Issue: Medicaid Expansion

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.

‘Everything is fine, until it isn’t’

By Whit Sides
Elizabeth works at a sewing machine in the family’s home. (Photo courtesy of Geoff)

Part 1: A hard winter ahead

Winter has been a long time coming for Geoff* and his wife, Elizabeth*. He didn’t think he could actually feel more anxious than he had since March, when he and his family began isolating along with the rest of the country.

(*Geoff and Elizabeth agreed to share their story using pseudonyms to protect their privacy.)

Every day since has been essentially the same. Geoff wakes up early to go for a run around his neighborhood in Montgomery. He gets back in time to get the kids ready for their long day of virtual learning.

But this morning, Geoff felt himself dragging.

“I am a young dude, but I get a new creak or squeak every day,” he says jokingly. Running used to be so much easier when he was in his 20s, he said. He’s now in his mid-30s.

His tone begins to shift, and his voice becomes heavy. “I lay down to go to sleep and everything is fine, until it isn’t,” he says.

Back in May, like millions of other Americans, Geoff started to realize his job was becoming less secure. Finally, in September, he was let go. “That’s when I started experiencing panic attacks,” Geoff said. “And like, who wouldn’t in my situation?”

Geoff lost his income, his daily routine and his health insurance on Oct. 1. He has found it hard to sleep ever since.

Alabama’s coverage losses have soared during the pandemic

The COVID-19 pandemic and resulting economic crash have caused the greatest health insurance losses in American history, according to research published by the nonpartisan research organization Families USA in July.

An estimated 5.4 million workers became uninsured because of job losses they experienced from February to May this year. And 69,000 of those are in Alabama.

“Even before COVID-19, Alabama’s failure to expand Medicaid left more than 220,000 adults uninsured,” Alabama Arise campaign director Jane Adams said. Adams directs Cover Alabama, a coalition of nearly 100 organizations pushing for Medicaid expansion in Alabama. Arise is a founding member of the coalition.

“Further coverage losses during the ongoing economic recession will bring health and financial suffering for even more families across our state. More people will go without needed health care. More hospital bills will go unpaid. And more families will fall into poverty.”

‘All the things I had that I suddenly don’t’

For Geoff, this coverage loss means every choice he makes could bring a new risk.

“I just lay there and my brain reminds me of all the things I had that I suddenly don’t, and it changes the way I interact with the world,” he said.

Geoff and his wife both remain physically active, he said. He used to take comfort in the alone time that running provided. But after he lost insurance, every crack in the pavement or acorn on the sidewalk gives him yet another thing to worry about.

“I have nothing,” he said. “If I fall and twist my ankle, that’s it. I won’t be able to provide for my family.”

Part 2: Sacrifice

Geoff and Elizabeth own a small event business in Montgomery. They have relied heavily on working weddings and other public events to pay the bills since losing his salary. Without these gigs, he said, he has no idea how they would make it after losing his salaried job.

Elizabeth also does freelance work that allows their kids to be covered under her private insurance. When Geoff first learned he’d be laid off, he immediately asked his wife if he could join her plan.

“You just take this stuff for granted, right?” Geoff said. “I had great insurance under my parents. Then, I was covered in college, and right after, I was blessed to get a good job,” he said.

But when he saw the monthly premium to get coverage with the rest of his family, he knew it wasn’t an option.

“It was thousands of dollars just to add me!” he said, exasperated. “She doesn’t even make that much altogether!”

Beyond just money, Geoff said he fears most for his children.

A simple hospital visit would cost several thousand dollars thanks to a high deductible, he said. Even a quick trip to the doctor for his children would set them back on groceries for a few weeks.

“I make sacrifices,” he said. “I haven’t bought anything for myself since April, but I still can’t give my kids everything they need, and that is terrifying.”

Geoff and his wife have relied on word of mouth to book business. Their work often means taking jobs that leave the family at higher risk of contracting COVID-19.

“I’m a healthy guy, but every day you see a news story with bodybuilders… guys bigger than me hospitalized and their bodies just ravaged by this virus,” he said.

Parental coverage loss hurts children, too

“COVID-19 is jeopardizing lives and economic security for thousands of Alabama workers just like Geoff,” Adams said.

And now that case numbers are rising exponentially as the United States faces its third wave of COVID-19, many local communities are facing long-term challenges for health care capacity and economic recovery.

Geoff and Elizabeth’s children at the dinner table. (Photo courtesy of Geoff)

But Geoff said he has more to worry about than just the virus. “I’m getting used to the panic attacks because even though I’m undiagnosed, I know it’s a product of the situation I’ve been put in,” he said. “It’s not so easy when I think of my daughter.”

Geoff and Elizabeth’s young daughter was diagnosed with autism spectrum disorder at a young age and was receiving regular care from a specialist. After months of research to find a provider, it would take them even longer to get an appointment.

“And that was with great insurance,” Geoff said.

After losing his job, they could no longer afford the $150 out of pocket per visit. They stopped going to appointments.

“We are left with a child who spends all day at home with two parents who are very clearly not experts for autism. Not even close,” Geoff said.

Part 3: The shock of it all

It’s becoming harder and harder for Geoff to relax. What weighs the most, he said, is the shock of it all – even this long into the pandemic.

“I mean, look, I’ve been blessed my whole life,” he said. “I’m a white guy in Alabama. I have a college degree. My parents set me up for success. But things are falling down all around us.”

Geoff said he would vote for Medicaid expansion if it were on the ballot.

“Growing up in Alabama, you always gotta expect the worst but still try to vote for the best,” he said.

For the first time in his 30 years of living in Alabama, Geoff said he feels like state leaders might finally shore up the safety net that keeps so many Alabamians afloat.

“We have got to give up this long legacy of Scotch-Irish stubbornness passed on from our state’s founders hundreds of years ago,” he said. “It’s 2020. You can no longer pretend that you don’t know who you’re hurting by not offering folks help.”

Geoff’s family enjoying the beach. (Photo courtesy of Geoff)

‘I feel like I did everything right’

Recovering from the COVID-19 recession – as families, as a workforce, as a state – is going to require every tool and resource available. Closing the health coverage gap for tens of thousands of hard-working Alabamians like Geoff is the single biggest step our state can take to protect families from delayed health care and medical debt, strengthen our economy and move Alabama forward.

Geoff said if this year has taught him anything, it’s that being nimble is just as important as planning.

“I feel like I did everything right,” he said. “I did everything right, and still I woke up one day and none of that matters. I need help just like everybody else.”

About Alabama Arise and Cover Alabama

Whit Sides is the story collection coordinator for Alabama Arise. Arise is a nonprofit, nonpartisan coalition of congregations, organizations and individuals promoting public policies to improve the lives of Alabamians with low incomes.

Arise is a founding member of the Cover Alabama Coalition. Cover Alabama is a nonpartisan alliance of nearly 100 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.

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.”

Town Hall Tuesdays 2020: What we heard from Arise supporters

By Presdelane Harris

Listening is often an underdeveloped skill, yet it is critical for mutual understanding and working together for meaningful change. That’s why Arise is committed to listening to our members, to our allies and most importantly, to those directly affected by the work we do together. We depend on what we hear from you to guide our issue work and our strategies.

This year’s COVID-19 pandemic challenged us to be creative in finding ways to listen. Instead of our usual face-to-face meetings around the state, we hosted a series of six statewide online Town Hall Tuesdays. We held events every two weeks, starting in June and ending Sept. 1. We averaged 65 attendees at each session. Here’s some of what we heard from members and supporters:

  • Affirmation for Medicaid expansion, untaxing groceries and other current Arise issues as important for achieving shared prosperity.
  • Empathy for those who were already living in vulnerable circumstances further strained by the pandemic.
  • Concern about ongoing, intentional barriers to voting, especially during the pandemic.
  • Desire to see more resources to meet the needs of our immigrant neighbors.
  • Alarm about payday and title lending and its impact on people’s lives and our communities.
  • Passion and concern about many other issues, including housing; living wages and pay equity; prison and sentencing reform; gun safety; juvenile justice reform; defunding the police; the Census; environmental justice; quality and funding of public education; and food insecurity and nutrition.
  • Willingness to take informed actions to make a difference in the policies that impact people’s lives.
  • Hope that Alabama can be a better place for all our neighbors to live despite systemic issues and ongoing challenges.

Notes from each town hall

Overviews of the town halls are below. Click the title for a PDF of the notes from the breakout sessions at each town hall.

June 23 – Money talks
We examined how to strengthen education, health care, child care and other services that help Alabamians make ends meet. And we explored ways to fund those services more equitably.

July 7 – Justice for all
We discussed Alabama’s unjust criminal justice system and how to fix it.

July 21 – Getting civic
Discussion focused on protecting voting rights and boosting Census responses during a pandemic.

Aug. 4 – Shared prosperity
We looked at policy solutions to boost opportunity and protect families from economic exploitation.

Aug. 18 – Feeding our families
We explored ways to increase household food security during and after the recession.

Sept. 1 – Closing the coverage gap
Discussion focused on how everyone can help expand Medicaid to ensure coverage for hundreds of thousands of struggling Alabamians. We also heard about the expansion campaign strategies of the Cover Alabama Coalition, headed by Arise campaign director Jane Adams.

Get in touch and stay in touch with Arise

Remember, we didn’t stop listening because the town halls ended. We want to hear from you, and we encourage you to contact the Arise organizer in your area:

We hope to see you at Arise’s online annual meeting Oct. 3!

Groups urge Dismukes’ resignation, ask Legislature to dismantle white supremacy through policy change

By Alabama Arise

Alabama Arise logo     Alabama NAACP logo    Greater Birmingham Ministries logo

The following is a joint statement from Alabama Arise, the Alabama State Conference of the NAACP and Greater Birmingham Ministries:

Our elected officials and appointed leaders should respect the full dignity, worth and humanity of all people they represent. We urge all political parties and public officials to acknowledge the harm that white supremacy continues to inflict upon Alabama. And we call upon them to dismantle white supremacist structures through intentional policy changes.

The cause of white supremacy permeates our state’s fundamental governing document. When the president of the 1901 constitutional convention, John Knox, was asked why Alabama needed a new constitution, his answer was clear: “to establish white supremacy in this state.”

Any celebration of Nathan Bedford Forrest of the Ku Klux Klan – a white supremacist terrorist organization – is contrary to the values that Alabamians expect from our leaders, elected officials and neighbors. In celebrating Forrest, Rep. Will Dismukes revealed he is unable or unwilling to represent the best interests of his constituents and his state. We condemn his actions in the strongest possible terms. We also understand this is not the first time Dismukes has celebrated the Confederacy or Forrest in such a manner. Therefore, we join with many other individuals and organizations across Alabama in calling for Dismukes to resign immediately.

Racial equity requires action, not just words

Alabama’s need for racial justice and healing reaches far beyond any one individual. All elected officials must take a hard look at both their actions and the impacts of their policy decisions. Most lawmakers claim to support racial equality, but the results of their policy choices often do not match this claim.

Examples of this mismatch are unfortunately common in our state. The 2017 Memorial Preservation Act prevents localities from removing statues that “honor” the Confederacy without paying a steep fine or getting approval from a panel of legislators that to our knowledge has not approved a removal since the law was enacted. Lawmakers’ failure to expand Medicaid leaves a disproportionate share of African Americans without health insurance during a pandemic. And the absence of racial impact data prevents communities and legislators from evaluating the full effects of state policy choices.

The harsh reality of racial disparities in Alabama

While Dismukes dismisses the need for racial reconciliation in today’s society, we cannot remain ignorant of the truth. We all must reckon with these disparities created and maintained by structural policy barriers:

It’s time for more than talk. Denouncing and rejecting white supremacy is only the beginning. Lawmakers also must enact meaningful policy changes to break down institutional barriers to opportunity and justice for all Alabamians.

Working in Alabama during the COVID-19 pandemic: Who faces the danger?

By Dev Wakeley

Many Alabamians have modified their work circumstances in recent months to reduce the risk of contracting COVID-19. But tens of thousands of people still must work in public-facing jobs that put them at increased risk of illness.

Front-line workers in grocery stores, hospitals and pharmacies perform necessary tasks to keep our communities functioning during the pandemic. The burden of facing those health risks is unevenly distributed, though. Workers in jobs like health care, food service and child care are disproportionately likely to be people of color or women. And state and national policy failures on COVID-19 are more likely to hit them the hardest.

Gender disparities and low wages increase risk

Differing employment levels in the health and retail fields particularly have forced more women to risk coronavirus infection. Two-thirds of Alabama’s essential workers are women, though women comprise just under half of the state’s total workforce.

Health care workers overall are much more likely to be women, and they face drastically heightened risk of infection at work. Among Alabama workers, women comprise 81% of health care workers and 89% of child care and social services workers. Jobs in these fields often require consistent exposure to large numbers of people.

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

Health care accounts for more than one in 10 jobs in Alabama. And the higher proportion of women in this field contributes to a gender-based disparity for COVID-19 exposure. In many cases, personal protective equipment (PPE) has run short for doctors, nurses and other health care professionals. This structural failure has forced many of these workers to reuse PPE, posing potentially severe health risks.

The wages and work conditions for essential front-line workers often don’t reflect the importance of their work. Many workers received higher hourly wages early in the pandemic, but now some employers have begun eliminating hazard bonuses. In the retail sector – already filled with low-wage jobs with sparse benefits – major employers like Amazon, Kroger and Target have stopped their wage bonuses.

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 has placed workers at risk of homelessness with an ill-timed wave of unemployment insurance (UI) benefits cutoffs coupled with the lifting of a two-month moratorium on evictions for nonpayment of rent. And a federally funded $600 weekly UI benefit increase during the pandemic will expire this month unless Congress renews it.

Racial disparities in employment and health coverage shape risk

Structural factors leave Black and Latino Alabamians at increased risk from COVID-19. Black and Latino people account for a disproportionate share of workers in essential jobs. And because of long-term, systemic racism that creates barriers to regular health care, Black people are more likely to have underlying conditions that worsen coronavirus outcomes.

Table: More than 1 in 3 of Alabama's front-line workers are people of color. 31.8% of Alabama front-line workers are Black, compared to 25% of the labor force. 2.3% of front-line workers are Latino and 1.3% are Asian Americans or Pacific Islanders.

Even among essential 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. The share of Asian Americans and Pacific Islanders who work in grocery and convenience stores is double their percentage of Alabama’s overall population.

Despite these elevated risks, Black and Latino Alabamians are far more likely than white people to lack health insurance coverage. And because Alabama hasn’t expanded Medicaid, Black and Latino 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.

This table shows the disproportionate burden that women, people of color and low-wage workers face across several essential employment fields:

Table: Women, people of color and low-wage workers are at greater risk of coronavirus exposure in front-line jobs across Alabama. Women are 47.9% of total workers in Alabama but 66.4% of front-line workers. People of color are 31.7% of all workers but 36.4% of front-line workers. 34.5% of front-line workers have incomes below 200% of the poverty line, compared to 31.9% of all workers.

Unfortunately, the chart’s data 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.

Shortsighted policy choices harm the economy and virus containment

Refusal to expand Medicaid and attempts to slash UI benefits are harmful policy decisions that fly in the face of the reality of the pandemic. And the burden of these cruel choices falls more heavily on people who already face disadvantages in the labor market.

More than 600,000 people have filed UI claims in Alabama since the pandemic reached the state in March. Thousands of Alabamians are already losing UI benefits for refusing to return to work in conditions they see as unsafe. Each person prematurely knocked off the UI rolls loses not only the $275 monthly state benefits, but also the $600 monthly federal supplement guaranteed through July. Alabama is forfeiting millions of federal dollars as a result.

That money would help shore up flagging state revenues for education, health care and other vital services. It also would help people meet basic needs and limit the coronavirus’s spread during an unprecedented economic and health crisis. Forcing people back to workplaces while COVID-19 is still rampant is a dangerous attempt to restore Alabama’s inequitable economic structure.

Alabama should move forward, not return to past failures

The pandemic has shined a light on many of Alabama’s policy mistakes. The state can take this opportunity to fix harsh, shortsighted policies that devalue and harm Alabamians. And our leaders must take the lead on implementing helpful policies because of a lack of comprehensive federal action. The U.S. Department of Labor has issued no guidance allowing workers in high-risk groups to stay home and retain benefits. And the department has not reinforced health and safety protections for workers whose employers don’t take proper coronavirus precautions.

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 the state cuts off UI benefits. Black and Latino people, women and struggling families will bear the brunt of this callous undermining of the safety net.

Alabama can and should do better. Instead of forcing people back into workplaces prematurely, lawmakers should fix failed policies like the 2019 cuts to UI benefits. Gov. Kay Ivey should expand Medicaid to ensure everyone can get the life-saving health care they need. And our state should abandon the impulse to punish people for inability to find work, especially during a deep recession. Instead, Alabama should enact policies that support and value people both while they work and when they lose their jobs.