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Medicaid cuts would devastate Alabama's health care system
ACPP executive director Kimble Forrister issued the following statement Tuesday, March 15, 2016, after the Alabama House passed a General Fund budget that would force deep Medicaid cuts:
“These Medicaid cuts would be devastating for Alabamians, our economy and our entire health care system. They could force many rural hospitals to close and prompt many pediatricians to leave the state. They would end coverage of essential services like outpatient dialysis and adult eyeglasses. And they would end promising new Medicaid reforms that would save money and keep people healthier.
“We simply can’t afford these Medicaid cuts. It’s wrong to put health care at risk for children, seniors, and people with disabilities in Alabama. It’s time to get serious about raising the revenue needed to invest in a healthier Alabama for all.”
SB 285: Adding red tape that would deny food and cash assistance to thousands of low-income Alabamians
SB 285 is a solution in search of a problem. The bill would add huge amounts of red tape that would deny food assistance and cash welfare to thousands of low-income Alabamians – many of them seniors or people with disabilities – who are doing nothing wrong. SB 285 also could cost Alabama tens of millions of dollars to implement during a difficult budget year, and it would not save the state money.
SB 285 would reduce Alabama’s flexibility in the administration of SNAP and TANF, make it more difficult for otherwise eligible households to apply for and receive assistance, and impose expensive and unnecessary verification and data collection procedures on the Department of Human Resources (DHR) and Medicaid. Policy analyst Carol Gundlach’s analysis of SB 285 details 13 things to know about how and why the bill would hurt low-income Alabamians and cost the state money.
2016 legislative update: Alabama Senate considers payday lending reform bill but doesn't vote on it
Payday lending reform got a debate but not a vote Thursday in the Alabama Senate. SB 91, sponsored by Sen. Arthur Orr, R-Decatur, cleared a procedural hurdle and received brief debate on the Senate floor, but lawmakers ultimately took no action on the measure. Still, the bill, which is supported by Arise and models Colorado’s payday loan laws, could return to the Senate floor next week.
Payday loans are short-term loans that carry annual interest rates of up to 456 percent a year in Alabama, often trapping borrowers in cycles of debt that can be hard to escape. SB 91 would reduce the interest rates and give borrowers at least six months to repay their loans, increasing affordability and reducing the default risk. The bill also would allow payday borrowers to pay down the principal in installments instead of the all-or-nothing, lump-sum payment now required.
The bill immediately came under heavy fire from several senators. Sen. Bobby Singleton, D-Greensboro, urged Orr simply to wait for the federal government to issue payday loan regulations. Sen. Trip Pittman, R-Montrose, also began to express concerns about the bill, but the Senate postponed further discussion of the bill after rejecting a proposed amendment by Orr.
Perhaps the most significant news from Thursday is that the Senate adopted a budget isolation resolution (BIR) on the bill. The BIR is a procedural vote required to debate any non-budgetary bill before the Legislature passes state budgets. That vote removed an obstacle from SB 91’s path and puts it in position for an up-or-down vote if the bill does return to the Senate floor.
Arise testifies in favor of House lending reform bills
House members may consider other lending proposals next week, representing alternative paths to reform. The House Financial Services Committee heard testimony this week on an auto title lending reform bill and two payday lending reform bills, though no votes were taken. Arise testified in favor of all three bills Wednesday, and the committee could vote on them next week.
Rep. Patricia Todd, D-Birmingham, sponsors two of those bills. HB 342 is the House version of SB 91’s payday lending reforms, and HB 326 would cap interest rates at 36 percent a year on almost all title loans in Alabama.
The committee also could consider another plausible path to payday lending reform: HB 297, sponsored by Rep. Danny Garrett, R-Trussville. The bill would reduce payday loan interest rates and extend repayment periods, though it would not allow installment payments.
By Stephen Stetson, policy analyst. Posted March 10, 2016.
SB 91: A step in the right direction for Alabama borrowers
Payday loans in Alabama carry astonishingly high interest rates: up to 456 percent a year. These loans pose as a helpful source of credit, but far too often they act as financial quicksand, trapping borrowers in cycles of debt that can be hard to escape. SB 91 would give Alabama’s payday borrowers a less expensive path out of debt. (Click here for a PDF version of this bill overview.)
What would SB 91 do?
SB 91 would help Alabama borrowers get out of debt.
SB 91 would not put the payday loan industry out of business.
What’s the bottom line?
By Stephen Stetson, policy analyst. Posted March 7, 2016. Last updated May 3, 2016.
2016 legislative update: Alabama's education budget begins to rebuild, but General Fund struggles put Medicaid at risk
The usual contrast between Alabama’s starving General Fund (GF) budget and its slightly healthier but still inadequate Education Trust Fund (ETF) budget is exceptionally stark this year. Nearly halfway through the Legislature’s 2016 regular session, both major state budgets have begun to move – in one case toward a predictable conclusion, and in the other with no settled end in sight.
State education support just now approaching return to 2008 level
The path forward looks easier for the ETF, which finally is beginning to recover from deep cuts during and after the Great Recession. The House ETF budget committee Wednesday approved an education budget that would bring K-12 funding nearly back to its 2008 peak. The committee’s budget includes a 4 percent teacher pay raise, a 3 percent increase for transportation, a 2.5 percent increase for universities, and a nearly 5 percent increase for two-year colleges.
Alabama’s K-12 cuts have been the nation’s second worst since 2008, and its higher education cuts have been the fourth worst. Even a return to 2008 funding levels would not be enough to account for the many needs that were still unmet then, especially in low-income rural schools.
The ETF has two primary sources of state revenue: income taxes (earmarked for teacher salaries) and sales taxes. Both are considered “growth taxes” because their revenues tend to increase during good economic times. As Alabama climbs slowly out of the recession, taxes that support the ETF are inching up. The Legislative Fiscal Office (LFO) projects the ETF will have $187 million more in available revenue in 2017 than in 2016.
Proposed Medicaid cuts would be disastrous for Alabama’s health care system
The picture is much bleaker and more uncertain for Alabama’s non-education services like health care, child care and public safety. All of the “big four” state agencies – Medicaid, the Department of Human Resources (DHR), mental health and corrections – would receive essentially the same amount of GF money next year as this year under the budget that the Senate passed last week. But “level funding” at the 2016 level would follow years of steady declines and failure to keep up with ordinary cost growth. Mental health and DHR, in particular, would find it difficult to serve the children, seniors, and people with disabilities who depend on their services.
For Medicaid, level funding would be a disaster. It would end the regional care organization (RCO) reforms designed to keep patients healthier by emphasizing preventive care and reducing the number of costly emergency room visits. Failure to implement the RCOs could cost Alabama more than $700 million in new federal money set aside for the changes. Without significant new revenue, Medicaid will be unable to launch the RCOs or maintain many vital services for the most vulnerable patients.
Level funding for Medicaid also would eliminate coverage of outpatient dialysis, hospice, and adult eyeglass services, and would reduce payments to physicians, Medicaid commissioner Stephanie Azar said. Advocates fear that lower Medicaid physician payments would lead many doctors, especially pediatricians, to leave the program – or possibly to leave Alabama entirely.
With no new money available and no new revenue measures on the move, Senate GF budget committee chairman Sen. Trip Pittman, R-Montrose, concentrated all GF reductions in one agency: Medicaid. Almost all other GF services would be level-funded under the plan. Public health, facing a tuberculosis outbreak and other potential infectious disease crises, is one of the rare services that, after years of cuts, would see an increase ($10 million, or 45 percent).
The GF has more than a dozen revenue sources, mostly small taxes that don’t grow with the economy. Nearly 8 percent of 2015 GF revenue was one-time money borrowed from the Alabama Trust Fund, which receives state revenues from oil and gas drilling. That money dried up for the 2016 budget year, fueling a funding crisis that took three legislative sessions to resolve.
The GF will have $95 million less available next year than it did in 2016, the LFO projects. Lost revenue includes the end of the borrowed money, lower oil and gas lease income, and lower interest on state deposits. Last year’s cigarette tax increase was not large enough to offset those revenue declines.
What lies ahead for Alabama’s 2017 budgets
Inadequate though they are, both budgets are moving forward in the Legislature. The GF budget passed the Senate last week. During the debate, Pittman said he would withdraw the budget if it returned to the Senate in the same form it passed. He predicted that “all-star” lobbyists representing health care providers would succeed in urging the House to find the revenue necessary to save Medicaid services while funding other vital functions like child protection, mental health and courts.
House action on both budgets is expected soon. The House could vote on the ETF budget as early as Tuesday. And House GF budget committee chairman Rep. Steve Clouse, R-Ozark, plans to unveil a substitute GF budget for the committee’s consideration this Wednesday.
By Carol Gundlach, policy analyst. Posted March 4, 2016.
Medicaid RCOs: Better care, better health, lower costs
Under the Medicaid reform plan approved by the Alabama Legislature in 2013, regional care organizations (RCOs) will manage patient care to improve efficiency, accountability and health outcomes. Federal approval of the plan in February 2016 was a huge vote of confidence in Alabama’s ability to achieve these goals. Below are short answers to basic questions about RCOs. (Click here for a PDF version of this overview of Alabama's RCO reforms.)
What are RCOs?
How are RCOs different from traditional Medicaid?
What does this mean for Medicaid patients?
How will RCOs impact the General Fund budget?
What is the future of Medicaid in Alabama?
Posted Feb. 26, 2016.