Issue: Health

Arise legislative update: Feb. 26, 2024

By Matt Okarmus

Arise’s Akiesha Anderson breaks down a flurry of legislation that kept us busy last week. She discusses bills filed in response to the Alabama Supreme Court’s decision on in vitro fertilization (IVF), updates us on anti-DEI legislation and examines the CHOOSE Act, a bill that would redirect public school funding to private schools and homeschooling. She also previews what’s ahead this week, including committee action on a harmful bill that would impose limits on absentee voting and a good bill that would increase help for those who can’t afford a lawyer when charged with a crime.

Full video transcript:

Hi there. My name is Akiesha Anderson, and as you know, I am the policy and advocacy director for Alabama Arise. I’m here once again to provide you with another weekly legislative update.

If you by any chance were following what happened at the State House last week, then you, like me, were probably somewhat exhausted if not depleted by the time the week was over. So before I delve into this week’s update, I do want to hold space for that reality and to thank you for all that you do to help to make this state better. Even in response to the tough political terrain that we often find ourselves in, it’s people like you that continue to show up and stay engaged with the political process that help to position us to create that Alabama that we hope to see.

Also, my apologies in advance — I know that these videos typically aren’t very long, but given all that happened last week and what’s slated to come up this week, I do think that I would be doing you a disservice by not talking about each of the things that I’m about to discuss.

Within the first three weeks of the legislative session, we have already seen a host of attacks targeting women’s health; diversity, equity and inclusion; public education funding; people’s rights to free speech and peaceful assembly; protecting our children from child labor and exploitation; and voting rights.

With regard to last week specifically, we started off with news about the Supreme Court ruling that embryos are human — something that has already had significant implications on women like me whose doctors have recommended IVF or other medical procedures in response to complications with conceiving naturally. In response to that decision, however, I am grateful that legislation like HB 225 designed to protect people’s ability to access IVF treatment without fear of prosecution has been filed by House Minority Leader Anthony Daniels.

Also less than ideal last week, we saw SB 129, the anti-diversity, equity and inclusion bill, be quickly introduced and placed on a committee agenda. Basically was heard the next day, within hours of being placed, or within hours of dropping in the Senate. This legislation unfortunately has already passed out of the Senate at an unprecedented speed. If passed into law, this bill would essentially ban diversity, equity and inclusion departments, programs and staff from existing on the campuses of our public institutions, namely colleges and universities. It would also rob many students of color of one of the few safe spaces that we often feel like we have while on the campuses of predominantly white institutions, or PWIs.

Also unfortunate last week, the CHOOSE Act, or HB 129, was voted out of the out of the House Ways and Means Education Committee. While I myself was someone who attended what would be considered a failing or an underperforming school while growing up here in Montgomery, Alabama, and while I definitely understand the desire of parents to have access to quality education, the truth is we cannot as a state ignore the fact that too many students are being failed by the public education system because of the fact that we have failed to properly fund the education system. Meaning our public schools need more, not less, resources in order to give our children the access to quality education that they deserve. Unfortunately, however, the CHOOSE Act, which would possibly help defund public education, is being backed by some powerful representatives and senators, Rep. Garrett in the House and Sen. Orr in the Senate, as well as being backed by Gov. Ivey. Thus it seems slated to be passed out of the House as early as this week.

Last week, we also saw a piece of legislation sponsored by Sen. Orr that would curb people’s ability to protest in residential areas. In particular, this bill would prohibit any protest near the residence of a public official that’s designed to “disturb” that official. Thus, this bill would have drastically undercut the right to protest public officials — and to be clear, all protests by nature are designed to disturb the peace of people in power. The right of Alabamians to make their voices heard is something that has been a bedrock to our democracy and has long been a tool utilized to transform both local and national policies. This right is also something that’s protected by both the First Amendment and the Alabama Constitution. Yet if passed, SB 57 would undermine both of those.

Looking ahead into this coming week, I am happy to report that things aren’t all bleak and grim. While many of the bills I just discussed may continue to move through the legislative process and advance this week, so too may other bills, including some that we are supportive of.

For example, HB 77 by Rep. Rigsby passed out of the House Health Committee last week, as well as the full House last week. Thus, it is positioned to be heard by the Senate at any point. If passed, this newborn screening bill would help advance some of our goals related to our new issue priority surrounding maternal and infant health.

Similarly, related to another new issue priority, HB 32 by Rep. England is slate to be heard in the House Judiciary Committee this Wednesday at 1:30 p.m. While a public hearing has been called on this bill and a vote won’t take place on it until next week, if passed, this bill could bring Alabama in line with the majority of states regarding the way that we apply the felony murder rule. As you may recall, working on this new issue under our criminal justice portfolio was proposed and approved by our Arise members last fall.

And for the sake of brevity, I’ll simply try to name a few other good bills to have on your radar, as they will be in committee this week as well.

SB 35 by Sen. Smitherman would require all history lessons to be fact-based. SB 83, also by Sen. Smitherman, would help more people in need of indigent defense by increasing the compensation that attorneys get for representing clients that need court-appointed counsel. Currently, many attorneys simply can’t justify taking on court-appointed cases given the low rate at which they’re currently compensated for such work. Also, HB 188 by Rep. Collins would create a uniform due process, procedure, standards and rights for schools to follow when taking certain disciplinary actions against students.

Also worth having on your radar, however, are going to be some bills of alarm that will also be in committee this week. Those include SB 1 by Sen. Gudger. If you recall, this is the bill that criminalizes certain forms of helping people with delivering their absentee ballot. This bill will have a public hearing in Room 418 at 9 a.m. on Wednesday, and if you are interested in testifying or being in that room to witness what happens, I definitely encourage you to show up early, because that is a very small room and the seats are limited.

Also, HB 102 by Rep. DuBose, which is a piece of legislation that mirrors Sen. Orr’s legislation that weakens protections against child labor in the state, will be deliberated in a House committee on Wednesday as well.

And honestly, y’all, I know that that is a lot, and it’s probably not as hopeful as we would like it to be. But those are this week’s updates on what happened during the third week of the legislative session and what we’re on the lookout for as we enter into the fourth week of session.

So hopefully the next time I come to you is with a more upbeat update, and just better news regarding what’s happening at the State House. In the meantime, take care, y’all.

The urgency of improving maternal health outcomes in Alabama

By Victoria Enyinda Petty

I am honored to join the Alabama Arise team to help address one of the most pressing issues facing our state: maternal health. My name is Victoria, and I am Arise’s new maternal health fellow. I come to Arise with a deep passion for improving maternal health outcomes for all individuals in our state.

About me

My professional journey spans several industries, including higher education, corporate wellness, disease intervention and event management. These experiences provided me with a unique and diverse perspective in all my pursuits. With a bachelor’s degree in health care management and a Master of Public Health degree from the University of Alabama at Birmingham (UAB), I have dedicated my academic and professional endeavors to understanding the complexities and nuances of health.

Victoria Enyinda Petty, Alabama Arise’s maternal health fellow

I am a fourth-year Ph.D. student in the Community Health Promotion program at UAB, where my research focuses on maternal health disparities and interventions to improve health outcomes for mothers. Throughout my professional and academic career, I have been consistently driven by a desire to make a meaningful impact on the population’s health and well-being, particularly in the realm of maternal health.

Why I do this work

I believe every Alabamian deserves access to high-quality maternal health care, regardless of their race, income or ZIP code. Pregnancy and childbirth should be moments of joy and celebration. But for far too many individuals in Alabama, they are shadowed with challenges, barriers and tragedy.

Maternal health in Alabama

Alabama has some of the worst maternal mortality rates in the country, particularly among Black residents. Many counties in Alabama also are considered “maternity care deserts.” This means pregnant individuals there lack access to essential obstetric services close to home. Additionally, the shortage of obstetricians and other maternal health care providers in rural areas further compounds maternal health challenges.

Without adequate access to prenatal care and skilled providers, pregnant individuals are at higher risk of experiencing complications during pregnancy and childbirth. This lack of access not only exacerbates existing health disparities, but it also puts lives at risk.

These are just a few examples of why our work in maternal health advocacy is so crucial. By advocating for policies that expand access to prenatal care, address racial disparities in maternal health outcomes and invest in maternal health care infrastructure, we can make a tangible difference in the lives of countless individuals and families across Alabama.

This year, I look forward to working with our community partners as we strive to create a future where individuals in Alabama have the opportunity to thrive during pregnancy and beyond.

Arise legislative update: Feb. 6, 2024

By Matt Okarmus

Arise’s Akiesha Anderson welcomes everyone to the Alabama Legislature’s 2024 regular session. She talks about what we’ll be looking out for on our members’ legislative priorities and how you can stay engaged with us this year as we work to build a better, more inclusive Alabama.

Full video transcript:

Hi, everyone. My name is Akiesha Anderson, and I am the policy and advocacy director for Alabama Arise. I am here to give a brief update on the 2024 legislative session.

So if you are not aware, the 2024 legislative session will begin on Tuesday, Feb. 6. In the day prior to the beginning of the legislative session on Monday, Feb. 5, there will be budget hearings that will take place just about all day, and on Tuesday morning, those budget hearings will continue.

And then Tuesday afternoon, the legislative session will begin. This legislative session, we believe that there is a lot in store for Arise and our members and supporters, and we look forward to keeping you posted each week with the updates of what happened at the State House in the week prior.

And so for now, what we are anticipating before the start of the legislative session is that there will be a lot of hot topic issues that come up this session, some controversial issues that we may not be in support of. But we also are hopeful that our legislative priority issues — things related to maternal infant health criminal justice reform, death penalty reform, state budgets, tax reform, closing the health care coverage gap — all those things we hope will be up on the agenda of this session.

And so, again, we look forward to keeping you posted throughout legislative session about how things are progressing. And if you have any questions along the way, please don’t hesitate to reach out to our office.

But we especially look forward to making sure that you all stay engaged with the different action alerts that we send out, contacting your legislator and making sure that your voice is uplifted, to make sure that people at the State House understand and know what it is that you care about and what it is that you would like to see this session.

Take care.

It’s time for Alabama to prove we care about mothers and children

By Akiesha Anderson

Healthy parents and healthy children mean a healthier future for Alabama. Comprehensive maternal and infant health care investments are crucial to ensure the health and safety of both infants and Alabamians of child-bearing age, especially postpartum mothers, pregnant women and future mothers.

Alabama Arise envisions a world in which each successive generation is ensured a secure and healthy future. By adopting policy solutions to increase the number of health care providers and extend health coverage to more people, Alabama lawmakers can help turn that vision of a brighter future into a reality.

A deadly problem

Alabama has the highest maternal mortality rate in the nation. Similarly, Alabama’s infant death rates are higher than those in most other states. Alabama has the nation’s third highest infant death rate, behind only Mississippi and Arkansas.

Another sobering fact accompanies these stark realities: Black infants and Black Alabamians who give birth experience higher mortality rates than their white and Hispanic counterparts. In fact, the infant mortality rate for Black babies is 1.5 times higher than the state average and nearly twice as high as the infant mortality rate for white babies. Similarly, Black mothers in Alabama are twice as likely to die during childbirth as their white counterparts.

Contributing factors

No one specific factor is solely responsible for the poor maternal and infant outcomes in Alabama. Rather, numerous challenges have combined to cause and worsen the situation. Listed below are a few of the key ones.

Maternity care deserts: Perhaps the most alarming factor is the prevalence of maternity care deserts in Alabama. A maternity care desert is defined as a county or area where there is a lack of access to maternity care resources. These areas often have no obstetric providers and no birth centers or hospitals offering obstetric care.

More than one-third of Alabama counties are maternity care deserts, with some people having to drive up to 100 miles to reach the nearest labor and delivery department. The lack of essential delivery and prenatal care in the Black Belt and other areas worsens the state’s maternal and infant health disparities, especially for women with low incomes.

Lack of Medicaid expansion: Alabama has a high rate of women of childbearing age who are uninsured. Nearly 300,000 Alabamians find themselves in the state’s health coverage gap. They make too much money to qualify for Medicaid, yet too little to afford private health insurance. In Alabama, 1 in 6 women aged 18 to 44 – or roughly 16% – are uninsured.

Alabama has the nation’s sixth highest rate of uninsured women of childbearing age. Research shows that Medicaid expansion is associated with lower rates of infant and maternal mortality as well as with improvements in preconception health care access and health care use before pregnancy. But Alabama remains one of only 10 states that have not expanded Medicaid to cover adults with low incomes.

Limitations resulting from state policies: Across the nation, the leading cause of infant mortality is birth defects. One in five infant deaths results from severe birth defects. But Alabama fails to screen many newborns for several rare but treatable diseases. One likely reason for that shortcoming is a lack of dedicated state funding for such screenings.

Chemical endangerment laws also lead many doctors to forgo screenings that could help catch addiction-related issues for expecting parents. Instead of incentivizing appropriate screening, treatment and harm reduction, these laws criminalize addiction and cause more harm, according to the Alabama Maternal Mortality Review Committee.

Administrative choices for Medicaid: Numerous other policy changes could promote better health for parents and infants across Alabama. Among the March of Dimes’ recommendations are “improved integration of the midwifery model of care, reimbursement for doula care, and increasing the availability of telehealth services.” Medicaid also could allow reimbursement for donor breast milk.

Impacts of the abortion ban: Alabama’s abortion ban is considered one of the nation’s most restrictive. Infants born in states with the most restrictive abortion laws are “significantly more likely to die before their first birthday than [a]re those born in states with no restrictions,” a 2020 study in the International Journal of Environmental Research and Public Health found. In addition, the exceptions to Alabama’s ban are inadequate to protect the health of the parent.

Where do we go from here?

Alabama Arise is committed to learning more about and advocating for policy solutions to improve maternal and infant health outcomes in the state. This will include advocacy for Medicaid expansion to close Alabama’s health coverage gap. We also will monitor and aim to support administrative efforts to promote better maternal and infant health.

Universal school breakfast would benefit Alabama’s children in many ways

By LaTrell Clifford Wood

 

Universal school breakfast would:

Improve the state of child hunger in Alabama.

  • 23% of school-age children in Alabama are food insecure.
  • Universal school breakfast could guarantee a morning meal for nearly 280,000 Alabama children during their required school day.

Address chronic absenteeism.

  • Alabama’s statewide chronic absenteeism more than doubled from 8% to 18% in 2023 after schools stopped serving universal school meals.

Improve adolescent mental health.

  • Young adults who reported experiencing food insecurity during childhood also reported greater psychological distress in adulthood, according to National Health and Nutrition Examination Survey data.

Improve standardized testing and math scores in Alabama.

  • Alabama ranks 46th in average math ACT scores.
  • Student academic achievement increases, especially for math, when accessible breakfasts are made available to school-age children.

Alleviate behavioral problems and the school-to-prison pipeline.

  • Alabama children ages 10 and up are detained at nearly twice the national average, with children of color detained twice as frequently as their white peers.
  • The School Breakfast Program originated from a community pilot program that demonstrated the positive impact of universal breakfast for Black school-age children specifically.

‘No one should have to go through what I did’

By Whit Sides
Diana Isom (right) smiles alongside her husband, Luke, and their son, Keenan. Diana, a resident of Athens, Ala., was uninsured during her pregnancy and struggled to find affordable options for the health care she needed. (Photo courtesy of Diana Isom)

When Diana Isom became pregnant with her first son, Keenan, back in 2021, it was what she’d always wanted.

“My husband and I had been trying for years. I was so happy, but immediately started thinking about timing,” Diana said.

Timing is always a big consideration for most first-time parents, but for Diana and her husband, Luke, things were a little more complicated. When Luke lost his job suddenly, he had to start training in a new technical field. This meant he lost the private health coverage they had previously.

Even though Diana was working full-time hours as a health care worker, she was paid hourly and offered no benefits. She faced a frightening new future: being pregnant with no health coverage.

“I knew I was fully on my own when the medicine I needed was $200 a month and I’m out here with no insurance. Zero options,” Diana said.

Diana, now 26 years old, was raised in Vestavia Hills. Her parents, native to Panama, moved to the United States more than two decades ago when she was 4 years old.

“When I was a child, my parents came to this country so I could have a better life and a better education. I was taught that America was freedom and happiness… and that hard work can get you whatever you want,” Diana said.

Building a life despite uncertainty

As she got older, Diana said she remained positive and worked hard so she could have opportunities her parents never did.

“When the DACA [Deferred Action for Childhood Arrivals] (policy) was passed in 2012, kids like me, who grew up here in America, qualified as ‘Dreamers.’ I was so excited to be able to get a work permit! I’ve been working ever since,” she said.

Under federal DACA provisions, Diana also could access her driver’s license, a Social Security card and other important documents. These documents could help her secure a job, a home or even just a doctor’s visit.

When Diana and Luke got married, she received a green card. But she decided she would begin the lengthy immigration process in 2017, to make everything “official.”

She grew up in Alabama and wanted to start her own family here. Even so, she had to spend five years – and thousands of dollars – to gain citizenship status.

“My life is here,” she said. “I don’t want to have to go back to Panama. My friends are here. My job and family are here.”

When she was growing up, Diana said, other kids bullied her about her status. Even though Alabama was all she had ever known, she still felt a gnawing sense of insecurity.

“In really bad times in my life, people would threaten to call immigration or ICE on my family,” Diana said. “So I jumped through all these hoops and saved up thousands of dollars to make sure that never happens again. Not for me, and not for my son.”

The stress of being uninsured during pregnancy

In 2021, the Isoms received the good news that Diana would finally receive her citizenship. There was only one hitch: It wouldn’t take effect until three months after her baby was due.

Most Alabama mothers with low incomes now are eligible for Medicaid coverage for up to one year after childbirth, thanks to the state’s postpartum coverage extension in 2022. Even though Diana now had her green card, she had to pay out of pocket for health care during and after pregnancy because of a five-year Medicaid eligibility waiting period.

So she faced it alone.

“I had horrible prenatal depression. No one talks about that. It’s awful,” Diana said. “All the stress of not having insurance and my husband working on a temp basis. He either gets hired on or he’s fired. Every time. That stress is crazy!”

Diana said finding the care she and her baby needed while pregnant became like a second job.

“It’s so mentally draining,” she said. “Ever since they rejected me from Medicaid, I’ve been crying and crying. I’m so numb with the whole process, but I couldn’t give up.”

When she realized the couple’s private insurance had lapsed and no other lifelines were in sight, she began researching resources. She went to a free primary care clinic serving mostly Hispanic patients. But she found it difficult to navigate materials provided in Spanish because her first language growing up was English. And the clinic couldn’t provide all the prenatal screenings she needed.

The experience left Diana lonely and struggling to bond with her child throughout her pregnancy.

“Most people get regular ultrasounds. Without insurance, the hospital I went to only offered me the bare minimum. I got to see my baby two times: at the beginning and at the end. That was it,” she said.

‘I shouldn’t have ever been left behind’

Diana’s local hospital was her only option. As she continued to be billed for more than $1,500 a visit, she said she spent many nights wondering how her new family could afford it all.

“You do what you have to do, and I made it all work for my child because that’s what my parents did for me,” she said. “I shouldn’t have ever been left behind, and now neither should my baby.”

After a 19-hour complicated labor and delivery, baby Keenan was born in early 2022. Three months later, Diana joined him in gaining full American citizenship.

Diana thought her citizenship ceremony would lift her spirits and give her family the celebration they needed after a stressful pregnancy, but the process proved a bit impersonal and underwhelming.

“We drove nearly four hours to the immigration office. When I sat down, there was just an officer calling in on Zoom. I was looking at an iPad screen when I ‘became an American,’” she said.

Diana said she is grateful for her new status, but her time as an uninsured mother was a stark reminder that the playing field is not equal for everyone who lives in Alabama.

“People like me who have been in this country for so long… we pay taxes,” she said. “You’re telling me I pay into it, but not benefit from it?”

Though most undocumented immigrants live in a family with a full-time worker, they have limited access to employer-sponsored coverage, a Kaiser Family Foundation report found. And while they pay the same taxes as citizens, they often are employed in low-wage jobs and industries that are less likely to offer employer-sponsored coverage, like Diana is.

Medicaid expansion is the path to a healthier future for Alabama parents

Diana was ineligible for Medicaid after her pregnancy, both because she was not yet a citizen and because Alabama had not yet extended postpartum coverage to one year.

She would now qualify for Medicaid coverage during and immediately after future pregnancies if she met the income eligibility standards. 

Alabama remains one of 10 states yet to expand Medicaid. That means tens of thousands of Alabama parents still have no affordable long-term path to the health care they need as they seek to provide for their families.

Hundreds of thousands of Alabamians stand to gain access to health coverage if our state expands Medicaid. In the Huntsville metro area where Diana and her family live, that includes more than 11,000 people in Madison County and nearly 3,000 people in Limestone County.

Diana said her difficult journey has turned her into a fierce advocate for Alabama mothers.

“Medicaid expansion is a given,” she said. “The stuff I had to deal with in my pregnancy; the days I had to cry myself to sleep. I was always thinking, ‘Today is gonna be the day that something bad happens to my baby.’”

The Isoms’ new son, Keenan, is now insured under Alabama’s Medicaid program. Diana recently returned to work, and her husband was hired on full time after completing workforce training. They soon will be covered by his health insurance. 

Diana said having coverage for both baby and mom has been such a relief to their family.

“I’ve been able to let go of so many things I was worried about before: being deported and away from my child, or how I was going to be able to go to the doctor, even just sleeping at night,” she said. “No one should have to go through what I did. No one.”

About Alabama Arise and Cover Alabama

Whit Sides is the Cover Alabama storyteller for Alabama Arise, a statewide, member-led organization advancing public policies to improve the lives of Alabamians who are marginalized by poverty. Arise’s membership includes faith-based, community, nonprofit and civic groups, grassroots leaders and individuals from across Alabama. Email: whit@alarise.org.

Arise is a founding member of the Cover Alabama coalition. Cover Alabama is a nonpartisan alliance of advocacy groups, businesses, community organizations, consumer groups, health care providers and religious congregations advocating for Alabama to provide quality, affordable health coverage to its residents and implement a sustainable health care system.

Medicaid ‘unwinding’ hits halfway mark in Alabama

By Jennifer Harris

In April, Medicaid ended a continuous coverage eligibility period brought on by the public health emergency during the COVID-19 pandemic. What followed was a return to traditional eligibility requirements. This return to normal rules is called “unwinding.” Coverage losses have begun, and tens of thousands of Alabamians likely will lose their Medicaid coverage by June 2024.

A little more than halfway through the unwinding process, Alabama Medicaid members have a renewal rate of 68%. Only 4% of Medicaid members have been determined to be ineligible, while 27% of members lost coverage for procedural reasons.

From this information, we know more than 70% of Medicaid members have responded to requests for eligibility information from Alabama Medicaid. This response rate can be credited to Alabama Medicaid having a clear and concise communication plan. It also is a testament to the strong support of health care advocates in communities across Alabama.

But this does leave many thousands of people who are disenrolled for procedural reasons. And these losses are especially harsh for those who still may be eligible for coverage. When coverage loss occurs for procedural reasons, enrollees may need to submit further information to keep or maintain coverage. To prevent unnecessary coverage loss, please return any application materials to Alabama Medicaid, even if you do not think you are eligible. Only Alabama Medicaid can determine eligibility status.

A graphic promoting an Alabama Arise toolkit. Headline: What you need to know about Alabama Medicaid's unwinding period. Text: Visit alarise.org/medicaidunwinding. Between the headline and text is a close-cropped photo of a woman reaching out to accept an insurance card while handing a clipboard to them. The clipboard includes a paper with "health insurance" as the headline. An Arise logo is at the bottom of the image.

If you have lost coverage, you may reapply with Alabama Medicaid. You also can contact Enroll Alabama for information on options for Marketplace insurance under the Affordable Care Act. If you feel that Medicaid terminated your coverage in error, you may appeal that decision. Call our partners at ADAP at 800-826-1675 for help.

For more information, please check out Alabama Arise’s Alabama Medicaid unwinding toolkit.

Maternal, infant health care debuts as an Alabama Arise priority

By Whitney Washington

Alabama Arise reached a new milestone in October when more than 500 members voted to determine Arise’s 2024 legislative priorities after our Annual Meeting. Nearly 100 members attended the meeting in person at the Equal Justice Initiative’s Legacy Institute in Montgomery, while almost 250 attended virtually. Outgoing board president Kathy Vincent led the meeting, which featured presentations from Arise staff and member group representatives.

Fifteen Alabama Arise staff members, all wearing either red or green shirts with the Arise logo, stand and smile for a group photo. To their left is a red brick wall, and behind them is a black wall with two framed photographs.
Alabama Arise was excited to have a record number of members voting on our legislative priorities this year! Above: Arise staff members pose for a group photo after our Annual Meeting on Sept. 30, 2023, in Montgomery. (Photo by Julie Bennett)

Six of the seven priorities are returning from our 2023 agenda:

  • Fully untaxing groceries
  • Expanding Medicaid
  • Voting rights
  • Criminal justice reform
  • Comprehensive maternal and infant health care
  • Dedicated funding for public transportation
  • Death penalty reform

Read our news release for more information about each priority.

A safer and healthier Alabama for parents and children

A notable newcomer to our roster is a comprehensive approach to maternal and infant health care, which was proposed by ACLU of Alabama. This priority certainly aligns with our ongoing work to expand Medicaid and close Alabama’s health coverage gap. And our members decided it was critical for this to become a named priority in its own right. We are starting off strong by hiring a maternal health fellow to support our work to protect coverage during the Medicaid unwinding period.

Advocates have a long road ahead on this issue. Alabama has the highest maternal mortality rate in the nation. And according to the March of Dimes, more than one-third of Alabama’s counties are “maternal care deserts.”

Two Alabama Arise members speak at our 2023 Annual Meeting. On the left is a white woman wearing glasses with a black blouse and a striped pink shirt over it. She has a purse over her shoulder and a bag in front of her. On the right is a Black man wearing a black hat and a cream-colored shirt with an Alabama Arise button. Both are wearing nametags.
Alabama Arise members Victoria Jenkins and Tem Samuel speak during the closing moments of our Annual Meeting on Sept. 30, 2023, in Montgomery. (Photo by Julie Bennett)

A safer Alabama for mothers will include access to high-quality maternal health care where patients live, removal of criminal penalties for doctors providing necessary care, and more freestanding maternal care centers across the state.

Alabama’s mothers and babies deserve so much better. Arise is committed to creating a safer and healthier state that will give parents, children and every Alabamian the chance to thrive and achieve their full potential.

Alabama Arise unveils 2024 roadmap for change in Alabama

By Chris Sanders

Expanding Medicaid and ending the state sales tax on groceries will remain top goals on Alabama Arise’s 2024 legislative agenda. The group also will pursue a multifaceted approach to improving maternal and infant health in Alabama.

More than 500 members voted to determine Arise’s legislative priorities in recent days after the organization’s annual meeting Saturday. The seven priorities chosen were:

  • Adequate budgets for human services, including expanding Medicaid to make health coverage affordable for all Alabamians and protecting public education funding for all students.
  • Tax reform to build a more just and sustainable revenue system, including eliminating the rest of Alabama’s state sales tax on groceries and replacing the revenue equitably.
  • Voting rights, including no-excuse early voting, removal of barriers to voting rights restoration for disenfranchised Alabamians, and other policies to protect and expand multiracial democracy.
  • Criminal justice reform, including legislation to reform punitive sentencing laws and efforts to reduce overreliance on exorbitant fines and fees as a revenue source.
  • Comprehensive maternal and infant health care investments to ensure the health and safety of Alabama families.
  • Dedicated funding for public transportation to empower Alabamians with low incomes to stay connected to work, school, health care and their communities.
  • Death penalty reform, including a law to require juries to be unanimous in any decision to impose a death sentence.

“Arise believes in dignity, equity and justice for everyone,” Alabama Arise executive director Robyn Hyden said. “Our 2024 legislative priorities reflect our members’ embrace of those values, and they underscore the need to enact policies that empower Alabamians of every race, income and background to reach their full potential. Together, we’re working to build a healthier, more just and more inclusive Alabama for all.”

An infographic naming Alabama Arise's 2024 legislative priorities, Arise's roadmap to a better Alabama. The priorities are untaxing groceries, Medicaid expansion, voting rights, criminal justice reform, maternal and infant health, public transportation and death penalty reform.

The time is right to close Alabama’s health coverage gap

One essential step toward a healthier future for Alabama is to ensure everyone can afford the health care they need. Arise members believe Medicaid expansion is a policy path to that destination, and research provides strong support for that position.

Expanding Medicaid to cover adults with low incomes would reduce racial health disparities and remove financial barriers to health care for nearly 300,000 Alabamians. It would support thousands of new jobs across the state. And most importantly, it would save hundreds of lives every year.

“Medicaid expansion would boost our economy and improve the lives of hundreds of thousands of Alabamians,” Hyden said. “It’s time for Alabama’s policymakers to make this life-saving and job-creating investment in the people of our state. Ensuring Alabamians’ health and well-being now will help our state flourish for decades to come.”

Alabama became one of only 10 states yet to expand Medicaid after North Carolina enacted expansion in March. Medicaid expansion would ensure health coverage for nearly 300,000 Alabamians caught in the coverage gap. Most of these residents earn too much to qualify for the state’s bare-bones Medicaid program but too little to afford private plans.

How Medicaid expansion would improve maternal and infant health

Medicaid expansion also would bolster health care access for Alabamians before, during and after pregnancies. This would be a critical life-saving move in Alabama, which has the nation’s worst maternal mortality rate. Those rates are even higher for Black women, who are twice as likely to die during birth as white women. Adding to the problem, more than two-thirds of Alabama counties offer little or no maternity care or obstetrical services.

“Alabama took an important step to help families stay healthy by extending Medicaid postpartum coverage last year,” Hyden said. “However, that step alone was not enough to meet our state’s numerous health care needs. Policymakers should pursue numerous solutions to make Alabama a better place for parents and babies. At the top of that list should be expanding Medicaid to ensure Alabamians of all ages can stay healthy before, during and after conception.”

New to Arise’s agenda this year is a comprehensive policy approach to safeguarding and expanding access to maternal and infant health care in Alabama. In addition to Medicaid expansion, this approach would promote seamless continuity of care between home and clinical settings. It would include coverage for contraception and midwifery services. And it would eliminate the specter of criminal penalties for doctors who provide care to pregnant people who are experiencing life-threatening complications.

Finish the job: Alabama should remove the rest of the state grocery tax

Arise advocacy got results this year when legislators voted unanimously to reduce Alabama’s state sales tax on groceries by half. The new law reduced the state grocery tax from 4 cents to 3 cents on Sept. 1. Another 1-cent reduction will occur in 2024 or the first subsequent year when education revenues grow by at least 3.5%.

Arise’s members have advocated for decades to untax groceries, and they renewed their commitment to continue that work in 2024. Ending the state grocery tax remains a core Arise priority because the tax makes it harder for people with low incomes to make ends meet. The tax adds hundreds of dollars a year to the cost of a basic necessity for families. And most states have abandoned it: Alabama is one of only 12 states that still tax groceries.

The state grocery tax brought in roughly 7% of the Education Trust Fund’s revenue in the last budget year. But lawmakers have options to remove the other half of the state grocery tax while protecting funding for public schools. Arise will continue to support legislation to untax groceries and replace the revenue by capping or eliminating the state income tax deduction for federal income taxes. This deduction is a tax break that overwhelmingly benefits the richest households.

“Reducing the state grocery tax was an important step toward righting the wrongs of Alabama’s upside-down tax system,” Hyden said. “By untaxing groceries and reining in the federal income tax deduction, lawmakers can do even more to empower families to keep food on the table. Closing this skewed loophole is an opportunity to protect funding for our children’s public schools and ensure Alabama can afford to end the state grocery tax forever.”

Here’s what Alabama Arise heard from you in summer 2023!

By Presdelane Harris

Alabama Arise listens because we deeply value the input we get from members, partners and most importantly, those directly affected by the work we do together. We depend on what we hear to help guide our issue work and our strategies.

We held three statewide online events this summer: two Town Hall Tuesdays and one public transportation listening session. And we facilitated eight additional listening sessions around the state, engaging a total of about 375 people.

The town halls happened on July 18 and Aug. 8, and the public transit event was Aug. 9. Other meetings took place throughout the summer. This year we are sharing the direct notes and highlights from each of the meetings as recorded during the sessions.

Town Hall Tuesdays & Public Transportation Listening Session

  • Building on our vision: We had three breakout rooms during this session. We asked folks in each group to discuss their thoughts on current issues and to share other priorities they had. Here’s what we heard:

Group One: Participants generally thought Arise should continue working on the current issues. They noted that the issues are interconnected, and that makes it hard to prioritize. Concerns about criminal justice conviction practices were raised, along with the need for continued work on voting rights and Medicaid expansion. Other issues raised were the need for more affordable housing, paying a living wage versus a minimum wage, and the need to discuss the impact of the opioid epidemic on grandparents now raising children because their parents suffer with addiction. Participants also raised reapportionment as an important issue.

Group Two: Participants strongly believed all of the Arise priority issues are important and that we should continue to work on them. Some of the specific issues lifted up were transportation, voting rights, payday lending and Medicaid expansion. Some issues that are not current Arise priorities raised were housing, disability, mental health access and accountability and prison reform.

Group Three: Medicaid expansion received the most support for continued work. Several people voiced prisons and criminal justice as a concern, including the need for prison reform and bail reform. Voting rights and the concern about the many voter suppression bills was a high-priority topic. Participants discussed passionate concern about payday loans, and the group supported the present slate of issues.

  • Building on our hope: We had three breakout rooms during this session. We asked folks in each group to discuss what motivates them to act on issues and how Arise supports their actions. We also asked them to indicate their priority issues. Here’s what we heard:

Group One: 

  1. The discussion in the group was hot and heavy concerning voting rights and specifically the absentee ballot application. The group concluded that a no-excuse absentee ballot should be the norm and should be an Arise issue for 2024.
  2. The group felt strongly that the 2023 Arise slate of issues should all remain on the 2024 list of Arise priority issues. Medicaid is an issue we need to keep fighting for, they said.
  3. This group had a primary focus and lengthy discussion around voting rights.

Group Two: 

  1. All members of the group strongly believe all the Arise priority issues are important and that we should continue to work on them.
  2. Members also strongly believe affordable housing and public transportation should receive a strong voice like Medicaid expansion.
  3. Members said that to further our support of advocacy work, Arise can help unite nonprofits and grassroots organizations across the state to work together toward shared goals as opposed to working separately toward shared goals.
  4. Members lifted up our education and lobbying work as essential to connecting the people to those who represent them in the Legislature.

Group Three: Voting rights emerged as a strong theme from this group’s discussion. Participants stressed the importance of voter education and folks making the connection between voting and the policies elected officials make that impact their lives. Other voting themes included restoration of voting rights and engaging younger and BIPOC voters. Other issues raised were around public transportation and the need to fund mental health services. One participant expressed appreciation for the storytelling work Arise does related to Medicaid expansion and urged similar storytelling to help move elected officials around other Arise issues.

  • Public Transportation Listening Session: We had three breakout rooms during this session. We asked folks in each group to discuss what’s needed to improve public transit in Alabama, what strategies are needed to move the issue forward and how public transit impacts quality of life in their communities.

Group One: 

  1. Private companies like Uber and Lyft are not equipped to serve the disability community, group members said. This is very important when talking about transportation for the disability community wherever they may be, rural or urban. In other words, the private companies are not a viable resource, participants said.
  2. Rural linkage: Many rural counties have transportation-on-demand systems, but they only serve the county boundaries. Many health services reside in urban centers, and the rider needs to get from Blount County to UAB or Children’s Hospital in Birmingham. These riders are out of luck. Transfer hubs for rural to urban systems do not exist.
  3. A state transportation planning system is needed to coordinate all the existing public systems, rural and urban. Participants hoped Arise’s forthcoming transit study will shine some light on the need for a statewide public transportation planning entity.
  4. The group felt a need for massive public education around the benefits of public transportation. Somehow, Arise or a group of organizations should seek funding for an advertising budget, participants said.
  1. The real cost of owning a car versus using public transportation. This kind of information should be available to the public.
  2. The fact that public transportation is good for business development throughout the state should be targeted to legislators and local business councils and chambers of commerce.

Group Two: 

  1. This group believes public transportation is essential.
  2. There is a need for more hubs and covered stops for locations that already have public transportation in place.
  3. There is a need for more routes with more frequent buses each hour, as well as drivers who are paid livable wages.
  4. Specific strategies discussed included working with for-profits, chambers of commerce, small businesses and corporations to improve transportation for their employees. Participants also suggested surveying the need for transportation by including a question on applications to ask if transportation is needed.
  5. Public transportation impacts the quality of life across the board: health, food, employment, education, leisure, etc.
  6. People have a right to comfort, dignity, pride and independence that public transportation can provide.
  7. One member said reaching out to people who do not need or use public transportation is important to educate them that they can still benefit from it. It helps reduce traffic and road congestion, decreases likelihood of drinking and driving, and helps people out of desperate situations, which can help decrease poverty and crime.
  8. A member of the Alabama Institute for the Deaf and Blind shared how losing the ability to drive caused depression. But oppression is felt when there are no options for transportation other than relying on friends or family if you have them, or simply being unable to go to doctor’s appointments, shop for groceries or pick up medications when needed.
  9. Some members suggested a public Lyft/Uber service.

Group Three: 

  1. Needs: Money/state funding, alternative models, transit-oriented development at local levels, accessibility, buy-in from agencies like ALDOT, changed perception of public transit.
  2. Strategies/tactics: Collect public transit stories, share statistics on earning power with vs. without good public transit and other data relevant to workforce development, and highlight workforce development as a theme for legislative lobbying. Participants discussed a license plate fee, tire fee or special license plate (like public schools have, for example).
  3. Quality of life: A visually impaired participant described how a trip to the grocery store or polling place only a couple miles away is a $25 Uber ride one way. Another participant who works with clients described how their lack of access to public transit affects not just work but health appointments, visiting DHR to secure SNAP, applications for housing, etc. They also mentioned that even “low-cost” transit can be a barrier to low-income folks who may not have a dollar for a ride.

Additional listening sessions

Following are the brief notes/summaries from eight other sessions our organizers held during the summer. In general, all participants strongly affirmed Arise’s work on the current issue priorities. They also highlighted some other issues of concern.

  • Cullman, July 26 (Stan Johnson) – This was a well-informed group with a lot of comments and questions concerning criminal justice, public transportation, death penalty and new prison construction.
  • Opelika, July 26 (Formeeca Tripp) – This group discussed issues surrounding housing, transportation, food insecurity, health care and the legal system. Housing was a top issue.
  • Zoom, Aug. 3 (Formeeca) – A death penalty group discussed issues related to recent executions in Alabama, as well as upcoming executions nationwide. Participants said more attention and connections are necessary to bring more awareness to death penalty reform.
  • Tuscaloosa, Aug. 7 (Stan) – The most passionate suggestion from this meeting was the need for legislative action to provide funding for mental health.
  • Opelika, Aug. 17 (Formeeca) – Arise conducted listening sessions in the form of a series of small group meetings.

Group 1: Predominantly parents, people of the community and law enforcement. They supported all current issues but wanted to focus on housing and transportation.

Group 2: Predominantly school staff, counselors, superintendents, principals, resource providers, etc. They wanted resources for non-English-speaking families, housing, transportation and effective mental health services.

Group 3: Predominantly youth, teenagers and support staff. They wanted to learn more about their representatives and how to lift up their own voices, as well as better wages and job opportunities.

  • Montgomery, Aug. 17 (Formeeca) – This group discussed their strategic plan to add to the existing public transportation priority issue. They want to add a $1 fee to license plates to fund the Public Transportation Trust Fund.
  • Birmingham, Sept. 10 (Stan) – This group showed special interest in fair housing and criminal justice reform. Voting rights also was a concern to the group, specifically absentee voting bills that may be reintroduced in the upcoming session.
  • Auburn, Sept. 21 (Formeeca) – Students from an Auburn University class filled out a 2024 issue proposal survey form asking them to rank issues of priority. The top three issues that seemed to rank the highest were public transportation, voting rights and criminal justice reform.