Category: Blog

Money matters: Budgets top priority for session; lawmakers also discussing Medicaid expansion, criminal justice reform, voting rights this year

By Jim Carnes

As the Alabama Legislature approaches the 2021 regular session’s final days, both state budgets are halfway to passage. The Education Trust Fund (ETF) budget has passed in the Senate and is in the House’s education budget committee. The General Fund (GF) budget, which funds all non-education services, has cleared the House and awaits Senate committee approval. Despite the COVID-19 recession, both budgets eked out small increases – 3% in the GF and 6% in the ETF. This will allow pay raises for teachers and state employees. It also will fund one-time additional 2022 teacher units and a new salary matrix for certified math and science teachers.

While budgets progressed, the Senate divided over whether to pass a gambling bill that would increase revenue for one or both. After Sen. Del Marsh’s lottery and gaming bill failed March 9, Sens. Garlan Gudger, R-Cullman, and Jim McClendon, R-Springville, introduced lottery bills. Meanwhile, Marsh, R-Anniston, introduced both a new lottery and a new gaming bill.

The Senate may consider some combination of these measures later this session. If approved by legislators and voters, expansion of gambling could increase state revenues anywhere from $118 million to $550 million. (Arise takes no position for or against gambling legislation.)

Health care

A big change on the health care front this year is the prominent role of Medicaid expansion in legislative discussions, both on and off the chamber floors. Gov. Kay Ivey can propose expansion through administrative steps, but lawmakers still control the purse strings. So legislative advocacy is essential!

As the pandemic highlights the need for rigorous health data, Alabama had been one of only two states lacking a statewide hospital discharge database. Now we’ll be shedding that dubious distinction with the enactment of HB 210 by Rep. Paul Lee, R-Dothan, a bill that Arise supported.

The Alabama Department of Public Health (ADPH) has been the target of several proposals to increase political control over the agency’s leadership and decision-making. McClendon’s SB 240, for example, would abolish the State Board of Health, the medical body that appoints the state health officer, and make ADPH’s director a gubernatorial appointment. Other bills would limit state and county health officials’ authority to declare health emergencies. One such measure, SB 97 by Sen. Tom Whatley, R-Auburn, passed the Senate in early April.

Criminal justice reform

Several criminal justice improvements have moved forward this year. These include partial reform of sentencing under the Habitual Felony Offender Act (HFOA) and expanded alternatives to imprisonment. Bigger reforms like HFOA repeal and abolition of driver’s license suspension have been slowed due to opposition, though. That inaction has persisted even in the face of a U.S. Department of Justice lawsuit over unconstitutional prison conditions.

Voting rights

Efforts to protect and expand voting rights continue to face an uphill battle. Bills prohibiting curbside voting have advanced, despite the practice’s success in Mississippi and other states. Meanwhile, a bill allowing no-cause absentee voting stalled, as did measures on early voting and same-day voter registration. Legislation improving voting rights restoration did advance, but only after removal of a provision that would have ended a de facto poll tax: the requirement for people with convictions to pay all fines and fees before regaining voting rights.

American Rescue Plan Act offers path to recovery

By Chris Sanders

As vaccinations continue across Alabama, COVID-19’s viselike grip on our lives is loosening. The pandemic has caused immense physical, emotional and economic suffering, and those aftereffects will not fade quickly. But the American Rescue Plan Act – the federal relief package that President Joe Biden signed March 11 – includes many important policies to begin the healing.

Some of the most crucial investments come in health care. The law increases subsidies for marketplace health coverage under the Affordable Care Act. It also creates new incentives that would more than offset the cost of Medicaid expansion. The incentives would remove Alabama’s last financial barrier to extending coverage to more than 340,000 adults with low incomes.

If Gov. Kay Ivey agrees to expand Medicaid, Alabama would receive between $740 million and $940 million over two years. That would result from a 5-percentage-point federal funding increase for traditional Medicaid coverage.

Alabama State Capitol in Montgomery

“Medicaid expansion is the single biggest step Alabama can take to recover from the pandemic,” Alabama Arise campaign director Jane Adams said.

“Congress did their job. Now it’s time for the governor and state lawmakers to do theirs.”

The act also slashes poverty by boosting unemployment insurance and nutrition assistance benefits and expanding the Child Tax Credit and Earned Income Tax Credit. It funds rental and mortgage assistance to help prevent evictions and foreclosures. And it provides Alabama’s state and local governments with $4 billion of federal assistance to help avoid cuts to education and other vital services.

Persistent disparities – and how to end them

The relief package provides opportunities to begin dismantling longtime structural barriers in Alabama. Arise offers many such policy recommendations in our recent report, The State of Working Alabama 2021, which details how COVID-19 cost hundreds of thousands of Alabamians their jobs and fueled a rapid surge of hunger and hardship across our state.

COVID-19’s toll has been especially heavy for women and people of color, the report finds. The pandemic exacerbated Alabama’s preexisting racial, gender and regional disparities in health care, housing, nutrition and economic opportunity. These inequities – the legacy of bad policy decisions – prevent Alabama from reaching its full potential.

“Alabama’s economic, racial and gender inequities are preventable and reversible,” Arise policy director Jim Carnes said. “By making better policy choices now and in the future, we can chart a path toward a more equitable economy.”

Arise legislative recap: April 10, 2021

By Alabama Arise

Arise’s Carol Gundlach provides an update on the lottery and medical marijuana bills moving through the Alabama Legislature and discusses how they could shape the policy landscape for Medicaid expansion and the grocery tax as the 2021 regular session nears its final days. (Correction: The lottery and medical marijuana bill debates were on Wednesday, not Tuesday.)

A healthier Alabama is just over the horizon

By Jim Carnes

340,000+ Alabamians need our help. The time is now! Together, we can expand Medicaid.I am thrilled to report that Alabama is closer to expanding Medicaid today than we’ve ever been before! Thanks to your strong advocacy, our leaders are beginning to see the connections between the COVID-19 pandemic and unequal access to health care. They’re facing the fact that rural communities, primary care providers and everyday Alabamians are buckling under the weight of a broken health care system.

Hundreds of thousands of friends and neighbors with low incomes have had to navigate the pandemic without health insurance. Alabama can do better. We can close the coverage gap now.

Alabama Arise has a goal of raising $50,000 before June 30 to accelerate our efforts to expand Medicaid in 2021. Will you consider making a contribution of any amount you feel comfortable giving?

How your support has helped protect and improve health coverage

For nearly 11 years now, Alabama’s leaders have stemmed the national tide of Medicaid expansion. They’ve let the three-year grace period of full federal funding for Medicaid expansion expire. They’ve watched most rural hospitals teeter on the brink and eight of them close.

Our lawmakers have allowed hundreds of thousands of Alabamians with low incomes to face a pandemic without health insurance. And they’ve ignored a report from their own legislatively authorized review committee recommending Medicaid expansion as the single biggest step to address Alabama’s maternal mortality crisis. Meanwhile, 38 states and the District of Columbia have opened Medicaid coverage to adults with low incomes. No state has reversed this life-saving decision.

It might feel like an 11-year stalemate, but we have slowly moved the ball forward. And your persistence has changed the game. Arise members and our partners have engaged policymakers on their own terms to protect and improve Medicaid.

  • When they said we couldn’t expand a “broken” system, you helped shape reforms that brought community voices to the Medicaid policy table.
  • When they said we needed to scrap the Affordable Care Act and risk losing Medicaid altogether, you pushed back and stopped the effort cold.
  • And when they said Medicaid consumers needed more “skin in the game,” you helped collect more than 1,800 public comments opposing a Medicaid work requirement and blocked the proposal.

Photos of Alabama Arise members speaking out for Medicaid expansion at our annual meeting and Legislative Day.

Medicaid expansion is now within reach in Alabama

Now, as news reports confirm that Alabama policymakers are no longer “dug in” against Medicaid expansion, 11 years of hard work and steady vision have brought the prize within reach. As you know, the federal government pays 90% of the cost for Medicaid expansion. In Alabama, more than 340,000 adults with low incomes would receive affordable health coverage in the bargain. The state would chip in just a dime on the dollar for their care.

That bargain would pay wider dividends as the new funding creates jobs and generates new tax revenues throughout the economy. As one Alabama hospital executive put it, if our state recruited a new factory with the same economic impact as Medicaid expansion, we would have a parade from Huntsville to Mobile!

For 11 years, our leaders have left this offer on the table, claiming a dime was too much to pay for a dollar’s worth of health care. Now, the pandemic has put Alabama’s health care – and our health itself – in a harsh new light. Our state leaders are finally getting the message.

It’s been a long 11 years, some of them dark and dreary. But you’ve kept pushing, and the light is breaking through.

We have bipartisan Medicaid support. We have a new administration in Washington that has dedicated funding to incentivize Medicaid expansion. And we have a community of more than 340,000 Alabamians who deserve access to affordable medical care.

We need your support now more than ever to support what we hope is our final push. Will you consider making a donation of any amount today to help Arise reach our goal? Please give today to support our Medicaid expansion campaign.

Arise legislative recap: April 5, 2021

By Matt Okarmus

Arise’s Jim Carnes provides an update on several good bills that won committee approval, including legislation to repeal Alabama’s broken and harmful Habitual Felony Offender Act. He also acknowledges a disturbing trend of bills that aim to limit the power of Alabama’s public health officials to respond to pandemics and other emergencies.

Arise legislative recap: March 19, 2021

By Alabama Arise

As the Alabama Legislature reaches the midpoint of this year’s regular session, Arise’s Celida Soto Garcia brings us up to date with the session so far. Lawmakers sadly have neglected many key needs while advancing numerous bills that would infringe on the civil rights of Alabamians. We need you to speak out for a better Alabama.

Two corrections reflected in the captions: The session will resume on Tuesday, March 30. And HB 285 is sponsored by Rep. Wes Allen.

New Medicaid expansion incentive clears the path to a healthier Alabama

By Jim Carnes

The American Rescue Plan Act of 2021 answers a question Alabama policymakers have been asking for years: How can we pay for Medicaid expansion? It’s a solution that lawmakers should embrace immediately to build a better, healthier future for our state. And it’s a step you can urge the governor to take today.

An incentive in the new federal COVID-19 relief package means Medicaid expansion in Alabama effectively would pay for itself. Medicaid expansion would bring peace of mind to more than 340,000 adults with low incomes who are uninsured or struggling to afford health coverage. It also would save lives, create jobs and help protect rural hospitals across our state.

If Alabama agrees to expansion, the law will reduce the state’s costs to provide Medicaid coverage for the much larger non-expansion population for two years. This offer would add 5 percentage points of federal funding to the generous match Alabama already receives for Medicaid expenditures.

The enhanced federal match would create more than enough General Fund (GF) “breathing room” to cover the state’s 10% share of Medicaid expansion costs for the first two years, which are the most expensive. Since 2014, Alabama taxpayers have paid $4 billion in federal taxes to help support Medicaid expansion in other states. This new provision is an unprecedented opportunity to bring some of those tax dollars home to cover Alabamians.

How the new federal Medicaid incentives work

Alabama’s “regular” Medicaid match rate (known as the Federal Medical Assistance Percentage, or FMAP) adjusts slightly from year to year. It will be 72.37% for 2022. And the state already is receiving an additional 6.2-percentage-point boost until the COVID-19 public health emergency ends. That brings the overall federal share to 78.57%.

With the additional 5 percentage points, Alabama’s federal match to cover current Medicaid enrollees would increase to 83.57% until the emergency ends. (It would revert to 77.37% for the remainder of the two-year incentive period after the emergency.) An even higher federal match of 90% will apply permanently to coverage for people newly eligible under Medicaid expansion.

Estimates of the value of Alabama’s incentive over the two years range from $740 million (Kaiser Family Foundation) to $940 million (Center on Budget and Policy Priorities). Even at the lower end, the increase would free up far more than the state’s estimated net share of the first year of Medicaid expansion ($168 million).

Research findings from UAB – and other states’ experiences – suggest Alabama’s net costs will drop dramatically after Year 1. (A UAB study projects the state’s net cost for expansion will be around $25 million a year in Alabama.) That’s because the increased federal funding would produce new tax revenues and offset previous state spending on newly covered services.

Alabama is one of 14 states eligible for the new incentive. They include two states – Missouri and Oklahoma – that have passed expansion by referendum but haven’t implemented it yet. They also include the 11 other states, mostly in the South, that have not yet moved to expand Medicaid. Those states are Florida, Georgia, Kansas, Mississippi, North Carolina, South Carolina, South Dakota, Tennessee, Texas, Wisconsin and Wyoming.

Why the time for Alabama to expand Medicaid is right now

Timing is a critical factor. While the two-year incentive offer remains available for 10 years, current conditions are especially favorable for Medicaid expansion in Alabama. Medicaid will enter the 2022 budget year with a $252 million “carryforward” from this year.

That surplus likely will allow lawmakers to reduce Medicaid’s GF appropriation next year and keep some funds in reserve. The 2022 GF budget that legislators are considering also was written before the new 5-percentage-point boost became available. So the difference truly would be a windfall.

Alabama can’t use federal funds to match federal funds. But hundreds of millions of dollars of additional, unanticipated federal money would relieve pressure on state budgets. And that would free up enough state funds to pay for Alabama’s share of Medicaid expansion for many years.

The Medicaid expansion incentive is a part of federal COVID-19 relief funding for a reason. The pandemic has tested our health care system to its limits. Besides killing more Alabamians than all modern wars combined, the crisis has revealed deep gaps in care and coverage that leave hundreds of thousands of Alabamians extra vulnerable to the virus and unable to pay for the care they need. A “lost year” has left local communities, businesses and families reeling.

The single biggest step our leaders can take to bridge Alabama’s health care gap and accelerate our economic recovery is to expand Medicaid. The new federal incentive removes the last hurdle in our way. It’s time to expand Medicaid now.

You can speak up now for this investment in a healthier future for Alabama. Click here to email Gov. Kay Ivey and urge her to save lives and create jobs by expanding Medicaid.

Arise legislative recap: March 12, 2021

By Alabama Arise

Arise’s Carol Gundlach breaks down the American Rescue Plan and what it means for Alabama families including expansions to the Child Tax Credit and EITC helping to reduce poverty across Alabama.

Arise legislative recap: March 5, 2021

By Alabama Arise

Arise’s Dev Wakeley provides an update on recent setbacks and successes on voting rights bills at the Alabama Legislature. He also discusses the U.S. House’s passage of the For the People Act, which would enact automatic voter registration and other changes to strengthen voters’ access to the ballot. Voting rights is one of Arise’s 2021 issue priorities, and you can learn more about our work at al-arise.org.

Join us for Arise’s Membership Mondays!

By Presdelane Harris

Membership Mondays are an opportunity for Alabama Arise members to network and get more energized in our work together. In these online sessions, members will get the latest updates on the legislative session. Then they will break into groups to talk to other Arise members around the state.

In the breakouts, participants can share about their advocacy actions and learn what others are doing. Meeting attendees will choose the issue topics for the breakout sessions.

Ideally, we are designating these meetings for Arise members. If you are not yet a member of Arise, we invite you to join thousands of other Arisers advocating for our vision of a better Alabama for all.

Click here to join Arise for as little as $15 a year. Add the strength of your voice to the work of making policies that improve life for struggling families across Alabama.

Registration is required. Sign up for one or both events below:

Membership Monday 2021 – March 15th, 6 p.m.

Register here.

Membership Monday 2021 – April 12th, 6 p.m.

Register here.