The American Rescue Plan Act of 2021 will reduce poverty while expanding health care, housing and nutrition protections across Alabama, according to analyses by Alabama Arise and other research organizations. President Joe Biden signed the new federal COVID-19 relief package into law Thursday.
The law will slash poverty by expanding tax credits to struggling households and boosting unemployment insurance (UI) benefits. It also will provide Alabama $2.3 billion of federal assistance to help avoid cuts to education and other vital services. Local governments in Alabama will receive another $1.7 billion in federal funding.
Some of the relief package’s most transformative investments will come in health care. The law will increase the affordability of health coverage through the marketplace created under the Affordable Care Act (ACA). And it will create new federal incentives that would more than offset the state’s cost to expand Medicaid, providing health coverage to hundreds of thousands of Alabama adults with low incomes.
“The American Rescue Plan Act throws Alabama’s struggling families a much needed lifeline,” Alabama Arise executive director Robyn Hyden said. “And it offers budgetary breathing room for policymakers to tackle chronic problems, address longstanding racial and gender inequities and build an economy that works for every Alabamian. Medicaid expansion should be at the very top of our legislators’ to-do list.”
A new pathway to Medicaid expansion in Alabama
The relief package could bring overdue peace of mind to some 300,000 Alabamians living in the health coverage gap. They earn too much to qualify for Medicaid under the state’s stringent income limit but too little to qualify for subsidized ACA marketplace plans.
Nearly seven in 10 Alabamians support expanding Medicaid to cover these adults, a statewide poll found last month. If Gov. Kay Ivey agrees to expansion, the law would give the state a 5-percentage-point increase in federal funding for its traditional Medicaid coverage for two years.
That would bring Alabama an additional $940 million over two years, the Center on Budget and Policy Priorities (CBPP) estimates. And it would remove any remaining financial barrier to Medicaid expansion, said Jane Adams, the Cover Alabama campaign director for Alabama Arise.
“This law is a much-needed step toward closing the health coverage gap in Alabama. We have no time to waste,” Adams said. “Tens of thousands of people have died in the South ‒ my home ‒ because they couldn’t afford to get the health care they needed.
“Medicaid expansion is the single biggest step Alabama can take to weather and recover from the COVID-19 pandemic and move our state forward. Congress did their job. Now it is time for Governor Ivey and our state lawmakers to do theirs and immediately expand Medicaid in Alabama.”
Enhancements to existing Medicaid, marketplace coverage
The relief package also makes multiple coverage improvements for tens of millions of Americans with Medicaid or ACA marketplace plans. Among other changes, the law:
Protects against tax liability on premium assistance because of income fluctuation.
Increases funding for COVID-19 testing and vaccine distribution.
Gives Alabama the option to increase the income limit and coverage period for postpartum Medicaid coverage.
Increases federal funding for home- and community-based Medicaid long-term care services.
Increases federal funding for substance abuse prevention and treatment and a broad spectrum of mental health services.
Child Tax Credit, EITC expansions will reduce poverty across Alabama
Poverty rates will fall nationwide thanks to tax credits and stimulus payments in the American Rescue Plan Act, studies predict. One of the greatest gains will result from a Child Tax Credit (CTC) expansion that could cut the U.S. child poverty rate in half, a Columbia University analysis found.
The relief package makes the full CTC available to children living in families with low or no earnings. It increases the credit’s maximum amount to $3,000 per child and $3,600 for children under age 6. And it extends the credit to 17-year-olds. This CTC expansion will help four in five Alabama children (or nearly 1.1 million), as well as nearly 1 million adults, the Institute on Taxation and Economic Policy (ITEP) estimates.
Direct payments and expanded tax credits will help Alabamians make ends meet as well. Among other changes, the law:
Provides a one-time payment of $1,400 per person for individuals making up to $75,000 and couples making up to $150,000. Individuals with incomes up to $80,000 and couples with incomes up to $160,000 are eligible for partial payments. These stimulus payments will benefit 91% of adults (3.1 million) and 92% of children in Alabama, ITEP estimates.
Raises the maximum Earned Income Tax Credit (EITC) for working adults without children from roughly $530 to roughly $1,500. The law also increases the income limit for these adults to qualify from about $16,000 to at least $21,000.
Expands the age range of EITC-eligible workers without children. Younger adults aged 19-24 who are not full-time students can qualify now, as can people 65 and over.
Helps more than 280,000 Alabamians with the EITC improvements mentioned above, CBPP estimates. The vast majority of the Alabamians who will benefit (205,200) have annual incomes below $20,400, according to ITEP.
Boosts to SNAP, unemployment, housing assistance to help Alabamians make ends meet
The American Rescue Plan Act includes additional provisions to keep more households fed and housed. Most urgently, it extends until Sept. 6 the supplemental $300 federal UI benefits that were set to expire this weekend. This extension more than doubles Alabama’s maximum total weekly benefit to $575, or roughly 60% of median household income.
The law also provides $37 billion nationwide in rental and mortgage assistance to help prevent evictions and foreclosures. For Alabama, this would mean an increase of more than 1,400% from 2020 Emergency Solutions Grant funding if states receive funding proportionate to their populations.
In addition, the package continues a 15% boost to food assistance under the Supplemental Nutrition Assistance Program (SNAP) through September. This increase will help nearly 800,000 Alabamians and bring $64 million in additional SNAP benefits into Alabama, CBPP finds.
The plan takes many other steps to alleviate hardship. Among other changes, the law:
Allows states to continue Pandemic EBT (P-EBT) benefits through early September. P-EBT replaces the value of meals that children miss when schools are closed.
Increases the monthly allocation for fruits and vegetables in the Women, Infants and Children (WIC) program from $9 to $35 for four months.
Makes the first $10,200 of UI benefits non-taxable for households with incomes below $150,000.
Excludes discharged student loan amounts from taxable income calculation through 2026.
“Everyone should know the security of having food on the table and a roof overhead,” Hyden said. “The American Rescue Plan Act will help ease Alabamians’ suffering during the COVID-19 pandemic. And it will lay a foundation to build a stronger, more inclusive Alabama in its aftermath.”
Alabama should rebuild from the COVID-19 recession by lifting policy barriers to economic opportunity and charting a path toward a more equitable and inclusive future, according to The State of Working Alabama 2021, a new report that Alabama Arise released Monday.
Medicaid expansion and a state law guaranteeing paid sick leave both would help strengthen Alabama’s workforce, the report says. Other policy recommendations include higher funding for nutrition and housing assistance and improvements to the state’s unemployment insurance (UI) system.
The Alabama Legislature moved quickly to pass “pro-business” bills in the opening days of the 2021 regular session. These measures included a new law providing a broad range of civil immunity against claims related to coronavirus exposure. As lawmakers return to Montgomery after a weeklong break, their policymaking focus should shift toward addressing their constituents’ urgent needs during and beyond the COVID-19 pandemic, Alabama Arise executive director Robyn Hyden said.
“Legislators spent the first two weeks of this session protecting the interests of corporations,” Hyden said. “They should spend the rest of the session protecting the interests of the people of Alabama. And Arise’s State of Working Alabama report provides a blueprint for how to do just that.”
COVID-19’s toll has fallen heavily on women, Black and Hispanic/Latinx Alabamians
Arise’s seven-section report examines economic challenges – both old and new – that Alabamians have faced over the last year. Health coverage, housing, hunger, wages and working conditions for front-line workers are among the topics covered in The State of Working Alabama 2021. The report also highlights how the pandemic has exacerbated preexisting racial, gender and regional disparities in our state.
“When the COVID-19 pandemic hit Alabama in March 2020, it didn’t just cause massive human suffering and economic disruption,” the Arise report says. “It also revealed suffering and disruption that have long existed and that policymakers have long neglected – or even perpetuated.”
Past policy decisions left Alabama inadequately prepared to respond to the pandemic, the report finds. They also created and maintained racial and gender disparities that prevent our state from reaching its full potential. Among the report’s major findings:
Alabama’s “essential workers,” hailed as pandemic heroes, often lack the basic protections of a living wage, health insurance, paid sick leave and family medical leave.
COVID-19 has caused disproportionate unemployment for Black people and women in Alabama. Economically disadvantaged counties in the Black Belt and other parts of Alabama also have lagged behind in unemployment recovery.
Before the pandemic, 62.2% of Alabama’s white workers had health insurance through their jobs. The same was true for only 46.4% of Black workers and just 35.5% of Hispanic/Latinx workers. The pandemic has widened those racial/ethnic disparities in health coverage.
Hunger has been widespread in Alabama’s communities of color during the COVID-19 recession. Early in the pandemic, nearly 21% of Black residents and 19% of Hispanic/Latinx residents said they didn’t have enough food.
Black and Hispanic/Latinx Alabamians are at higher risk of eviction for inability to pay rent. Even basic apartments are out of financial reach for low-wage workers everywhere in Alabama.
Policies to increase equity, expand economic opportunity for working Alabamians
Alabama’s policy legacy has exacerbated the damage that COVID-19 has wreaked on working people across the state, the report finds. The State of Working Alabama 2021 outlines a policy agenda to repair that damage and promote broadly shared prosperity. Among the report’s key recommendations:
Expand Medicaid to ensure more than 300,000 Alabamians with low incomes can afford treatment for COVID-19 and other health problems.
Guarantee permanent paid sick leave for all working Alabamians, so that no one has to choose between earning a paycheck and going to work sick.
Roll back the 2019 cuts to Alabama’s UI benefits and create a modernized claims system capable of handling future crises.
Provide state support for the Alabama Housing Trust Fund and abandon efforts to impose harmful limits on safety net programs.
Expand high-speed, affordable broadband technology, targeting rural and low-income communities and explicitly addressing racial equity in broadband access.
“The economic, racial and gender inequities in Alabama are preventable and reversible,” Alabama Arise policy director Jim Carnes said. “These disparities are the direct result of bad policy choices in the past. By making better choices now and in the future, we can chart a path toward a more equitable economy. The power to build a stronger, more inclusive Alabama is in the hands of our lawmakers – and all of us.”
When the COVID-19 pandemic hit Alabama in March 2020, it didn’t just cause massive human suffering and economic disruption. It also revealed suffering and disruption that have long existed and that policymakers have long neglected – or even perpetuated.
COVID-19 has laid bare deep racial inequities in Alabama’s economy and social system that have left our state unprepared to meet the needs of its people in this disaster. As the workers predominantly on the front lines, women and people of color bore the brunt of the economic meltdown. They also simultaneously have suffered greater exposure to the virus that caused it.
Alabama has a weak safety net for struggling families and an approach to economic growth that all too often leaves workers underprotected and underpaid. This ongoing policy legacy has exacerbated the damage that the virus has wreaked on the state’s working people.
In The State of Working Alabama 2021, Alabama Arise explores COVID-19’s significant and negative impacts on the state’s workforce. We also look ahead to outline a state and federal policy agenda for repairing the damage – not by repeating the policy mistakes of the past, but by charting a new path toward a more equitable economy marked by broadly shared prosperity.
Report navigation
You can read all seven sections of the report by clicking on the corresponding section’s icon at the bottom of this page. The executive summary of each section and of some of the report’s key policy recommendations is below, as are the report acknowledgments.
You can click any image in this report to enlarge it. To download a printable version of the executive summary, click here. To read our news release on the report, click here.
COVID-19 and Alabama’s policy legacy
COVID-19 struck Alabama’s families and communities hard, and the toll has been especially high for Alabamians of color. The virus and the shutdown exacerbated massive underlying disparities in health care, economic security and access to essential resources that policymakers have long ignored. And they revealed how our neglect of the common good – through low wages for average working people, low taxes for rich people and racially discriminatory policies for our entire state – has left many Alabamians unable to weather a crisis and hindered the entire state’s ability to rebound.
The “essential workers” hailed as pandemic heroes often lack the basic protections of a living wage, health insurance, paid sick leave and family medical leave.
Alabama’s fundamental state policies have been unequal by design, including its explicitly racist 1901 constitution. Right-to-work laws, preemption and other measures have blocked efforts to protect and support working families.
Working Alabamians without health coverage are at even greater risk during the pandemic due to extension of broad liability protection to corporations and other entities for damages related to COVID-19.
Labor market
The COVID-19 recession hit vulnerable Alabama workers hard and fast, disproportionately affecting women and workers of color.
Alabamians working in already low-wage industries suffered immediate and severe job losses, which fell hardest on women and people of color. By December 2020 – nine months into the pandemic – Alabama still had a net loss of 35,400 jobs, a 1.7% decline from pre-pandemic levels. The hardest hit industry was leisure and hospitality, including entertainment and food service establishments where workers were already struggling.
Unemployment insurance (UI), designed for just such a moment, was inadequate and insufficient to meet working people’s needs because of Alabama’s policy choices. In 2019, the state cut compensable weeks of UI and tied benefit extensions to longer-term statewide unemployment rates. This framework is wholly unsuited to catastrophe response.
COVID-19 has caused disproportionate unemployment for Black people and women. Economically disadvantaged counties in the Black Belt and other parts of Alabama also have lagged behind in unemployment recovery.
Alabama’s lack of investment in updated claim processing systems has caused harmful lags in paying out UI claims. The state’s failure to modernize claim processing damages the well-being of people who drive the economy. Modernization would be quick, efficient and helpful to Alabamians.
Alabama’s failure to invest in rural broadband made it even more difficult for people in large swaths of the state to work or attend school remotely. This “digital divide” is depriving many Alabamians of opportunities to learn and earn.
Recommendations
Establish a state minimum wage significantly higher than the current federal minimum wage. The pandemic recession’s impacts have fallen hardest on people who were already struggling to make ends meet.
Roll back the harmful 2019 cuts to UI benefits. Those changes reflected a shortsighted approach to UI and demonstrated counterproductive hostility to working people who have lost their jobs.
Invest in support structures to allow communities that are at an economic disadvantage to participate fully in the workforce.
Create a reliable, modernized claims system capable of handling a crisis with claims significantly exceeding peak UI claims resulting from the pandemic.
Expandhigh-speed, affordable broadband technology, targeting rural and low-income communities and explicitly addressing racial equity in broadband access.
Front-line workers
Since the beginning of the COVID-19 pandemic, Alabamians have come to recognize a new category of “heroes.” Front-line workers in grocery stores, hospitals, pharmacies and other settings perform necessary tasks to keep our communities functioning during the public health emergency.
Front-line workers, who face greater exposure to COVID-19 than the general population, are disproportionately women and people of color. Because of barriers to health care, Black and Hispanic/Latinx workers also are more likely to have underlying conditions that worsen COVID-19 outcomes. State and national policy failures on the pandemic response, especially inadequate supplies of personal protective equipment (PPE), are more likely to hit front-line workers the hardest.
Thousands of working Alabamians were left out of paid sick days protections. Between half and three-quarters of all Alabamians were left out of the paid sick days protections in the federal Families First Coronavirus Response Act. This omission places entire workplaces at risk of exposure to the virus.
Recommendations
Implement hazard pay for front-line workers during the pandemic.
Guarantee permanent paid sick leave for all working Alabamians, regardless of employer size, so that no one has to choose between earning a paycheck and going to work sick.
Expand Medicaid so front-line workers have affordable, timely access to treatment for health risks that worsen COVID-19 outcomes.
Health care
While the COVID-19 pandemic has slammed all segments of our economy and society in one way or another, health care is where most of these effects converge.
Alabama had the 11th highest COVID-19 death rate among states in mid-February 2021. That means a higher share of Alabamians have died from the virus than in most other parts of the country. By mid-February, Alabama’s COVID-19 deaths in less than a year had surpassed 9,200, far more than the number of Alabamians who died in World War II and all subsequent wars (8,215).
COVID-19 has exposed a shameful legacy of unequal access to health care. In the early days of the pandemic, Black Alabamians accounted for as many as 55.2% of Alabama’s daily COVID-19 deaths, more than double their 26.8% share of the population.
The pandemic widened racial/ethnic disparities in health coverage. Before the pandemic, 62.2% of Alabama’s white workers had health insurance through their jobs. The same was true for only 46.4% of Black workers and just 35.5% of Hispanic/Latinx workers. Early in the COVID-19 shutdown, Hispanic/Latinx Alabamians reported lack of insurance at nearly three times the rate of white residents.
COVID-19’s disparate impact on communities of color has opened a new conversation about health equity. A smart recovery will take a broader approach to building a healthy workforce by adopting policies that address food security, adequate housing and other social determinants of health.
Recommendations
Expand Medicaid to cover more than 300,000 Alabama adults with low incomes. This health coverage expansion would facilitate COVID-19 testing, treatment and vaccination; allow working people to stay healthier and more productive; and strengthen Alabama’s health care system, especially rural hospitals. The Legislature’s eagerness to provide businesses with immunity against COVID-19 liability claims only makes the need for worker protections like health coverage more urgent.
Make reducing health disparities a state priority. Alabama should adopt a rigorous program of data collection across state agencies to identify disparities in health outcomes related to race/ethnicity, income and geography. This effort should engage research universities and state health agencies in developing and implementing a strategic plan to reduce targeted health disparities and give all Alabamians a chance to thrive.
Hunger
Job and income losses during the pandemic have contributed to widespread hunger in Alabama.
Too many people struggled to keep food on the table during the COVID-19 pandemic. During the spring/early summer stage of the pandemic (April through July 2020), 12% of all Alabama families and 13% of Alabama families with children either sometimes or often didn’t have enough food to eat.
Hunger was much more widespread in communities of color. Nearly 21% of Black residents and 19% of Hispanic/Latinx residents said they didn’t have enough food.
Proven safety net programs played a critical role in alleviating hunger. Food assistance through the Supplemental Nutrition Assistance Program (SNAP) was key to helping hundreds of thousands of Alabamians keep food on the table during this recession. And emergency food and child nutrition services eased hardship among Alabama’s children as schools closed or went virtual.
Recommendations
Alabama lawmakers should abandon efforts to slash the state’s safety net. Past proposals to restrict SNAP and other safety net programs would have made the recent hunger and hardship in Alabama even more dire.
Congress should move quickly to institutionalize recently increased UI, child nutrition and SNAP assistance. Hunger has grown during the pandemic, reaching crisis proportions. Boosts to UI, child nutrition and SNAP benefits have been essential tools to help struggling Alabamians meet their basic needs.
Congress should provide additional cash assistance, similar to the earlier relief payments, targeted specifically to families with low incomes. Targeted relief should include a fully refundable Child Tax Credit and an expanded Earned Income Tax Credit (EITC). Relief payments were a significant source of cash for food and other basic needs during early stages of the recession. And federal assistance will remain important as struggling Alabamians rebuild in the aftermath of the COVID-19 recession.
Housing
Thousands of Alabamians face potential eviction and homelessness because of inadequate response to the COVID-19 pandemic and its associated recession.
Alabamians can’t afford adequate housing. Many Alabamians in the workforce face housing insecurity because low wages burden renters heavily. Even basic apartments are out of reach for low-wage workers everywhere in the state.
COVID-19 has caused increased housing insecurity. Alabamians face high risk of eviction during the COVID-19 pandemic, largely because of insufficient state-level protections.
Housing insecurity is significantly racially disparate. Black and Hispanic/Latinx Alabamians face far higher risk of eviction for inability to pay rent. Long-standing inequities in the state’s economic structure have caused Black and Hispanic/Latinx communities to have fewer resources in reserve for weathering hard times.
Recommendations
Fund the Alabama Housing Trust Fund (AHTF). Lawmakers in 2012 created the AHTF as a vehicle to promote safe, affordable homes for people with extremely low incomes. A small increase in the recording fee for mortgages could boost the AHTF and significantly increase housing availability. This would facilitate more construction of affordable homes in the Black Belt and other rural areas.
Renew the state moratorium on evictions. Job losses amid the pandemic recession are causing evictions that otherwise would not have happened. The current limited federal moratorium fails to cover all Alabamians and requires administrative hurdles that leave holes in the system. By restricting evictions during the pandemic to reasons directly related to public safety, the governor could protect thousands of Alabamians from higher risk of COVID-19 transmission and from devastating long-term economic consequences.
Acknowledgments
This Alabama Arise report was made possible by a generous grant from EARN in the South. The findings and conclusions presented in this report are those of Arise and do not necessarily reflect the opinions of EARN in the South.
The report’s authors are Arise policy director Jim Carnes, policy analysts Carol Gundlach and Dev Wakeley, visiting fellow Allan Freyer and intern Resha Swanson. Arise communications director Chris Sanders was the report’s primary editor. Arise communications associate Matt Okarmus designed the charts and graphs and provided online design for the report. Bixler Creative designed the report logo and provided print design for the executive summary. Other report editors and contributors included Arise executive director Robyn Hyden and organizer Mike Nicholson.
Introduction: The high cost of failing to protect the common good (Section 1)Unequal by design: COVID-19 and Alabama’s policy legacy (Section 2)Assessing the damage: COVID-19 and Alabama’s labor market (Section 3)Praised but underprotected: Front-line workers in the pandemic (Section 4)
Why coverage matters: Health care in the time of COVID-19 (Section 5)The ugly reality: Alabama’s hunger problem during the pandemic (Section 6)No place to call home: Housing insecurity amid COVID-19 (Section 7)
When the COVID-19 pandemic hit Alabama in March 2020, it didn’t just cause massive human suffering and economic disruption. It also revealed suffering and disruption that have long existed and that policymakers have long neglected – or even perpetuated.
COVID-19 has laid bare deep racial and gender inequities in Alabama’s economy and social system that have left our state unprepared to meet the needs of its people in this disaster. As the workers predominantly on the front lines, women and people of color bore the brunt of the economic meltdown. They also simultaneously have suffered greater exposure to the virus that caused it.
Alabama has a weak safety net for struggling families and an approach to economic growth that all too often leaves workers underprotected and underpaid. This ongoing policy legacy has exacerbated the damage that the virus has wreaked on the state’s working people.
In The State of Working Alabama 2021, Alabama Arise explores COVID-19’s significant and negative impacts on the state’s workforce. We also look ahead to outline a state and federal policy agenda for repairing the damage – not by repeating the policy mistakes of the past, but by charting a new path toward a more equitable economy marked by broadly shared prosperity.
The lessons of COVID-19
This report makes the case that economic recovery from the COVID-19 recession requires more than restoring the former status quo. All Alabamians are eager to feel connected, productive and at ease again. But for many individuals and families across the state, disruptions and barriers to a decent, sufficient – “normal” – quality of life are nothing new.
A smart plan for restoring and expanding Alabama’s economy will take long-standing inequities explicitly into account to elevate the common good. That plan will require accommodations, supports, policies of inclusion and other interventions to create new opportunities for participation and empowerment. The result will be a post-pandemic Alabama that’s more vibrant, resourceful and equitable than the state we had before.
The spike from record low unemployment to record high in a few weeks in spring 2020 left Alabama families reeling. Many found themselves in desperate situations they never envisioned. Many others, however, have long experienced marginalization and exclusion from the workforce, or have worked for generations at low wages without benefits.
Before COVID-19, Black and Hispanic/Latinx Alabamians had significantly higher rates of poverty than white Alabamians.[1] Communities of color also experienced higher rates of medical debt in collections and defaulted student loan debt.[2] Accumulated debt from COVID-19 likely will increase this already alarming disparity. A smart recovery plan should protect workers against unreasonable debt, eviction, predatory lending and other financial burdens that will slow their ability to return to or gain economic independence.
While the COVID-19 recession has caused unprecedented layoffs, it also has highlighted the critical role of service workers in keeping our communities going. Our state leaders hail these front-line and essential workers as heroes – but often in name only, denying them the respect of decent wages and strong protections.
Shortcomings on paid leave, wages, health coverage
The Families First Coronavirus Response Act of March 2020 required many businesses to offer sick leave with full or partial pay. But this benefit expired Dec. 31, and broad exemptions left thousands of Alabama workers unprotected.
Like our Deep South neighbors, Alabama has resisted implementing mandatory paid sick leave or family medical leave for private-sector workers. Lack of paid sick leave gives underpaid working people in particular a stark choice: Continue to work while sick, or stay home and lose pay – or even lose their jobs.
Efforts to strengthen the minimum wage have begun to gain traction at last in the Deep South. Florida voters in November 2020 approved a gradual minimum wage increase,[3] the first such step in a state neighboring Alabama.
Prior to COVID-19, Alabama’s refusal to extend health coverage to adults with low incomes had already left hundreds of thousands of Alabamians in the coverage gap. Most of them are working people. They also include family caregivers, students, people awaiting disability determinations and others who have no affordable coverage option.[4]
The COVID-19 recession has only widened this coverage gap and the suffering associated with it. People without health insurance often struggle to work while dealing with health problems that sap their productivity, add stress to their households and worsen without timely care.
The changing nature of workplaces
For another range of workers and employers, the recession has transformed assumptions about how workplaces operate and how workers function. It also has raised questions about how work and family life interact and highlighted what employers are capable of doing to accommodate workers’ needs. Many changes are adaptations that people with disabilities, child care responsibilities, inadequate transportation and other challenges have sought for decades.
The surge in telecommuting is both an impressive achievement and a cautionary tale. Remote working and learning have helped many families keep their lives moving forward during the pandemic. But for households lacking high-speed broadband service, working from home doesn’t work, and children’s progress in school has stalled.[5]
Recent federal broadband grants can go a long way toward bridging Alabama’s “digital divide” if administered under strict equity guidelines and community oversight.[6] Technology access aside, many jobs are impossible to perform remotely, and this limitation falls disproportionately on low-wage workers.
Innovative public programs kept families fed
The COVID-19 pandemic and its accompanying recession have highlighted the critical role of the safety net during a crisis. Families who never before had to seek assistance suddenly found themselves unable to afford the basics of life – food, shelter, utilities, health care – and turned to public assistance for the first time.
Enrollment for food assistance under the Supplemental Nutrition Assistance Program (SNAP) rose 12% between February 2020 and October 2020.[7] Federal waivers allowed the Department of Human Resources (DHR) to cut red tape and increase assistance for most SNAP participants. State and county SNAP workers worked nights and weekends to process more than 83,000 new SNAP applications.[8]
DHR and the state Department of Education also partnered to create – in just weeks – an entirely new program, called Pandemic EBT (P-EBT), that replaced school meals lost when schools closed.[9] By the end of the 2019-20 school year, P-EBT had distributed at least $132 million in food assistance to more than 420,000 Alabama children.[10]
Meanwhile, workers in school districts and emergency food closets across the state risked their own health to distribute federally funded school meals and food boxes to hungry families waiting in lines that ran for blocks. Federal Emergency Solutions Grants will help community-based agencies prevent an eviction epidemic if a federal moratorium ends in 2021.[11]
Efforts to cut the safety net are cruel and shortsighted
For the past five years, the Alabama Legislature has attempted to cut and restrict critical safety net programs. Fortunately, those efforts largely have failed because of hard work by advocates and directly affected Alabamians. The one safety net restriction that lawmakers approved – reducing the time workers could receive unemployment insurance (UI) benefits – was effectively reversed briefly when the state Department of Labor implemented federal extended benefits (EB) that were available because Alabama’s reported unemployment rate had exceeded 5.9%. But this reversal of the state’s policy failure was only temporary. The EB program has stopped paying benefits as of Oct. 3, 2020.[12]
Had proponents of safety net cuts been more successful, critical programs like Medicaid, SNAP and Temporary Assistance for Needy Families (TANF) might have not been available to meet Alabamians’ most basic needs today. Our leaders should remember this moment and the importance of the safety net as they prepare for future emergencies.
How we should respond now
Alabama is a torchbearer to the nation for civil and human rights achievements. We boast a world-class medical research center and regional hubs of education, business, manufacturing and finance. Our rich cultural legacy has produced artists of world renown.
But these proud assets stand against a backdrop of low wages, lingering rural and urban poverty, and racial injustice rooted in slavery and violent oppression. These structural failures have created unequal access to basic necessities, education and economic opportunity; wide health disparities; and other violations of the common good.
The COVID-19 crisis has created new challenges for our state and worsened persistent ones. If there is a bright spot to be found, it is in the light the pandemic has shined on these old problems and on new ways we can and must address them. We call on our leaders to envision a new Alabama beyond the pandemic horizon, where all residents can share in the best the state has to offer.
In focus
The Household Pulse Survey: An important new source of data on the pandemic’s impact on Alabamians
Shortly after the pandemic began, the U.S. Census Bureau launched the Household Pulse Survey to get a sense of the rapid changes occurring in people’s lives and livelihoods.[13] A sample of residents from every state answered questions – weekly for several months, then later every two weeks – about how the pandemic was affecting their household finances, health, education and other social and economic activities.
The survey asked people questions like:
Have you or anyone in your household experienced a loss of income since March 13?
In the last seven days, how difficult has it been for your household to pay for usual expenses?
How confident are you that your household will be able to afford the food you need for the next four weeks?
How confident are you that your household will be able to pay your next rent or mortgage payment on time?
We now have more than 20 installments of Alabama responses to this survey, and they are both frightening and telling. These responses inform much of this report. They provide snapshots of the impact of the pandemic and resulting recession on Alabamians’ economic and employment status. They provide crucial information about Alabamians’ ability to pay bills, access health care and participate in education. And they show us how people are making ends meet – or not – during the crisis.
Snapshots of pandemic life in Alabama
The Household Pulse Survey has rolled out in three phases, reflecting stages of the pandemic. The spring/early summer stage ran from late April until late July. The late summer/fall stage ran from mid-August until late October. And the winter stage runs from Oct. 28 until March 2021.
Because the questions have been tweaked and the frequency of the survey has changed between the phases, we can’t compare results in one phase to that in others, so we have to treat each stage as its own snapshot during each season of the pandemic. It’s important to know, too, that not everyone who answered the survey answered every question. Some survey questions have a high “non-response rate,” which could skew our understanding of the results. Household Pulse data included in this report does not include non-responses. While these caveats limit the conclusions we can draw from the data, the survey nonetheless offers valuable real-time reporting on the pandemic’s profound and far-reaching impact on our state.
The State of Working Alabama 2021: Executive summaryUnequal by design: COVID-19 and Alabama’s policy legacy (Section 2)Assessing the damage: COVID-19 and Alabama’s labor market (Section 3)Praised but underprotected: Front-line workers in the pandemic (Section 4)
Why coverage matters: Health care in the time of COVID-19 (Section 5)The ugly reality: Alabama’s hunger problem during the pandemic (Section 6)No place to call home: Housing insecurity amid COVID-19 (Section 7)
The COVID-19 recession hit vulnerable Alabama workers hard and fast. Alabamians working in low-paying industries suffered immediate and severe job losses, which fell hardest on women and people of color. Unemployment insurance (UI), designed for just such a moment, was inadequate and insufficient to the needs of these workers because of Alabama’s policy choices.
By December 2020, after the first nine months of the pandemic, 35,400 fewer Alabamians were employed than in February 2020.[1] That reflects a 1.7% drop in overall employment, which includes people who have dropped out of the labor market. The hardest-hit industry was leisure and hospitality, which lost 19,000 jobs, a 9.1% decline.[2] People working in this industry, which includes restaurants and entertainment establishments, often have fewer educational opportunities and lower incomes. They also are disproportionately women, people of color and younger adults.[3]
Also hard-hit was the education and health industry, which lost 16,600 jobs (a 6.6% decline) and also disproportionately employs women.[4] In Alabama, 81% of health care workers are women, as are 89% of child care and social service workers.[5] Almost instantly as the pandemic struck, Alabama’s official unemployment rate shot up to 13.8%.[6] By December, it had declined to 3.9% – still an increase of 1 percentage point over February 2020.[7]
The precipitous increase in unemployment during the first six months of the COVID-19 recession was nearly five times Alabama’s job loss during the first six months of the Great Recession.[8] Many Alabama workers simply had no cushion to reduce the damage.
Job losses hammered women, people of color
The official unemployment rate masks the true extent of the damage, especially among women and communities of color. The true number of jobless Alabamians is much higher once we also take into account the people temporarily furloughed when their businesses were closed. These are real job and income losses that are not included in the official unemployment rate. By this count, almost two out of every five working-age Alabamians reported they were not working during the spring/early summer stage of the crisis (late April until late July).[9]
In the same period, women and workers of color – especially Black workers – were hit the hardest. Half of women reported they were not working, compared to 43% of men.[10] Nearly 53% of Black respondents reported they were not working, compared to 47% of white people.[11] Hispanic/Latinx respondents reported not working at a rate roughly the same as white respondents.[12]
Joblessness remained elevated above pre-pandemic levels into mid-December, especially for women. While three out of 10 working-age Alabamians reported not working, a full 47% of women were jobless, a number significantly elevated above the 38% of men who were out of work.[13] The large differences in the percentages of men and women working during both the spring/early summer and late summer/fall stages reflect both the concentration of women working in the hardest-hit industries and the impact of child care responsibilities on working women.
Alabama’s claims for UI benefits tell a similar story. More than 967,000 initial unemployment claims were filed between the weeks of March 14, 2020, and Feb. 6, 2021.[14] If each claim were from a single worker, that number would be 45% of all employed people in Alabama as of December 2020.[15]
With the U.S. average duration of unemployment at 22.8 weeks[16] and an Alabama initial claim payout rate of 47%,[17] the state would be on pace to pay more than 9.4 million weeks of benefits on claims arising through the week of Feb. 6, 2021, with the same benefit duration and eligibility structure available under the Coronavirus Aid, Relief and Economic Security (CARES) Act. This is a massive increase over pre-pandemic unemployment.
There were fewer than 2,000 UI claims for the week of March 14, 2020, the claim period immediately before the pandemic began causing widespread business shutdowns. Since then, the average weekly number of UI claims has been 1,105% higher than that amount, as of Feb. 6, 2021.[18]
UI claims underscore the racial inequities driving COVID-19’s unequal impact on employment. Black workers lost their jobs because of the COVID-19 pandemic at a much higher rate than their percentage of the overall workforce. Forty-seven percent of state UI claimants since March are Black, far higher than the 25% Black share of the state’s total workforce.[19]
Gender disparities in UI claims also reflect worsening inequities in the workforce. Women make up 58% of Alabama’s UI claimants since March but only 47% of the workforce overall.[20] Women also face greatly increased exposure to the dangers of COVID-19 because they work the majority of health care jobs.[21]
The pandemic’s high economic toll in rural Alabama
The recovery from catastrophically high unemployment has been inequitable by region. Rural counties in Alabama’s Black Belt in particular have lagged behind the state average in returning to pre-pandemic UI claim levels. The populations of these counties are disproportionately Black, and residents continue to face long-term negative consequences both from centuries of wealth extraction and the state’s failure to invest adequately in community well-being.
Black Belt residents also have been economically harmed by unusually high long-term unemployment.[22] Persistently high unemployment resulting from the pandemic simply compounds the region’s existing unemployment and wage disparities.
How did we get here?
Long-term neglect and recent harmful policy changes to the UI system failed Alabama’s workers when they needed the most support. The COVID-19 pandemic has exposed the state’s failure to maintain and modernize its UI claim infrastructure.[23] Alabama’s UI claim system was unsuited to the unprecedented demand, in part because it operated on outdated technology, as do many other states’ systems. The state’s failure to modernize its computer systems caused long periods of severe financial stress for Alabamians who could afford it the least.
The flawed structure of the state’s UI system is intentional. Alabama’s low-road policy decisions have consistently devalued workers and perpetuated inequality by keeping people insecure about meeting basic needs. The state’s neglect of the claims system is a passive example of undermining worker well-being, but officials also recently have taken active steps that harmed workers.
In 2019, the Legislature and governor enacted a law that lowered the total amount of UI benefits significantly. The law reduced the length of time a worker could claim benefits from 26 weeks to 14, or 19 if a worker could participate in approved job training.[24] It also tied a potential increase of weeks of benefits to reported overall state unemployment rates from the prior quarter.
Besides its harmful impact on workers, the recent UI restriction has two major conceptual flaws. First, the changes fail to account for significant differences in employment opportunities across the state. This increases pressure on people to find work where few or no jobs exist. Second, the lag in reporting the unemployment rate failed to account for the sort of catastrophic economic conditions that COVID-19 delivered. When unemployment rises quickly and sharply, the number of weeks that UI benefits are available does not increase quickly enough to prevent economic pain for unemployed workers.
A UI system that isn’t meeting Alabamians’ needs
Alabama’s UI system has a low payout rate. Though the number of repeated weeks of claims for a single loss of employment has dropped since March 2020, fewer than half of initial claims had been deemed valid and paid out through Nov. 30.[25] This low payout rate shows Alabama is not doing enough to provide UI coverage to people harmed by layoffs.
The state’s failure to pay out claims in a timely manner has compounded the hardship for Alabamians out of work because of COVID-19. And further, the state response has inaccurately assessed the damage that the pandemic has caused to Alabama workers. The state Department of Labor has classified a substantial portion of these UI claims as unrelated to COVID-19.[26] But that characterization is unpersuasive in light of the drastic increase in claims, with the pandemic’s beginning the only major change in workforce conditions.
Lack of broadband access limits opportunities
The COVID-19 shutdown has heightened the impact of Alabama’s “digital divide.” As schools and many workplaces shifted to online activities, workers with lower incomes often found themselves at a double disadvantage. First, their jobs were less likely to be adaptable to remote settings. Second, their households were less likely to have the reliable internet connection and computer equipment required for online learning or work.
Alabama’s lack of broadband internet can limit remote work even for people whose jobs allow it. The Alabama Broadband Accessibility Act defines an “unserved area” as a rural part of the state where internet service falls below the minimum threshold of an average 25 megabits per second for downloading and 3 megabits per second for uploading.[27] And much of Alabama is designated as “unserved” by the state authority that oversees broadband access.[28] Huge swaths of rural Alabama are caught in this gap, including almost all of Greene and Perry counties and much of west Alabama from Fayette and Lamar counties in the north to Choctaw and Clarke counties in the south.[29] Even in relatively urbanized counties like Jefferson, Madison, Montgomery and Shelby, many rural areas lack reliable internet service.[30]
One-time relief payments simply aren’t enough
Relief payments helped individuals and families pay the bills but went away too soon. The quick passage of the CARES Act in late March 2020 provided a lifeline for Alabama families reeling from the shutdown.[31] In the spring/early summer stage, an average of 23% of Alabamians who were not working (including both those who were unemployed and those who are retired) reported relying on the relief payments to help with bills.[32]
In a telling and troubling sign, the percentage of such households declined over the same period.[33] This probably reflects exhaustion of one-time stimulus checks as people used them to meet basic needs. In mid-June, 34% of people who were not working said they used relief funds to pay bills during the past week.[34] This percentage declined to 17% by mid-July.[35]
What should we do now?
Alabama can create a better system for responding to the needs of workers who lose their jobs. Worker-friendly policies create a better, more stable economy for everyone. Alabama can make several changes that would improve conditions for unemployed workers, including strengthening work supports, fixing the UI system and improving implementation of federal COVID-19 relief measures. Specifically:
Alabama must invest in its UI compensation infrastructure, both human and technological, to improve our ability to get these funds out quickly to unemployed people. Specific changes would include institutionalizing the recent temporary move to 26 or more weeks of UI assistance and permanently repealing the 2019 law cutting available weeks of assistance. In addition, the Alabama Department of Labor should issue guidance to allow people at high risk from COVID-19 to retain UI benefits if they quit a job that is taking insufficient virus precautions.
The state should stop conditioning receipt of benefits on participation in job training programs. Workers receiving UI benefits already have demonstrated a desire to work and the ability to maintain long-term employment by meeting the minimum earnings and time requirements for UI eligibility. Creating barriers for people who lose their jobs only serves to punish job seekers and burden an already strained state claims system.
The state should expand the availability of work supports, including training, child care and transportation. To get to work, people first need the ability to get to the workplace. They also need adequate job preparation and reliable care for family members to ensure full participation in the state’s economy.
Expandhigh-speed, affordable broadband technology, targeting rural and low-income communities and explicitly addressing racial equity in broadband access.
Federal relief
Alabama should direct significant federal relief funds to emergency housing and utility assistance. Unemployed Alabama workers are facing hunger, eviction and utility shutoffs in the dead of winter. And Alabamians already pay one of the highest rates for electricity in the South. While federal relief funding is available for emergency housing and utility assistance, the housing assistance is still being processed by the state, and utility assistance ran out in January. CARES Act funding could fill the temporary void in housing assistance and supplement the inadequate federal utility assistance.
Congress should pass a comprehensive new relief package. Significant numbers of unemployed Alabamians relied on relief payments to meet basic needs early in the recession. That need has not disappeared. Congress’ next relief measure should increase targeted relief payments and reinstate the $600 weekly federal UI boost for eligible workers. The package also should expand the Earned Income Tax Credit (EITC) and make the Child Tax Credit fully refundable. And it should extend the December 2020 increase to Supplemental Nutrition Assistance Program (SNAP) benefits.
The State of Working Alabama 2021
The State of Working Alabama 2021: Executive summaryIntroduction: The high cost of failing to protect the common good (Section 1)Unequal by design: COVID-19 and Alabama’s policy legacy (Section 2)Praised but underprotected: Front-line workers in the pandemic (Section 4)
Why coverage matters: Health care in the time of COVID-19 (Section 5)The ugly reality: Alabama’s hunger problem during the pandemic (Section 6)No place to call home: Housing insecurity amid COVID-19 (Section 7)
Footnotes
[1] Economic Policy Institute (EPI) analysis of Local Area Unemployment Statistics data from the Bureau of Labor Statistics (BLS), December 2020.
[2] EPI analysis of BLS Current Employment Statistics, December 2020.
[21] Bureau of Labor Statistics, “Employed persons by detailed industry, sex, race, and Hispanic or Latino ethnicity” (Jan. 22, 2020), https://www.bls.gov/cps/cpsaat18.htm.
[26]See generally Alabama Department of Labor, News, https://labor.alabama.gov/news_feed/News_Page.aspx (linking press releases with individual weekly breakdowns of UI claims caused by COVID-19 and purportedly not caused by COVID-19).
While the COVID-19 pandemic has slammed all segments of Alabama’s economy and society in one way or another, the health care industry is where most of these effects converge. By the end of 2020, more than 350,000 Alabamians had tested positive or were considered likely positive for the virus, 72% of them in the working-age range of 18 to 64.[1] More than 4,500 Alabamians had died of COVID-19 by Christmas.[2]
The pandemic’s toll has continued to mount in 2021. Alabama had the 11th highest COVID-19 death rate among states in mid-February 2021.[3] That means a higher share of Alabamians have died from the virus than in most other parts of the country. By mid-February, Alabama’s COVID-19 deaths in less than a year had surpassed 9,200,[4] far more than the number of Alabamians who died in World War II and all subsequent wars.[5] The average risk of death from the virus remains low, but:
The risk is not distributed evenly across age, racial/ethnic and economic groups.
Complications can be long-lasting and debilitating.
Everyone with a positive diagnosis has a new preexisting condition. This could affect their access to health coverage if Congress seeks to remove Affordable Care Act protections in the future.
Pandemic’s burden heavier on women, Black Alabamians
As COVID-19 swept across the country in spring 2020, the virus’s disproportionate impact on Black Americans quickly became apparent in emergency rooms, ICUs and death data, where that information was available.[6] When the Alabama Department of Public Health (ADPH) began daily COVID-19 data reporting in early April, Black people accounted for 52.1% of confirmed deaths,[7] while comprising only 26.6% of the population. Americans of color are more likely to have chronic health problems than their white counterparts for numerous reasons. These factors include barriers to health care, transportation, adequate nutrition and other basic necessities.
Other sections of this report highlight Alabama’s disproportionate reliance on women and people of color in various jobs that pose high risk of coronavirus exposure. Health care workers are a special case in this regard. For these workers, contact with infected individuals is not just a risk but a job requirement. And the Alabamians meeting this challenge are overwhelmingly women, at 80.6% of the health care workforce.[8] Black people make up 31.2% of Alabama’s health care workers, as compared to their 25% share of the state workforce overall.[9]
As providers of costly health services, doctors’ offices, clinics, hospitals and nursing homes are businesses, too. They can’t operate without keeping their personnel safe, functional and paid, without essential supplies on hand, and without keeping the doors open – challenges for any business during a pandemic. While many retail, manufacturing and hospitality businesses have seen their customer bases shrink dramatically during the shutdown, many health care providers have experienced waves of increased demand. Alabama’s failure to expand Medicaid to cover adults with low incomes has placed economic strain on providers serving these patients.
How did we get here?
The lifeblood of all this activity is the health insurance coverage that, for most Alabamians, pays much of the bill. While 55.9% of Alabama workers had employer-sponsored coverage in 2019, this overall rate masked wide disparity by race and ethnicity.[10] Among white workers, 62.2% had health insurance through their jobs, while the same was true for only 46.4% of Black workers and just 35.5% of Hispanic/Latinx workers in our state.[11]
Prior to COVID-19, almost 300,000 Alabamians with low incomes were caught in the state’s health coverage gap.[12] They earn too much to qualify for Medicaid under the state’s stringent eligibility limits but too little to afford private plans. Working-age Alabama parents are generally ineligible if their income is above 18% of the federal poverty line – just $3,960 a year for a family of three.[13] And virtually all Alabama adults without children are ineligible regardless of income.[14]
COVID-19 deepens coverage disparities by race, income
Working Alabamians make up the majority of those in the coverage gap, along with people who are caring for family members, going to school or awaiting disability determinations.[15] And the racial coverage disparity is stark: Forty-nine percent of uninsured Alabamians with low incomes are people of color, even though people of color make up just one-third of the state’s population.[16]
Job losses during the pandemic have reinforced racial disparities in health coverage. The initial impact during spring and early summer fell particularly hard on working-age Hispanic/Latinx Alabamians, who reported being uninsured at a rate of 30.3%. That was nearly twice the rate for Black people (15.7%) and nearly three times the rate for white people (10.3%).[17] Despite some gains, by late summer and early fall, Hispanic/Latinx Alabamians still reported being uninsured at twice the rate for white people.[18]
An analysis of uninsured rates by income level reveals even more striking disparities. During both the spring/early summer and late summer/fall stages of the pandemic, uninsured rates were highest by far for workers earning below $35,000 a year, and the rates decreased consistently as income increased.[19] In the first stage, Alabamians earning below $35,000 reported an uninsured rate of 27.2%, while those earning $100,000 and above showed a rate of just 3.8%.[20] In the second stage, those rates dropped to 22.9% and 1.8%, respectively.[21] Broadly speaking, the higher the income, the more likely workers are to have either employer-based health insurance or the means to purchase private plans.
Expand Medicaid to save lives, advance racial equity
The most direct solution to these coverage gaps is Medicaid expansion. A 2019 UAB study estimated that expansion would enroll more than 346,000 Alabamians – most of the eligible uninsured, plus some people who are paying for insurance they can’t afford.[22] Alabama’s high uninsured rate for low-wage workers underscores the fact that Medicaid expansion is a pro-worker policy. And given the disproportionate share of people of color in the coverage gap, expanding Medicaid is the biggest step Alabama can take to advance racial equity in our health care system.
It’s been hard to break through with numerous policy solutions to remove Alabama’s barriers to health care. For example, Alabama Medicaid was unwilling to cover most telehealth services for people who lack reliable transportation – until the COVID-19 shutdown made remote services imperative. And though nutritional supports like vouchers for healthy groceries are available through Medicaid in some states, they’re not in Alabama.
Alabama also has refused to remove the 4% state sales tax on groceries,[23] which would make nutritious food more affordable and give all state households the equivalent of two weeks of free groceries every year. And most notably, Alabama has yet to join 38 other states (plus the District of Columbia) in covering working people with low incomes through Medicaid expansion,[24] a policy change that would directly address Alabama’s racial/ethnic health disparities.
As noted elsewhere in this report, many Alabama lawmakers have expressed more interest in protecting businesses from COVID-19 liability claims than in protecting working people from health risks and economic hardship. A balanced approach to corporate immunity would include expanding health coverage and workers’ compensation for the working Alabamians who have enabled companies to stay in business during the pandemic.
What should we do now?
Just as a hurricane or earthquake tests the strength of buildings and provides a template for improving durability, a health crisis like COVID-19 offers clear lessons for strengthening worker health protections and services. The following measures would help Alabama be better prepared for the next pandemic. They also would promote a healthier workforce and an economy in which everyone has an equal opportunity to thrive. Alabama should:
Provide health coverage for adults with low incomes by expanding Medicaid. This single step would facilitate more COVID-19 testing, treatment and vaccination; increase worker health and productivity; and strengthen Alabama’s health care system, especially rural hospitals. Lawmakers’ rush to immunize businesses against pandemic-related claims only makes the need for worker protections like health coverage more urgent.
Expand use of telehealth services by means of universal broadband access and provider incentives.
Identify and address health disparities. Adopt a rigorous data collection program across state agencies to identify health outcome disparities related to race/ethnicity, income and geography. Engage research universities and state health agencies in developing and implementing a strategic plan for reducing targeted health disparities.
Support community health. Develop and implement a strategic plan for linking underserved communities with health care by means of community health workers. Alabama is one of just three states that have not defined a role for community health workers in the state health care system, according to the National Academy for State Health Policy. Our state’s failure to act is depriving underserved communities not only of improved health services and outcomes but also job creation and economic development.
Promote community-based participatory research to increase chronic and infectious disease awareness, preventive behaviors and health equity.
In focus
Powering up for recovery: The vaccine trust factor
If we’re smart, the links between social justice and health that the pandemic is exposing will improve our chances for beating it. All eyes are on vaccine distribution. Immunizing Alabama against COVID-19 is a matter not just of coordinating vaccine delivery and covering costs, but also building trust.
Alabama had mixed success with the adoption of protective equipment and protocols to mitigate COVID-19’s spread during most of 2020. Similar resistance to accepting the vaccine could delay our state’s economic recovery even further.
Understanding the relative influences of skepticism and lack of information and access on vaccine participation warrants further research. But Alabama’s public health legacy – and living memory – adds a painful dimension to this issue. In the home state of the racist and deadly Tuskegee syphilis experiment,[25] public health officials have a long way to go to win the full confidence of communities long betrayed.[26]
Nationally, Black Americans are significantly less likely than white people to get the annual flu vaccine.[27] This fact raises the stakes for a new vaccination campaign. A 2020 CDC study found that Hispanic/Latinx adults had lower flu vaccine uptake than any other racial/ethnic group.[28] People with disabilities also have shown lower flu vaccine participation.[29] And a recent study found that unemployed Americans were less likely to receive the flu vaccine and also less likely to say they would accept a COVID-19 vaccine.[30]
We have to make sure – and make clear – that Alabama’s response to the COVID-19 pandemic and our plans for recovery take all segments of our population into equal account. The ADPH deserves applause for its efforts to account for racial inequities by partnering with historically Black colleges and universities and other Black-led institutions and networks in its COVID-19 vaccination planning.
Public health funding cuts haunt Alabama
Despite this collaborative approach, though, the state’s vaccination rollout got off to a troubled start. Inadequate vaccine supplies only compounded the challenge of conducting a massive public health campaign with a system undermined by chronic budget cuts. In 2019, Alabama’s state-administered county health departments operated at 65% of the professional staffing they had in 2010.[31]
The ADPH’s phased vaccine distribution plan places front-line health care workers, first responders and support personnel (e.g., hospital janitorial and medical transportation services) at the “head of the line” in Phase 1a for receiving the vaccine, along with residents and staff of nursing facilities.[32] These initial target populations are easy to identify, but some of the targets for Phases 1b and 1c – people with age- and health-related risk factors – will be more challenging to reach.
Community outreach and referral will play a critical role in successful implementation of these phases. Phase 1b also targets front-line essential workers, who are comparatively easy to identify and reach. But both this phase and the later Phases 1c and 2 include industries and general population groups that will require diversified and sustained communications and engagement.
Medicaid expansion would help ensure Alabama is prepared for the next pandemic
The COVID-19 vaccine will pose numerous logistical and economic challenges. Getting ahead of those challenges will be a key part of strengthening Alabama’s workforce as our state recovers. Let’s bring more than 340,000 Alabamians into a health care system that can provide them with accurate information, encourage them to get vaccinated and pay the cost when they do. And let’s make sure the pandemic and its associated recession don’t break our hospitals and our communities.
That’s the kind of heavy lifting Medicaid expansion was made for. Medicaid expansion is a tool for removing barriers, improving health outcomes and saving lives. Now, of all times, why aren’t we using it?
The State of Working Alabama 2021
The State of Working Alabama 2021: Executive summaryIntroduction: The high cost of failing to protect the common good (Section 1)Unequal by design: COVID-19 and Alabama’s policy legacy (Section 2)Assessing the damage: COVID-19 and Alabama’s labor market (Section 3)
Praised but underprotected: Front-line workers in the pandemic (Section 4)The ugly reality: Alabama’s hunger problem during the pandemic (Section 6)No place to call home: Housing insecurity amid COVID-19 (Section 7)
[26] Reuben C. Warren, Lachlan Forrow, David Augustin Hodge, Sr. & Robert D. Truog, “Trustworthiness before Trust – Covid-19 Vaccine Trials and the Black Community, New England Journal of Medicine (Nov. 26, 2020), https://www.nejm.org/doi/full/10.1056/NEJMp2030033.
[27] Sandra Crouse Quinn, “African American adults and seasonal influenza vaccination: Changing our approach can move the needle,” National Center for Biotechnology Information (Nov. 17, 2017), https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5861789.
[29] Jenny O’Neill, Fiona Newall, Giuliana Antolovich, Sally Lima & Margie Danchin, “Vaccination in people with disabilities: a review,” National Center for Biotechnology Information (July 24, 2019), https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7012164.
The COVID-19 pandemic has contributed to widespread hunger in Alabama. We all have seen the pictures – lines of cars stretching for blocks waiting to receive an emergency food box, desperate appeals from food banks that distributed as much food in the first six months of the pandemic as they did in the prior year, school buses filled with lunches for delivery to hungry children unable to go to school in person. Facebook pages have sprung up to offer desperately needed peer advice on how to navigate the food assistance system.
Hunger is an ugly public face of this pandemic and its associated recession. Amid persistent job and income losses, hundreds of thousands of Alabama families are struggling to keep food on the table.
Where are we now?
In the spring/early summer stage of the pandemic (late April until late July 2020), 12% of all Alabama families and 13% of Alabama families with children either sometimes or often didn’t have enough food to eat, according to the U.S. Census Bureau’s Household Pulse Survey.[1] And the hunger challenges were much more serious in communities of color. Nearly 19% of Hispanic/Latinx Alabamians and 21% of Black Alabamians said they didn’t have enough food, compared to slightly more than 8% of white Alabamians.[2]
How did we get here?
Unequal job losses have led to increased hunger. Between mid-August and late October (the late summer/fall stage of the pandemic), one in five Alabamians who reported income loss said they either sometimes or often didn’t have enough to eat.[3] This includes a third of the people who reported losing their jobs due to pandemic-related layoffs, plus another third – mostly women – who wanted to return to work but couldn’t because they were caring for children whose schools or day cares were closed due to the pandemic.[4]
The Household Pulse Survey shows both the value and the limitations of critical safety net programs. Nearly three in four (or 74%) of Alabamians who used unemployment insurance (UI) benefits were able to afford their basic food needs during the late summer/fall stage of the pandemic, as were 78% of people who used federal stimulus payments to make ends meet.[5] Two in three Alabamians who received food assistance through the Supplemental Nutrition Assistance Program (SNAP) said they had enough food.[6]
High demand at food banks shows need to strengthen nutrition assistance
These and other safety net programs have eased suffering for hundreds of thousands of Alabamians during the pandemic. Even so, significant numbers of people still reported they didn’t have enough to eat.
Revealing the limitations of the safety net, tens of thousands of Alabamians also used emergency food programs and free school meals to feed their families. The week before Thanksgiving, 10% of Pulse Survey respondents in Alabama said they still relied on free groceries in the last week.[7] The largest share of people who relied on emergency food received it from Alabama’s food banks or faith-based and community food pantries (61%), followed by school-based or other programs that provided food to children (31%) and family or friends (27%).[8]
Food banks and other sources of emergency food play a vital role feeding hungry families. But these programs simply cannot meet the scale of need that the COVID-19 recession has caused.
What should we do now?
The state and federal governments can make a number of important public policy changes to help feed Alabama families during this difficult time and beyond:
Alabama lawmakers should abandon efforts to slash the state’s safety net. The COVID-19 recession has taught many painful lessons about the critical role that safety net programs play during a crisis. Legislators should resist the temptation to introduce and pass bills restricting access to SNAP and other safety net programs. If enacted in past years, these bills would have made the recent hunger and hardship in Alabama even more dire.
The state departments of Education and Human Resources should move quickly to implement P-EBT for the 2020-21 school year. When schools closed, Congress created the Pandemic EBT (P-EBT) program, which provided debit-like cards with enough money on them to replace the value of lost school meals. Lawmakers later expanded this program in a continuing resolution in September. Now Alabama needs to distribute these desperately needed benefits rapidly to families whose children are going to school remotely or who are in hybrid classrooms.
Eligible schools in Alabama should reduce childhood hunger by participating in the Community Eligibility Provision for the 2021-22 school year. Community eligibility allows eligible schools to serve meals at no cost to all enrolled students, streamlining the usual paperwork. Participation in community eligibility automatically makes children eligible for P-EBT. And it eases logistical barriers for schools to provide free meals to children who are attending school remotely.
Congress should move quickly to pass another COVID-19 relief bill that further increases federal UI benefits and SNAP assistance. The bill also should provide additional cash assistance for struggling families, including relief payments, a fully refundable Child Tax Credit and an increased Earned Income Tax Credit.
The State of Working Alabama 2021
The State of Working Alabama 2021: Executive summaryIntroduction: The high cost of failing to protect the common good (Section 1)Unequal by design: COVID-19 and Alabama’s policy legacy (Section 2)Assessing the damage: COVID-19 and Alabama’s labor market (Section 3)
Praised but underprotected: Front-line workers in the pandemic (Section 4)Why coverage matters: Health care in the time of COVID-19 (Section 5)No place to call home: Housing insecurity amid COVID-19 (Section 7)
More than 800,000 job losses in the first eight months of the pandemic caused Alabamians severe economic damage and heightened insecurity. Thousands of Alabamians face potential eviction and homelessness as a result of the pandemic. And unfortunately, the state’s recent scattershot approach to eviction policy has resulted in inconsistent protection for renters across Alabama.
Gov. Kay Ivey’s initial eviction emergency order provided broad protections against eviction, directing all law enforcement personnel to cease “enforcement of any order that would result in the displacement of a person from his or her place of residence.”[1]
This proclamation faced immediate attempts to chip away its broad protections. A second emergency proclamation on May 8 limited the protections significantly by allowing evictions for all reasons except nonpayment of rent specifically.[2] This modification was a major limitation that cut against the original order’s basic purpose: to reduce health risks to Alabamians by preventing homelessness and forced moves into crowded group housing settings with many other people.
Further, allowing evictions for all reasons except nonpayment allowed landlords to put people on the streets for reasons unrelated to public safety, even though the stated reason for limiting protections was to ensure public safety. For example, a person could be evicted for allowing family members not named on the lease to move in after those family members had themselves lost housing.
State eviction safeguards gone; housing instability remains
The near-shutdown of state courts in early spring 2020 greatly slowed the pace of eviction proceedings for months in Alabama.[3] But administrative difficulties are not a reliable brake on policies designed to punish poverty. And worse, Ivey’s eviction protection order expired in June, leaving no state-level eviction protections in place thereafter.[4]
Alabamians have high rates of housing instability. As recently as the week before Thanksgiving, nearly 13% of Alabamians who responded to the Household Pulse Survey said they either missed their previous rent or mortgage payment or had little confidence they would make their next payment.[5]
How did we get here?
Housing costs are a heightened burden for Alabamians with low incomes even in more normal times. Full-time work at the minimum wage is insufficient to afford a two-bedroom apartment anywhere in the state.[6] A minimum-wage worker would need to work 12 hours a day, seven days a week to afford such an apartment.
Alabama’s shortage of affordable housing causes significant harm for tens of thousands of state residents. The state lacks nearly 80,000 affordable homes for people with extremely low incomes, defined as 30% of area median income or lower.[7] More than three in four of these Alabamians are seniors, people with disabilities and/or in the workforce.[8]
Long-term failure to invest in affordable housing has brought Alabama to this point. The state has a mechanism, created in 2012, to address the housing shortage: the Alabama Housing Trust Fund (AHTF).[9] But the Legislature has never appropriated funding for the AHTF. During the pandemic-shortened 2020 regular session, a bill to fund the AHTF through a small increase in the mortgage recording fee for housing purchases advanced out of committee. But the Legislature adjourned without passing the bill.
What should we do now?
Alabama can take steps to fix this policy shortcoming quickly. And addressing the state’s housing shortage would bring significant benefits. State investment in affordable housing would create jobs with good wages. Construction workers in Alabama make about $43,000 per year, just $5,000 short of the median household wage.[10]
Even though the federal moratorium on many evictions has been extended through March 2021,[11] a state-level eviction moratorium is still needed to ensure the well-being of thousands of Alabamians. The Centers for Disease Control and Prevention (CDC) eviction moratorium requires renters to file paperwork with their landlords attesting to their inability to pay because of COVID-19. This requirement is readily abusable by unscrupulous landlords, who could make themselves unavailable for service and assert failure to provide notice. Those landlords also could falsely claim not to have received the notice.
A blanket state eviction moratorium (with an exception for people posing serious danger to others) would be a better solution. It would avoid an administrative burden on renters already experiencing financial hardship. And it would prevent rental companies from potentially abusing the CDC’s notice requirement.
A policy path to keep Alabamians housed
To ensure everyone has a place to call home during the pandemic and beyond, Alabama should:
Reinstitute eviction protections for the duration of the pandemic for all people who are not a danger to others.
Provide direct housing subsidies to renters impacted by COVID-19. This assistance would help people remain in their homes and help smaller landlords cover their mortgages and other expenses.
Provide adequate appropriations to support affordable housing in Alabama. The state should dedicate a substantial source of funding, such as the recently proposed increase in the mortgage recording fee, to providing affordable housing. At current housing prices, a mortgage recording fee increase of just 15 cents per $100 financed would provide more than $14 million yearly toward addressing the housing needs of Alabamians.
Halt utility cutoffs and begin reporting data on shutoffs for nonpayment. Cutting off water and power to people during a pandemic because of nonpayment is cruel and counterproductive. These cutoffs increase human suffering and limit people’s ability to protect themselves against the spread of coronavirus. Alabama needs to collect more data about the scope of these shutoffs and craft policies to make them less prevalent.
The State of Working Alabama 2021
The State of Working Alabama 2021: Executive summaryIntroduction: The high cost of failing to protect the common good (Section 1)Unequal by design: COVID-19 and Alabama’s policy legacy (Section 2)Assessing the damage: COVID-19 and Alabama’s labor market (Section 3)
Praised but underprotected: Front-line workers in the pandemic (Section 4)Why coverage matters: Health care in the time of COVID-19 (Section 5)The ugly reality: Alabama’s hunger problem during the pandemic (Section 6)
[10] Bureau of Labor Statistics, Occupational Employment Statistics, May 2019 State Occupational Employment and Wage Estimates – Alabama (March 31, 2020), https://www.bls.gov/oes/current/oes_al.htm.
The poll, conducted for Cover Alabama in January by Cygnal, shows support for Medicaid expansion across all demographics, including age, gender, income, education and geography. Alabama Arise is a founding member of Cover Alabama.
The poll also reveals the popularity of various funding sources for Alabama’s required 10% match for Medicaid expansion. Respondents expressed the most support for legalizing a state lottery and using part of the revenue to expand Medicaid. Proposed funding sources that won an overall majority or plurality of support were:
Growing support and growing opportunities to expand coverage
Participants responded strongly when informed that more than 5,000 veterans (and 8,000 of their family members) do not have health coverage in Alabama. A full 70% of respondents were more likely to support expanding Medicaid when presented with that information. Respondents also were more likely to support expansion when informed that Alabama taxpayers have paid $4 billion in federal taxes since 2014 to help support Medicaid expansion in other states.
Both Republican and Democratic respondents were more likely to support Medicaid expansion with increased financial support from the federal government. A U.S. House bill would offer a dramatic increase in federal incentives for states like Alabama to expand Medicaid. If enacted, the legislation would provide an additional $940 million in federal money to Alabama over two years if the state expanded Medicaid. Medicaid expansion would benefit more than 340,000 Alabamians who are uninsured or struggling to afford coverage.
The overwhelming polling support reflects an ever-growing group of individuals, organizations and businesses that support expanding Medicaid in Alabama. This group includes the Alabama Hospital Association, the Alabama Chapter of the American Academy of Pediatrics, the Alabama Department of Health’s Maternal Mortality Review Committee, the Medical Association of the State of Alabama and 100 nonprofits, faith-based groups and medical advocacy organizations in Alabama.
Federal legislation would leave ‘no financial barrier’ to Medicaid expansion in Alabama
Jane Adams, campaign director of Alabama Arise and director of the Cover Alabama Coalition, said in a statement:
“This poll shows that Medicaid expansion is popular and that both Republican and Democratic voters support using federal funds or revenue from a lottery to pay for Medicaid expansion. For four years, Governor Ivey has said the obstacle to expanding Medicaid in Alabama is the cost. Last week, the House Energy and Commerce Committee passed a provision that is on track to pass both chambers of Congress and become law. This provision would offer states that have not yet expanded Medicaid significant financial incentives to do so.
“If Governor Ivey expands Medicaid, Alabama will receive an estimated $940 million of federal money over two years to help Alabama expand. There is no financial barrier or obstacle to overcome. Now is the time for Governor Ivey to save lives, create jobs and protect rural hospitals by expanding Medicaid.”
“The Medical Association of the State of Alabama commends the work of the Cover Alabama Coalition in its efforts to expand Medicaid. Without question, increasing access to quality care improves health outcomes for patients. While this obviously has a positive impact on individuals, the benefits also trickle up through families and communities, ultimately bettering our entire state. We are pleased to support ‒ along with a majority of Alabamians as the poll shows ‒ the expansion of Medicaid.”
Advocates will continue working to establish wide support for Medicaid expansion across the state and across political lines. And they will look toward Gov. Kay Ivey and state lawmakers to act accordingly.
Arise executive director Robyn Hyden breaks down the first two weeks in the Alabama Legislature’s 2021 regular session and outlines Arise’s goals for this session. Legislators have prioritized protecting corporations over workers so far this month, even as hundreds of thousands of Alabamians continue to struggle with hunger and hardship during the COVID-19 recession.
Jane Adams, campaign director of Alabama Arise and director of