Issue: Health

The State of Working Alabama 2021, Section 1 – Introduction: The high cost of failing to protect the common good

By Jim Carnes

State of Working Alabama logo

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.

Click here for more information on the survey.[14]

The State of Working Alabama 2021

The State of Working Alabama 2021: Executive summary
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)

 

 

 

 

 

 

 

Footnotes

[1] Kaiser Family Foundation, “Poverty Rate by Race/Ethnicity,” State Health Facts 2019, https://www.kff.org/other/state-indicator/poverty-rate-by-raceethnicity/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D.

[2] Urban Institute, “Debt in America: An Interactive Map” (Dec. 17, 2019), https://apps.urban.org/features/debt-interactive-map/?type=overall&variable=pct_debt_collections&state=1.

[3] Andrea Hsu, “Florida Just Passed a $15 Minimum Wage. Is the Time Right for a Big Nationwide Hike?,” NPR (Nov. 18, 2020), https://www.npr.org/2020/11/18/934476124/florida-just-passed-a-15-minimum-wage-is-the-time-right-for-a-big-nationwide-hik.

[4] Alabama Arise, Medicaid Matters: Charting the Course to a Healthier Alabama, “Section 3 – Who’s still left out of health coverage in Alabama?” (June 17, 2020), https://www.alarise.org/resources/medicaid-matters-section-3-whos-still-left-out-of-health-coverage.

[5] A+ Education Partnership, “No Child Left Offline: Tackling the Digital Divide in Alabama” (Aug. 17, 2020), https://aplusala.org/blog/2020/08/17/no-child-left-offline-tackling-the-digital-divide-in-alabama.

[6] U.S. Department of Agriculture, “USDA Invests $62.3 Million in Rural Broadband Infrastructure for Alabama Families” (Dec. 5, 2019), https://www.usda.gov/media/press-releases/2019/12/05/usda-invests-623-million-rural-broadband-infrastructure-alabama.

[7] Alabama Department of Human Resources (DHR), Detailed Monthly Statistical Reporting for DHR Services, Table 19: Food Assistance Program (February 2020), https://dhr.alabama.gov/wp-content/uploads/2020/05/STAT0220.pdf; ibid. (October 2020), https://dhr.alabama.gov/wp-content/uploads/2020/12/STAT1020.pdf.

[8] Ibid.

[9] Celida Soto Garcia, “P-EBT, rapid school actions keep Alabama children fed,” Alabama Arise (Sept. 23, 2020), https://www.alarise.org/blog-posts/p-ebt-rapid-school-actions-keep-alabama-children-fed.

[10] Koné Consulting, Report: Pandemic EBT Implementation Documentation Project 13 (September 2020), https://frac.org/wp-content/uploads/P-EBT-Documentation-Report.pdf.

[11] Benefits.gov, “Emergency Solutions Grants (ESG),” https://www.benefits.gov/benefit/5890.

[12] Alabama Department of Labor, “ADOL Announces Extended Benefits Program to Expire: Benefits to Continue Through October 3” (Sept. 14, 2020), https://labor.alabama.gov/news_feed/News_Page.aspx?id=274.

[13] U.S. Census Bureau, Household Pulse Survey Data Tables, https://www.census.gov/programs-surveys/household-pulse-survey/data.html.

[14] U.S. Census Bureau, “Household Pulse Survey: Measuring Social and Economic Impacts during the Coronavirus Pandemic,” https://www.census.gov/programs-surveys/household-pulse-survey.html.

The State of Working Alabama 2021, Section 4 – Praised but underprotected: Front-line workers in the pandemic

By Carol Gundlach

State of Working Alabama logo

Where are we now?

Since the COVID-19 pandemic began, we’ve grown used to seeing, and applauding, signs in front of hospitals, fire departments, police stations and other emergency service providers saying “Heroes work here.” And we’ve learned to say “thank you” to people serving their communities’ needs at grocery, drug and convenience stores.

We’ve learned to call these folks “essential workers” and “front-line heroes,” recognizing they are putting themselves at elevated COVID-19 risk to provide the rest of us with essential needs during a frightening pandemic. But Alabama’s actions on wages, health coverage and worker protections do not live up to the promise of those words.

How did we get here?

Front-line workers include tens of thousands of people working in public-facing jobs that put them at increased COVID-19 risk. Alabamians working in grocery stores, hospitals and pharmacies perform necessary tasks to keep our communities functioning during the pandemic. But their jobs often tend to pay less and offer fewer benefits.

The physical and financial burdens on the front-line workers facing those health risks are unevenly distributed. Alabamians in jobs like health care, food service and child care are disproportionately likely to be people of color and women. And state and national policy failures on COVID-19 are more likely to hit them the hardest.

Nearly two-thirds of Alabama’s front-line workers are women, according to the Center for Economic and Policy Research, though women comprise just under half of the state’s total workforce.[1] And women make up an even larger share of workers in some crucial front-line industries. Women comprise 81% of Alabama’s health care workers and 89% of child care and social services workers.[2] These jobs often involve consistent exposure to large numbers of people and thus greater risk of contracting COVID-19.

Alabama front-line workers are much more likely to be women. Women make up 66.4% of all Alabama front-line workers and 80.6% of Alabama health care workers.

PPE shortages endanger health care workers

Health care accounts for more than one in 10 jobs in Alabama.[3] And the higher proportion of women in this field contributes to an overall gender-based disparity for coronavirus exposure. In many facilities – especially early in the pandemic – personal protective equipment (PPE) like masks, gloves and face shields has run short for doctors, nurses and other health care professionals.

This structural failure has forced many workers to reuse PPE, posing potentially severe health risks. Get Us PPE, a grassroots organization founded by emergency physicians, reports that it received nearly 300 requests for PPE from Alabama businesses and health care providers between March and October.[4] Nationally, the group was able to provide only 12% of the total PPE requested.[5] Production and supply chain problems continue to cause PPE shortages, even for many health care facilities.

Low pay abounds in critical front-line industries

The wages and work conditions for front-line workers often don’t reflect the importance of their work. And that is especially true in fields where women predominate. Child care workers in Alabama for example, have a median wage of $9.19 an hour.[6] For home health workers, the median hourly wage is $11.89, and for cashiers, it is only $9.81.[7] By contrast, more predominantly male jobs like production and construction have median wages beginning at $15.11 per hour.[8]

Many workers received higher hourly wages early in the pandemic, but some employers began eliminating hazard bonuses as early as May. In the retail sector – already filled with low-wage jobs with sparse benefits – major employers like Amazon[9] and Kroger[10] ended wage bonuses before July 4, 2020.

UI cutoffs, eviction risk add to economic pressure

Returning to work at unsustainably low wages amid a pandemic isn’t the only way many hard-working Alabamians are being squeezed. The state also placed workers at risk of homelessness with an ill-timed, one-two policy punch. First came a wave of unemployment insurance (UI) benefit cutoffs beginning in May 2020.[11] A month later, Alabama lifted its two-month moratorium on evictions for nonpayment of rent.[12] Adding to the squeeze, a federally funded $600 weekly UI benefit increase lapsed at the end of July 2020, and Congress has renewed only half of that amount through March 14, 2021.[13]

The Biden administration has extended the Centers for Disease Control and Prevention (CDC)’s eviction moratorium through March.[14] But that moratorium does not cover all renters affected by COVID-19 and requires unnecessary paperwork. Alabama should reimplement its own eviction moratorium rather than relying on the more limited federal version.

Lack of health coverage increases risk for many people of color in Alabama

Structural factors leave Black and Hispanic/Latinx people at increased risk from COVID-19. Together, they account for a disproportionate share of workers in front-line jobs.[15] And because of long-term, systemic racism that creates barriers to regular health care,[16] Black Alabamians are more likely to have underlying conditions that worsen coronavirus outcomes.

Black workers hold a disproportionate share of front-line jobs in Alabama. Black people are 25% of Alabama's labor force but 31% of front-line workers. The corresponding shares for white Alabamians are 68.3% and 63.6%. For Hispanic/Latinx workers: 3.8% and 2.3%. For Asian American/Pacific Islander workers: 1.8% and 1.3%.

Even among front-line workers, people of color are more likely to face heightened exposure in certain public-facing industries. In Alabama, the share of Black people working in grocery or convenience stores is two and a half times larger than in the U.S. workforce overall.[17] The share of Asian Americans and Pacific Islanders who work in grocery and convenience stores is double their percentage of Alabama’s overall population.[18]

Despite these elevated risks, Black and Hispanic/Latinx Alabamians are far more likely than white people to lack health insurance coverage. And because Alabama hasn’t expanded Medicaid, Black and Hispanic/Latinx residents are more likely to fall into the health coverage gap, earning too much to qualify for Medicaid but too little to afford insurance. People of color make up 34% of Alabama’s population but comprise 49% of uninsured Alabamians with low incomes.[19]

Data on the composition of front-line workers cannot account for differing exposure rates based on specific jobs within those career fields. But given that women in medical fields often face bias inhibiting their promotion into supervisory roles, women are likely at greater risk of coronavirus infection than their high proportion in the health care industry indicates. And overall, people of color are more likely to work non-supervisory jobs with higher public exposure in many front-line fields.

A choice no one should have to make

As a result, many older adults, cancer survivors and immunocompromised people face a stark choice between their lives and livelihoods. They must either subject themselves to a higher chance of death from COVID-19 or risk hunger and homelessness when they leave dangerous jobs or when the state cuts off UI benefits. Black and Hispanic/Latinx people, women and struggling families bear the brunt of this front-line risk.

What should we do now?

The pandemic has shined a light on many of Alabama’s policy mistakes. The state and nation can take this opportunity to fix harsh, shortsighted policies that devalue and harm working people by taking the following steps:

  • Expand Medicaid to cover low-paid Alabama adults. Expansion would ensure that front-line workers who lack health insurance can access treatment for COVID-19 and other health risks.
  • Allocate a share of the state’s federal COVID-19 relief funds to cover increased pay and benefits for front-line workers. This could and should include hazard pay for health care workers and direct service providers in long-term care during the pandemic.
  • Include workers’ compensation for illnesses related to COVID-19 among front-line workers as a key component of fair pay policy.
  • 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.
  • Encourage workforce diversity and equal employment opportunities so more women and people of color can enter higher-paying jobs. Workforce development programs should develop inclusive trainee recruitment plans that prioritize women and people of color. Employers also should engage actively in efforts to expand child care and other work support programs that facilitate workforce diversity.
  • State and federal policymakers should aggressively address wage and employment discrimination based on gender and race to reduce occupational segregation and wage disparities.
  • Congress should increase the federal minimum wage to at least $15 per hour. A crucial way to honor “front-line heroes” is to ensure they are paid enough to make ends meet.
  • The Biden administration should bring procurement and distribution of PPE under federal control. This step would help increase front-line workers’ access to the protective equipment they need for the duration of this pandemic.
In focus

Tens of thousands of front-line workers left out of paid sick days protections

Like most states, Alabama does not require employers to provide paid sick, family, parental or personal leave. Long-standing government hostility to workers’ rights and Alabama’s origin as a plantation economy have made progress on workers’ issues difficult. This dearth of public policy protections for working people is a major reason Alabama is in an unsustainable position amid the pandemic. And other traditional methods of gaining economic security for working-class people, like unionization, are less robust here than elsewhere.

Early in the COVID-19 pandemic, the federal government provided the first paid leave provision available in many states. The Families First Coronavirus Response Act (FFCRA) provided 80 hours of paid sick leave, paid at full wages for workers infected with COVID-19 and two-thirds wages for family caregiving.[20] For Alabamians, total amounts paid through Feb. 16, 2021, to workers who lacked paid leave before the FFCRA would have been $1.26 billion.[21]

Unfortunately, Congress exempted companies with more than 500 employees from the FFCRA’s paid leave requirements. And further exceptions existed for businesses with fewer than 50 workers if a business could not pay a worker’s child care leave, or if lack of an employee would place the business at risk of failure, potentially requiring workers to work while having COVID-19 for the survival of their employer.[22]

Due to these exclusions, far too many Alabamians lack paid sick leave in the midst of the pandemic. Almost 840,000 people employed by major employers lack guaranteed coverage, and as many as another 421,000 Alabamians employed by small businesses could lose access as well because of the small business waiver.[23] All told, four in five workers in Alabama lack access to paid sick days thanks to loopholes in the FFCRA.[24]

Why Alabama should enact a paid leave law

Widespread lack of paid sick leave for Alabama’s low-wage jobs lessens job security and raises Alabamians’ health care costs. Paid sick leave and health insurance are two sides of the same coin. One benefit without the other forces working people to go to work while sick, exposing their coworkers to illness. It also forces people to take off work only when symptoms are severe, requiring more expensive care and longer recovery time. In a pandemic, this dilemma is literally a matter of life and death.

To fix this shortcoming, Alabama should implement the core of the FFCRA at the state level. But the state should remove the large-employer exception and reimburse small employers contemporaneously for emergency child care leave. This would avoid unnecessary strain on small employers’ finances and relieve major stressors on working Alabamians.

Alabama should lead the way for the South by taking these important steps on comprehensive family and sick leave. These policies would increase stability for working people and promote greater resilience in the face of health-related setbacks.

The State of Working Alabama 2021

The State of Working Alabama 2021: Executive summary
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)

 

 

 

 

 

 

 

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] Hye Jin Rho, Hayley Brown & Shawn Fremstad, “A Basic Demographic Profile of Workers in Frontline Industries,” Center for Economic and Policy Research (April 7, 2020), https://cepr.net/a-basic-demographic-profile-of-workers-in-frontline-industries.

[2] Ibid.

[3] Ibid.

[4] Amanda Peery-Wolf, Ali Hickerson & Stephanie Zeller, Get Us PPE Shortage Index (December 2020), https://v9b3g8f2.stackpathcdn.com/wp-content/uploads/2021/01/PPE-Shortage-Index-December-2020-Get-Us-PPE.pdf.

[5] Ibid.

[6] 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.

[7] Ibid.

[8] Ibid.

[9] Isobel Asher Hamilton, “Amazon Drops $2 Coronavirus Pay Rise for Warehouse Workers As Jeff Bezos’ Fortune Nears $150 Billion,” Business Insider (June 3, 2020), https://www.businessinsider.com/amazon-cuts-2-dollar-hazard-pay-bezos-150-billion-2020-6.

[10] Dan Monk, “Kroger CEO: No more hazard pay for grocery workers,” WCPO 9 News (June 25, 2020), https://www.wcpo.com/news/local-news/i-team/kroger-ceo-no-more-hazard-pay-for-grocery-workers.

[11] Sarah Whites-Koditschek, “Alabama begins cutting unemployment for thousands for ‘refusal to work,’” AL.com (June 23, 2020), https://www.al.com/news/2020/06/alabama-begins-cutting-employment-for-thousands-for-refusal-to-work.html.

[12] Moriah Mason, “The federal eviction moratorium has been extended, but is it enough?,” Alabama Political Reporter (Jan. 28, 2021), https://www.alreporter.com/2021/01/28/the-federal-eviction-moratorium-has-been-extended-but-is-it-enough.

[13] Jennifer Liu, “Millions of unemployed Americans will get a $300 per week federal UI boost through March with new stimulus bill,” CNBC (Dec. 21, 2020), https://www.cnbc.com/2020/12/21/new-stimulus-provides-300-per-week-11-weeks-enhanced-unemployment.html.

[14] Mason, supra note 12.

[15] Celine McNicholas & Margaret Poydock, “Who are essential workers? A comprehensive look at their wages, demographics and unionization rates,” Economic Policy Institute (May 19, 2020), https://www.epi.org/blog/who-are-essential-workers-a-comprehensive-look-at-their-wages-demographics-and-unionization-rates.

[16] See, e.g., Grace Segers, “Fauci says he knows of no order to slow down coronavirus testing,” CBS News (June 23, 2020), https://www.cbsnews.com/news/fauci-coronavirus-testing-house-committee-testimony (quoting Dr. Anthony Fauci on the public health effects of institutional racism).

[17] Center for Economic and Policy Research analysis of U.S. Census Bureau, Community Population Survey 2014-18 five-year estimates; Bureau of Labor Statistics, “Civilian labor force by age, race, sex and ethnicity,” 2019.

[18] Annette Jones Watters, “Diversity in Alabama,” University of Alabama, Center for Business and Economic Research (Aug. 7, 2019), https://cber.culverhouse.ua.edu/2019/08/07/diversity-in-alabama.

[19] Alabama Arise, Medicaid Matters: Charting the Course to a Healthier Alabama, “Section 4 – How can we make Alabama healthier?” (June 17, 2020), https://www.alarise.org/resources/medicaid-matters-section-4-how-can-we-make-alabama-healthier.

[20] Kellie Moss, Lindsey Dawson, Michelle Long, Jennifer Kates, MaryBeth Musumeci, Juliette Cubanski & Karen Pollitz, “The Families First Coronavirus Response Act: Summary of Key Provisions,” Kaiser Family Foundation (March 23, 2020), https://www.kff.org/global-health-policy/issue-brief/the-families-first-coronavirus-response-act-summary-of-key-provisions.

[21] Alabama Arise analysis of Bureau of Labor Statistics data, available at https://www.bls.gov/news.release/archives/laus_03272020.pdf, https://www.bls.gov/opub/ted/2019/access-to-paid-and-unpaid-family-leave-in-2018.htm and https://www.bls.gov/oes/current/oes_al.htm.

[22] Moss, et al., supra note 20.

[23] Alabama Arise analysis of U.S. Census Bureau, Quarterly Workforce Indicators, Q4 2019.

[24] Ibid.

The State of Working Alabama 2021, Section 5 – Why coverage matters: Health care in the time of COVID-19

By Jim Carnes

State of Working Alabama logo

Where are we now?

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]

 

Hispanic and Black Alabamians are more likely to lack health coverage. 32.8% of Hispanic/Latinx residents were uninsured in the spring/early summer stage of the pandemic, and 20.7% were uninsured in the late summer/fall stage. The corresponding rates for Black residents were 17.8% and 13.5%. For white residents, the rates were 11.7% and 11.5%.

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.

 

Alabamians with lower incomes are more likely to lack health coverage. 27.2% of residents with an annual household income below $35,000 were uninsured in the early spring/summer stage of the pandemic, while 22.9% were uninsured in the late summer/fall stage. The corresponding rates for residents with incomes between $35,000 and $75,000 were 9.8% and 10.9%. For residents with incomes between $75,000 and $100,000, the rates were 3.5% and 4.9%. For residents with incomes above $100,000, the rates were 3.8% and 1.8%.

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 summary
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)
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] Alabama Department of Public Health, Alabama’s COVID-19 Data and Surveillance Dashboard, https://alpublichealth.maps.arcgis.com/apps/opsdashboard/index.html#/6d2771faa9da4a2786a509d82c8cf0f7.

[2] Ibid.

[3] John Elflein, “Death rates from coronavirus (COVID-19) in the United States,” Statista (accessed Feb. 16, 2021), https://www.statista.com/statistics/1109011/coronavirus-covid19-death-rates-us-by-state.

[4] Bama Tracker, Alabama COVID-19 Deaths, https://bamatracker.com/chart/deaths (reflecting cumulative + probable COVID-19 deaths).

[5] Congressional Research Service, American War and Military Operations Casualties: Lists and Statistics (updated July 29, 2020), https://fas.org/sgp/crs/natsec/RL32492.pdf; Statista, “U.S. military fatalities in Iraq and Afghanistan, by state” (accessed Feb. 16, 2021), https://www.statista.com/statistics/303472/us-military-fatalities-in-iraq-and-afghanistan.

[6] Centers for Disease Control and Prevention, “Health Equity Considerations and Racial and Ethnic Minority Groups” (updated July 24, 2020), https://www.cdc.gov/coronavirus/2019-ncov/community/health-equity/race-ethnicity.html.

[7] Alabama Department of Public Health, Laboratory-Confirmed COVID-19 Case Characteristics (April 7, 2020), https://www.alabamapublichealth.gov/covid19/assets/cov-al-cases-040820.pdf.

[8] Hye Jin Rho, Hayley Brown & Shawn Fremstad, “A Basic Demographic Profile of Workers in Frontline Industries,” Center for Economic and Policy Research (April 7, 2020), https://cepr.net/a-basic-demographic-profile-of-workers-in-frontline-industries.

[9] Ibid.

[10] Kaiser Family Foundation, “Employer-Sponsored Coverage Rates for the Nonelderly by Race/Ethnicity” (2019), https://www.kff.org/other/state-indicator/nonelderly-employer-coverage-rate-by-raceethnicity/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D.

[11] Ibid.

[12] David J. Becker, “Medicaid Expansion in Alabama: Revisiting the Economic Case for Expansion,” University of Alabama at Birmingham School of Public Health, Department of Health Care Organization and Policy (Jan. 31, 2019), https://docs.wixstatic.com/ugd/72a465_8f37c24eeccf4e15bc6b2b97c00c3922.pdf.

[13] Alabama Arise, Medicaid Matters: Charting the Course to a Healthier Alabama, “Section 1 – How does Medicaid work in Alabama?” (June 17, 2020), https://www.alarise.org/resources/medicaid-matters-section-1-how-does-medicaid-work-in-alabama.

[14] Ibid.

[15] Alabama Arise, Medicaid Matters: Charting the Course to a Healthier Alabama, “Section 3 – Who’s still left out of health coverage in Alabama?” (June 17, 2020), https://www.alarise.org/resources/medicaid-matters-section-3-whos-still-left-out-of-health-coverage.

[16] Alabama Arise, Medicaid Matters: Charting the Course to a Healthier Alabama, “Section 4 – How can we make Alabama healthier?” (June 17, 2020), https://www.alarise.org/resources/medicaid-matters-section-4-how-can-we-make-alabama-healthier.

[17] U.S. Census Bureau, Household Pulse Survey, Phase 1, April 23 – July 21, 2020, https://www.census.gov/programs-surveys/household-pulse-survey/data.html#phase1.

[18] Alabama Arise analysis of U.S. Census Bureau, Household Pulse Survey, Phase 2, Aug. 19 – Oct. 26, 2020, https://www.census.gov/programs-surveys/household-pulse-survey/data.html#phase2.

[19] Alabama Arise analysis of U.S. Census Bureau, Household Pulse Survey, https://www.census.gov/programs-surveys/household-pulse-survey/data.html.

[20] Arise analysis of U.S. Census Bureau, supra note 17.

[21] Arise analysis, supra note 18.

[22] Becker, supra note 12.

[23] Carol Gundlach, “How the state grocery tax hurts struggling Alabamians,” Alabama Arise (Feb. 22, 2019), https://www.alarise.org/resources/how-the-state-grocery-tax-hurts-struggling-alabamians.

[24] Kaiser Family Foundation, “Status of State Medicaid Expansion Decisions: Interactive Map” (updated Feb. 12, 2021), https://www.kff.org/medicaid/issue-brief/status-of-state-medicaid-expansion-decisions-interactive-map.

[25] Tuskegee University, “About the USPHS Syphilis Study,” https://www.tuskegee.edu/about-us/centers-of-excellence/bioethics-center/about-the-usphs-syphilis-study.

[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.

[28] Centers for Disease Control and Prevention, “Influenza (Flu) General Population Vaccination Coverage” (Oct. 1, 2020), https://www.cdc.gov/flu/fluvaxview/coverage-1920estimates.htm.

[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.

[30] Amyn A. Malik, SarahAnn M. McFadden, Jad Elharake & Saad B. Omer, “Determinants of Covid-19 vaccine acceptance in the US,” The Lancet (Aug. 12, 2020), https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(20)30239-X/fulltext.

[31] Arian Campo-Flores, “Why Alabama Has the Worst Covid-19 Vaccination Rates,” Wall Street Journal (Feb. 11, 2021), https://www.wsj.com/articles/why-alabama-has-the-worst-covid-19-vaccination-rates-11613048418.

[32] Alabama Department of Public Health, Alabama COVID-19 Vaccination Allocation Plan (updated Jan. 29, 2021), https://www.alabamapublichealth.gov/covid19vaccine/assets/adph-covid19-vaccination-allocation-plan.pdf.

69% of Alabama voters support Medicaid expansion, new poll finds

By Chris Sanders

Sixty-nine percent of Alabamians, including 64% of Republican voters, support expanding Medicaid when told about arguments for and against the idea, according to a new poll that the Cover Alabama Coalition released Wednesday.

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.

Cover Alabama logo

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:

  • Legalizing a state lottery.
  • Increasing the state tobacco tax.
  • Legalizing and taxing medical marijuana.
  • Eliminating the federal income tax deduction for state income taxes.

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

Photo of Jane AdamsJane 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.”

Dr. John Meigs, president of the Medical Association of the State of Alabama, said in a statement:

“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.

The full poll results are available here.

Arise legislative recap: Feb. 16, 2021

By Matt Okarmus

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.

How Alabama Arise is working to build a brighter future after the pandemic

By Chris Sanders

After a year of darkness, the light at the end of the tunnel is finally in sight. Promising vaccine news offers hope that public health officials can rein in COVID-19 in the coming months. And as our state and nation seek policy solutions to rebuild from the pandemic’s health and economic devastation, Alabama Arise will seek to advance equity and shared prosperity for Alabamians who are marginalized and excluded.

That vital work won’t be fast or easy. In the meantime, the pandemic’s harrowing toll continues to grow. COVID-19 has killed more than 1.5 million people worldwide, including more than 3,900 Alabamians, and sickened tens of millions. It has fueled a deep recession, caused millions of layoffs and left more than 40% of U.S. children living in households struggling to make ends meet. It has stretched hospitals to the breaking point and disrupted education, commerce and social interactions in every community.

The Alabama Legislature will begin its 2021 regular session Feb. 2. As the health and economic tolls of the COVID-19 pandemic continue to mount, Alabama Arise will keep working hard to empower people who live in poverty and to lift up their voices in state policy debates.

COVID-19 has created suffering on a staggering scale. It also has highlighted long-standing economic and racial disparities and underscored the urgency of ending them. A new legislative session and a new presidency will offer new opportunities to right those wrongs in 2021 and beyond.

The federal and state work ahead

The most immediate needs will require federal action. Congress must extend state aid and additional unemployment insurance (UI) benefits before they expire this month. But those extensions should be just a down payment on a more comprehensive response.

Arise will urge further UI benefit increases and more federal relief to help states avoid layoffs and damaging cuts. We also will advocate for emergency rental and mortgage assistance and a 15% boost to food assistance under the Supplemental Nutrition Assistance Program (SNAP). And we’ll support regulatory efforts to lift harmful Medicaid and SNAP barriers created in recent years.

Flyer on Alabama Arise's 2021 issue priorities. For more information, visit https://www.alarise.org/news-releases/alabama-arise-unveils-members-2021-roadmap-for-change.

We’ll also keep working for better state policies when the Legislature returns in February. Our top focus will be Medicaid expansion, which we’ll pursue along with partners in the Cover Alabama Coalition. Expansion would cover more than 340,000 Alabamians with low incomes and ease the financial strain on rural hospitals. It also would attack structural health care disparities that led COVID-19 to take a disproportionate toll on Black Alabamians.

Arise’s work won’t stop there. We’ll support legislation to expand voting rights and ensure broadband internet access for all Alabamians. We’ll seek to increase consumer protections and overhaul the state’s criminal justice system. And we’ll fight to untax groceries once and for all.

Breakthroughs on many of these issues won’t be fast or easy. But together, we’ll emerge from dark times into the light of a brighter, more inclusive future for Alabama.

Get covered: 2021 ACA open enrollment ends Dec. 15, 2020

By Alabama Arise

The deadline to #GetCovered is just weeks away! Open enrollment for 2021 Marketplace health coverage under the Affordable Care Act ends Tuesday, Dec. 15, 2020. Don’t miss your chance to make sure you’re covered in case of accident or illness.

Visit healthcare.gov or call 800-318-2596 to explore your coverage options. And be sure to spread the word about this opportunity to your friends and family, too.

Welcome! HealthCare.gov is open. Sign up for affordable health coverage from Nov. 1 to Dec. 15.

Our friends at the Center on Budget and Policy Priorities share why you should visit healthcare.gov during open enrollment. This resource discusses how to compare plans, seek financial help and ensure your insurance meets your needs.

Even if you already have Marketplace coverage, we still recommend that you log in and double-check your options. Another plan may better meet your needs in the coming year.

We also want to share resources from our partner organizations Enroll Alabama and the Cover Alabama Coalition around health care accessibility and advocacy.

Screenshot of Cover Alabama petition

More than 220,000 Alabamians are caught in the state’s health coverage gap, earning too much to qualify for Medicaid and too little to afford private insurance. Right now, more than ever, affordable health care is a necessity. Please sign this petition to Gov. Kay Ivey on behalf of Cover Alabama.

Enroll Alabama logo

Enroll Alabama answers questions and offers services for open enrollment. For more information and free in-person assistance, call toll free at 844-248-7698 or email enrollalabama@gmail.com today.

Medicaid expansion would save Alabama mothers from preventable deaths, boost treatment resources for mental health and substance use disorders

By Chris Sanders

Alabama Arise and Cover Alabama partner organization logos

Nearly 70% of Alabama’s pregnancy-related deaths in 2016 were preventable, according to a report this month from the state Department of Public Health and Maternal Mortality Review Committee. The committee recommended that Alabama improve maternal health by expanding Medicaid coverage and increasing resources and services for women with mental health and substance use disorders. The report also recommended improving Medicaid reimbursement for providers and encouraging broader education of mothers and families regarding the various health issues identified as maternal death risk factors and their warning signs.

Partner organizations in the Cover Alabama Coalition released the following statements Thursday in response:

Jane Adams, Campaign Director, Alabama Arise:

“Thirty-six Alabama mothers died in 2016 from causes linked to their pregnancies. Their children will go to bed tonight – and every night – without their birth mother there to tuck them in. And for 70% of these kids, their mother’s death was preventable. This report is a haunting reminder that poverty and access to health insurance are significant drivers of maternal mortality in Alabama. We encourage Gov. Kay Ivey, Commissioner Stephanie Azar and our legislators to save lives and protect families by expanding Medicaid to cover mothers before, during and after pregnancy.”

Jada Shaffer, Government Relations Regional Director, American Heart Association:

“We urge the Legislature and Governor Ivey to immediately implement the reforms the Maternal Mortality Review Committee recommends. In 2016, cardiovascular-related conditions were the leading underlying cause of pregnancy-related deaths in Alabama. When women lack health insurance, they are less likely to get treatment for preexisting conditions and are much more likely to die during or after pregnancy. Improving maternal health outcomes will require expanding Medicaid and equitably providing access to care for all Alabama families.”

Dr. John S. Meigs, President, Medical Association of the State of Alabama:

“The Medical Association of the State of Alabama commends the Maternal Mortality Review Committee (MMRC) for its diligence in researching the factors that impact maternal deaths, in hopes to mitigate and prevent future maternal deaths. It is very concerning for physicians throughout the state that 70% of the deaths reviewed by the MMRC were preventable and that women of color are disproportionately affected. Alabama mothers deserve the best medical care that we can offer. To that end, the Medical Association supports the MMRC’s recommendation of expanding Medicaid coverage for women postpartum beyond where it is today, as well as informing our communities that mental health and substance abuse issues can contribute to maternal mortality. Physicians have a responsibility to help mothers get the medical care that they need and deserve.”

Dr. Nadia Richardson, Executive Director, No More Martyrs:

“In Alabama, Black women are dying at three to four times the rate of white women from pregnancy-related complications. In 2016, thirty-six mothers died because they did not have consistent access to care. We fail mothers when they are forced to drive two counties over to see their OB-GYN for a check-up because they live in one of 29 Alabama counties that have lost obstetrical services.

“Now is not the time to turn a blind eye to health disparities rooted in injustice and indifference. Now is not a time to ignore the impact that this continued neglect has on the mental, physical and holistic wellness of Black women in our state. Now is not the time to pretend that these inequities are not remnants of a history that we have yet to come to terms with – a history of racism and sexism that remains embedded throughout our health care system. Now is the time to demand more. Alabama leaders must accelerate progress on ending maternal mortality by investing in access to quality and affordable health care.”

Britta E. Cedergren, MPH, MPA, Associate Director, Postpartum Care, March of Dimes:

“The health of a society is measured by the health of its moms and babies. In Alabama, we are not only facing the crisis of one in eight babies being born too sick, too soon, but mothers dying from potentially preventable causes. In the inaugural report by the Alabama Maternal Mortality Review Committee, we found that two-thirds of women die between 43 and 365 days postpartum. When moms have access to high-quality, equitable and uninterrupted care, outcomes can improve. Fully expanding, or even extending Medicaid for a full year postpartum, while only one step in combating the crisis of moms dying from pregnancy related causes, is a big step that can improve the health and well-being of all Alabamians.

Rev. Carolyn Foster, Faith in Community Coordinator, Greater Birmingham Ministries:

“It is our moral responsibility to care for one another. ‘Do unto others as you would have them do unto you’ is a mandate in many of our faith traditions. It is the most basic command in our religious tradition. We cannot stand by or look the other way or cross on the other side when people suffer. To do so is to turn one’s back on God because ‘when you do it to the least of these, you do it to me.’ Access to health care would be life-giving to many who are vulnerable. We are our sister’s and brother’s keepers. And we must bear one another’s burdens. Dr. Martin Luther King Jr. said, ‘Our lives begin to end the day we become silent about things that matter.’ We strongly urge the Legislature and Gov. Kay Ivey to increase access to quality affordable health insurance by expanding Medicaid.”

Holly Caraway McCorkle, Executive Director, Alabama Council for Behavioral Healthcare:

“The Alabama Council for Behavioral Healthcare urges policymakers to act quickly to increase access to coverage by expanding Medicaid in Alabama. Sadly, the Alabama Maternal Mortality Review Committee found that mental health and substance use disorders were identified as key contributors in almost half of pregnancy-associated and pregnancy-related deaths. These deaths are preventable, and Medicaid expansion will offer women who suffer from mental health and substance use disorders life-saving coverage and access to critically needed resources and services before, during and after pregnancies.”

Kim Cochran, Vice President, External Affairs, The Women’s Fund of Greater Birmingham:

“A recent report by Alabama’s Maternal Mortality Review Committee revealed that the maternal mortality rate is rising in the United States. Alabama’s rate is the second highest in the nation and disproportionately affects Black women. Even more alarming, 70% of the maternal deaths in Alabama were deemed preventable. As identified by the Maternal Mortality Review Committee, Medicaid expansion could reduce Alabama’s maternal deaths and change the narrative for women. A region, state or county’s ability to keep women and children alive during and after childbirth speaks volumes about our economic, social and political fabric. I urge our lawmakers to stand up for women and expand Medicaid to help reduce our state’s maternal mortality rate and provide health care coverage for an additional 152,000 women.”

ACA lawsuit could end health coverage for 122,000 Alabamians

By Chris Sanders

At least 122,000 Alabamians would lose health coverage if the U.S. Supreme Court strikes down the Affordable Care Act (ACA), according to a new analysis from the nonpartisan Urban Institute. The state’s uninsured rate would increase by 25% as a result.

That number also doesn’t include hundreds of thousands of uninsured or underinsured adults with low incomes who would gain coverage if Alabama expands Medicaid. If the lawsuit succeeds, the ACA’s 9-to-1 federal funding match for Medicaid expansion would disappear.

“Repealing the ACA would throw our health care system into chaos in the middle of a pandemic and a deep recession,” Alabama Arise executive director Robyn Hyden said. “Tens of thousands of Alabamians would lose health coverage when they need it most. And hundreds of thousands would pay more for coverage or lose protections for their preexisting conditions.”

The White House and 18 states, including Alabama, are asking the Supreme Court to strike down the entire ACA. Oral arguments before the Supreme Court are scheduled for Nov. 10.

More than 21 million Americans would lose coverage in 2022 if the ACA falls, according to the Urban Institute. Coverage losses could be even larger next year, as the COVID-19 pandemic and recession likely still will be ongoing.

“The ACA has been a health lifeline for many Alabamians during the pandemic,” Hyden said. “It provides coverage options for people who have lost their jobs or seen sharp reductions in their income. And it ensures people aren’t denied insurance just because they got sick.”

Ending the ACA would undermine racial equity, harm people with preexisting conditions

The ACA made important progress in reducing racial disparities in health care that often stem from structural racism. But large coverage losses from ending the ACA would reverse many of those gains, the Urban Institute finds. Overturning the ACA would strip health coverage from nearly one in 10 Black and Latino Americans under age 65. More than one in 10 Native Americans nationwide would become uninsured.

Ending the ACA also would eliminate protections for people with preexisting conditions. This would allow insurers to charge higher rates to people with conditions like asthma, cancer, diabetes or COVID-19. Insurance companies also could refuse to offer them coverage at any price. One in three Alabamians under age 65 have a preexisting condition that would have been “declinable” before the ACA.

ACA repeal would harm people who have health insurance through their jobs, too. Their plans could reintroduce annual and lifetime coverage limits. Requirements for plans to cover essential benefits and provide free preventive services would disappear. So would the requirement for insurers to allow young adults to be covered through their parents’ plans.

Striking down the ACA would be a tax windfall for wealthy people, large corporations

Wealthy people and some large corporations would be among the few winners if the lawsuit succeeds. They would get billions of dollars in tax cuts, the nonpartisan Center on Budget and Policy Priorities finds:

  • The highest-income 0.1% of households would receive tax cuts averaging about $198,000 per year. This group has annual incomes of more than $3 million. A portion of these tax cuts would come at the expense of the Medicare Trust Fund, which would lose about $10 billion in revenue each year.
  • Pharmaceutical companies would pay $2.8 billion less in taxes each year. Meanwhile, millions of seniors could pay billions of dollars more for prescription drugs annually. That’s because eliminating the ACA could reopen the “donut hole” gap in Medicare’s prescription drug benefit.

“The ACA has left Alabama better equipped to fight COVID-19 and rebuild our economy after the recession,” Hyden said. “And those benefits would be even greater if Alabama would adopt Medicaid expansion.

“Striking down the ACA would harm the Alabamians who have suffered the most during the pandemic and the recession. It would deprive our state of the opportunity to save lives and strengthen our health care system by expanding Medicaid. And it would shower huge tax cuts on rich people while making life harder for everyone else. Alabama officials should stop seeking to undermine the ACA and start investing in a healthier future for our entire state.”

Alabama Arise unveils members’ 2021 roadmap for change

By Chris Sanders

Sentencing reform and universal broadband access are two new goals on Alabama Arise’s 2021 legislative agenda. Members voted for Arise’s issue priorities this week after nearly 300 people attended the organization’s online annual meeting Saturday. The seven issues chosen were:

  • Tax reform, including untaxing groceries and ending the state’s upside-down deduction for federal income taxes, which overwhelmingly benefits rich households.
  • Adequate budgets for human services like education, health care and child care, including Medicaid expansion and extension of pre-K to serve all eligible Alabama children.
  • Criminal justice reform, including repeal of the Habitual Felony Offender Act and changes to civil asset forfeiture policies.
  • Voting rights, including automatic universal voter registration and removal of barriers to voting rights restoration for disenfranchised Alabamians.
  • Payday and title lending reform to protect consumers from getting trapped in debt.
  • Death penalty reform, including a law to require juries to be unanimous in any decision to impose a death sentence.
  • Universal broadband access to help Alabamians who have low incomes or live in rural areas stay connected to work, school and health care.

“Arise believes in dignity, equity and justice for all Alabamians,” Alabama Arise executive director Robyn Hyden said. “And our 2021 issue priorities would break down many of the policy barriers that keep people in poverty. We can and will build a more inclusive future for our state.”

Graphic naming Alabama Arise's 2021 issue priorities

The urgent need for criminal justice reform

Alabama’s criminal justice system is broken and in desperate need of repair. The state’s prisons are violent and dangerously overcrowded. Exorbitant court fines and fees impose heavy burdens on thousands of families every year, taking a disproportionate toll on communities of color and families who are already struggling to make ends meet. And Alabama’s civil asset forfeiture policies let law enforcement seize people’s property even if they aren’t charged with a crime.

Arise will continue to seek needed reforms in those areas in the coming year. The organization also will work for repeal of the Habitual Felony Offender Act (HFOA), the state’s “three-strikes” law. The HFOA is an unjust driver of sentencing disparities and prison overcrowding in Alabama. The law lengthens sentences for a felony conviction after a prior felony conviction, even when the prior offense was nonviolent. Hundreds of people in Alabama are serving life sentences for non-homicide crimes because of the HFOA. Thousands more have had their sentences increased as a result. Repealing the law would reduce prison overcrowding and end some of Alabama’s most abusive sentencing practices.

Universal broadband access would help struggling Alabamians stay connected

The COVID-19 pandemic has illustrated the essential role that the internet plays in modern life. Remote work, education, health care and shopping are a reality for millions in our state today. But far too many Alabamians, especially in rural areas, can’t access the high-speed broadband that these services require. These access challenges also reveal a racial disparity: About 10% each of Black and Latino households have no internet subscription, compared to 6% of white households.

Policy solutions can facilitate the investments needed to ensure all Alabamians can stay connected. Lawmakers can help by guaranteeing that all communities have the right to own, operate or deploy their own broadband services. The Legislature also can enact targeted and transparent tax credits to promote broadband for underserved populations.