Issue: Medicaid Expansion

Expand Medicaid to shore up children’s health coverage in Alabama

By Jim Carnes

Children’s health coverage has long been a point of pride for Alabama, and we can’t afford to backslide. But Alabama’s rate of uninsured children has moved in the wrong direction since 2016, according to a recent report from Georgetown University’s Center for Children and Families (CCF).

Our state’s uninsured rate for children (3.5%) remained one of the best in the South in 2018. After years of improvement, though, Alabama’s number of uninsured children ticked up from 32,000 in 2016 to 41,000 in 2018.

That’s a warning sign that our policymakers should heed. Alabama must protect the coverage gains we’ve made through ALL Kids. And we should build on those gains by expanding Medicaid to cover adults with low incomes.

When parents have health insurance, their children are more likely to have coverage as well. Medicaid expansion would boost health security for struggling families across Alabama. That would be good for children, good for communities and good for our entire state.

Check out our news release for more on the Georgetown CCF report. Then urge Gov. Kay Ivey to expand Medicaid so all Alabamians can get the care they need to survive and thrive.

Medicaid expansion would help Alabama veterans meet their health care needs

By Jim Carnes

Veterans Day gives Alabama a chance to shine. Our cities and towns hold parades and ceremonies each Nov. 11 to honor service members and to burnish the state’s reputation as a great place for veterans to retire.

This year, as we celebrate those who have risked and sacrificed to defend our country, let’s remember a group too often overlooked: veterans who have low incomes and no health insurance. And let’s commit to expanding Medicaid to help them meet their health needs.

Medicaid expansion would help Alabama veterans. Thousands of Alabama veterans are living without health coverage for themselves or their family members. They don't qualify for Medicaid or VA care, and they can't afford employer-based coverage or private insurance. 5,062 Alabama veterans with low incomes have no health insurance. (1,812 women and 3,250 men.) 7,934 low-income adults who live with Alabama veterans have no health insurance. (4,703 women and 3,231 men.) Medicaid expansion would give Alabama veterans and their families the health security they need.

It’s a common misconception that people who serve in the U.S. military automatically receive lifetime eligibility for health coverage and other benefits. In reality, though, veterans’ health benefits depend on their length of service, military classification, type of discharge and other factors. Treatment for service-connected conditions has no time-of-service requirement, but other health benefits do.

Active-duty service members and their families receive health coverage through the Department of Veterans Affairs (VA). Most also receive “bridge” health insurance coverage in the 180 days before and after their active-duty service.

But many veterans — including many National Guard and Reserve members — return home without military health care for the long term. For the 13,000 Alabama veterans and adult family members who have no military health insurance and can’t afford private plans, the consequences can be dire.

A lasting commitment to Alabama’s uninsured veterans

Returning to civilian life can be challenging enough without the added burden of being uninsured. Injuries sustained from combat, environmental hazards or physical stress can cause chronic disability or loss of function. And the mental stress of combat and separation from family also puts some veterans at risk for mental health problems and substance use disorders. The rising rate of veteran suicides is stark evidence of this troubling toll.

There’s something Alabama can do to help. If we expanded Medicaid to adults earning up to 138% of the federal poverty level ($29,435 a year for a family of three), nearly 13,000 uninsured veterans and family members could get the health coverage they need. Medicaid expansion would be a meaningful and lasting commitment to make life better for veterans across Alabama.

Alabama’s uninsured rate is growing because we haven’t expanded Medicaid

By Chris Sanders

U.S. Census findings released Tuesday show that about 32,000 more Alabamians were uninsured in 2018 than in 2017. They also found that the state’s uninsured rate remained higher than the national average. Alabama Arise policy director Jim Carnes issued the following statement in response:

“No one should have to go without the medical care they need simply because they can’t afford it. But that’s the reality for a growing number of Alabamians, because our state has refused to expand Medicaid. Gov. Kay Ivey and state lawmakers need to lift this policy barrier that separates hundreds of thousands of Alabamians from affordable health coverage.

“As Alabama’s inaction on Medicaid expansion continues, our state’s uninsured rate continues to climb. The share of Alabamians without health insurance coverage rose to 10% in 2018, up from 9.4% in 2017. This is a trend in the wrong direction, but we can reverse it with better policy choices.

“All Alabamians would benefit from Medicaid expansion. More than 340,000 adults across the state would gain health security. The new coverage would pump about $1.7 billion a year in direct federal spending into our economy. And over the next four years, economic activity related to expansion would generate $446 million in state tax revenues.

“Even more important than the economic gains would be the human gains. Medicaid expansion would give Alabama better tools to address mental illnesses, substance use disorders, infant mortality and other longstanding challenges. Closing our state’s coverage gap would mean healthier families, more vibrant communities and a more productive workforce.

“It’s time to make an investment in Alabama’s future. The governor should expand Medicaid to protect rural hospitals, create thousands of jobs and make Alabama healthier.”

Alabama Arise members vow to renew ‘untax groceries’ push in 2020

By Chris Sanders

Ending the state sales tax on groceries is one of the top goals on Alabama Arise’s 2020 legislative agenda. Nearly 200 Arise members picked the organization’s issue priorities at its annual meeting Saturday in Montgomery. The seven issues chosen were:

  • Tax reform, including untaxing groceries and ending the state’s upside-down deduction for federal income taxes, which overwhelmingly benefits rich households.
  • Adequate budgets for human services like education, health care and child care, including Medicaid expansion and investment in home visiting services for parents of young children.
  • Voting rights, including creation of automatic universal voter registration and removal of barriers to voting rights restoration for disenfranchised Alabamians.
  • Payday and title lending reform to protect consumers from getting trapped in deep debt.
  • Criminal justice debt reform, including changes related to cash bail and civil asset forfeiture.
  • Death penalty reform, including a moratorium on executions.
  • Public transportation, including state investment in the Public Transportation Trust Fund.

“We believe in dignity, equity and justice for all Alabamians,” Alabama Arise executive director Robyn Hyden said. “And we believe our 2020 issue priorities would break down policy barriers that keep people in poverty. We must build a more inclusive future where everyone can prosper.”

Why Alabama should untax groceries

The state grocery tax is particularly harmful for Alabamians who struggle to make ends meet. The tax adds hundreds of dollars a year to the cost of a basic necessity. And most states have abandoned it: Alabama is one of only three states with no sales tax break on groceries.

Alabama is also one of only three states with a full income tax deduction for federal income taxes (FIT). For those who earn $30,000 a year, the deduction saves them about $27 on average. But for the top 1% of taxpayers, the FIT break is worth an average of more than $11,000 a year. Ending the FIT deduction would allow Alabama to remove the sales tax on groceries and still have funding left over to address other critical needs.

The grocery tax and FIT deduction are two key factors behind Alabama’s upside-down tax system. On average, Alabamians with low and moderate incomes must pay twice as much of what they make in state and local taxes as the richest households do.

“By untaxing groceries and ending the FIT deduction, lawmakers can make Alabama’s tax system more equitable for everyone,” Hyden said. “They can strengthen state support for K-12 and higher education. And they can make it easier for struggling families to put food on the table. This is an opportunity to make life better for everyone in our state, and the Legislature should do it.”

Meet the working men and women caught in Alabama’s health coverage gap

By Jim Carnes

As we celebrate Alabama’s workforce on Labor Day, here’s a fact that deserves special attention: More than 100,000 Alabamians are working without health insurance. They work in child care, construction, food services and other vital jobs. They’re the folks who keep things going.

Yet they’re trapped in the health coverage gap. They can’t afford employer-based coverage or private insurance. And they earn too much to qualify for Medicaid. As a result, many struggle with health problems that sap productivity, add household stress and get worse without timely care.

Here are the jobs employing the most working women in Alabama’s coverage gap:

And here are the jobs employing the most working men in Alabama’s coverage gap:

Think about the importance of these lines of work. Then think about what access to regular health care would mean in the lives of these workers and their families.

Across the country, 36 states have closed their coverage gaps, but Alabama is lagging behind. What’s holding us back?

Lack of awareness plays a part. As folks go about their daily activities, they rarely stop to wonder who has health insurance and who doesn’t. It’s not something most people talk about – but it should be. Helping state leaders understand the real people who will benefit most from expanding coverage is an important step toward change.

Our entire state would benefit from Medicaid expansion. Broader access to regular care would improve the health of working families. Healthier families would mean higher productivity at work and better learning at school. And the additional federal funding would strengthen our health system and create jobs.

All these gains would spell a brighter future for Alabama. It’s time to expand Medicaid and make health coverage affordable for the workers we all depend on every day.

The workers who would benefit most from Medicaid expansion in Alabama

By Jim Carnes

They’re the folks who keep things going: the people who serve food at restaurants, bag groceries, patch roofs and repair cars. They’re Alabamians with economically essential jobs that pay low wages.

But tens of thousands of these workers have no health coverage. As a result, they often struggle with health problems that sap productivity, add stress to their households and get worse without timely care.

Imagine what it would mean to the state’s business community to have a workforce with access to regular health care. And more importantly, imagine the peace of mind that coverage would bring for workers and their families.

Most uninsured Alabamians aged 19 to 64 who would qualify for expanded Medicaid coverage (those earning below 138% of the federal poverty level) are workers. The graphic below shows the nine industries employing the largest number of these workers. More than 70,000 work in food service, sales or construction.

Overall, more than 180,000 Alabama workers would gain health security from Medicaid expansion. Our businesses would gain a more reliable workforce. And our economy would gain billions of federal dollars, stronger tax revenues and thousands of new health care jobs.

Alabama Medicaid has succeeded in providing health care for children, people with disabilities, and seniors living in nursing homes. Our state can build on these gains and make coverage affordable for the workers we all depend on every day.

Arise legislative recap: June 14, 2019

By Matt Okarmus

Now that the Alabama Legislature’s 2019 regular session has come to a close, we’ve turned our focus to the expected special session on the state’s prison crisis later this year. In our latest video, Arise’s Jim Carnes explains how Medicaid expansion is an essential component of fixing the state’s prison crisis and increasing economic opportunity for all Alabamians.

The 2019 session that was, and the one yet to come

By Chris Sanders

Alabama legislators ended their 2019 regular session last week. But they’re not done yet.

Amid the threat of federal intervention, the Legislature likely will hold a special session this fall to address horrendous conditions in our state’s overcrowded prisons. This summer, Arise will continue making the case that meaningful prison reform must include Medicaid expansion. This move would cut state health care costs and help former inmates stay healthy and productive after release. And it would help people stay out of prison by strengthening treatment for mental illness and substance use disorders.

Arise will renew our call to fund these needed investments by fixing Alabama’s upside-down tax system. With high sales taxes and big tax breaks for rich people, this broken system is the worst of both worlds. It pushes struggling families deeper into poverty, and it doesn’t bring in enough money to provide adequate funding for corrections and other vital services. Untaxing groceries and ending the state’s deduction for federal income taxes would be two huge steps to undo that damage.

Breakthroughs on civil asset forfeiture, voting rights

Arise members’ advocacy led to progress on civil asset forfeiture and voting rights this year. Lawmakers voted unanimously for SB 191, sponsored by Sen. Arthur Orr, R-Decatur, which will increase transparency around forfeitures in Alabama. And they approved SB 301, sponsored by Sen. Rodger Smitherman, D-Birmingham, which will expand access to absentee ballots.

Our supporters were key in stopping numerous proposals to erect harmful new barriers to Medicaid and food assistance under the Supplemental Nutrition Assistance Program (SNAP). We also saw major breakthroughs on several recent Arise issue priorities and endorsements:

  • HB 225, sponsored by Rep. Adline Clarke, D-Mobile, will forbid pay discrimination based on race or sex.
  • SB 30, sponsored by Sen. Cam Ward, R-Alabaster, will ensure that inability to pay filing fees won’t block low-income Alabamians from pursuing their rights in court.
  • SB 228, sponsored by Orr, will increase jail food funding and prevent sheriffs from pocketing any leftover money.

Two other topics dominated the headlines at the State House this year. Legislators moved quickly to pass an abortion ban that is certain to face a lengthy, expensive court challenge. They also hustled to pass a 10-cent gas tax increase for infrastructure improvements during a special session in March.

The work that remains undone

But lawmakers showed much less urgency when it came to investments in human services. While Alabama’s funding for K-12 and higher education is increasing, it’s still well below 2008 levels. Similarly, General Fund (GF) revenues are rising. But it’s not nearly enough to reverse decades of underinvestment in Medicaid, mental health care, child care and other services.

The Legislature also waited until the session’s final week before finally deciding the GF, rather than the education budget, would pay for the state’s share of the Children’s Health Insurance Program. CHIP supports coverage for more than 170,000 Alabama kids.

Some climbs remain steeper than others. Reforms of payday lending and the death penalty struggled to gain traction this year. So did proposals for automatic voter registration and early voting. But Arise members – unafraid and undeterred – will keep working for those changes and others to promote opportunity, prosperity and justice for all Alabamians.

Alabama’s prison reform solution must include Medicaid expansion

By Jim Carnes

Alabama’s prison crisis is about more than overcrowding and understaffing. It’s about the generational impacts of a criminal justice system warped by racism, chronic poverty, inadequate education and poor health.

The solution will require both new revenue and broad policy reform. And one essential step is to extend health coverage to uninsured Alabama adults with low incomes. Expanding Medicaid would address the prison crisis in four ways:

  • Untreated mental illnesses and substance use disorders are major contributors to Alabama’s over-incarceration problem, and Medicaid expansion would tackle these challenges head-on. Strengthening these services would help more people stay out of prison.
  • When a person leaves prison, it’s hard to get a job that offers health coverage. But to get and keep a job, you need to be healthy. Medicaid expansion would help former inmates become productive members of the workforce.
  • Federal funding would cover 90% of the cost of Medicaid expansion. That would slash state costs for hospitalizing prisoners.
  • A stronger education system creates economic opportunity that, in turn, reduces crime. As new federal dollars for Medicaid expansion flowed into the economy, they would generate major new state and local tax revenues for schools.

Bottom line

Alabama is one of only 14 states that have not yet accepted Medicaid expansion. The 36 states that have embraced it show how this single policy decision can strengthen the health care system, make the population healthier, reduce racial health disparities and shore up state budgets.

Alabama’s legacy of failure on all four counts is a major contributor to the prison crisis. And Medicaid expansion is an essential part of the solution.

Arise legislative recap: May 17, 2019

By Matt Okarmus

Legislators talked a lot about pregnancy and childbirth at the State House this week, but the spotlight has left some disturbing facts about the reality of health care in Alabama in the shadows. Arise’s Jim Carnes talks about why it’s so crucial for Alabama to expand Medicaid to strengthen the state’s health care system and promote healthy families.