Alabama Hospital Association highlights importance of expanding Medicaid

News Analysis by: John Zippert, Co-Publisher

The Alabama Hospital Association, a statewide trade organization representing 100 hospitals in the state is launching the ALhealthmatters campaign highlighting the importance of expanding Medicaid. The Association says If Alabama expands Medicaid, almost 300,000 uninsured Alabamians would receive health insurance coverage, an estimated 30,000 jobs would be created, and $28 billion in new economic activity would be generated.  Alabama would also save millions of dollars on current state services.  “On average, almost one out of every 10 hospital patients does not have health insurance, resulting in more than $530 million annually in uncompensated care,” said Danne Howard, executive vice president and chief policy officer of the Alabama Hospital Association.  “Currently, 75 percent of Alabama’s hospitals are operating in the red, meaning the dollars they receive for caring for patients are not enough to cover the cost of that care.  Expanding Medicaid would be a significant investment in the state’s fragile health care infrastructure and would help maintain access to care for everyone.” “In Greene County because we are a poor county, one in three patients do not have any insurance, which means we provide an average of $100,000 in uncompensated care per month. Expanding Medicaid under the Affordable Care Act would help people in our county whose earn less than 138% of poverty (approximately $20,000 annual for a family of four) to secure affordable health insurance coverage,” said Dr. Marcia Pugh, Administrator of the Greene County Health System. Howard adds that hospitals and other health care providers are a critical piece of the state’s infrastructure.  “Alabama’s hospitals employ about 90,000 individuals and indirectly support another 96,000 jobs,” she said.  “Not only are they often one of the largest employers in their communities, but hospitals also have a huge economic impact on their local economy.  Statewide, the annual economic impact of Alabama hospitals is nearly $20 billion, not to mention the pivotal role access to quality health care plays in recruiting and keeping new businesses.” The Alabama Hospital Association statement indicates the importance of expanding Medicaid but does not endorse the state’s Democratic political candidates who support Medicaid expansion. Walt Maddox, Democratic candidate for Governor, in the November election, says, “ I will expand Medicaid for Alabama during the first hour of the first day that I am Governor. We will find the resources to pay our part of the costs to pay for this critical life-saving service from our people.” Incumbent Gov. Kay Ivey has not expanded Medicaid and does not intend to because of cost. State Senator Hank Sanders said, “ It is clear that on the one issue of expanding Medicaid, there is a clear distinction between the candidates for Governor on the ballot in November.

Democratic candidate Walt Maddox will expand Medicaid and help save lives in Alabama as well as expand our economy in every county, while Kay Ivey will continue to oppose this program for narrow political reasons.” Since 2010 when Medicaid expansion has been available under the Affordable Care Act, Alabama has lost $7 billion in Federal support under the program. For the first three years of the program, there was no cost to the states to participate. This has increased by 2.5% a year until it reached the maximum 10% this fiscal year. In addition in coming years beginning in 2020, the disproportionate share reimbursement rate payment to rural hospitals will decline because the program assumes coverage for low-income people in the state by Medicaid expansion under the ACA. Rural hospitals in states like Alabama, that have not expanded Medicaid, will begin to take a “double-whammy” for not expanding Medicaid – more patients without insurance coupled with lower reimbursement rates. Howard notes that a recent study showed that hospitals in expansion states were 84 percent less likely to close than hospitals in non-expansion states.  “Alabama has had 12 hospitals close since 2011, and more are on the verge of closing if something doesn’t change,” she added. “Plus, the economic impact in other states has been tremendous; Louisiana has added 19,000 jobs; nearly 50 percent of new enrollees in Ohio have been able to receive mental health and substance abuse treatment, and the state has seen a 17-percent drop in emergency department use; Kentucky has seen an increase in state revenues of $300 million.” The AHA study says, “Investing in the rural health care infrastructure is critical as Alabama works to improve rural prosperity.  Alabama’s rural hospitals are an anchor in their communities‒creating jobs, providing critical care, and supporting other industries.   ​“When a rural hospital closes, other mainstays in the community often follow … local pharmacies, physicians, banks, and grocery stores to name a few. When a rural hospital closes, it’s very difficult to attract new business. “ ​Throughout the next few months, hospitals will be talking with business, civic and government leaders to stress the importance of expanding Medicaid in Alabama and to share quantitative results of the positive impact it is having in other states.  For more information on the impact Medicaid expansion could have in Alabama, visitwww.alhealthmatters.com.

Alabama’s rural hospitals are on life support Legislature claims victory in adjourning early while ignoring life-saving issues Alabama SOS again calls for Medicaid Expansion in Alabama

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Shown above John Zippert Chair of SOS Health Committee addresses crowd

 

Montgomery, AL – Members of Alabama SOS, the Save OurSelves Movement for Justice and Democracy, held a news conference, Tuesday, March 27th, at 11:30 a.m. in the 3rd Floor Press Room of the Alabama State House to address critical and time-sensitive health care issues facing the State of Alabama.
John Zippert, Chair of the SOS Health Committee said: “We are concerned about the State of Alabama’s requesting a Medicaid rule change that would affect 8,500 Medicaid caretakers in our state, denying them Medicaid coverage. The rule requires they show they are earning a mandatory wage. These 8,500 people are taking care of Medicaid-eligible children and/or seniors and adults. They are hardworking Alabamians caring for others, but they are not earning a wage that would provide them Medicaid coverage under this rule.

“For these Alabamians to be covered under this new rule, they would no longer be able to care for other Medicaid-eligible Alabamians, who are either children or adults or seniors in much greater need. This makes absolutely no sense. This is part of a national trend that is needlessly hurting people in Alabama and other states by putting political rhetoric ahead of facts and dollars and sense.”
“SOS is urging everyone who disagrees with Governor Ivey’s shortsighted and meanspirited effort to impose a work requirement on Medicaid caretakers to write the State of Alabama Medicaid agency expressing our concern and opposition.. Each of us has the opportunity to email our comments by April 2nd at PublicComment@medicaid.alabama.gov and by mail to Administrative Secretary, Alabama Medicaid Agency, 501 Dexter Ave., P.O. Box 5624, Montgomery, AL 36103-5624,” said John Zippert, SOS Health Committee Co-Chair.
Johnny Ford, SOS Health Care Committee Co-Chair and founder of the World Conference of Mayors, said: “Because the State of Alabama has not expanded Medicaid coverage, small rural hospitals across Alabama are being hurt, threatened with closure, or closed. Many of the people coming to these hospitals were supposed to be covered by Medicaid but currently are not. This is harming the area where I live as well as rural areas throughout our entire state. If these hospitals close, all people in these areas will be directly hurt.”
Another critical issue SOS addressed is the ongoing failure of the State of Alabama to expand Medicaid coverage. “Expanding Medicaid would be a huge economic boon to our state,” said Alabama State Senator Hank Sanders. “More than 30 states across the country, including in the South, have already expanded Medicaid. Alabama tax dollars are going to help people in other states instead of the people of Alabama.”
Zippert, who is also Chair of the Board of the Greene County Health System and President of the Alabama New South Coalition added: “Medicaid reimbursement – including the disproportionate share that rural hospitals already receive – has been even further reduced by the failure to expand Medicaid. People who have insurance are also going to pay higher premiums in Alabama because we have not expanded Medicaid. So many Alabamians are paying the cost because the State refuses to expand Medicaid”
“Rural hospitals are on life support,” said Ford, “and the Governor could save them with the stroke of her pen. The Alabama Legislature is proud to be adjourning early this week claiming their work has been done while rural hospitals across the state – both in Black and White communities – are threatened with closure every day. This can be fixed with Medicaid expansion. We need action – not today, not yesterday, but years ago. But we will take action today. The Legislature’s work is not done nor is the work of the Governor.”
SOS is comprised of more than 40 statewide Alabama organizations committed to justice and democracy. Members of the SOS Health Committee led today’s news conference.

How a repeal of the Affordable Care Act will affect Blacks

By Glenn Ellis, Health columnist

acasigning President Barack Obama, Vice President Biden, members of Congress and guests before the signing of the ACA on March 23, 2010. PHOTO: The White House

(TriceEdneyWire.com) – Racism has historically had a significant, negative impact on the health care of Blacks and other people of color in the United States. The Affordable Care Act (ACA) is truly the first time that African-Americans have, collectively, had significant access to health care. It is noteworthy that America’s first African-American president is chiefly responsible for this access.

Improved access to care; Medicaid expansion; prevention medicine; and lifting of barriers for pre-existing conditions, are all aspects of the ACA that have been of great benefit to Blacks. But there is a thick air of uncertainty on the horizon.

In a few weeks, Donald John Trump will become the 45th president of the United States. It is unclear how quickly, or when, Trump’s vow to repeal and replace Obamacare will play out. But make no mistake, just like the adage, “when white folks catch a cold, black folks get pneumonia!”, a repeal of the ACA would disproportionately hurt blacks.

Republicans in Congress have put out their plans: to repeal most of the ACA without replacing it; doubling the number of uninsured people – from roughly 29 million to 59 million – and leave the nation with an even higher uninsured rate than before the ACA.

Let me point out a few ways that Blacks have, specifically, benefitted from the ACA, what many now call “Obamacare”. Given the low incomes of uninsured Blacks, nearly all (94 percent) are in the income range to qualify for the Medicaid expansion or premium tax credits. Nearly two thirds (62 percent) of uninsured Blacks have incomes at or below the Medicaid expansion limit, while an additional 31 percent are income-eligible for tax subsidies to help cover the cost of buying health insurance through the exchange marketplaces. Under the new law, insurance companies are banned from denying coverage because of a pre-existing condition, such as cancer and having been pregnant.

Importantly, for people living with HIV there also new protections in the law that make access to health coverage more equitable including the expansion of Medicaid and in the private market, prohibition on rate setting tied to health status, elimination of preexisting condition exclusions, and an end to lifetime and annual caps. The passage of the Affordable Care Act (ACA) in March 2010 provided new opportunities for expanding health care access, prevention, and treatment services for millions of people in the U.S., including many people with, or at risk for, HIV.

Safety net hospitals play a critical role in the nation’s health care system by serving low-income, uninsured and medically and socially vulnerable patients regardless of their ability to pay. Also, in agreeing to lower payments, hospitals in the 31 states that expanded Medicaid under the law, have made up that revenue in part through the Medicaid expansion.

These places are critical to the health of Black communities, and in the poorest neighborhoods. They have been among the loudest voices against repeal of the health law, as they could lose billions if the 20 million people lose the insurance they gained under the law. This could bring about widespread layoffs, cuts in outpatient care and services for the mentally ill, and even hospital closings.

Under the ACA, these hospitals have received subsidies (or credits) to provide care based on a patients’ income levels. Should this change, community hospitals may have more difficulty weathering the storm of an increase in the number of uninsured.

Admittedly, there are some real problems with the ACA as we have come to know it; not the least being steady increases in premiums (midrange plans increased 22 percent nationally in 2016, with the average premium set to rise 25 percent in 2017); nearly 70 percent of all ACA plan provider networks are narrower than promised; and the high-deductibles and co-pays. Perhaps the most universal complaint is the “individual mandate”, that requires everyone in the United States to have insurance, or face a financial penalty.

Republicans are dead set on repealing the Affordable Care Act. Congress will likely pass significant modifications to the Affordable Care Act this month, which will be signed by incoming President Trump. The plans they have proposed so far would leave millions of people without insurance and make it harder for sicker, older Americans to access coverage. No version of a Republican plan would keep the Medicaid expansion as Obamacare envisions it.

Donald Trump’s presidency absolutely puts the future of the Affordable Care Act (ACA) in jeopardy. A full repeal is unlikely, but major changes through the budget reconciliation process (which cannot be filibustered) are nearly certain.

But let me be clear; changes are needed in the ACA, but the idea of dismantling it remains a troubling prospect for Blacks.

Moral March for Higher Ground unveils ‘Healthcare Justice Quilt’ on the steps of the Capitol in Montgomery

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On Monday, September 12 a group of a hundred or more clergy and lay leaders marched from the Dexter Avenue Baptist Church to the State Capitol steps in Montgomery, Alabama.
The group carried a letter to Governor Bentley entitled “Higher Ground Moral Declaration” signed by more than 10,000 Alabama citizens and unfurled a quilt with a thousand pieces representing people in Alabama who had died because they did not have health insurance. Governor Bentley has not extended Medicaid to reach people up to 138% of the poverty level. There are 250,000 people in this gap between Medicaid coverage for the very poor and working poor people who do not make enough to qualify for insurance subsidies under the Affordable Care Act. The actions in Montgomery were coordinated with demonstrations in more than twenty states by Rev. William Barber, North Carolina NAACP leader and head of the “Moral Monday Movement” to raise moral concerns about the future direction of America.
In the Higher Ground Moral Declaration it states, “Following moral traditions rooted in our faith and the Constitution, we are called to stand up for justice and tell the truth. We challenge the position that the preeminent moral issues today are about prayer in public schools, abortion, and homosexuality. Instead, we declare the deepest public concerns of our faith traditions are how our society treats the poor, those on the margins, the least of these, women, children, workers, immigrants and the sick; equality and representation under the law; and the desire for peace, love and harmony within and among nations.”
“This Higher Ground Moral Declaration provides a moral agenda for our nation on issues including: democracy and voting rights; poverty and economic justice; workers’ rights; education; healthcare; environmental justice; immigrant rights and challenging xenophobia; criminal justice; LGBTQ rights; and war-mongering and the military. For each issue area, an individual moral and constitutional foundation is established. The positions are neither left nor right, nor conservative or liberal. Rather, they are morally defensible, constitutionally consistent, and economically sound. Most importantly, they represent, as Dr. King urged, a revolution in values.”
At the Capitol steps, the persons who unveiled the Healthcare Justice Quilt made this statement, “The quilt has 1000 squares. We chose this figure to represent the minimum 1000 lives prematurely lost every year in Alabama, due to lack of health insurance. The quilt is also intended to remember additional lives lost due to inability to afford co-pays and deductibles, hospital closures, and all financial barriers to healthcare.
“We would like to recognize quilters around the state who have contributed to this project, including Mopsy Forsee, Linda Harman, Katherine Weathers, Pippa Abston, and the members of Project Linus in Huntsville.
“Our plan for the quilt is to write names of those who have died prematurely because of financial barriers to healthcare in our state. This is not restricted by year. We have pens here for any of you who wish to contribute names today. We will use this quilt as both a memorial for those named and unnamed, and as a call to action.
“We plan to have it at events in the state and to take it to government officials, so they have a visual reminder of the consequences of their policy decisions. Please contact us if you want to set up a meeting with your legislator or other government official or if you have an event in mind.
We will initially focus our efforts on the Medicaid Expansion. Even the expansion, however, will not bring health insurance to everyone; and full health insurance coverage that includes co-pays and deductibles will not make quality healthcare affordable to everyone. So this quilt will be used as long as it is needed—as long as there is anyone whose healthcare is limited due to money. We hope that one day, it will live in a museum, as a remembrance of what we did before we learned better.
“Our quilt is made of many different fabrics and by many hands, and it was stitched with love. Notice how the different fabrics, brought together, create a new and beautiful whole! We in Alabama are also of many colors, textures and patterns, all connected with the common thread of our humanity. When we come together, we are as beautiful as this quilt. We commit ourselves today to the love and care of all human beings!”