VOICES for Alabama’s Children published the 2023 Alabama Kids Count Data Book today, marking the 30th edition of the book published by the nonprofit. For the 8th year in a row, PARCA worked with VOICES as a data partner for the project.

– Children of color and children in poverty are shown to have much poorer outcomes and much poorer achievements in education.

– Child population continues to decrease. Over the last year, the number of children grew in only 20 of 67 counties.

– Children in Alabama are becoming increasingly more diverse ethnically and racially. While white and Black child populations are declining, since 2000, Hispanic children grew approximately 276%. The Asian/Pacific Islander population grew by 120%.

– The infant mortality rate has slightly decreased from 8.1 to 7.6 per 1,000 live births from 2011-2021. In real numbers, that means that 443 babies did not live to their 1st birthday in 2021. Maternity care is critical. 34.3% of Alabama counties are defined as maternity care deserts. More than 28% of Alabama women had no birthing hospital within 30 minutes, which is more than double the U.S. rate.

– In 2022, the percentage of Alabama high school students meeting college and career ready requirements was 79.1% from 76.5% in 2021.

– 2023 Work-based learning programs (Dual Enrollment and Career Training Programs) are estimated to have had an economic impact of $420,209,126.

– From 2015-2023 there has been a 16.9% increase in the number of children entering foster care services. Parental drug use is the leading reason for children entering foster care, making up 44%, followed by neglect at 22%.

– 10.4% of children in the state are living in extreme poverty. Black and Hispanic populations are disproportionately affected (38.3% and 36.7% respectively), while white children make up 13.5% of children in extreme poverty.

See how children in all 67 counties of our state are faring in education, health, economic security, and more. VOICES believers that every child in Alabama should have access and opportunity to thrive and become all they can be, and hopes that by utilizing this book’s insights, we can identify the challenges, set priorities, track our progress, and achieve real outcomes for children and families.

Access the 2023 Alabama Kids Count Data Book here.

Want to see this data at the national level? Visit the national KIDS COUNT Data Center to access hundreds of indicators, download data and create reports and graphics!

Alabama’s population increased by 34,000 last year to 5.1 million, driven by increased domestic migration and a decreasing number of deaths, according to the latest population estimates published by the U.S. Census Bureau, covering the period between July 1, 2022 and July 1, 2023.

That’s the 15th fastest rate of growth among U.S. states and ranks 11th in terms of the number of people added. Still, Alabama’s growth rate trails other Sunbelt and Mountain West states, including Southeastern neighbors like Florida, Georgia, Tennessee, and South and North Carolina.

Alabama’s death rate fell from the third-highest in 2021 to the sixth-highest in 2023. Still, more people died in Alabama than were born here, according to the 2023 estimates. But the gap narrowed. Births were up by about 150, and the estimated number of deaths in 2023 was down by almost 10,000 from the 2021 peak of the Covid-19 pandemic.

Most of the population change resulted from people moving in from other states. The state received 30,744 domestic migrants, 2,000 more than moved in the year before. International migration into Alabama increased to 5,364 net new arrivals, or about 1,000 more than the year before.

In 2023, Alabama’s rate of domestic immigration was the 10th highest in the U.S. However, Alabama still has one of the lowest rates of international immigration among states, ranking No. 45.

Texas and Florida added the most people. New York, Illinois, and California saw the biggest declines. All the Southeastern states, with the exception of Louisiana and Mississippi, recorded population increases. That pattern has been consistent since 2020.

Census population and change estimates for counties, metro areas, and cities will be released later in the year. Use the tabs and menus in the visualizations to explore the data.

The percentage of Alabamians without health insurance rose between 2019 and 2020, according to the latest estimates from the U.S. Census Bureau. In 2020, 11.8% of the population under 65 was uninsured, compared to 11.6% in 2019.

Printable PDF available here.

Nationally, the uninsured rate declined from 10.8% to 10.4%. Alabama ranks 39^th among the states in the percentage of its population with health insurance.

Comparison Among States

The latest estimates come from the Census Bureau’s Small Area Health Insurance Estimates (SAHIE). The Bureau has built an interactive tool for exploring the data in depth at the national, state, and county levels.

With the implementation of the Affordable Care Act in 2014, Americans gained access to health care exchanges and subsidies, which increased the percentage of people with health insurance. The law also encouraged states to expand Medicaid eligibility in order to provide health insurance to more low-income individuals. To date, 12 states, including Alabama and several other Southeastern states, chose not to expand Medicaid. Those states tend to have higher percentages of their population uninsured.

Three Southeastern states did expand Medicaid eligibility. Those states have a smaller percentage of the population uninsured than Alabama: Kentucky, 6.9%; Louisiana, 9.6%; and Arkansas, 10.2%.   

Health Insurance By County

Dekalb County has the highest percentage of the population without insurance, at 19%. Dekalb and other counties across North Alabama have a greater share of residents who are Hispanic compared to other parts of Alabama. Nationally, the health insurance rate is much lower among Hispanics than in other demographic groups. On the other end of the spectrum is Shelby County, which has the lowest percentage without insurance, 9.3%

Coverage For Children: A Bright Spot for Alabama

Alabama ranks in the top 20 when it comes to providing health insurance to children. Only 3.6% of individuals 18 and younger lack health insurance, largely thanks to the ALL Kids, Alabama’s Children’s Health Insurance Program (CHIP). The program is administered by the Alabama Department of Public Health and Blue Cross Blue Shield of Alabama (BCBSAL) to provide medical, mental health, and substance abuse services through their preferred provider organizations (PPO).

Conclusion

Alabama has policy options for decreasing the number of people who lack health insurance. Recent federal legislation has provided additional incentives to expand Medicaid. An analysis by PARCA and the Center for Economic Development and Business Research at Jacksonville State University found that expanding Medicaid coverage to low-income adults in Alabama would actually save the state almost $400 million per year over the next six years. Much of that savings would come through having federally supported Medicaid coverage pay health care costs that are currently paid for by other state programs. Expansion can be handled by expanding coverage under the government program or a through insurance policies subsidized by Medicaid funding but offered by private companies.

– Economic Security: While 16% of Alabamians live in poverty, 23.9% of Alabama children live in poverty (ex. a household of 4 making $24,750 or less). Further, 1 in 5 children in Alabama are food insecure.

– Education: Poverty leads to significant disparities in education. For Alabama 4th graders in poverty, only 37.9% are proficient in reading and 12.1% are proficient in math.

–  Safety and Permanency: In 2021, 3,453 children entered foster care. While cases can have multiple causes of entry, 48% of cases involved parental substance abuse.

See how children in all 67 counties of our state are faring in education, health, economic security, and more.

Access the 2021 Alabama Kids Count Data Book here.

Expanding Medicaid coverage in Alabama could save the state almost $400 million per year over the next six years – more than enough to cover the cost of expansion – and have an average positive economic impact of $1.89 billion per year over that same time frame.

These findings are based on analysis conducted by the Public Affairs Research Council of Alabama and the Center for Economic Development and Business Research at Jacksonville State University.

The analysis was supported by the Daniel Foundation of Alabama, the Community Foundation of Northeast Alabama, the Community Foundation of Greater Birmingham, the Mike and Gillian Goodrich Foundation, and the Women’s Foundation of Alabama.

Medicaid is a federal healthcare program administered by the states. The federal government funds approximately 71% of Alabama’s current Medicaid costs. The state’s General Fund covers the balance.

Medicaid covers approximately 925,000 Alabamians – the majority are children. Low-income adults are only covered if they are caretakers of someone under 19, pregnant, over 65, legally blind, disabled, or in a nursing home. The income limits vary by program but can be very low. For example, the income threshold for a caretaker is 13% of the federal poverty level or $3,445 per year for a family of four.

Since 2014, states have been able to expand their Medicaid programs to cover adults earning up to 138% of the federal poverty level, $36,570 for a family of four. Initially, the federal government would cover 100% of the cost. From 2018 onward, the federal government covers 90%.

Alabama is one of 12 states which have chosen not to expand Medicaid. If Alabama chose to expand Medicaid, this would extend access to coverage to more than 280,000 people. The state would be responsible for 10% of the cost. Policymakers have expressed concern about the state’s ability to cover these increased costs – a reasonable concern given the troubled history of the state’s General Fund.

However, recent changes to federal law, including those in the various COVID relief packages, change the equation.

Our analysis finds that over the next six years, expanding Medicaid in Alabama could:

• extend coverage to as many as 283,636 people.
• create an average of 20,083 new jobs per year.
• have an estimated positive economic impact of $11.36 billion.

Our analysis estimates covering that expanded population through Medicaid would cost an average of $225.4 million per year. However, expansion would result in the federal government paying $397.88 million in annual expenses currently paid by the state. As a result, the state could expand coverage, and at the same time, reduce or reinvest the amount paid to support healthcare for low-income Alabamians by $172 million annually.

Read the full report.

VOICES for Alabama’s Children recently released its 2020 Alabama Kids Count Data Book last month. This annual statistical portrait is meant to provide a roadmap for policymakers who seek to improve the lives of Alabama’s children. PARCA provides research support for the project.

The Data Book can be used to raise the visibility of children’s issues, identify areas of need, set priorities in child well-being, and inform decision-making at the state and local levels.

See how children in all 67 counties of our state are faring in education, health, economic security, and more.

View the 2020 Alabama Kids Count Data Book here.

Alabama schools are set to re-open in August, with plans for local systems to offer educational services through traditional on-campus schools, remote on-line education, and a hybrid of traditional and remote learning options.

With the novel Coronavirus still spreading, all plans are subject to change. Already, the state’s largest system, Mobile County, and the Selma City School System have decided not to open school buildings and to proceed with only remote learning for all of its students this fall.

As policymakers, educators, and parents prepare for what will likely be a most unusual school year—including the possibility of additional shutdowns— PARCA gathered information from local reports and two major national polls that attempt to describe what parents and students experienced during the school closures this spring. As schools plan for the fall, these experiences are important to understand.

According to the polls, parents worried the online school experience was resulting in:

The Shutdown

As COVID-19 spread this spring, schools across the country closed. By March 20, 45 states had closed all schools. By early May, the number climbed to 48 states and the District of Columbia—affecting more than 55 million students. Only Montana and Wyoming allowed schools to remain open, although some systems in those states did close. ¹

Almost overnight, schools entered uncharted waters. States, systems, and local schools mobilized resources for parents and students and reimagined teacher-student interaction. For most schools, this entailed some version of virtual education.

According to a Gallop Survey conducted in March 2020, 70% of parents of K-12 students not in school at that time reported their child was participating in an online education program run by his or her school. The survey found that among parents whose children were not enrolled in a formal online education program, 52% were homeschooling with their own materials, 25% were using a free online learning program not associated with their child’s school, and 35% were not engaged in any formal education. ²

Some schools had the capacity to respond to COVID-19 closures comparatively easily. That includes schools in Alabama and elsewhere that were already designed as virtual schools. Other systems in other parts of the country are more experienced in online education because of long winter breaks with harsh weather. Conversely, most schools, educators, parents, and students were thrust into a new learning environment for which they were little prepared.

Parents and students around Alabama reported a wide variance in student experiences, varying according to system, school, grade, and teacher. Some reported students having more work than before the shutdown and spending hours each day with regular virtual check-ins. Others reported that work was considered optional or that students finished nine-weeks of work in just a few days. The long-term effects of the academic transition and the inconsistency of students’ experience will take time to assess.

Parent Reactions

The national nonprofit educational organization Learning Heroes conducted a survey of parents in April and March 2020. The survey, which reached 3,645 parents from across the nation, was conducted in conjunction with the Council of Chief State School Officers (CCSSO), National Board for Professional Teaching Standards (NBPTS), and the National Association of State Boards of Education (NASBE).

Results show that parents, now in the role of educators or critical partners in their child’s learning, have gained a new appreciation for what teachers and schools do. ³

Figure 1

Some parents reported being overwhelmed, while others reported more involvement in their child’s learning has given them a healthy sense of engagement and better insight on how to help their children learn. These parents look forward to being more involved in schools and their child’s education once schools re-open.

Academic Concerns – Loss of Learning Assessed

Seventy percent of parents expressed concern about the loss of learning and how this will be made up.  Fifty-four percent are concerned their children will not be ready for the upcoming school year. These issues raise more fundamental questions about the nature of teaching and learning. High-quality teaching and learning can presumably occur in different forms. With state testing postponed, measuring the impact on student learning gain or loss will be complicated but is an important objective.

Figure 2

States such as California and South Carolina are planning to implement new tools for assessing learning loss. Quick, real-time assessments conducted by teachers in the classroom, or virtually, will likely be most effective. Assessments that take time to report results will have limited utility for teachers but may be instructive for administrators and researchers.

Researchers have tried to predict the magnitude of pandemic-related learning loss by analyzing normal summer learning loss — the degree of academic regression between the end of one school year and the beginning of the next – and treating the COVID shutdown as an extended summer. Some researchers estimate that students likely ended the school year with only 40% to 60% of learning gains achieved during a typical school year. [efn-note] M., Soland, J., Tarasawa, B., Johnson, A., Ruzek, E., and Liu, J. (2020). Projecting the potential impacts of COVID-19 school closures on academic achievement. Edworking Papers, May 2020. Annenberg Institute for School Reform at Brown University [/efn_note] Other studies estimated much lower losses. ^{4 5 6}

Some experts believe the projected learning loss is over estimated.

They note that estimates using summer loss as a baseline are not taking into account the learning that occurred through virtual forums and support provided by schools this past spring. Likewise, most of the content students were expected to learn was already introduced to students by March, although students did not have an opportunity in class to practice skills, and develop mastery. Furthermore, teachers are prepared to work with students coming back at different levels of preparation after the summer break, so they will not be caught off-guard. At the same time, this will likely be much more challenging and will be taxing for teachers who are less prepared and motivated to work with diverse learners.

These same experts, however, are alarmed about the challenges facing beginning readers, who usually need continued re-enforcement throughout the year. This could affect future literacy rates and have implications for implementing Alabama’s Literacy Act in the lower grades. ⁷

Social and Mental Health Concerns

Parents expressed fear about the impact of COVID-19 on their children’s social-emotional well-being, and 59% worry about the impact of reduced social interactions. For young children in unsettled or abusive home environments, the school can be a safe place. Long-term absence from this safe place can become a source of heightened trauma with long term consequences.

Many children may be coping well, but medical experts are concerned about the stress and trauma children (and adults) are experiencing during the pandemic, especially those with underlying mental health conditions. School-aged children experienced sudden changes in their educational setting and routines. Many experienced shock. Some families have had the stress of sickness and death in their families as a result of the virus – though overall a relatively small percentage. Many more families are under financial strain. Concerns have been raised about abuse, neglect, loneliness, and isolation. The virus has affected every facet of the life of children and adults. ⁸

Symptoms of trauma in school-aged children can include:

Physical Symptoms	Over-or under-reacting to stimuli (physical contact, doors slamming, sirens) Increased activity level (fidgeting) Withdrawal from other people and activities
Cognitive	Recreating the traumatic event (e.g., repeatedly talking about or “playing out” the event) or avoiding topics that serve as reminders Difficulties with attention Worry and fear about safety of self and others Disconnected from surroundings, “spacing out”
Social-Emotional	Rapid changes in heightened emotions (e.g., extremely sad to angry) Difficulties with controlling emotions angry outbursts, aggression, increased distress) Emotional numbness, isolation, and detachment
Language and Communication	Language development delays and challenges Difficulties with expressive (e.g., expressing thoughts and feelings) and receptive language (e.g., understanding nonverbal cues) Difficulties with nonverbal communication (e.g., eye contact) Use of hurtful language (e.g., to keep others at a distance)
Learning	Absenteeism and changes in academic performance/engagement Difficulties listening and concentrating during instruction Difficulties with memory 9

Parents can reduce the risk of stress by creating a calm, safe, and predictable environment, communicating and building a positive-supportive relationship with their children, and encouraging their children to develop self-regulation skills.

Teacher Interaction

Parents expressed concern about the lack of regular ongoing contact they and their children have with their children’s teacher(s). This is perhaps less critical for self-motivated students with highly resourceful parents or guardians with time devoted to learning at home. But many students depend on regular high-level teacher interaction. Parents indeed may have the will and skill to perform in this role but are working in fulltime jobs. Others express concern about not having the background to adequately support their children. Still, others may be in stressful life situations that rob them of the motivation and energy to serve in this role. In each of these situations more ongoing contact with teachers and community support specialists would likely make a significant difference.

Figure 3

Though parents find communication with teachers extremely helpful, the majority did not receive this support on an ongoing basis.  Teachers have found themselves in uncharted territory for which they were not prepared. They too may not have the skills and background needed for online teaching and tutoring.  The awkwardness of online communication and technical hiccups can generate additional frustration. Everyone is learning and adapting.

Resources Provided by the School

An especially important issue for schools this past spring was providing guidance and resources to parents to assist them in working with their children. The figure below shows the percent of parents indicating they received key resources from their child’s school during the pandemic this past Spring.

Figure 4 

But sometimes what parents received was not what they needed or found most useful. In Figure 5 below, resources are ordered by the percent of parents who found the assistance useful (red bar), from highest to lowest, and the percent receiving the guidance or resource.  

Figure 5

The most useful assistance included:

• school provided personal technology
• online guidance
• one-to-one tutoring with teachers
• ongoing regular contact with teachers
• printed versions of class materials
• remote classes delivered online

Parents found printed materials more helpful than digital materials.

The gap between what was offered and what was found most useful, when offered, was largest for the following:

• personal guidance in supporting your child’s learning at home
• remote one-to-one tutoring by teachers
• school provided technology
• access to mental health services

COVID-19 and Equity

A number of observers have focused attention on the profound inequities in education magnified by COVID-19.  Systems vary in funding, resources, curriculum, extracurricular offering, teacher experience and in many other ways. These disparities are likely exacerbated when the home becomes, not by choice, the primary learning environment for all students.  

Virtual education has the potential for system-by-system and house-by-house differences in capacity to compound each other.

Differences in capacity across households include the following:

• Income and educational attainment of parents.
• The knowledge and experience of parents, guardians, or other adults.
• The time and availability of parents, guardians, or other adults to actively facilitate or assist in their children’s learning.
• Family structure: One and two-parent families where responsibilities are shared.
• Relationships between parent-child, parent-teacher, and student-teacher.
• Access to communication, guidance, and support from teachers and schools. 
• Access to community supports and enrichment.
• Access to computer technology and high-speed internet. Capacity and motivation to make use of these resources.
• Access to nutritional food daily.

These obstacles may be greater, but in no way limited, to lower-income areas.

The general public and government leaders most frequently cite a child’s school and teachers as the primary difference in their education. But research has long noted that children do not enter school as a blank slate, and that inequalities begin at birth as a result of different prenatal conditions, and too often are made worse during those early years before school.  Children enter school with vastly different levels of preparation. The achievement gap, from this point of view, is a symptom of broader inequality, past and present. Improving education on campus and on-line and building a solid workforce calls for addressing these inequalities in the home and school. ¹⁰ Strauss, V. (2020). How COVID-19 has laid bare the vast inequities in U.S. public education. The Washington Post, April 14, 2020. /efn_note]

Alabama’s seven congressional representatives issued recommendations on re-opening Alabama’s economy to Governor Ivey last week. Governor Ivey plans to announce her decision on April 28.

Guidelines for Opening Up America Again

Several of the reports reference the Guidelines for Opening Up America Again published by the White House and the Centers for Disease Control on April 16. A summary of those recommendations is useful before considering the reports from Alabama’s congressional delegation.

The Guidelines suggest a three-phased strategy for re-opening. Phase One is most relevant now. Five metrics determine when a Phase One re-opening is safe:

1. When flu-like illnesses decline for 14 days
2. When COVID-like syndromic cases decline for 14 days
3. When documented cases of COVID-19 or the percentage of positive tests decline for 14 days
4. When hospitals are able to treat all patients without crisis care
5. When robust testing, including anti-body testing, is in place for at-risk healthcare workers

Presuming the above conditions are met, the Guidelines make the following recommendations for a Phase One re-opening.

• Vulnerable individuals should shelter in place.
• All individuals should practice social distancing.
• All individuals should avoid groups larger than 10.
• Minimize non-essential travel.
• Employers should:
  • encourage telework
  • return to work in phases
  • close common areas
  • minimize non-essential travel
  • consider special accommodations for vulnerable populations.
• Schools and youth organizations should remain closed.
• Visits to senior living facilities and hospitals should be prohibited.
• Restaurants, theaters, sporting venues, gyms, and houses of worship can operate under strict social distancing guidelines.
• Bars should remain closed.
• Elective medical procedures can resume.

Congressional Recommendations

Below is a high-level summary of the reports. By necessity, the reports are summarized. Not all recommendations of every report are included. Unique contributions are summarized or quoted. Likewise, inclusion below does not reflect PARCA’s endorsement and should not be seen as an affirmation of the efficacy, practicality, or legality of the recommendation.

Disclosures: PARCA Board Secretary Tyrone Fenderson served on the Advisory Committee for Rep. Bradley Byrne. PARCA Board Member Ted Hosp served on the Advisory Committee for Rep. Terri Sewell. PARCA staff designed and conducted a stakeholder survey for Rep. Sewell’s report. PARCA Executive Director Ryan Hankins is listed in Rep. Sewell’s Advisory Committee because of PARCA’s work on the survey.

Key Themes

The reports differ in accessibility, approach, and focus, but there are common and reoccurring themes in the report, including:

• balancing economic and public health concerns
• the danger of mixed messages
• the need for the state to speak a clear message with one voice
• the need for expanded testing
• accuracy of data reporting
• the need to reduce maximum occupancy guidelines
• the importance of social distancing
• the importance of personal protective equipment (PPE)
• the need for input from professional associations, licensing agencies, and regulatory boards
• the availability of safety equipment, hygiene, and cleaning supplies

When Should Alabama Re-Open?

Immediately: according to Rep. Brooks. This is an inference. Opening immediately did not receive the most votes from Rep. Brooks’ committee, but it is listed first among the proposals. “When COVID-19 is no longer a threat” received the most votes among Rep. Brooks’ re-opening proposals.

May 1: according to Reps. Aderholt and Byrne.

After 14 days of declining hospitalizations: Rep. Sewell

No specific date or metric: Reps. Palmer, Roby, and Rogers

Recommendations from Rep. Bradley Byrne and Alabama’s 1^st Congressional District

Rep. Bradley Byrne issued a 22-page report summarizing the recommendations of a 28-member advisory group. The report notes that every member may not agree with every recommendation in the report.

The report recommends the 1^st Congressional District implement the CDC’s Phase One recommendations summarized above. The report includes data suggesting the District will reach the CDC benchmarks by May 1.

Thus, the report recommends retail and personal services businesses, beaches, and in-house restaurant service should re-open or resume on May 1. 

However, a key caveat is included. Rep, Byrne states his recommendations should be superseded if expected data trends do not hold, or “by the advice of public health professionals on whom Governor Ivey relies.”

Rep. Byrne’s report includes the most extensive discussion of the mental health implications of the economic shutdown.

The report includes topline recommendations.

• Retail and personal services businesses should reopen beginning on May 1.

• Restaurants should reopen for in-house dining beginning May 1

• Beaches should reopen beginning May 1.

• Self-enforcement and reporting are critical.

• “Future closures should be implemented on an individual basis for businesses/organizations who fail to comply with guidelines.”

• Local law enforcement and health department officials must be prepared to handle oversight and complaints related to non-compliant businesses.

• The state must prioritize expanding testing and workforce contract tracing.

• The state must increase the supply of Personal Protective Equipment (PPE).

• The state must improve reporting.

• The state should expand mental health services.

Recommendations from Rep. Martha Roby and Alabama’s 2^nd Congressional District

Rep. Roby issued an 8-page report summarizing recommendations from “individuals from a cross-section of Alabama’s Second Congressional District.” The report includes five concise recommendations that summarize the thoughts of people in the district.

“1. There must be an increase of personal protective equipment (PPE) available and more testing capacity.

2. Any changes to the existing State order should be clear and concise.

3. The re-opening of businesses should be on a rolling or tiered base consistent with set benchmarks.

4. Social distancing guidelines should be in place inside buildings such as businesses, restaurants, and schools.

5. Health and prevention measures should be implemented in places of business.”

Also included in the report are other suggestions and recommendations from constituents. These comments may not be representative of the entire district but offer a glimpse of Alabamians’ ideas and concerns. Unique recommendations in the report include:

• declaring community colleges as essential businesses
• fines or other legal action for businesses failing to comply with public health regulations
• rolling or tiered reopening as determined by state officials, then county and local officials
• staggering of class schedules to reduce the number of students on campus (the report does not clarify if this recommendation is restricted to higher education or could apply to elementary and secondary schools also)
• increasing social distancing from 6 feet to 25 feet
• deferring re-opening guidelines for business regulated by state boards and agencies to those board and agencies

The top five recommendations and subsequent suggestions are presented as the sentiments of those in the 2nd District and not the formal recommendations of Rep. Roby or her office.

Recommendations from Rep. Mike Rogers and Alabama’s 3^rd Congressional District

Rep. Rogers issued a four-page letter based on talks with “numerous small business owners, farmers, employees, elected leaders, EMA directors, hospital administrators, law enforcement, and Chambers of Commerce….” and “…conference calls with Alabama’s National Federation of Independent Business (NFIB), Members of the State Legislative delegation, mayors and city councils, and county commissioners.”

Unique observations and recommendations from the report include:

• recognition of the uniqueness of businesses, even if in the same industry
• high levels of cleanliness and regulations already required of restaurants
• the impossibility of social distancing in most medical fields
• hospitals’ reliance on elective medical procedures
• coordinating with various sports’ governing bodies and conferences to determine “…appropriate public health protocols, including the possibility of a closed venue setting regarding these sporting events.’”
• providing virtual job fairs and job training
• limitations on businesses’ cash transactions and new requirements for PPE and sanitation
• tax deductions for supplies necessary to comply with public health mandates
• incentives for Alabama manufacturers to produce PPE and other goods in short supply
• creating resiliency plans to prepare for future public health crises

Recommendations from Rep. Mike Aderholt and Alabama’s 4^th Congressional District

Rep. Aderholt issued a two-page letter, posted on his website summarizing the recommendations of a 13-member advisory board and input from 26 chambers in the 4th District. Rep. Aderholt’s office also sent surveys to both chambers and chambers’ members. The office collected 400 responses to the survey or similar surveys conducted by chambers.

The report notes that 29% of respondents are in favor of opening immediately, 35% on May 1, 9% on May 15, 7% on June 1, and 20% chose “other,” with the caveat that most respondents choosing other had not closed.

Similar to Rep. Byrne, Rep. Aderholt recommends Alabama follow the CDC guidelines summarized above and re-open on May 1 on a county-by-county basis.

The report noted the need and opportunity to seek guidance from various professional associations and regulatory agencies.

The report also notes concerns that employees cannot or will not return to work due to a lack of childcare.

He also notes concerns that some employees may earn more collecting unemployment than working.

Recommendations from Rep. Mo Brooks and Alabama’s 5^th Congressional District

Rep. Mo Brooks’ report, a letter and appendices, present the results of the votes of a 14-member advisory committee on various re-opening proposals. The proposals are designed as responses to Alabama Public Health Officer Dr. Scott Harris’ April 3 stay home order. The appendices include Governor Ivey’s request to the Congressional delegation and a set of recommendations to keep employees safe.

The report makes no direct mention of public health measures or metrics but does note that the advisory committee voted 13 – 1 to maintain the stay-home orders “so long as a COVID-19 Pandemic emergency exists.”

Other proposals and votes include:

• rescinding the stay at home order immediately [April 20], without any replacement government mandates [emphasis in the original] (10-0)
• allowing the order to expire on April 30, without any replacement government mandates [emphasis in the original] (10-4)
• following the Guidelines for Opening Up America Again, summarized above (11-3)
• the state adopt mandates and recommendations concerning employee safety (12-0)
• “promoting and continuing” telehealth and telemedicine (12-0)
• repealing Certificate of Need (CON) laws governing the numbering allowable hospital beds and other medical services (10-0)

Specific recommendations regarding employee safety mirror those made in other reports. Noticeable variances include:

1. training employees on CDC guidelines to prevent the spread of COVID-19
2. noting that employees are free to wear reasonable PPE provided by employers
3. requiring employees interacting with the public at a fixed workstation wear face masks/shields or be shielded by a barrier and wear gloves.  
4. retail establishments may ask customers to wear masks
5. personal care providers such as barbers, nail, and beauty salons should wear masks and gloves
6. self-serving resturants and buffets should be avoided.
7. employers of high-risk workers should consider:
   • telework
   • FMLA-like policies
   • loosened sick pay regulations
   • unpaid leave with positions held
   • leave advances
   • no or low-interest employee loans

Recommendations from Rep. Gary Palmer, Alabama’s 6^th Congressional District

Rep. Palmer’s four-page letter references “…ideas and concerns … received from business owners representing a broad cross section of Alabama’s economy. “

Chief among these concerns and recommendations are:

• Strong oversight of unemployment benefits. Rep. Palmer notes concerns about some people earning more in unemployment, employs filing for—and receiving—unemployment while still working, and employees refusing to return to work when called by their employers.

• The need for a steady supply of PPE and the importance of both removing barriers to production and enforcement of anti-gouging laws.

• The opportunity for “non-essential businesses” to open and demonstrate the capacity to comply with current or new occupancy and social distancing regulations

• Clear expectations and clear communications.

Rep. Palmer includes general and specific suggestions for medical facilities (screen all patients), restaurants (disposable menus and tableware, reservations), hotels, industry, childcare (waivers from social distancing), home builders, barbers and salons (requiring masks, gloves, gowns).

Recommendations from Rep. Terri Sewell, Alabama’s 7^th Congressional District

Rep. Sewell issued the longest report (55 pages). The report reflects the general, but not unanimous, consensus of a 61–member advisory committee, including several public health professionals.

The report established a 14-day downward trend in hospitalizations by public health district as the primary metric for a safe re-open.

The report makes recommendations in three broad areas: public health, workplace and workforce, protecting vulnerable communities. These include:

Public Health

• provide widespread testing
• recruit a contact tracing workforce,
• ensure widespread access to affordable treatment when developed
• establish information systems that allow for the swift detection of any increase in cases following the reopening.

Workplace and Workforce  

• create flexibility for businesses
• implement phased re-openings based on employees’ exposure to the public
• work with the State Superintendent to address the childcare needs of workers, including grant possibilities and state funding for childcare, after-school care, summer learning, and care for young children.
• provide increased support to small businesses, hospitals, and nonprofits through expanded loans and grants
• ensure that COVID-related federal resources received by these businesses are not taxable at the state level

Protecting Vulnerable Communities

• prioritize testing, tracing, and treatment for vulnerable communities and essential workers
• ensure testing in all 67 counties
• provide financial assistance for disadvantaged businesses
• protect Alabama’s uninsured population by expanding Medicaid
• expand broadband access
• incentivize paid sick leave and emergency family leave
• provide hazard pay or state tax credits to health care and essential workers

What’s Next?

The current stay-at-home order expires on April 30. Governor Ivey has indicated she will announce a decision on April 28.