to be a model” to other organizations and businesses around the country, Psaki said of the federal workforce. An AP-NORC poll conducted in August found 55% of Americans in favor of requiring government workers to be fully vaccinated, compared with 21% opposed. Similar majorities also backed vaccine mandates for health care workers, teachers working at K-12 schools, and workers who interact with the public, as at restaurants and stores. Biden has encouraged COVID-19 vaccine requirements in settings like schools, workplaces, and university campuses, and the White House hopes the strengthened federal mandate will inspire more businesses to follow suit. On Thursday, the Los Angeles Board of Education was expected to vote on requiring all students 12 and older to be fully vaccinated in the nation’s second-largest school district. Walmart, the nation’s largest private employer, said in late July it was requiring that all workers at its headquarters in Bentonville, Arkansas, as well as its managers who travel within the U.S., be vaccinated against COVID-19 by Oct. 4. But the company stopped short of requiring shots for its frontline workers. CVS Health said in late August it would require certain employees who interact with patients to be fully vaccinated by the end of October. That includes nurses, care managers, and pharmacists. In the government, several federal agencies have previously announced vaccine requirements for much of their staff, particularly those in healthcare roles like the Department of Veterans Affairs, and the Pentagon moved last month to require all service members to get vaccinated. Combined, the White House estimates those requirements cover 2.5 million Americans. Thursday’s order is expected to impact nearly 2 million more federal workers and potentially millions of contractors. Biden’s measures should help, but what’s really needed is a change in mindset for many people, said Dr. Joshua Sharfstein, vice dean at the Johns Hopkins Bloomberg School of Public Health
Greg Reed: Alabama’s innovative reform to medicaid is paying dividends
One of the toughest, yet least-talked about, challenges facing the U.S. today is how to effectively deliver affordable health care to America’s growing population of senior citizens. The U.S. Census Bureau has predicted that by 2035, the number of adults over the age of 65 will exceed the number of children under the age of 18. The graying of America’s population especially creates a challenge for what, at times, can be a fractured and overly complicated health care delivery system. In Alabama, over 90,000 senior citizens’ health care is funded in part via Medicaid, the federally-mandated insurance program that serves the elderly, the poor, and the disabled. Even though Medicaid is federally-mandated, that definitely does not mean that the federal government covers all of the costs — Alabama’s portion of the costs provided by the general fund was $755 million in Fiscal Year 2019, a figure which eats up 37 percent of all non-education spending by the State of Alabama. Over the past several years, I have worked closely with the past two Governors, other legislative leaders, Medicaid Commissioner Stephanie Azar, and private sector partners to identify new delivery models that will bend the cost curve down for Medicaid, while ensuring Alabama’s senior citizens on Medicaid still receive good medical care. In early 2017, I went to Washington, along with Speaker of the Alabama House of Representatives Mac McCutcheon, Medicaid Commissioner Azar, and other state leaders, to meet with Dr. Tom Price, who then served as President Donald Trump’s Secretary of Health and Human Services. That trip and subsequent phone calls and data presentations paid off: in 2018, the Centers for Medicare and Medicaid Services (CMS) in Washington granted Alabama the opportunity to pursue a new delivery model of health care services for the more than 20,000 senior citizens in Alabama who are receiving long-term care through Medicaid. Let me tell you: it is not an easy thing to persuade a federal agency to grant a state a waiver from any program’s requirements. Federal government employees – even the hardest-working and best-intentioned – are not necessarily keen on innovation. In October of 2018, Alabama launched the Integrated Care Network (ICN). In this new model, Medicaid contracts with an Alabama-based healthcare provider to serve the 22,500 patients who are receiving long-term care through Medicaid. These senior patients and their families have expanded choices through the ICN: most are in nursing homes, but about 30 percent have chosen to receive care in the comfort of their own homes. Where are we nearly a year down the road from the ICN launch? A few weeks ago, I convened a meeting of Medicaid, the Department of Senior Services, nursing home owners, and health care providers. Their reports were encouraging. According to Medicaid’s estimates, the ICN model has already saved the state $4 million — and Medicaid projects the savings to grow over the next few years. In 2039, if trends hold, 42 percent of Alabamians will be 60 years or older. For the senior citizens who will need Medicaid’s assistance, it is imperative that we continue to modernize and innovate in the area of health care, especially for programs like Medicaid that are funded by the taxpayers. Newton’s first law states that an object will remain at rest or in uniform motion along a straight line, unless it is acted upon by an external force — inertia, in a word. That is a concept that often applies to government programs and agencies. In this instance, the innovation of the Integrated Care Network represents the external force that is moving Medicaid to a sounder fiscal footing. Greg Reed is the Alabama Senate Majority Leader, and represents Senate District 5, which is comprised of all or parts of Walker, Winston, Fayette, Tuscaloosa, and Jefferson counties.
Brian Feldman: Medicare for All: a plan driven by politics, not patients
Last month, Sen. Bernie Sanders visited Alabama where he held campaign rallies and town halls in Birmingham and Montgomery touting his Medicare for All plan. His staunch opposition to anything other than a complete overhaul of the U.S. health care system has often dominated political and health care conversations. Every American deserves access to affordable coverage. However, we shouldn’t do it at the expense of high-quality care or access. Medicare for All is a government insurance system that would force everyone into a one-size-fits-all program. This idea is a slippery slope to full-blown government control of every American’s health. This would have disastrous consequences, none of which put patients first. Under these plans, Americans would be forced to give up their current coverage. In fact, it would cause 91% of Americans to lose their current plan, many of whom rely on coverage to receive the care they need. Sanders’ Medicare for All proposal would also compromise the high-quality care that every American deserves. The Congressional Budget Office says implementing a Medicare for All plan would be “complicated, challenging and potentially disruptive.” With a single-payer system, the CBO says patients may see longer wait times, reduced access to care and loss of services. Americans do not want a government insurance system that limits their choice of doctor and threatens the viability of the entire system. This diminished quality of care would especially hurt those in rural areas. Government insurance systems would lead to massive cuts in funding, exacerbating Alabama’s increase in rural hospital closings and health care job losses. With Alabama’s current rural health care issues and funding woes, we can’t afford to take risks when it comes to quality and access of care. In a time when rhetoric surrounding health care often becomes impractical and even polarizing, it’s up to our lawmakers in Washington to deliver patient-centered policies that will improve the affordability of health care without promising a one-size-fits-all approach. Health care reform should be driven by what’s best for patients, not politics. Brian Feldman is the Healthcare Leadership Council Regional Director for Region 3, overseeing Alabama, Arkansas, Florida, Georgia, Louisiana, Missouri, Mississippi and South Carolina.
J. Pepper Bryars: Alabama should wait and watch before considering Medicaid
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, Republican-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 waivers, partial 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.
J.W. Cowan: We need state Medicaid expansion not federal overhaul
Later this month, another Alabama hospital will close. This marks the state’s thirteenth hospital closing in eight years. Unfortunately, this has become all too common in the state and it puts many lives at risk. Our state and nation’s health care system should be the number one priority, but we need to focus on appropriate solutions that will solve this problem, not create new ones. As administrator for Choctaw General Hospital in Butler, Ala., a small rural town in the Black Belt, I see firsthand every day the rural health challenges our state faces with disparities and lack of access. I’m encouraged by the strides our health care system has made to improve on ACA and identify real solutions moving forward. One of these solutions is expanding Medicaid. Many of our patients rely on Medicaid to get the health care coverage they need. Recently, Rep. Terri Sewell and Sen. Doug Jones made Medicaid expansion their top priority by sponsoring legislation that would give states like Alabama incentives for expanding Medicaid. This is commonsense legislation that would have a tremendous impact on our rural hospitals and health care system. However, some members of Congress have proposed a “Medicare for all” plan where the government runs everyone’s health care coverage. Elizabeth Warren was in Alabama last week visiting Selma and discussed her support of a Medicare for all plan. She’s part of a group of outspoken Democrats pushing for a massive overhaul of the country’s healthcare system. Providing greater access to care for Americans is important, but a one-size-fits-all approach to coverage will only exacerbate our current problems and create new ones. The American Hospital Association and the Federation of American Hospitals (FAH) recently released a report that examined the Medicare for all plan. It found that under the government run plan, hospitals would be faced with $774 billion in cuts. Alabama specifically would lose $10.9 billion under a Medicare public option proposal. This would be detrimental to many hospitals, especially in rural areas, who are already facing financial setbacks and, most importantly, could impact patient access and care. Medicaid has helped millions of Americans receive health care coverage. The Alabama Hospital Association estimates that about 326,000 Alabamians would gain health care coverage if Medicaid was expanded in the state. This is the health care reform we need instead of a complete overhaul of the system that would harm patients and providers. It’s time we put patients first and focus on solutions that make sense. J.W. Cowan is Administrator for Choctaw General Hospital in Butler, Alabama.
