Issue: Medicaid Expansion

Removing the FIT deduction would allow Alabama to untax groceries, expand Medicaid

By Alabama Arise

Alabama’s federal income tax (FIT) deduction provides a huge tax break for high-income individuals – but at what cost? $719 million to be exact.

The FIT deduction is one big reason Alabama’s tax system is upside down. 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. The higher the income, the more the FIT deduction is worth for those who can most afford to pay more to fund education, health care and other vital needs.

Only two other states offer a full FIT deduction like Alabama does. (Three other states offer a partial deduction.) Ending the FIT deduction would bring in an additional $719 million a year, the Institute on Taxation and Economic Policy estimates. That would be enough to allow Alabama to remove the state sales tax on groceries. For most people in our state, the net result would be a tax cut.

This proposal would make it easier for everyday Alabamians to make ends meet, but its benefits wouldn’t end there. Alabama also could use the new revenue to expand Medicaid, ensure full funding for the Children’s Health Insurance Program (CHIP) in 2021 and make critical investments in education and other areas. CHIP supports health coverage for more than 170,000 children through Medicaid and ALL Kids.

Alabama’s constitution dedicates income tax revenue to education, and the FIT deduction is written into the document as well. So this plan would require the Legislature and the public to approve a constitutional amendment. But ending the FIT deduction would be a good way for Alabama to begin prioritizing public investments that benefit everyone over tax breaks that primarily benefit a select few.

The real story of the House’s 2020 General Fund budget is what isn’t in it

By Carol Gundlach

Now that the gas tax is a reality, the Alabama Legislature appears to be in a hurry to finish up essential business – and maybe even adjourn a little early. The House on Tuesday passed a General Fund (GF) budget that differed little from Gov. Kay Ivey’s recommendations.

With Alabama finally out of the worst of the recession and revenues beginning to flow again, many legislators seem to be feeling a bit like Santa Claus. But the real story is what’s not under the GF’s tree.

The House’s GF budget, which awaits Senate action, would squeeze out increases for nearly every state agency, most of which have been living through tight times for the last decade. The state’s badly cash-strapped court system would receive nearly $40 million more, hopefully reducing its dependence on fines and fees. The Department of Corrections, facing court challenges over treatment for inmates with cognitive disabilities, would get an additional $41 million. That money would allow the department to hire an additional 500 prison guards.

Helping agencies would get increases, too. Mental health would receive an additional $9 million, as would the Department of Human Resources (DHR). The small but vital Department of Senior Services would get an additional $1 million.

Even state employees, who haven’t seen a pay increase in years, would get a 2% cost of living increase. And retired state employees would receive a one-time bonus based on the number of years served.

The head-scratcher budget request came from Medicaid. For years now, Medicaid’s funding needs have challenged previous bare-bones GF budgets. Now, during a good revenue year, Medicaid Commissioner Stephanie Azar actually requested $52 million less. Azar said the agency can carry over a considerable sum from this year to maintain current services in 2020.

The investments our state isn’t making

The 2020 GF budget does indeed look pretty good at first glance. But the House plan is conspicuous for what was not included.

Perhaps most notably, the budget doesn’t fund Medicaid expansion to cover more than 300,000 Alabama adults with low incomes. The net state cost would be $164 million in the first year and about $25 million a year thereafter. The $52 million reduction in Medicaid’s budget would have made a nice down payment on expansion.

While the Department of Corrections can hire another 500 prison guards, the real need is closer to 2,000 new guards, according to a federal court order. And the budget does not include money for the new prison construction that Ivey has urged.

Lawmakers transferred ALL Kids to the education budget for 2020 to help balance the GF budget. But House GF budget committee chairman Rep. Steve Clouse, R-Ozark, said ALL Kids will move back to the GF in 2021. That move would add to the strain that the underfunded GF budget regularly faces. To draw down available federal matching money, the Children’s Health Insurance Program (CHIP) will need $98 million more from the state in 2021 than it receives today. CHIP provides health coverage for more than 173,000 Alabama children through both ALL Kids and Medicaid.

A funding solution to help everyday Alabamians

Alabama is, quite simply, in need of new revenue. And Alabama Arise has a plan to raise that revenue while giving most residents an overall tax cut.

Alabama is one of only three states that allow taxpayers to deduct all of their federal income tax (FIT) payments from their state income taxes. This tax loophole makes little (if any) difference for families with low and moderate incomes. But it saves millionaires a whopping average of $11,327 a year in state income taxes. If Alabama ended its FIT deduction, the state would bring in an additional $719 million a year.

That new money would allow Alabama to expand Medicaid and end the state grocery tax (two long-time Arise priorities). It also would ensure full CHIP funding in 2021 and leave additional money to meet other critical needs. (Because the state constitution earmarks income tax revenue for education, some of those moves would require an amendment.)

The proposed 2020 GF budget is only flush when compared with years when the state was truly in dire straits. It’s time for our lawmakers to find the political courage to address Alabama’s needs and raise the revenue required to meet them. Ending the state’s FIT deduction would be a good first step.

Arise legislative recap: April 12, 2019

By Matt Okarmus

“While the General Fund budget looks really good for what it is, what it is is not enough.” Arise policy analyst Carol Gundlach breaks down what’s missing from the General Fund budget that the Alabama House passed April 9.

 

Arise legislative recap: March 29, 2019

By Matt Okarmus

Lawmakers may have been on spring break this week, but we still have plenty to discuss in our second video update of the 2019 legislative session.

 

Watch Arise organizing director Pres Harris discuss upcoming community forums on Medicaid expansion, as well as reminders on action you can take in anticipation of the Legislature reconvening on April 2.

Arise legislative recap: March 22, 2019

By Matt Okarmus

We had a problem Tuesday – and we were glad to have it. So many people came to Arise Legislative Day that we couldn’t fit everyone in the State House’s largest committee room! Nearly 300 Arise supporters came to Montgomery to tell their lawmakers that it’s time to expand Medicaid. We appreciate everyone who showed their support for this investment in a healthier Alabama.

 

Click above to watch Arise executive director Robyn Hyden talk about our successful Legislative Day, as well as the Senate’s vote for a bill to make Alabama’s justice system more equitable. We’re excited to build on this momentum when the Legislature returns from spring break on April 2.

Revenue options for Medicaid expansion

By Jim Carnes

Alabama’s budget is an expression of our values. Medicaid expansion means healthier families, thriving communities and a stronger economy. Policymakers have a range of options for making this bold investment in a brighter future. Now is the time to choose.

Remove the state deduction for federal income taxes (FIT)

► $719 million in new revenue per year

► Only two other states offer a full FIT deduction

► This money would allow Alabama to achieve multiple goals:

— Expand Medicaid (cost: $168 million in first year, $25 million per year thereafter)*

— Remove the state sales tax on groceries (cost: approximately $400 million per year)

— Secure long-term funding for ALL Kids (cost: $38.4 million for 2020, approximately $90 million for 2021)*

Remove the state deduction for FICA payroll taxes

► $261 million in new revenue per year*

► Only one other state offers a full FICA deduction

Raise the cigarette tax by $1 per pack

► $180 million in new revenue in 2020

Other revenue options include:

► Make large landowners pay their fair share of property tax

► Tax sugar-sweetened beverages and vaping-related products

► Close corporate tax loopholes – for example, enact combined reporting*

 

* Would require transfer from Education Trust Fund to General Fund

What we’re watching during the 2019 special session

By Jim Carnes

This week brought a first in recent memory at the Alabama Legislature: a session within a session. The regular session began Tuesday, but lawmakers have put it on hold until March 19 to make way for a special session on the state gas tax.

At Gov. Kay Ivey’s call, legislators will consider a proposed 10-cent gas tax increase, to be phased in over three years. (The current tax is 18 cents per gallon.) Ivey’s plan aims to strengthen Alabama’s roads, bridges and port, which has become a mantra for state leaders in the run-up to the 2019 session.

Arise hasn’t taken a position on the gas tax proposal, but we have a lot to say about infrastructure. We’re calling on lawmakers to claim a larger vision of infrastructure as Alabama begins its third century of statehood.

Rural hospitals, for example, are key infrastructure but weren’t mentioned in the governor’s State of the State address Tuesday night. Seven rural hospitals have closed since 2011, including one in Georgiana that will close Friday. Another overlooked sector is public transportation, which receives no state funding in Alabama.

There’s a good chance we’ll see Arise issues emerge in the gas tax debate. For example, the Montgomery Advertiser on Wednesday cited a potential push for Medicaid expansion to win gas tax votes from Democratic members. Some lawmakers also have expressed interest in reducing the grocery tax to offset the effects of the gas tax hike. Wouldn’t it be amazing if a plan to rebuild roads and bridges became the first step toward helping struggling Alabama families get health coverage and make ends meet?

Why is this special session happening?

Ivey called a special session to remove a procedural hurdle for the gas tax bill. To pass in the regular session, any bills other than the Education Trust Fund and General Fund budgets must first win a three-fifths majority in both chambers in a vote called the budget isolation resolution (BIR). But in a special session, any bill included in the governor’s “call” can pass with a simple majority.

The Legislature can meet for up to 12 legislative days across 30 calendar days during a special session. But because the regular session started first, each day of the special session also will count against the 105 calendar days available for the regular session. Lawmakers can meet for up to 30 legislative days during the regular session.

Medicaid expansion by the numbers

By Jim Carnes
  • ± 223,000 Alabamians are caught in the coverage gap, unable to afford health insurance. Another 120,000 or more are stretching to pay for private or employer-based coverage.
  • 13 Alabama hospitals – including 7 rural ones – have closed since 2011.
  • 88 percent of Alabama’s rural hospitals operate in the red.
  • If we expand Medicaid to cover low-income adults, the permanent federal match is 9:1.
  • The first four years of federal match would generate $11.4 billion in new economic activity:

— $6.7 billion in direct federal spending

— $4.6 billion in indirect economic activity

  • Over four years, the enhanced match would free up $316 million in current state spending to address additional unmet health care needs:

— Existing Medicaid groups – $87.1 million

— Mental health & substance abuse – $121.6 million

— Corrections – $46.8 million

— Public health – $60.6 million

  • Expansion-related economic activity would generate $446 million in state tax revenues over four years. New local tax revenues would total $270 million over four years.
  • Net cost to the state would be $168 million in the first year, dropping to about $25 million annually in the following years because of savings and revenues, for a total of $239 million over four years. (This figure does not include local revenue gains.)

Bottom line

Medicaid expansion would help more than 340,000 Alabamians get health coverage, stabilize our rural hospitals and jump-start our economy – all for a dime on the dollar. It’s a bargain Alabama can’t afford to pass up.

(Sources: U.S. Census Bureau; Alabama Hospital Association; David J. Becker, “Medicaid Expansion in Alabama: Revisiting the Economic Case for Expansion,” January 2019; Manatt, “Alabama Medicaid Expansion: Summary of Estimated Costs and Savings, SFYs 2020-2023,” February 2019.)

How to advance our vision for Alabama’s next century

By Chris Sanders

What kind of future do we want for Alabama? It’s a question worth reflecting on as our state enters its third century this year. Are we all right with limiting power and prosperity to a select few? Or would we rather build a state where everyone has a voice and where people of all races, genders and incomes have a real chance to get ahead?

Alabama Arise believes in justice and opportunity for all, and our policy priori­ties flow from that vision. It’s why we support expanding Medicaid for Alabam­ians who can’t afford coverage. It’s why we want to rebalance an upside-down tax system that taxes struggling families deeper into poverty. And it’s why we urge stronger investments in education, housing, public transportation and other services that improve quality of life and promote economic opportunity.

We expect lots of infrastructure talk at the Legislature this year. The regular session starts Tuesday, but lawmak­ers may move quickly into a special session on the gas tax. Gov. Kay Ivey has asked legislators to increase the state’s 18-cent gas tax by 10 cents over three years. That money would fund road and bridge maintenance and oth­er infrastructure improvements.

Many of Alabama’s deteriorating roads are overdue for repair. But the defi­nition of “public infrastructure” goes far beyond tar and gravel. Education, health care and public transportation also help lay the foundation for shared prosperity. This session could bring chances to strengthen those invest­ments – and to make the tax system that funds them more progressive.

Hope on grocery tax, Medicaid expansion

One key breakthrough could be on a longtime Arise priority: ending the state grocery tax. We came heartbreaking­ly close in 2008, when a bill to untax groceries passed the House and fell one vote short in the Senate. But Arise members never gave up the advocacy fight. Now legislators face renewed pressure to end or cut the state’s 4 percent sales tax on groceries. (Some conservative lawmakers are urging a grocery tax reduction to accompany a gas tax increase.) Alabama is one of only three states with no tax break on groceries. It’s a highly regressive tax on a basic necessity, hitting hardest on people who struggle to make ends meet.

Pressure also is building for Alabama to expand Medicaid to cover more than 340,000 adults with low incomes. Medicaid expansion would save hun­dreds of lives annually and create a healthier, more productive workforce. It also would help save rural hospitals, support thousands of jobs and pump hundreds of millions of dollars into the economy.

Our work for a brighter, more inclu­sive future won’t end there. We’ll keep pushing for stronger consumer protec­tions against high-cost payday loans. We’ll make the case for the state to fund public transportation and remove barriers to voter registration. And we’ll continue seeking an end to injustices in Alabama’s civil asset forfeiture and death penalty systems. Visit our website and follow us on Facebook and Twitter for updates on these issues throughout the year.

Budget hearings show need for Alabama to expand Medicaid, boost public investments

By Chris Sanders

Alabama needs to expand Medicaid and invest more in education and other human services. Those were key takeaways from this week’s state budget hearings in Montgomery. The hearings highlighted a range of policy challenges and illustrated the connections between many of them.

We heard a lot of talk this week about the need to strengthen Alabama’s “infrastructure.” Many legislators say the state just doesn’t have enough money to make further investments in human infrastructure – the services like health care, child welfare and public safety that serve as a basic measure of what we value. But that’s incorrect.

Alabama’s lack of money for education, health care, child care and other services isn’t a natural force like the weather. It’s the result of decades of policy choices, as our Tax & Budget Handbook shows. And better choices can lead to better outcomes for Alabama.

Medicaid expansion could cut costs for corrections, DHR

Numerous agency leaders identified Alabama’s fraying rural health care system as a major concern. Rural hospital closures hurt communities and make it harder to get care. A lack of mental health care takes a toll on families, schools and workers. And both challenges increase financial strain on the corrections system.

The opioid epidemic is one problem that cuts across multiple areas: corrections, education, human resources, law enforcement, Medicaid, mental health and public health. Many parents fighting addiction lose child custody to the Department of Human Resources (DHR), which struggles to recruit foster parents for an average $16 daily allowance.

While bare-bones health agencies tackle the epidemic’s medical consequences, Alabama’s corrections system has emerged as the largest provider of mental health services, with many of them linked to substance use disorders.

That’s true even as Alabama’s prison overcrowding remains staggeringly high. The state prison system once operated at nearly double its designed capacity. Recent sentencing reforms helped cut that rate to 163 percent, and Corrections Commissioner Jeff Dunn expects it to sink to 145 percent. But further reductions are unlikely without broader changes, Dunn said.

Rural hospital closures affect prison overcrowding, too. Sen. Cam Ward, R-Alabaster, said a private prison in Perry County is vacant despite an appropriation to buy it. The county has no hospital, which would make it hard to use the prison even if the state bought it, Ward said.

Medicaid expansion would cut costs and improve lives across all these areas of concern. It would stem the tide of rural hospital closures. It would expand access to mental health and substance use treatment. And that would save many Alabamians from going to jail or losing child custody. Arise members and other advocates must keep making the case for Medicaid expansion throughout 2019.

Decades of inadequate funding cause unmet needs, staff shortages

Our state’s upside-down tax system requires most Alabamians to pay twice the share of income in state and local taxes that the richest households pay on average. It also means Alabama struggles to raise enough money to fund health care, child welfare and other important services.

Staff shortages were a running theme at this year’s budget hearings. Alabama’s corrections and mental health commissioners both emphasized problems with hiring and keeping qualified employees. DHR cited high turnover in child welfare staff, who are first on the scene when children’s safety is at risk. And the Alabama Law Enforcement Agency (ALEA) needs more state troopers to ensure highway safety.

DHR Commissioner Nancy Buckner asked lawmakers for an additional $21 million for 2020. Buckner said DHR struggles to retain staff, especially in the stressful child welfare division, which has 36 percent turnover. “Anything you can see on TV, we probably have multiple cases,” Buckner said.

The new money would allow for salary increases, technology improvements, and higher payments for foster families, Buckner said. Foster parents are difficult to recruit, she said, and the opioid epidemic has left more children in foster care.

For corrections, Dunn asked for another $42 million to hire and retain 500 prison guards and improve mental health services. (Low unemployment makes it harder to retain officers, Dunn said, because they often can earn more at safer jobs.) A federal judge has ordered Alabama to address its guard shortage and inadequate health services in state prisons.

ALEA Secretary Hal Taylor requested another $8.7 million to provide raises and hire 50 new state troopers. Up to 200 troopers could retire soon, Taylor said, and ALEA must compete with other departments for officers.

K-12 schools seek to hire more teachers, expand mental health support

Alabama schools discussed their needs for 2020 as well. State school Superintendent Eric Mackey requested an additional $295 million from the Education Trust Fund. With that money, schools could hire more teachers in grades 4-6 and invest more in the Alabama Reading Initiative. They also could hire more school nurses and provide a $600 allowance per teacher for classroom supplies.

Mackey asked for an extra $270 per student to teach about 25,000 students for whom English is a second language. And he requested another $22 million for school safety improvements and school-based mental health services.

Mackey echoed other agency heads by raising concerns about future personnel shortages. A recent survey of high school seniors found only 4 percent want to become teachers, down from 12 percent in previous surveys, Mackey said.

Sen. Vivian Figures, D-Mobile, asked Mackey to address the state Department of Education’s listing of 76 schools as “failing.” Most of those schools are in low-income areas and serve mostly black students. Mackey said the Alabama Accountability Act requires him to designate the lowest performing 6 percent of schools as “failing,” no matter how well they may educate students. The Accountability Act, enacted mere hours after introduction in 2013, diverts tens of millions of dollars a year from public schools to private school scholarship funds.

ALL Kids, pre-K, SNAP offer models for success

The budget hearings painted a stark picture of Alabama’s challenges, but they brought good news, too. Lawmakers heard numerous examples of how investments in health care and education are paying off.

Alabama’s rate of uninsured children is among the South’s best, and ALL Kids is a big reason why. The program provides health coverage for children whose low- and middle-income households don’t qualify for Medicaid. ALL Kids was the country’s first Children’s Health Insurance Program, and it remains a national performance leader in children’s health coverage.

The Program for All-Inclusive Care for the Elderly (PACE) provides an exemplary community-based long-term care option for residents of Mobile and Baldwin counties. The state’s commitment to pre-kindergarten has created a model for early childhood education. And aggressive workforce training programs in K-12 and two-year colleges are boosting Alabama’s economic potential.

Medicaid Commissioner Stephanie Azar highlighted investments in long-term care reform and primary care reform. The statewide Integrated Care Network (ICN) has already launched its case management system, designed to steer more long-term care patients into home- and community-based services. On the primary care side, Alabama Coordinated Health Networks (ACHNs) will launch in seven regions this fall. That move will bring Medicaid decision-making closer to communities and emphasize preventive and coordinated care.

Buckner thanked DHR’s Food Assistance Division for ensuring Alabamians received benefits under the Supplemental Nutrition Assistance Program (SNAP) during the recent federal government shutdown. Facing a Jan. 20 deadline to distribute February benefits, employees worked nights and weekends to approve 1,700 SNAP applications.

Buckner also praised the Food Assistance Division for earning federal bonuses of $2.4 million for timely processing of applications and low error rates in benefit calculations. Unfortunately for Alabama, which has a highly efficient and accurate SNAP program, Congress ended future bonuses in the 2018 Farm Bill.

It’s time to invest in a brighter future

Successful investments like these aren’t “one and done.” Alabama must resume providing some state money for ALL Kids next year as full federal funding ends. PACE seeks to expand, but its requests have been rejected so far. Only one-third of Alabama’s 4-year-olds are enrolled in pre-K. And gearing up for the 21st century will require even bolder workforce development.

Treading water is not enough. Education, Medicaid and other vital services need more funding so they can do more than the bare minimum. Smart investments in these services will pay off in a stronger, healthier future for all Alabamians.

Policy director Jim Carnes, policy analyst Carol Gundlach and communications director Chris Sanders contributed to this post.