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Alabama Policy Institute releases Medicaid expansion report

https://1819news.com/news/item/alabama-policy-institute-releases-medicaid-expansion-report

The Alabama Policy Institute released a new report on Medicaid expansion on Tuesday.

In the report, the conservative think tank argues that expanding traditional Medicaid or expanding it through a public-private partnership would lead to long-term costs for the state’s General Fund and lower labor force participation.

“Alabama ranks amongst the bottom of the United States for labor participation, with a rate of 57.5% as of August 2024. Medicaid expansion, whether through the traditional model or a public-private partnership would almost certainly have a negative impact on the state’s labor participation rate, giving some citizens a disincentive to join Alabama’s labor market. The state cannot and should not take any action that further disincentivizes able-bodied workers from entering or remaining in the state’s labor pool,” the report’s author says.

“Medicaid expansion has led to increased costs and diminished labor participation rates in expansion states. While the public-private partnership seems appealing due to its perceived lack of immediate costs, it could potentially lead to long-term price increases and significant impacts on the state General Fund Budget. The same level of consideration should be applied to traditional expansion. Ensuring that all Alabamians have access to high quality health care is important, but yielding to pressure to expand Medicaid could pose significant risks to state budgets and Alabama’s overall economy in the long run,” the author adds.

Read the full report from API here.

To connect with the author of this story or to comment, email caleb.taylor@1819News.com.

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Is expanding Medicaid in Alabama worth the price and federal dependency? New API report says no

As Alabama gears up for another year of legislative debate when lawmakers reconvene for the 2025 state legislative session, one topic that refuses to disappear is Medicaid expansion. For years, Alabama has been one of the few states to hold out. 41 states have now expanded, North Carolina and South Dakota being the most recent.

This year, the Mississippi Legislature considered an expansion proposal, but later rejected it over disagreements primarily related to implementing a work requirement, which was uncertain to be federally accepted under the current Biden-Harris administration. 

According to a new report by the Alabama Policy Institute, “Medicaid Expansion in Alabama: Responsibilities, Costs & Consequences,” that entanglement between Alabama and the federal government is a chief concern about the state’s long-term fiscal health.

The report argues that expanding Medicaid would deepen Alabama’s dependency on federal dollars, making the state vulnerable to changes in federal policy. Currently, the federal government covers about 72% of Alabama’s Medicaid costs, but this contribution could fluctuate based on political shifts in Washington. 

API highlights that any federal cuts to Medicaid funding, whether due to budget constraints or policy changes, would leave Alabama scrambling to cover the shortfall, forcing the state to make tough choices — either drastically cut other essential services or raise taxes to make up the difference.

“Additionally, it has been projected that Medicaid expansion would add an average additional state cost of $225.4 million per year. The estimate began with a forecast of $208 million in 2022, but the costs keep increasing every year, reaching $243 million in 2026,” API argues in their latest report. 

“Therefore, the trend suggests that in the long run, the costs will continue to rise, an amount that will be paid from the state General Fund budget. As the state Medicaid match requirement increases, less money will be available to fund other General Fund budget priorities, creating a shortfall that will have to be filled through budget cuts or new revenues paid by Alabama citizens and businesses. This could include higher taxes on medical providers, which would then be passed on to citizens in the form of higher overall medical costs.”

Timely to a recent legislative effort by state leaders to increase the state’s labor force participation rate, API argues that expanding Medicaid could actually harm those efforts, and drive Alabama’s rate down further into one of the lowest in the country. 

“Data shows that while Medicaid has expanded, the Labor Force Participation rate nationally has decreased…After Medicaid expansion, full-time work among the study population of non-disabled, low-educated, childless adults aged 50-64 decreased by 7.06%67. Another study showed that, after expanding Medicaid, there was a reduction in employment in individual states by an average of 1.6%,” API writes.

labama is also likely considering some form of Medicaid expansion through a public-private partnership. This would mean the state contracts with private healthcare providers, such as Blue Cross Blue and Shield of Alabama, to cover those who fall below a certain income threshold but don’t qualify for traditional Medicaid. Proponents argue that this method could bring competition and stability to Alabama’s healthcare system by infusing private market efficiencies while drawing on federal expansion dollars to cover a large portion of the cost.

API argues this isn’t as straightforward as it seems. Other states, like Arkansas, Iowa, and New Hampshire, have tried this route.

“We can only measure the performance of the public/private model by comparing it to what other states have done. Arkansas decided to further expand their Medicaid program with a public-private partnership. According to a study made by the Foundation of Government Accountability, it has been a failure.”

In Alabama, the authority to expand Medicaid rests solely with the executive branch. Earlier this year, Governor Kay Ivey’s office said “she remains concerned for how the state would pay for it long-term.”

Grayson Everett is the state and political editor for Yellowhammer News. You can follow him on X @Grayson27

ALDOTCOM

Alabama is too heavily dependent on federal funds & government employment

By 
  • Justin Bogie Alabama Policy Institute

Alabama’s labor force is becoming increasingly dominated by government employees, including federal, state, and local workers. The bottom line is that all levels of government continue to grow, not only in Washington, D.C., but here in Alabama as well, and taxpayers are paying for that expansion.

According to June numbers from the federal Bureau of Labor Statistics, in 2024 government employees made up 17.9% of Alabama’s workforce, 4.2% higher than the national average. Of the approximately 2.25 million citizens working in Alabama today, more than 405,000 of those are working for some form of government, nearly one in every five employees. The Federal Reserve estimates that around 58,400 (14.4%) of those employees work for the federal government, an increase of more than 3,000 workers since 2020.

From a historical perspective, the percentage of government workers in Alabama has remained relatively constant over the past 35 years. In 1990, approximately 18.4% of employees worked for some form of government. That percentage grew to 20.4% in 2010, before declining to its current level. However, in terms of the actual number of Alabamians employed by some level of government, the total has increased by 84,500 employees since 1990. In seven of the past 10 years, the state has increased overall government employment, a total growth of 8.0%.

Why should you care that more Alabamians than ever before are employed by the government? There are several reasons.

First, anyone who pays federal, state, or local taxes is directly fueling the expansion of government. As the public sector becomes larger so does its influence and encroachment into activities that should be performed by the private sector. Instead of investing more money into the government, lawmakers should be looking for policy solutions that spur additional private sector growth.

Second, public sector spending growth cannot happen without increases in tax revenue and/or increases in debt. Over the past 20 years, nominal federal spending has grown by more than 167%, peaking at $6.8 trillion in 2021 amid the federal government’s response to the COVID-19 pandemic, before declining to $6.1 trillion in 2023. Over the same period, federal tax revenues increased by 136.1%.

Increases in federal spending have been accompanied by substantial increases in annual federal deficits as well as cumulative debt.

The last time that the federal government had a budget surplus was in 2000. Since then, annual federal deficits have ranged from $32.4 billion in 2001 to a peak of $3.1 trillion in 2020. Last year the federal government spent about $1.7 trillion more than it collected from taxpayers. In just the past 10 years federal debt held by the public has increased by more than 105%, reaching $26.2 trillion in 2023. According to the Heritage Foundation, a child born in 2024 will assume $82,590 in federal debt, with that number projected to grow 2.5 times by the time they reach the age of 30.

Eventually all Americans will pay the price for unsustainable spending, whether that be in the form of significant tax increases or a severe downturn in the U.S. economy.

Thankfully, the Alabama Constitution requires the state to have a balanced budget each year. However, that does not mean that taxes and spending have not increased here as well. In the past 10 years combined state General Fund and Education Trust Fund spending has grown by 47%, not including supplemental appropriations approved by the Legislature. Over the same period, combined revenues grew by nearly 81%.
With each new dollar spent by federal, state, or local governments, dependency on those governments increases. In 2023 alone, the federal government funneled over $64 billion through direct payments, contracts, grants, and other forms of financial assistance to Alabama, making our state one of the most federally dependent states in the nation.

The more money that Alabama’s state and local governments take from Washington, D.C., the less control our elected officials have over how that money, as well as state and local funds that are required to match federal funding, can be spent, forcing Alabama values to bend to whichever political party controls the federal government at any given time.


https://www.al.com/opinion/2024/09/alabama-is-too-heavily-dependent-on-federal-funds-government-employment-op-ed.html

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Stephanie Smith & Sheila Banister talk school choice on “Bama Knows Education” Podcast

In this episode, we spotlight school choice and discuss how the Alabama Policy Institute, where Stephanie is the CEO, is working to advance policies that give parents the freedom to choose the best educational path for their children. We explore the importance of school choice in fostering strong families, the principles of free markets, and limited government.

Episode Highlights:

  • How Stephanie champions school choice and its importance for Alabama families.
  • The Alabama Policy Institute’s dedication to promoting educational freedom.
  • Key legislation supporting school choice in Alabama.
  • The effects of school choice on Alabama’s education system.
  • How Stephanie’s political background shapes her approach to education reform.
  • Why school choice is vital for Alabama families.
  • The Choose Act
  • Ways to advocate for expanding educational options in Alabama.
  • The link between strong families and the freedom to choose the best education.
Reflector

API continues its push to eliminate the grocery tax

The Alabama Policy Institute, a conservative organization, has also pushed to end the grocery tax.

“API has been an advocate for, not only the reduction in that tax because it is highly regressive, but the complete elimination of it,” said Stephanie Smith, president and CEO of the Alabama Policy Institute. “We are still pushing for the elimination of it.”

Until last year, Alabama had applied the full state sales tax to groceries since 1939, when the tax was introduced. The 4% state tax, combined with local levies, meant that Alabamians paid up to 10% in taxes on their groceries. In Montgomery, a family spending $600 a month on food would pay $60 in taxes on top of that.

https://alabamareflector.com/2024/09/09/grocery-tax-cut-may-have-had-smaller-than-expected-effect-on-alabama-education-budget/

 

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API Announces a strategic partnership with Christians Engaged

API began 35 years ago as the Alabama Family Alliance. The Family Policy Alliance (FPA) hosts and serves the nation’s leading alliance of state pro-family groups. Each state-based organization is independent and autonomous. FPA recently announced a strategic partnership with an organization called Christians Engaged. Christians Engaged (CE) is the nation’s leading non-partisan Christian-based, voter turnout operation.
In turn, API signed onto this alliance; with FPA’s help, we’ve put together a strategy to encouraging voting – we don’t tell anyone how to vote but we will remind them TO VOTE! This is a new initiative for the Alabama Policy Institute, but CE is not a new organization. In previous elections, Christians Engaged has turned out 91.7% of those who have signed up to participate. That kind of turnout has the potential not only to change elections but to impact public policy in our localities, state, and nation for generations to come. 
 
Volunteers taking the pledge agree to commit to pray for 5 minutes a week for our nation, commit to vote in every election (local, state, and national), and commit to engage in some form of civic education and involvement.
API expects this initiative to have a positive impact on issues pertaining to our mission of promoting free markets, limited government, and strong families.

Pledge Here