Issue: Health

CHIP renewal is overdue good news for parents of 85,000 Alabama children on ALL Kids

By Chris Sanders

Arise Citizens’ Policy Project policy director Jim Carnes issued the following statement Monday, Jan. 22, 2018, in response to the U.S. Senate’s vote to renew federal funding for the Children’s Health Insurance Program (CHIP) for six years:

“The parents of more than 85,000 children with ALL Kids coverage finally received some overdue good news today: Their kids aren’t about to lose health insurance. Congress’ agreement to renew CHIP funding for six years will allow ALL Kids to avoid an enrollment freeze and continue providing life-saving coverage for Alabama children.

“Families across Alabama deserve to breathe a sigh of relief, but it never should have come to this. CHIP funding deserved a quick, straightforward renewal before it expired nearly four months ago. Delaying the renewal and tying it to other important issues was unnecessary and irresponsible.

“A big untold story is the stress that Congress’ inaction placed on millions of hard-working parents across the country who lost the certainty that their children would be able to get the health care they needed. Instead of protecting children’s health coverage, congressional leaders spent month after month trying to undermine the Affordable Care Act. Then they focused on passing a tax bill that disproportionately benefited rich people and large corporations.

“CHIP, known as ALL Kids in Alabama, is a proven success story that played a big part in cutting our state’s uninsured rate for children from 20 percent to just 2.4 percent over the last two decades. Other states have seen similar improvements.

“Letting CHIP funding expire and remain in doubt for months was an attack on families. Congress should make sure this sad chapter can’t be repeated. It’s time to fund CHIP permanently and guarantee that all children can receive the health care they need to grow and thrive.”

Alabamians must keep urging Congress to protect health care

By Chris Sanders

Arise Citizens’ Policy Project policy director Jim Carnes issued the following statement Friday, Jan. 13, 2017, after the U.S. House approved a resolution that would make it easier for Congress to repeal portions of the Affordable Care Act:

“Protecting access to quality, affordable health care is more important than ever. Congress voted this week to make it easier to repeal parts of the Affordable Care Act, but that wasn’t the end of this debate. Now comes the hard work of ensuring that tens of millions of Americans don’t lose their health coverage and important consumer protections in the process.

“The Affordable Care Act has helped millions of people and saved thousands of lives across Alabama. Nearly 200,000 Alabamians have gained insurance through the ACA, and the vast majority of them receive tax credits to make their coverage more affordable. About 2 million Alabamians have pre-existing conditions that would have made it hard or impossible for them to get full coverage before the ACA lifted coverage caps and guaranteed their access to insurance. And the ACA has significantly reduced the number of uninsured young Alabamians by allowing 35,000 of them to remain on their parents’ plans until age 26.

“We urge Alabamians to continue pressuring their members of Congress not to repeal the Affordable Care Act without an immediate replacement that offers comparable coverage and consumer protections. ‘Repeal and delay’ is a dangerous and unacceptable path.”

Medicaid work requirements, ALL Kids, prison mental health funding among top 2019 budget challenges in Alabama

By Jim Carnes

Alabama Medicaid had good news for legislators last week, but it won’t last long. Lower-than-expected prescription drug costs will help Medicaid carry $53 million forward into 2019, meaning the agency will need less General Fund (GF) money next year than initially expected, Medicaid Commissioner Stephanie Azar said during state GF budget hearings Thursday. But that still won’t solve Medicaid’s need for stable, adequate long-term support.

Medicaid funding is just one of many GF challenges for Arise and other advocates this year. In a move that would create new barriers to health care for many low-income households, Alabama may seek to increase copays and impose work requirements for some Medicaid patients. The future of federal funding for ALL Kids, which provides health coverage for more than 85,000 children across the state, remains uncertain. Alabama also faces a federal court order to invest more in mental health care and other health services in state prisons.

Those issues and many others stand against the backdrop of a GF that struggles with a long-term structural deficit. That means GF revenue growth is not strong enough to keep pace with ordinary cost growth for Medicaid, mental health care, corrections and other services.

But lawmakers may be able to get through this year without addressing those deeper budgetary problems. The GF will carry forward $129 million into next year, enough to cover most of the requested increases for Medicaid, mental health care and corrections if Congress provides full federal funding for ALL Kids over the next two years.

The Legislature will have to finalize budgets for both the GF and the Education Trust Fund during a fast-moving 2018 regular session, which began Tuesday and is expected to end in March.

Temporary ‘good news’ won’t solve long-term Medicaid funding woes

Medicaid provides health coverage for one in five Alabamians – most of whom are children, seniors, pregnant women, or people with disabilities. The federal government provides about 70 percent of Medicaid funding in Alabama. The rest comes from the GF (11 percent) and other state sources like provider taxes on hospitals, nursing homes and pharmacies (19 percent).

Medicaid received $806 million from the GF last year, of which $105 million was one-time money from the state’s share of the BP oil spill settlement. Medicaid’s 2019 GF request is for $757 million. That would be 6 percent less than the agency’s total GF allocation last year, but 8 percent more than the amount that Medicaid received out of recurring GF revenues.

The end of Medicaid’s regional care organization (RCO) initiative in July 2017 also drew great legislative interest during the hearings. Azar discussed an “RCO pivot,” which will preserve several features of the RCO plan, with a broader scope and some structural changes. The basic idea of coordinating patient care to produce better health outcomes will continue to drive the reforms, Azar said. But new federal rules will allow Alabama to include more categories of patients in the new system.

Like the RCOs, the “pivot” plan will build on existing care management initiatives known as “health homes,” Azar said. Health homes seek to cut costs and keep patients healthier by using primary care doctors to coordinate enrollees’ health care. Alabama Medicaid has operated health homes since three regional pilot projects launched in 2010.

Arise is committed to ensuring strong consumer oversight and community engagement in whatever shape the new Medicaid reforms take. In a written proposal to Medicaid last fall, Arise emphasized that our statutory responsibility to provide consumer representatives for RCO advisory committees and governing boards gave Arise and our partners at the Disabilities Leadership Coalition of Alabama both a wealth of experiential learning over the last three years and a team of trained appointees eager to participate in the transition.

Azar reaffirmed her support for consumer involvement after the budget hearing, but advocates must keep up the pressure to ensure that principle becomes reality. To that end, Arise and our allies will provide comments on the draft Medicaid reform plan when it is unveiled in coming weeks.

Medicaid work requirement, copay proposals would hurt low-income Alabamians

Arise will seek to minimize the harm from proposals to increase Medicaid copays and impose work requirements on some Medicaid beneficiaries. Azar mentioned the possibility of increasing Medicaid copays but offered few details, other than noting that federal law would limit them to no more than 5 percent of a household’s annual income. She also said it remains unclear whether it would cost the state more to implement such a program than it would raise in return.

Azar’s discussion of work requirements was much more robust. Alabama soon will request a federal waiver to impose a work requirement for Medicaid beneficiaries in the “Parent and Other Caretaker Relative” category, Azar said. That group includes about 75,000 of the more than 1 million Alabamians with Medicaid coverage. Caretaker responsibilities, disabilities and other factors preclude many of them from working outside the home.

On an encouraging note, Azar highlighted the importance of an “exclusion list” of circumstances that would exempt many members of this group from the requirement. The scope of such a list will be a primary focus of Arise’s advocacy.

The White House has welcomed states to impose or increase work requirements and other “personal responsibility” measures for Medicaid patients, and Alabama is moving in that direction. For the vast majority of people served by Alabama Medicaid – children, seniors, and people with disabilities – the expectation of employment is not appropriate.

Most states requesting work requirements so far have expanded Medicaid to cover low-income adults without disabilities, which Alabama has not done, Azar pointed out to lawmakers Thursday. Research shows that Medicaid work requirements would limit access to the health care that many beneficiaries need to stay in the workforce while doing little to increase employment among low-income families.

ALL Kids’ future still in limbo as Congress drags feet on federal CHIP funding

Congress’ failure to provide long-term federal funding for the Children’s Health Insurance Program (CHIP) is another threat to affordable health care in Alabama. That inaction jeopardizes ALL Kids coverage for more than 85,000 Alabama children whose low- and moderate-income families earn too much to qualify for Medicaid.

ALL Kids’ future has been uncertain since long-term federal CHIP funding expired on Sept. 30, 2017. As available funding dwindled, ALL Kids in December announced that the program would end Feb. 1 without additional money. Congress approved temporary CHIP funding in December, which forestalled that move. But if the uncertainty continues, ALL Kids officials said Thursday, they will mail letters this month announcing that the program will freeze enrollment in February and terminate in March.

Under the Affordable Care Act, states have been receiving an enhanced federal match for their CHIPs, which in Alabama amounted to 100 percent federal funding. It remains unclear how Congress will handle this funding formula in a long-term funding plan. The Department of Public Health has requested an extra $53.6 million from the GF next year in case Congress requires Alabama to resume providing state matching money for ALL Kids.

For Medicaid, the loss of CHIP funding would mean that an additional 87,000 children whose Medicaid coverage is paid for by ALL Kids – but cannot legally be terminated – will move to the Medicaid budget. That would increase the state’s cost to cover those children.

Alabama was the first state to win approval for its CHIP when Congress created the program in the late 1990s. It has played a huge role in reducing the state’s rate of uninsured children from 20 percent then to just 2.4 percent today. Arise and other advocates urge Congress to honor this historic commitment by moving forward with a five-year plan for full CHIP funding without further delay.

Federal lawsuit to force more state investment in mental health care in prisons

Mental health care in Alabama prisons is “horrendously inadequate,” a federal judge ruled last summer. That led to an order for the state to solve the chronic understaffing in its prison system, particularly among corrections officers and mental health professionals. Corrections Commissioner Jeff Dunn has requested an additional $80 million in GF support over the next two years to address those issues.

Staffing in Alabama’s prison system is at only half of its expected level, Dunn told lawmakers Thursday. In some facilities, that number is as low as 30 percent, he said. Sentencing reforms have helped reduce the state’s prison overcrowding from 190 percent of designed capacity to 160 percent in recent years, but Alabama still has the nation’s “highest overcrowding percentage,” Dunn said.

State education funding up but still lower than a decade ago

Alabama’s education funding will be up again next year, but it still will be well below its inflation-adjusted level from 2008, before the Great Recession. The Education Trust Fund (ETF) funding cap for 2019 will be $6.6 billion. That’s $216 million, or 3.4 percent, higher than this year’s allocations. The Rolling Reserve Act sets the cap annually based on a moving average of the previous 15 years of ETF revenues. Gov. Kay Ivey’s proposed ETF and GF budgets include cost-of-living raises for both education employees and state employees.

By Jim Carnes, policy director, and Chris Sanders, communications director. Posted Jan. 9, 2018.

Children’s health care takes a back seat as Congress rushes to cut taxes for corporations, wealthy people

By Chris Sanders

Arise Citizens’ Policy Project executive director Kimble Forrister issued the following statement Wednesday, Dec. 20, 2017, in response to Congress’ passage of a tax bill that disproportionately benefits rich people and corporations:

“Congress’ misplaced priorities were on clear display today. Nearly 84,000 Alabama children are about to lose their ALL Kids coverage because lawmakers allowed federal funding for it to expire months ago. But instead of solving that problem, Congress hurried to create a new one by increasing the deficit to give huge tax cuts to big corporations and wealthy people.

“This tax plan is a massive giveaway to the rich at the expense of everyday Americans. Over time, it will raise taxes on tens of millions of families at low and middle incomes. It will increase health insurance premiums for millions of people and leave millions more uninsured in exchange for permanent tax cuts for big corporations. And it will drive up the federal deficit, setting the stage for calls to cut Medicare, Medicaid, education, food assistance and other vital services next year.

“Struggling families shouldn’t have to pay for tax cuts for rich people. And tens of thousands of Alabama families can’t afford for Congress to wait any longer to renew federal funding for the Children’s Health Insurance Program. Lawmakers across Alabama and across the country should commit now to renew CHIP funding before a single child loses coverage and to reject budget cuts that would make it harder for families to make ends meet.”

Congress’ shameful neglect puts health coverage at risk for 84,000 Alabama children on ALL Kids

By Chris Sanders

Arise Citizens’ Policy Project policy director Jim Carnes issued the following statement Monday, Dec. 18, 2017, in response to the announcement of ALL Kids’ pending termination:

“Tens of thousands of Alabama working families learned today – one week before Christmas – that their children will lose health insurance Feb. 1 if Congress continues to delay funding for the Children’s Health Insurance Program (CHIP), known here as ALL Kids. Alabama officials had been holding their breath since Congress failed to reauthorize CHIP funding by Sept. 30. They were hoping reserve funds could tide the coverage over for a few months – surely enough time for Congress to act. But today those hopes were dashed.

“ALL Kids’ announcement that it would stop enrolling children in new coverage on Jan. 1 and end the program entirely a month later strikes a painful blow not only to 84,000 ALL Kids children and their families but also to Alabama’s nationally praised gains in children’s health coverage. In the two decades since ALL Kids became the first state CHIP authorized by Congress, our uninsured rate for children has dropped from 20 percent to 2.4 percent. That record has earned Alabama’s program national recognition as the ‘Star of the South.’

“Ending ALL Kids also places a strain on Alabama’s threadbare General Fund. CHIP funds now pay for the health care of around 75,000 children enrolled in Medicaid, who will continue to receive coverage but at new cost to the state.

“In this shameful development, Congress has turned children’s health care – a vital part of family well-being – into a political football. Toying with children’s coverage creates a health hazard in its own right – and an entirely preventable one. Alabama’s hard decision today is a sign of things to come as other states face the grim realities of Congress’ failure to address children’s health needs. Our lawmakers must come to their senses and act now. Every wasted day puts children’s health in greater danger.”

GOP tax plan would slash taxes for wealthy people while laying groundwork for cuts to education, Medicaid

By Chris Sanders

Arise Citizens’ Policy Project executive director Kimble Forrister issued the following statement Friday, Nov. 3, 2017, in response to the release of U.S. House Republicans’ tax proposal:

“The House Republican tax plan is an expensive new giveaway to wealthy households and big corporations at the expense of working families. It would offer little or nothing to most Alabamians, and it actually would increase taxes for many low- and middle-income folks.

“This plan would add at least $1.5 trillion to the national deficit – and to pay for it, many in Congress will try next year to cut everything from education and Medicaid to food assistance for struggling families. Those cuts would make it even tougher for hard-working Alabamians to make ends meet.

“Taking from those who have the least to give to those who have the most is no way to build a better economy, a better state or a better world. Congress should reject this tax bill and focus instead on closing corporate tax loopholes and investing in education, health care, transportation and other vital services that help struggling families get ahead across Alabama and across the country.”

Keep kids covered: Congressional inaction threatens ALL Kids coverage for Alabama children

By Alabama Arise

Federal funding for the Children’s Health Insurance Program (CHIP) has expired, and health coverage for millions of American kids is at stake. Despite a history of strong bipartisan support, Congress allowed a Sept. 30 deadline to pass without renewing federal funding for the program, which offers affordable coverage for children whose low- and moderate-income families don’t qualify for Medicaid.

CHIP covers about 150,000 children across Alabama, through both ALL Kids and Medicaid. ALL Kids officials say they have enough funding on hand to maintain coverage until early 2018. But continued uncertainty in Congress may force Alabama to start sending termination letters to many ALL Kids families as soon as next month.

ALL Kids has been a huge success story for Alabama. It was the first plan in the country to win federal approval after Congress authorized the creation of state CHIPs in 1997. Alabama’s uninsured rate for children at that time was 14 percent. Two decades later, that rate is less than 3 percent. It’s a proud achievement that affirms ALL Kids’ consistent performance as a national model program. Alabama also has benefited recently from extra CHIP funding through the Affordable Care Act (ACA). A temporary boost in federal matching funds under the ACA has meant that Alabama has not had to contribute any state money toward CHIP for the past two years. The future of this boost is another question Congress faces on CHIP’s funding.

Failure to renew CHIP funding would put children and families at risk:

  • Nearly 9 million children nationwide, including more than 150,000 in Alabama, receive essential health coverage through CHIP.
  • Families pay a reduced, income-based premium for CHIP, which keeps health coverage in reach for families who otherwise couldn’t afford insurance.
  • The threat of lost coverage puts unnecessary strain on hard-working families.

BOTTOM LINE: Congress needs to lift the cloud of uncertainty over children’s health coverage and renew full CHIP funding for five years.

Executive order could mean soaring health insurance costs for Alabamians with pre-existing conditions

By Chris Sanders

Arise Citizens’ Policy Project policy director Jim Carnes issued the following statement Thursday, Oct. 12, 2017, in response to the White House’s release of a new executive order on health care:

“This executive order risks turning back the clock to the bad old days when many people were priced out of health insurance just because they got sick. Allowing more insurers to sell plans that don’t cover essential health benefits would weaken consumer protections under the guise of promoting consumer choice.

“These changes could open the door to a wave of ‘cheaper’ plans that cost less because they don’t provide as much coverage. By luring in many healthier people, these plans could undermine protections for folks with pre-existing conditions like cancer and diabetes by sending costs soaring for more comprehensive coverage.

“Recent cuts to the Marketplace enrollment period, enrollment assistance and outreach activities already have created unnecessary barriers for consumers and threaten to reverse gains in health coverage and care. Today’s announcement doesn’t immediately change anything, but it sows even more confusion in the health insurance market just as tens of thousands of Alabamians are getting ready to enroll for 2018 coverage. It’s more important than ever for advocates and leaders across our state to ensure that Alabamians have the information they need to find affordable coverage that’s there for them when they need it most.”

Graham-Cassidy health plan would cost Alabama $27 billion through 2036

By Chris Sanders

Alabama would lose $27 billion in federal health care funding through 2036 if the Graham-Cassidy health care plan becomes law, according to a new study by Avalere Health, an independent analysis firm. The proposal also would open the door to erosion or elimination of pre-existing condition protections for more than 2 million Alabamians with cancer, diabetes or other medical conditions.

The plan temporarily would divert federal funding from states that expanded Medicaid to cover low-income adults to states like Alabama that have not, but the gains would disappear in 2027. Medicaid expansion in Alabama would generate at least as much new federal money through 2026 as Graham-Cassidy – and likely more, according to research from the University of Alabama at Birmingham.

“Every state would be a loser under Graham-Cassidy, and Alabama is no exception,” Arise Citizens’ Policy Project policy director Jim Carnes said Thursday. “Over time, this bill would wreck our state’s General Fund budget and force enormous Medicaid cuts that would hurt children, seniors, and people with disabilities across Alabama. We urge Congress to reject this harmful plan and work together in a bipartisan way to strengthen our country’s health care system.”

The amendment, sponsored by Sens. Lindsey Graham, R-S.C., and Bill Cassidy, R-La., would:

The risks to Medicaid and rural health care in Alabama

The Graham-Cassidy plan would end both Medicaid expansion for low-income adults and subsidies for individual plans under the Affordable Care Act. (Alabama has not expanded Medicaid, but more than 140,000 Alabamians receive subsidies for individual ACA coverage.) In their place, the Graham-Cassidy plan would give states a block grant that would not increase in response to growing costs or enrollment. The plan also would impose a per capita (or per-person) cap on federal Medicaid funding.

“This bill plays bait-and-switch with Alabama’s federal health care funding,” Carnes said. “The temporary gain wouldn’t be worth wreaking long-term havoc on our state’s health care system.”

At the same time, the Medicaid cap would force Alabama and all other states to pick up an increasingly larger share of health care funding. The result would be either higher state taxes or – perhaps more likely – deep cuts to Medicaid, which covers more than one in five Alabamians, almost all of whom are children, seniors, pregnant women, or people with disabilities.

Such cuts would be devastating for Medicaid patients, and they also would be bad news for rural communities across Alabama, where Medicaid plays a huge role in helping many hospitals and clinics stay open. Closure of those facilities would harm not just Medicaid patients but people with private insurance coverage as well.

The risks to Alabamians with pre-existing conditions

The Graham-Cassidy plan’s threats to Alabamians with private insurance would not end there. The bill also could put essential consumer protections at risk for more than 2 million Alabamians who have pre-existing health conditions like asthma, cancer, diabetes or heart disease.

Under the ACA, insurers are not allowed to charge higher premiums based on an applicant’s health history. The ACA also requires insurance plans to cover 10 “essential health benefits,” including maternity care, prescription drugs and mental health care, and forbids insurers to impose annual or lifetime coverage limits for those services.

The Graham-Cassidy proposal would allow states to seek waivers of those protections for any insurance plan subsidized by block grant funding. States seeking waivers would have to explain how they “intend” to keep insurance affordable for people with pre-existing conditions, but the bill does not set a clear definition of affordability.

If the ACA’s protection against higher premiums based on health status disappeared, many Alabamians with pre-existing conditions could see premiums soar by tens of thousands of dollars a year, effectively pricing them out of the insurance market. And if maternity care, mental health care or other services were no longer deemed to be “essential health benefits,” insurers once again could impose annual or lifetime coverage limits on them – or refuse to cover them at all.

“We can’t afford to return to the bad old days when people were punished with soaring premiums just because they got sick,” Carnes said. “Congress needs to stop trying to undermine consumer protections and start working together to ensure that all Americans can get quality, affordable health care when they need it.”

Medicaid funding, public transportation highlight Arise’s 2018 priorities

By Chris Sanders

New Medicaid revenue and creation of a state Public Transportation Trust Fund are among the goals on Alabama Arise’s 2018 legislative agenda. Nearly 200 Arise members picked the group’s issue priorities at its annual meeting Saturday, Sept. 16, 2017, in Montgomery. The seven goals chosen were:

  • Tax reform, including untaxing groceries and closing corporate income tax loopholes;
  • Adequate funding for vital services like education, health care and child care, including approval of new tax revenue to prevent Medicaid cuts;
  • Consumer protections to limit high-interest payday loans and auto title loans in Alabama;
  • Dedicated state revenue for the Alabama Housing Trust Fund;
  • Reforms to Alabama’s death penalty system, including a moratorium on executions;
  • Creation of a state Public Transportation Trust Fund; and
  • Reforms to Alabama’s criminal justice debt policies, including changes related to cash bail and driver’s license revocations for minor offenses.

“All Alabamians deserve equal justice and an opportunity to build a better life for themselves and their families,” Alabama Arise state coordinator Kimble Forrister said. “We’re excited to continue our work for policy changes that would make it easier for hard-working Alabamians to get ahead.”

More than one in five Alabamians – almost all of whom are children, seniors, pregnant women, or people with disabilities – have health coverage through Medicaid. That coverage plays an important role in keeping hospitals and doctors’ offices open across the state, especially in rural areas.

“Medicaid is the backbone of Alabama’s health care system, and we must keep it strong,” Forrister said. “The Legislature needs to step up and approve new, sustainable revenue for Medicaid in 2018. It’s time to stop the annual funding battles and ensure all Alabamians have access to health care.”

Lack of adequate transportation is another major challenge that limits economic growth and erects barriers to daily living for many low-income residents and people with disabilities across Alabama. Arise will push for creation of a state Public Transportation Trust Fund as a step toward closing that gap. A bill to create a trust fund passed the Senate this year and has momentum heading into 2018.