In late 2017, the Public Affairs Research Council of Alabama (PARCA) surveyed Alabama voters to determine their thoughts about the general direction of the state and the issues that most concern them. PARCA partnered with Samford University to survey policy professionals from across the state including academics, journalists, business and nonprofit leaders, and lobbyists. Their responses provided a list of 17 critical issues facing Alabama. PARCA partnered with USA Polling at the University of South Alabama to ask registered voters about these 17 issues. The voters’ responses generated the Top Ten list of voter priorities. Details about the survey and its methodology can be found in the full Alabama Priorities report.

Alabama Priorities

Key Findings

• Voters broadly agree on the critical issues facing the state.
• Voters are not polarized along traditional political, ideological, racial, or generational lines. There is a significant gap between the priorities of experts and the priorities of voters.
• Policymakers have an opportunity to inform and educate voters on critical and systemic challenges facing the state.
• Policymakers have an opportunity to respond to immediate, often highly personal issues that concern voters.
• Elected officials and candidates have an opportunity to show leadership and to build broad coalitions to address Alabama’s most pressing challenges.

In the following months, PARCA will produce summary briefs on each of the top ten priorities chosen by Alabama voters. Each brief will answer four critical questions: what is the issue, why it matters, how Alabama compares, and what options are available to Alabama policymakers.

#7: Crime and Public Safety

What is the Issue?

Alabama voters ranked crime and public safety as the 7^th most important issue among the priorities, with approximately 58% of voters indicating they were very concerned about the issue. The issue averaged 4.10 on a 1 – 5 scale where 1 is “not at all concerned” and 5 is “very concerned.”

Majorities of every racial group are very concerned about this issue. Approximately three-quarters of African-Americans say they are very concerned. Respondents with lower incomes are more likely to say they are very concerned than respondents with higher incomes. While majorities of conservatives and liberals say they are very concerned, only a plurality (more than any other category but not a majority) of self-described moderates holds this view.

Survey respondents were also asked about their top policy responses to crime and public safety. Twenty-seven percent of voters were more concerned about the number of police, 24% civil liberties, and lesser percentages identifying sentencing reform and conditions of state prisons as their top priority.

Why Is Crime and Public Safety Important?

In previous generations, a basic high school education was sufficient for entry into the workforce. Today, an increasing share of entry-level jobs require a level of training beyond a high school diploma. To generate a prepared workforce, there is continued need to improve preparation for and access to two and four-year colleges. However, the demand for advanced training is also being addressed by K-12 schools, where students are increasingly presented with options for earning industry-recognized credentials while still in high school. Certificate programs are being expanded for new graduates and current workers.

Alabama has enjoyed an unprecedented run of industrial recruitment and new job creation. According to the Alabama Department of Commerce, the state has added or announced 138,197 new jobs between 2010 and 2017. In that same time, employment in Alabama has grown from 1,893,169 to 2,081,176 – an increase of 188,007, and the unemployment rate has fallen to 3.8% (December 2017). Recent monthly unemployment rates for the state have hovered between 3.7 and 4.1%, the lowest numbers since at least 1976. Despite the surging demand for labor, Alabama’s population growth has been sluggish, creating a tight labor market and a pending shortage of workers.

How Does Alabama Compare?

Crime has many negative impacts on a community.

Crime and the response to crime create a large economic and social cost, including the direct economic losses suffered by victims and the costs of police protection, legal services, and corrections.

Crime data and perceptions of public safety are widely used in quality of life rankings, which can impact the perceived livability and desirability of a community.[1]

High crime rates deter business. Crime can reduce the size and skills of the labor force. Crime can have a negative impact on education and training, diminishing the long-term creativity and innovative capacity of a community. Crime can deter business investment and location.

The economic, societal, familial, and personal costs of incarceration are immense.

Public safety plays a crucial role in supporting economic growth and vitality by reducing the cost of crime and enhancing the desirability of communities as places to live and locate businesses and has a direct impact on the levels of societal trust and interaction.[2]

How Does Alabama Compare?

The Crime Rate

Alabama reported 532.3[3] violent crimes per 100,000 residents in 2016, placing Alabama 8^th highest in the nation for violent crimes. Alabama fared worse than most Southeastern states, except Tennessee, Louisiana and Arkansas. The state fared somewhat better in terms of property crimes, ranking 14^th in the nation. Alabama’s property crime index for 2016 was 2,947.8 per 100,000 residents but was lower than that of only four Southeastern states. When violent and property crimes are considered together, Alabama ranked 9^th in the nation with a crime index of 3,480.1 per 100,000 residents.

According to the Alabama Law Enforcement Agency’s annual crime report[4], total crime in the state has decreased from 2011 to 2015 but increased roughly 2% from 2015 to 2016.

However, during this same period, the number of violent crimes increased every year except between 2012 and 2014. Violent crime in the state increased from 405.5 per 100,000 residents in 2014 to 518.2 in 2016.

Although the number of violent crimes increased significantly over that two-year period, the number of crimes cleared has been decreasing.[5] In 2014, 45% of violent crimes were cleared, but that percentage decreased to 39% in 2016. The clearance rate for total crime in the state has also been declining over the same period.

The Incarceration Rate

In 2016, there were 27,799 inmates in Alabama prisons, a rate of 633 people per 100,000 – the 3^rd highest incarceration rate in the U.S. The state’s incarceration rate is significantly higher than the national rate of 471 per 100,000 residents and lower than only Oklahoma and Louisiana; 700 and 816 per 100,000 residents, respectively.

The high number of incarcerations makes the state’s prisons the most overcrowded in the country; housing almost twice the number of inmates the facilities were designed to house.

In addition to a high incarceration rate, the ratio of supervising probation and parole officers to probationers, parolees, and offenders poses a significant problem for the state’s system. At the end of fiscal year 2017, the total caseload average per officer on any given day was measured at 169 to 1. When broken down by total and active caseloads, the active caseload average per officer was 110 to 1. The American Probation and Parole Association (APPA) recommended caseload is 20 probationers per probation officer for intensive supervision, 50 to 1 for moderate to high-risk offenders, and 200 to 1 for low-risk offenders.

The Recidivism Rate

Recidivism, which refers to a person’s relapse into criminal behavior and is measured by criminal acts that result in rearrests, reconviction, or return to prison within three years, is a major driver of incarceration rates.

In 2017, the recidivism rate in Alabama was 31.5%, including all cohorts.[6] The high percent of recidivists continues to negatively impact the state’s prison system which is already overburdened. It also sheds light on the need for more effective programs to help released prisoners readjust to their communities and rebuild their lives.

Juvenile Detention

The percentage of violent crimes and property crimes committed by juveniles in Alabama decreased since 2013. As of 2016, juveniles account for 6% of violent crimes and property crimes.

Despite the decline in juvenile crime, the number of detained juveniles is also a cause for concern. Alabama’s juvenile custody rate of 184 per 100,000 youths places the state 20^th in the nation. When compared to Southeastern states, the state ranked 3^rd with only Arkansas and Virginia having higher rates.

There is a long-term impact on juveniles with criminal convictions that goes beyond the immediate effect to individual and family. A study from University of Pittsburgh found that 52% to 57% of juvenile delinquents continue to offend up to the age of 25, and about 16 – 19% up to the age of 30.[7]

Funding

Like many parts of state government, Alabama’s corrections and justice systems struggle with funding. Alabama spends less on corrections than a majority of states across the country.

According to the Alabama Department of Corrections 2017 Annual Report, Alabama spent $52.07 per day per inmate, compared to the national average of $99.45.

Alabama’s low per inmate spending may be seen as a positive by some. However, it is important to remember that with this level of spending comes a Department of Corrections that is understaffed, pays the lowest of any public safety agency in the state, and which suffers from very high turnover rates. The state’s corrections spending also contributes to legal issues facing the state. Alabama is currently engaged in two different lawsuits concerning the healthcare and conditions of Alabama’s prisons. It is highly likely that the outcome of these cases will result in court-mandated increases in Alabama’s corrections budget.

Beyond funding Alabama’s prison system, Alabama’s funding for judicial, legal and police protection is also low. Based on 2016 expenditure data from the Bureau of Justice Statistics, Alabama’s justice system expenditures, which include police protection, judicial and legal, and corrections, were low when compared to more than 30 states across the country and most Southeastern states. In 2016, the state spent $2.5 billion, while other southeastern states spent a significantly higher amount (example Florida’s 2016 expenditures totaled roughly $14 billion and Georgia approximately $6 billion).

What Can We Do?

The state has made recent attempts to address overcrowding in prisons, the high rate of supervision caseloads, and the lack of treatment in the community. In 2015, the state passed the Justice Reinvestment Act (Act 2015-185), which strengthened community-based supervision as an alternative to prison, while prioritizing prison space for violent and dangerous offenders. The legislation also took steps to ensure supervision for everyone upon release from prison. Since then, the state’s prison population has decreased by 15%, and more than 100 new probation and parole officers have been hired to help reduce officers’ caseloads.

In June 2018, the Alabama Department of Corrections announced pay raises of 5% for correctional officers at medium security facilities and 10% for officers at maximum security facilities.

Further reductions of the inmate population will be challenging, and additional investment in the prison system will be fiscally and politically difficult – although court orders may leave the state with no choice.

There are additional options the state can explore, including:

• Continued expansion of day reporting facilities[8] and related programs designed to reduce recidivism;
• Explore recommendations of the Alabama Juvenile Justice Task Force[9] designed to reform the retention of juvenile offenders; and
• Expand mental health and drug treatment options both inside state prisons and in local communities.

Drafted by Kenesha Reynolds-Allie, Ph.D. and the Staff of the Public Affairs Research Council of Alabama

View the full PDF report here.

[1] Blair, J.P., “Quality of life and economic development policy”, Economic Development Review 16, 1998.

[2] Keeling, Mary and Mark Cleverly, “Accelerating economic growth and vitality through smarter public safety management”, IBM Institute for Business Value, Executive Report.

[3] Crime index (violent and property crimes) was calculated using 2016 Crime in the United States (CIUS) data from the Federal Bureau of Investigation (FBI) Uniform Crime Reporting (https://ucr.fbi.gov/crime-in-the-u.s)  and 2016 population estimates from the U.S. Census Bureau, Population Division (https://www.factfinder.census.gov)

[4] http://www.alea.gov/Home/wfContent.aspx?PLH1=plhACJIC-CrimeInAlabama

[5] A clearance is a measure of law enforcement activity whereby enough evidence is found to charge a suspect and take him into custody (an arrest) or when a crime is solved but no formal charges are brought against a suspect (clearance by exceptional means).

[6] Alabama Department of Corrections – FY2017 Annual Report (http://www.doc.state.al.us/StatReports)

[7] Stouthamer-Loeber, Magda, “Persistence and Desistance in Offending” (unpolished report, Pittsburg, Pa.: Life History Research Program, University of Pittsburg, 2010).

[8] Board of Pardons and Paroles, 2017 Annual Report http://www.pardons.state.al.us/Reports.aspx

[9] Alabama Juvenile Justice Task Force Final Report, December 2017. http://dys.alabama.gov/images/task_force/AL%20JJ%20Task%20Force%20Report_FINAL.pdf

In late 2017, the Public Affairs Research Council of Alabama (PARCA) surveyed Alabama voters to determine their thoughts about the general direction of the state and the issues that most concern them. PARCA partnered with Samford University to survey policy professionals from across the state including academics, journalists, business and nonprofit leaders, and lobbyists. Their responses provided a list of 17 critical issues facing Alabama. PARCA partnered with USA Polling at the University of South Alabama to ask registered voters about these 17 issues. The voters’ responses generated the Top Ten list of voter priorities. Details about the survey and its methodology can be found in the full Alabama Priorities report at www.parcalabama.org

Alabama Priorities

Key Findings

Voters broadly agree on the critical issues facing the state.

Voters are not polarized along traditional political, ideological, racial, or generational lines. There is a significant gap between the priorities of experts and the priorities of voters.

Policymakers have an opportunity to inform and educate voters on critical and systemic challenges facing the state.

Policymakers have an opportunity to respond to immediate, often highly personal issues that concern voters.

Elected officials and candidates have an opportunity to show leadership and to build broad coalitions to address Alabama’s most pressing challenges.

In the following months, PARCA will produce summary briefs on each of the top ten priorities chosen by Alabama voters. Each brief will answer four critical questions: what is the issue, why it matters, how Alabama compares, and what options are available to Alabama policymakers.

#9: The State’s Image

What is the Issue?

The state’s image is the 9^th most important issue for Alabama voters, with 57% of survey respondents indicating they are very concerned about improving the state’s image.

When examining the top ten priorities by population, the state’s image made the top ten for most groups. Interestingly, the issue ranked higher for older voters and for those with lower incomes and levels of education.

Some would say that Alabama’s image is well earned. Alabama ranks poorly compared to other states in many measures of corruption, education, health, income, and general well-being – issues that will be explored more fully in future briefs.

The State’s Image by Group – asterisks (*) indicates the issue did not rank in the top ten

Alabamians are reminded of this fact frequently. Every few days there is a story in the media highlighting how Alabama compares to other states on some measure. A simple web search generates many such rankings – some concerning more substantive issues than others and some rankings compiled with more rigor than others. In just the last few weeks, Alabama has been ranked as:

• 42^nd in child-well being[1]
• schools rank 42^nd in the nation[2]
• #3 in speed-related deaths[3]
• #1 for fast-food restaurants per capita[4]
• 41^st in places to start a business[5]
• 40^th in children’s health[6]
• 49^th in hiring people with disabilities[7]

Rankings such as these do not tell the whole story, but as has been said, perception is reality.

Why is the State’s Image Important?

Perception

Alabama, like other southern states, labors under stereotypical and outdated assumptions about the rural south: remote, uneducated, and uncivilized. This narrative continues to be nurtured in popular culture and, sometimes by the state and its people. Alabamians, however, and those that visit, know that these descriptions do not reflect the state.

Fairly or not, Alabama must contend with its reputation when attracting new industry and new investment to Alabama. At the same time, the state has been relatively successful on this front in recent years, suggesting that perceptions can be challenged.

Economic developers know that quality of life is fast becoming one of the most important factors businesses consider when choosing a new location. When recruiting a new industry or a new employee, business leaders in Alabama often say, ‘if we can get them to visit, we can get them to stay.’

Reality

At the same time, while some aspects of the state’s image might be misguided or stereotypical, other aspects are based in reality. On average, Alabama students do lag behind their peers in most states. On average, Alabamians are more unhealthy than residents in many other states. Alabama’s median income is in the bottom five in the country, and the state’s recovery from the Great Recession has been slower than many other states.

These are real issues affecting real people, every day – regardless of the state’s reputation.

As noted, the state’s image emerged as a higher priority for voters with lower levels of income and education. The issue also ranked higher for voters generally (9^th) than for policy professionals (16^th). This could be because policy professionals believe that the best way to change the state’s image is indirectly, by addressing the individual factors that create the image. They are not wrong.

However, that the issue ranks so highly for voters underscores the extent to which voters believe the state’s image affects them personally. We suggest that people with more resources – more education, skills, and income – are held less captive by the state’s reputation. They also have more ability to relocate to other parts of the state or to leave the state altogether to seek other opportunities. Conversely, those with fewer resources – less education, skills, and income – may be, or feel, stuck. In other words, their prospects and those of their families may be more intimately tied with those of the state, their county, and their town.

How Does Alabama Compare?

Rather than attempting to measure Alabama’s image compared to other states, we look at three indicators as proxies: job creation, economic growth, and population. These metrics do not constitute image – but we suggest that the same factors that drive these metrics also drive the larger concept of image.

Job Creation

According to the Alabama Department of Commerce, the state has added or announced 138,197 new jobs and $35.2 billion in investment between 2010 and 2017. This suggests Alabama is increasingly attractive to business. However, as with many issues, the distribution of new jobs is not equal. In 2017, 19 counties reported zero jobs from new industry and three counties reported no new jobs from industry expansion.

Economic Growth

The effects of job growth – and decreasing unemployment – are beginning to show in the state’s GDP. Alabama experienced 3.3% growth between 2016 and 2017, outpacing recent trends, but below its southeastern neighbors. For the period 2010 to 2017, Alabama’s compounded annual growth rate is estimated at 2.7%, lower than every other southern state except Mississippi and Louisiana – and far behind regional leaders Tennessee (4.6%), Georgia (4.3%), and South Carolina (4.2%).

Population

The state may be adding jobs and seeing a positive trend in GDP, but these trends are not correlating to population growth. The state’s image surely plays a large role in people’s decisions to move to, or remain in, Alabama – and in recent years, Alabama has struggled to compete with surrounding states.

Between 2010 and 2017, the population of southern states has grown an average of 5.6%. Florida leads the pack at 11.6%. More comparable to Alabama however, are South Carolina, North Carolina, and Georgia. These states have grown 8.6%, 7.7%, and 7.6% respectively.

Comparatively, in this same period, Alabama grew at 2.0%. This translates to a net population increase of 95,000 people in seven years – compared to an increase of 398,988 in South Carolina – a state that was approximately the same size as Alabama in 2010.

Moreover, the source of our population growth is telling. In the past seven years, Alabama has added population through natural growth (number of births minus number of death) and international migration. Alabama’s rate of international in-migration is much slower than most states, and its rate of domestic migration is lower than most other Southeastern states. Domestic migration – people moving from other states to Alabama – has accounted for a net increase of 1,153 people – less than 1% of the state’s population growth since 2010.

Alabama is adding jobs – but not people.  Alabama did see a larger year-over-year population increase in 2017. Perhaps this is the beginning of a new trend.

What Can We Do?

What, then, does this suggest for policy makers?

We suggest that policy makers recognize and prioritize the issues that give rise to a negative reputation. They have a real and profound impact on real people’s lives. As Alabama finds and implements effective responses to education, healthcare, jobs and the economy, crime and more – the state’s image will improve. More importantly, the lives of Alabamians will improve.

At the same time, leaders have an opportunity to remind Alabamians, and a larger national and international audience, of a broader story.

Alabama is emerging as a leader in advanced manufacturing and enjoys a growing reputation in research and innovation, as well as arts, culture, and cuisine.

Successes such as these should be celebrated. At the same time, the state’s challenges should be addressed in a straightforward manner, with an inclusive, broad-based program for expanding opportunity for all.

For the PDF version of the State’s Image summary brief, click here.

1] http://www.gadsdentimes.com/news/20180729/alabama-ranks-42nd-in-child-well-being

[2] http://www.waaytv.com/content/news/New-study-Alabama–489500431.html

[3] http://www.waff.com/story/38728591/alabama-ranks-no-3-in-speed-related-deaths

[4] https://whnt.com/2018/07/03/alabama-ranks-number-one-for-the-most-fast-food-restaurants-per-capita/

[5] https://www.bizjournals.com/birmingham/news/2018/07/02/alabama-ranks-low-for-best-places-to-start-a.html

[6] https://www.bizjournals.com/birmingham/news/2018/04/26/alabama-ranks-near-bottom-for-childrens-health.html

[7] https://www.al.com/business/index.ssf/2018/03/alabama_ranks_49th_among_state.html

In 2018, Alabamians will elect a governor and five other statewide executive branch officers, 140 legislators, and scores of local officials. Those elected will lead Alabama for the next four years. These leaders should be responsive to the concerns of those they represent but also willing to help citizens understand critical, but perhaps less obvious, public policy issues. Such leadership requires understanding what issues most concern voters and what issues voters may not fully appreciate.

In this election year, PARCA surveyed Alabama voters to determine their thoughts about the general direction of the state and the issues that most concern them. We found broad agreement on the critical issues facing the state. Based on voter response, PARCA identified and ranked voters’ top 10 critical issues. Alabama Priorities explores this issue.

The Priorities

Alabama voters are eager to see improvement in K – 12 education, with 70% indicating they are very concerned about the state’s education system. Voters are worried about healthcare , particularly access and cost. With the recent resignations of a Governor, a Speaker of the House, and a state Supreme Court Justice, it should come as no surprise that voters are concerned about corruption and ethics. For many voters, mental health and substance abuse are not just theoretical problems—56% of Alabamians indicate they are very concerned about the issue. The poor and homeless have not been forgotten.

These issues, along with jobs and the economy, crime and public safety, job training and work force development, the state’s image, and tax reform comprise the top 10 list of Alabama’s priorities.

Perhaps this list should not come as a surprise. Previous polling by PARCA and other organizations have found similar results.

What is perhaps more surprising, however, is the extent to which these are shared priorities. We found few significant differences between Republicans and Democrats, liberals and conservatives, blacks and whites, or other groups. While differences exist, Alabama voters are not polarized.

Alabama Priorities

Experts and Voters: Differing Priorities

At the same time, while the data suggests broad agreement among voters, there is an area where significant gaps exist. PARCA surveyed business, civic, and nonprofit leaders, journalists, and academics. The differences between the priorities of these experts and voters were noticeable.

Four top 10 issues for voters fell outside the top 10 for experts:

• Mental health and substance abuse
• Poverty and homelessness
• Job training and workforce development
• Improving the state’s image

Conversely, experts identified four issues that did not register high on voters’ list of concerns:

• Infrastructure and transportation
• Prison and sentencing reform
• Funding state government
• Civil rights

Possible explanations as to why some issues are more important to voters and others more important to experts are offered in the “Differences Between Experts and Voters” section of the report. three implications are suggested.

Implications

The data suggest four implications.

1. Voters are not polarized along traditional political, ideological, racial or generational lines.
2. There is a significant gap between the priorities of experts and the priorities of voters.
3. Policymakers have a two-fold opportunity to inform and educate voters on critical and systemic challenges facing the state.
4. Policymakers have an opportunity to respond to immediate, often highly personal issues that concern voters.

This research suggests that elected officials and candidates have an opportunity to show leadership and to build broad coalitions to address Alabama’s most pressing challenges.

Read the full report here.

As a follow-up to PARCA’s previous post on estimated changes to Alabama’s population in comparison to other states, we now present recent U.S. Census estimates of population change in Alabama counties and metro areas.

As a state, Alabama’s population has increased 2 percent since 2010, a faster rate of growth than Mississippi, but slower than other Southeastern states. A closer look, examining population change at the county level, reveals a wide disparity between the population growth rates within the state, with 45 of Alabama’s 67 counties experiencing population loss between 2010 and 2017, according to the Census estimates.

Rural counties in Central Alabama, particularly in Alabama’s Black Belt have experienced the greatest losses in percentage terms. The steepest loss was Macon County, which has experienced a 12.6 percent population decline since 2010, according to the estimates. Dallas County has lost the greatest number of residents over the time period, with the estimated population dropping by 4,605.

Meanwhile, in percentage terms, the strongest growth over the course of the decade is occurring in coastal Baldwin County and in Lee County, home to Auburn University.

The Huntsville area counties of Madison and Limestone counties are continuing to grow at a rapid pace, as are the suburban counties around Birmingham. Tuscaloosa County also continues to grow. Suburban counties around Montgomery are growing but at a slightly slower pace. Houston and Coffee counties, in the Wiregrass region, are also seeing moderate growth.

As for the state’s largest counties, Jefferson County and Mobile counties are seeing minimal growth while Montgomery County is losing population, according to the estimates.
Looking at the estimates for the most recent year, 2016-2017, there appears to have been positive population growth in most of the counties bordering Georgia.

Examining the components of change, the central counties of the three largest metro areas, Jefferson, Montgomery, and Mobile, are losing large numbers of residents through domestic migration. Residents of the central counties moving to suburban counties or elsewhere in the U.S.

That population loss in the central counties is offset by the natural increase in those counties and by international in-migration. Tuscaloosa, Lee, and Madison counties are also seeing population gains through international in-migration. Much of the rest of the state, particularly rural counties, have received little in terms of international in-migration.

In 40 out of the 67 Alabama counties, the number of deaths outnumbers the number of births, leading to a negative rate of natural increase. Counties where deaths outnumber births tend to have an aging population and low levels of population in-flow. Poorer health in those counties may also contribute to higher rates of death.

When looking at population change at the metropolitan level, the Birmingham-Hoover metro area is seeing modest growth. Mobile County, which is its own metro area, has grown only slightly since 2010, but neighboring Baldwin County, a separate MSA officially called the Daphne-Fairhope-Foley MSA, is the Alabama’s fastest growing in percentage terms (16.7 percent growth since 2010) and is second to the Huntsville MSA in numeric growth over the period.

Looking at the bigger picture, the visualization below allows you to compare rates of population change across all the metropolitan statistical areas in the U.S. It is worth noting that despite, Alabama’s slow growth overall, the Auburn-Opelika and Daphne-Fairhope-Foley MSA rank in the top 20 of the U.S. in terms of percentage growth. With the exception of Huntsville, which ranks 75th in terms of percentage growth since 2010, Alabama’s major metros, Birmingham, Mobile, and Montgomery, are growing more slowly than major MSAs in Florida, Georgia, and the Carolinas.

Alabama’s pace of population growth increased in 2017, but the state remains slow-growing compared to most of its Southeastern neighbors, according to the latest estimates from the U.S. Census Bureau.

Two factors holding down growth: Alabama has the nation’s second-highest death rate and one of the lowest rates of immigration from other countries.

Domestic in-migration

For the first time in several years, Alabama had a positive rate of domestic in-migration — more people moving to the state than leavingvfor other states, according to PARCA’s analysis of the recently released data.

For most of the past decade, more U.S. residents have left Alabama than moved into the state. While the new Census estimates show Alabama with a net positive in domestic migration, most other Southeastern states have much higher rates of domestic in-migration. That’s been true since 2010.

A case in point is South Carolina. In 2010, Alabama’s population was greater than South Carolina’s: 4,785,579 vs. 4,635,834. But since 2010 South Carolina has added almost 400,000 new residents with the strongest source of growth being through domestic in-migration. Alabama has added fewer than 100,000 residents over the same period. According to the estimates, South Carolina’s population now exceeds Alabama’s, with 5,024,369 residents to Alabama’s 4,874,747.

After the next Census, due to its relatively sluggish population growth, Alabama is expected to lose a seat in the U.S. House of Representatives. North Carolina is expected to gain a seat and Florida is expected to gain two.

A high death rate

Though Alabama may be beginning to attract residents from other states, our state residents are dying faster and earlier than residents of other states.

Alabama has the country’s second highest death rate in 2017, according to Census estimates (only West Virginia’s is higher). Over 52,000 Alabamians died in 2012, yielding a death rate of 10.8 per 1,000 population. That’s twice the rate of death rate of the leading state, Idaho, which has a death rate of 5.4. And 2017 is not an anomaly: Alabama has been No. 2 every year of this decade, except for 2012 when our death rate ranked No. 3.

Alabama’s high death rate isn’t just noted in Census estimates. The Centers for Disease Control consistently ranks Alabama’s death rate from a variety of leading causes of death in the country’s top 10.

In 2016, Alabama had the fourth highest death rate from heart disease, the nation’s leading cause of death. Alabama also had the country’s highest death rate from stroke, ranked No. 7 from deaths from cancer and Chronic Lower Respiratory Diseases.

In 2016 Alabama had the country’s highest infant mortality rate and the second highest rate of deaths from firearms.

The more than 58,000 births in Alabama, a rate of 12 per 1,000, more than offset the number of deaths, resulting in a net positive natural increase in the population of approximately 6,000. Alabama’s birth rate ranked 30th among the US states, slightly below the U.S. average of 12.16.

International immigration

A final factor in population change is international migration and relatively few migrants from other countries are moving to Alabama. In 2017, Alabama ranked No. 46 among U.S. states in its rate of international in-migration. Five states attracted less than 1 foreign immigrant for every 1,000 residents: Alabama, Mississippi, West Virginia, Montana and Wyoming.

Overall picture

Most states added population in 2017, according to the estimates. Only, Illinois, West Virginia, Wyoming, Louisiana, Alaska, Mississippi, and Hawaii lost population.

Alabama had a net addition of 14,202 residents from July 1, 2016 to July 1, 2017, a 0.3 percent increase in the state’s population. Alabama’s percentage population increase ranked 33rd.

Since 2010, Alabama’s population has increased by 94,612, or 2 percent, ranking 38th among the states in percentage population growth during that period.

Any attempt to address the perennial shortfalls faced by the state’s General Fund account has to start with attention to Medicaid, the program that pays for the healthcare and long-term care of the poor and disabled.

Total spending on Medicaid in Alabama is budgeted to reach $6.1 billion in 2015, with about 30 percent of funding coming from state sources and 70 percent from the federal government.

Medicaid’s draw on the state’s General Fund account has nearly quadrupled over the past 20 years, rising to $685 million for 2015. That’s 37 percent of the $1.8 billion Fund, the largest General Fund expenditure. Back in 1995, Medicaid accounted for just 16 percent of the General Fund, around $140 million. Medicaid costs have risen because of rising medical costs and a rise in the number of people covered (due to population growth, changing demographics and expansions in coverage). In 1995, around 600,000 people were covered by Medicaid; today more than 1 million Alabamians qualify.

The steep rise in the cost of Medicaid has been one of the central problems in balancing the General Fund budget, which in 2016 is expected to face a $200 million gap between expenditures and anticipated revenues.

In October 2012, recognizing that health costs were rising at an unsustainable rate, the Governor convened a Medicaid Advisory Commission and charged it with finding a way to curb the Medicaid Agency’s growth trajectory while also improving the quality and types of care provided to Medicaid beneficiaries.

Growing out of the Commission’s work is a strategy to move most Medicaid beneficiaries from the existing fee-for-service system, under which providers bill Medicaid for services rendered, into a delivery system in which Regional Care Organizations (RCOs) will coordinate medical benefits and be paid on a capitated, per-enrollee basis, bearing the risk of managing costs within the established caps.

To accomplish this, the state has been divided into five regions. Within each region, RCOs will be established. RCOs will consist of a coalition of hospitals, doctors, other care providers and community representatives. These RCOs will receive a capped amount of money based on the number of enrollees they are assigned to serve. With that money, the RCOs will pay for the care of their enrollees. Through a variety of mechanisms, the RCOs will attempt to encourage better health outcomes and more cost-effective medical practices, thus, decreasing medical expenses. It is hoped that this new approach, by replacing the traditional fee-for-service model, will contain and make more predictable for the state the cost of Medicaid for the portion of the Medicaid population covered by the changes.

By capping Medicaid spending to a set level of expenditure per enrollee, the agency estimates the new delivery system will reduce future increases in state funding by between $40 million and $85 million per year compared to the current fee-for-service arrangements. Considering state and federal spending together, estimates are that the approach could save between $750 million and $1.08 billion over five years compared to expected expenditures under fee-for-service. The new system is expected to be operating by 2016.

Overview of the Medicaid Program

Alabama’s Medicaid Program pays medical providers (doctors, hospitals, nursing homes, pharmacies, etc.) for the care of the poor and disabled. The program is a key component of Alabama’s health care sector. As of July 2014, the total number of individuals eligible for Medicaid was 1,041,588, or about 23 percent of the state’s population. Medicaid provides health care services to 43 percent of Alabama’s children and accounts for more than half of the births in the State.

In addition to state general fund sources, Medicaid is funded by an assortment of taxes on providers, intergovernmental transfers, certified expenditures that meet requirements for matching Medicaid dollars, and miscellaneous other revenues.

Medicaid enrollees are the unduplicated number of individuals who qualified for full or partial Medicaid coverage in each month of the fiscal year. Annual average is the arithmetic average of the twelve months. Average cost per enrollee is calculated by dividing total local, state, and federal expenditures by the number of enrollees.

Changing Medicaid from a fee-based to a managed care approach

The Governor’s Medicaid Commission brought together representatives from state agencies, State Senators and Representatives, insurance companies, consumer advocates, medical providers, and professional organizations representing hospitals, physicians, pharmacies, nurses, primary and rural health clinics, hospices, and nursing homes.

Based on the Commission’s recommendations, the Alabama Legislature passed legislation in May 2013, outlining a reform plan for Alabama Medicaid. In April 2014, the Alabama Legislature amended the RCO legislation to make some changes to the structure and operation of the RCOs. In May of 1014, the Medicaid Agency applied for a waiver from the federal Medicaid Agency seeking permission to implement the new delivery system. The federal Centers for Medicare & Medicaid Services has acknowledged receipt of the state’s application and is considering it.

Under the reforms, Medicaid reimbursement for the services included in the waiver will no longer be based on recipients’ use of medical services; instead, the health care of recipients will be paid for, coordinated and managed by Regional Care Organizations. The RCOs will be financed through a capitated model in which the RCOs receive a set payment from Medicaid based on the number of enrollees the RCO covers. The RCOs will operate within five regions that reflect existing medical referral patterns and care provider systems.

Click on the map to Explore additional information on caseloads and statistics.

Under the current system, the state reimburses providers on the basis of utilization and volume, rather than value and quality. The state’s only tools for constraining costs have been to limit who is eligible, what it pays providers for services, and what services beneficiaries receive. Many of these decisions are constrained by federal law and rules.

The new system creates a limit to Medicaid expenditures for each region. As of October 2014, 12 organizations have applied to be certified as RCOs.

About two-thirds of Alabama’s Medicaid population will initially be covered by the RCOs. Included populations include Medicaid enrollees who are aged, blind and disabled, those in the breast and cervical cancer treatment program, those covered by Medicaid for Low Income Families, and those covered under SOBRA, the Medicaid program for children and pregnant women.

Not covered by the RCOs at this point are nursing home and institutional care recipients, foster children, recipients qualified for both Medicare and Medicaid, hospice patients, the mentally retarded, recipients of family planning services, and children in the custody of the Department of Youth Services. Dental services will also fall outside the RCO system and will continue to be provided on a fee for service basis.

The RCOs are designed to replicate the successes achieved by four existing primary care networks (PCN) established by the Alabama Medicaid Agency that are currently providing a level of managed care in 21 counties. The PCN model includes the assignment of each Medicaid beneficiary to a medical or health home. According to the Agency, that program has shown reductions in emergency department utilization, hospital admissions, and total cost, as well as increases in medical compliance and delivery system efficiency.

Generically, the RCOs are known as “accountable care organizations.” A recent article in Governing Magazine describes how these organizations operate: “At a basic level, an ACO gives doctors, hospitals, and clinics the responsibility to provide care for a group of patients within a specified budget. If health-care providers better coordinate care to provide good quality for less money, they can share in the savings.”

The new approach provides a financial incentive to keep clients healthy. By providing consistent and coordinated care for Medicaid beneficiaries, many of whom have chronic conditions like asthma or mental illness, RCOs have the potential to increase health outcomes and reduce unnecessary emergency room visits and hospitalizations.

Currently, some, but not all of Medicaid’s most costly care recipients, will be covered under the new system. The aged, blind, and disabled make up 31 percent of the Medicaid population, but account for 66 percent of program spending. About 17 percent of those covered under the new RCO system would fall into this most expensive category. Those in nursing home care won’t be part of the current reform effort. The Medicaid Agency is exploring further reforms that would reach the rest of its beneficiaries.

According to the Medicaid Agency’s waiver application, “the anticipated growth of the aged, blind, and disabled population in the current system threatens the State’s ability to maintain even a modest benefit package and eligibility criteria for Medicaid beneficiaries, and highlights the necessity for Medicaid reform in Alabama.”

Approaches similar to the one Alabama is trying have shown promise elsewhere. The New York Times recently reported on the reduction of costs in the Rio Grande Valley in Texas. Based on an analysis of patient data, providers in the Rio Grande Valley Accountable Care Organization (ACO) in McAllen, Texas offered quick follow-ups from hospital visits, provided cell phones for patients who had trouble communicating with their doctors, and visited patients at home who could not get to offices. By focusing on high-risk patients, and shifting to preventative care for many others, the ACO was able to reduce costs and improve a variety of health indicators, such as the number of patients in control of diabetes and those receiving vaccinations.

Alabama hopes to have similar success in improving care and decreasing costs.

Critical Dates for Implementing Medicaid Reforms in Alabama as Required by Law:

• October 1, 2013 Medicaid establishes RCO regions (Complete)
• October 1, 2014 Governing boards for each region approved (Awaiting Announcement)
• April 1, 2015 RCOs must prove their ability to establish an adequate network
• October 1, 2015 RCOs must meet solvency requirements
• October 1, 2016 RCOs must demonstrate ability to provide services under a risk contract (RCOs start bearing risk) no later than this date

Impact Alabama, a statewide service organization that harnesses the energy of college students, deployed more than 570 IRS-certified students and volunteersduring this spring’s tax season to provide free tax preparation assistance to 8,200 families.

The returns they filed brought home $14.9 million in refunds. They also saved families over $2.5 million they would otherwise have spent on commercial tax preparation services. Impact Alabama was founded by PARCA Roundtable alumnus Stephen Black, who now serves as the director of the University of Alabama’s Center for Ethics and Social Responsibility. Impact’s executive director, Sarah Louise Smith, is the immediate past chairman of the Roundtable.

IMPACT’s tax preparation initiative, SaveFirst, targets those who qualify for the Earned Income Tax Credit, the federal government’s largest anti-poverty program supporting low- to moderate-income working individuals and families. Students from sixteen college campuses participated in SaveFirst in 2014. The number of families served increased by 31 percent.

The effort, which helps families avoid the sometimes predatory fees charged by tax preparation companies that set up shop in low-income communities, drew attention from several national news outlets.  The New York Times, National Public Radio, MSNBC and NBC all produced feature stories on the initiative and issues surrounding tax preparation.

Alabama children face steeper obstacles to opportunity than children in the rest of the nation, and that is particularly the case for black and Hispanic children, according to Race for Results, a new report from the Annie E. Casey Foundation.

Race for Results focuses on 12 conditions that either create advantage or disadvantage for children on the journey to success and prosperity. Those include the percent of children born at normal birthweight, the percent of children in two parent homes, the education and economic conditions of the surrounding neighborhood, and academic and employment levels at various stages in life.

On virtually all the indicators, Alabama children face an uphill climb compared to children in the country at large. That is particularly true of minority children in Alabama.

Race for Results is a new publication for the Annie E. Casey Foundation, the child advocacy organization that publishes the Kids Count Databook and also maintains an online data center that tracks a host of statistics on child well-being. In Alabama, VOICES for Alabama’s Children is Casey’s partner in the collection and distribution of information.

Economic and educational disparities between blacks, whites, and Hispanics are a stubborn public policy challenge. The online version of the Race for Results report allows you to explore the data and build your own charts and graphs. Here is a PDF document that contains results on the indicators comparing Alabama to the U.S. Those charts can also be viewed online at the link below. Click on the bottom right hand corner of the chart below for a full screen version.