Issue: Medicaid Expansion

Grocery tax, health care key Arise focuses this year

By Chris Sanders

Untax groceries. Expand health coverage. Make the criminal justice system more just. Those are a few of Alabama Arise’s major priorities during the Legislature’s 2022 regular session. And we’re making real progress toward turning those goals into realities.

Untaxing groceries

Ending the state’s regressive sales tax on groceries has been a longtime Arise priority. It was the centerpiece of Alabama Arise Action’s online Legislative Day on Feb. 15, which attracted nearly 200 advocates from across the state. It also will be the focus of a March 15 rally in Montgomery.

Legislative Day attendees heard from two lawmakers working to untax groceries: Sen. Andrew Jones, R-Centre, and Rep. Penni McClammy, D-Montgomery. Jones’ and McClammy’s bills reflect growing support for untaxing groceries while protecting funding for public schools.

McClammy said the grocery tax is a policy concern that transcends political lines. “It’s important that we stand together united as one and show the citizens that we all care about what’s going on in our homes,” she said.

Jones expressed optimism that lawmakers are nearing a breakthrough on the grocery tax. “This is not a partisan issue,” he said. “This is something that really meets the full criteria of being a bipartisan issue.”

Nearly 200 advocates from across Alabama attended Arise’s virtual 2022 Legislative Day on Feb. 15. Supporters gathered to learn more about our issue priorities and get updates on where things stand legislatively on them. Sen. Andrew Jones, R-Centre (top right), and Rep. Penni McClammy, D-Montgomery (bottom left), joined us for a discussion of their bills to untax groceries.

Expanding health coverage

The COVID-19 pandemic has underscored a cruel fact: Hundreds of thousands of Alabamians can’t afford the health care they need. Gov. Kay Ivey can remove that financial barrier by expanding Medicaid to cover nearly 300,000 adults with low incomes. Arise and our Cover Alabama campaign are working hard to make that happen.

Public support for Medicaid expansion is strong and growing. More than seven in 10 Alabamians support expansion, according to a statewide Arise poll conducted in January. Expansion would create more than 20,000 jobs and save the state almost $400 million annually, a recent report estimated.

Extending Alabama Medicaid’s postpartum coverage to one year (up from the current 60 days) is another key goal this year. Nearly 70% of Alabama’s maternal deaths in 2016 were preventable, one study found. That’s why Arise is working hard to ensure legislators fund this life-saving coverage extension in the General Fund budget.

Advancing justice

Numerous reforms of Alabama’s criminal justice system are moving in the Legislature this year. Arise supports two bills – HB 200 by Rep. Merika Coleman, D-Birmingham, and SB 117 by Sen. Will Barfoot, R-Montgomery – to end driver’s license suspensions for failure to pay fines and fees. Arise also backs HB 57 by Rep. Chris England, D-Tuscaloosa, and SB 215 by Sen. Bobby Singleton, D-Greensboro, which would increase transparency in parole decisions.

Together, we can make a difference. Subscribe to our email list for timely alerts on these bills and others. And visit the Bills of Interest page to track legislation throughout the year.

New poll: More than 7 in 10 Alabamians support Medicaid expansion

By Chris Sanders

More than seven in 10 Alabamians (71.5%), including 65.8% of Republican voters, support expanding Medicaid when told about arguments in support of the idea, according to a new poll commissioned by Alabama Arise. The poll also showed robust bipartisan support for using a portion of the state’s funding under the American Rescue Plan Act (ARPA) to support Medicaid expansion.

Participants responded strongly when informed that expanding Medicaid would create an average of 20,000 new jobs per year over the next six years and have an economic impact of $1.8 billion per year. Nearly 69% of respondents, including 61.8% of Republican voters, supported using a portion of the state’s $2 billion in ARPA funds to expand access to Medicaid in Alabama.

Jane Adams, Cover Alabama campaign director at Alabama Arise, said the poll results underscore Alabama’s urgent need for Medicaid expansion.

“Voters support Medicaid expansion because it is a tremendous opportunity to create jobs, protect rural hospitals and provide life-saving care,” Adams said. “This poll shows Medicaid expansion is no longer a partisan issue and that most Alabamians support expanding Medicaid coverage to adults with low incomes.”

Support for Medicaid expansion grows across Alabama

The overwhelming polling support reflects an ever-growing group of individuals, organizations, veterans, faith leaders, medical professionals and businesses that support expanding Medicaid in Alabama. This group includes the Alabama Hospital Association, Alabama Chapter of the American Academy of Pediatrics, the Alabama Department of Public Health’s Maternal Mortality Review Committee and the Medical Association of the State of Alabama, as well as more than 100 nonprofits, faith-based groups and medical advocacy organizations in the Cover Alabama Coalition.

Alabama Arise commissioned the poll, which the Montgomery-based firm Cygnal conducted in January. The poll surveyed 631 likely voters across Alabama and has a margin of error of +/- 3.85%. Interviews of known registered voters occurred via live phone calls, online panel, texts and email invitation.

Click here for Arise’s poll results on Medicaid expansion in Alabama.

New report highlights economic benefits of Medicaid expansion

A recent report from the nonprofit Public Affairs Research Council of Alabama (PARCA) shows how Medicaid expansion would create jobs and boost local economies across the state. “Expanding Medicaid coverage in Alabama could save the state almost $400 million per year over the next six years – more than enough to cover the cost of expansion – and have an average positive economic impact of $1.89 billion per year over that same time frame,” the report found.

Medicaid expansion in Alabama would cost an average of $225.4 million per year, according to the PARCA report. But the report also found that expansion would lead to the federal government covering $379.9 million in annual expenses now paid by the state. “As a result, the state could expand coverage, and at the same time, reduce or reinvest the amount paid to support health care for low-income Alabamians by $172 million annually,” PARCA found.

The economic impact of Medicaid expansion. Medicaid covers approximately 925,000 Alabamians -- the majority are children. Alabama is 1 of 12 states that have not expanded Medicaid. Over the next six years, research by PARCA and Jacksonville State University shows Medicaid expansion in Alabama could save the state more than $400 million a year, increase Medicaid enrollment by as many as 283,636 people, drop the uninsured rate by 43%, create an average of 20,083 new jobs per year, cost an average of $225.4 million above current expenditures and yield average annual savings of $397.8 million. Recent polling by Cygnal shows more than 7 in 10 Alabama voters would like to expand Medicaid so more people can access health care. 71.5% of voters support Medicaid expansion, including 65.8% of Republicans. 50.2% strongly support expansion, while only 17.5% overall and only 20.6% of Republicans oppose expansion.

Adams said ARPA funding and other federal incentives make Medicaid expansion an opportunity too good for Alabama to pass up.

“Governor Ivey and leaders in Montgomery have said the obstacle to expanding Medicaid in Alabama is the cost. But with the American Rescue Plan Act funding, Alabama can expand Medicaid and could reinvest more than $170 million in state funding to provide more access to care,” Adams said.

“Public support is strong, and the report and polling data show there is no financial barrier or obstacle to overcome. We urge Governor Ivey and leaders in Montgomery to put forward a Medicaid expansion plan that is tailored to the needs of Alabamians.”

Six ways Alabama should use ARPA funds to build a better, more inclusive future

By Carol Gundlach

The Alabama Legislature’s 2022 regular session, which began Tuesday, will be unusual in one important way. For the first time in many years, Alabama has more than enough revenue to maintain its bare-bones public services. That means instead of scrambling to avoid cuts, the legislative focus can be on strengthening investments in our state’s future.

Both the Education Trust Fund (ETF) budget and the General Fund (GF) budget, which funds non-education programs, have seen tax revenues rise more than 10% in the last year. ETF revenues actually increased 16% in 2021. In addition, Alabama has about $1.6 billion of federal relief funds remaining under the American Rescue Plan Act (ARPA). President Joe Biden signed ARPA into law in March 2021.

Alabama lawmakers already allocated $480 million of the state’s ARPA money last year. Of that amount, $400 million went toward prison construction and $80 million went to hospitals and nursing homes.

Budget growth faces sustainability challenges

State budget officials have steadily cautioned lawmakers to consider the one-time nature of both relief money and the bump in tax revenues. Recent revenue growth almost certainly will not be sustained in future years, budget officials warn. And one-time ARPA funds are by definition only temporary.

Alabama’s budget officials have strongly recommended that both ARPA funds and increased state revenues be invested in programs and services that won’t require regular, recurring revenue but that still meet critical needs for the people of the state. Alabama Arise questions whether the new revenue is as unsustainable as budget officials predict. But Arise agrees that this money needs to fund big ideas that will benefit the state for years to come.

Areas for investment

If spent wisely, ARPA funds could create vital long-term improvements for Alabamians. Alabama Arise has numerous specific suggestions for what those big ideas, and investments, could be.

Serve underserved communities

ARPA investments should focus on the most underserved areas and most underserved Alabamians. Communities of color and communities with low incomes, particularly in the Black Belt, have long-festering unmet infrastructure needs. The lack of wastewater treatment, accessible broadband internet, affordable housing and public transportation has held these communities back for decades.

In deciding where to spend new one-time dollars, the most historically neglected parts of Alabama should come first. An urgent public health need in many rural Black Belt counties is for sewer and other water treatment systems. These should be a top priority.

Modernize state technology

A major lesson from the COVID-19 recession was that Alabama’s technology infrastructure is totally inadequate for remote access to services. Suddenly unemployed people desperately tried to apply for unemployment insurance (UI) benefits, food assistance, COVID-19 tests and other services on overwhelmed state computer and telephone systems. People who had never before applied for public assistance couldn’t find one-stop sources of information about services for which they might be eligible. And when new federal programs were created, they were hard to implement. That’s because Alabama’s computer systems didn’t talk to each other and couldn’t share information needed to help people get assistance.

Modernizing the state’s computer systems would be a great investment to increase efficiency and prepare us for the next crisis. This would allow for integrated eligibility and data sharing systems across state agencies. And it would be an opportunity to modernize and upgrade the state’s UI application and payment process.

Expand Medicaid and strengthen public health

Alabama has failed for decades to invest adequately in our health care infrastructure, including Medicaid. The devastating toll of the COVID-19 pandemic has made the consequences of that failure apparent to everyone in the state. We need to invest now in a health care infrastructure that will improve the delivery of health services to underserved individuals and communities.

Medicaid expansion to cover adults with low incomes is an essential step to strengthen Alabama’s health care system. Other investments should include more funding for mobile health services and telehealth services. Alabama also should provide additional resources for our local and state public health departments.

Reduce hunger and promote healthier communities

Hunger was already a large and perpetual problem across Alabama even before the pandemic. But the COVID-19 recession and its aftermath exacerbated this problem by fueling a rapid, major increase in food insecurity. Sudden income loss, rising prices and occasional shortages have made it much more difficult for many people to feed their children and families.

The Supplemental Nutrition Assistance Program (SNAP) and various child nutrition programs are essential standing resources to fight hunger in Alabama. But the state can and should do more to support our food infrastructure. Alabama should provide healthy food financing grants to expand community groceries, farmers markets and mobile markets. This would improve access to healthy foods in communities without ready access to fresh foods, especially fruits and vegetables.

Invest in affordable housing

The COVID-19 recession has caused a wave of evictions and foreclosures across Alabama. This has occurred as the cost of housing has been driven up amid supply chain issues and fewer available workers.

Alabama could help address its housing shortage and resulting homelessness by providing $25 million for the state Housing Trust Fund. This investment would create and support jobs across the state. And it would reduce Alabama’s shortfall of more than 73,000 affordable homes for people with incomes below the federal poverty level.

Fund public transportation

Alabama’s elected leaders, including Gov. Kay Ivey in her State of the State address, have celebrated the state’s low unemployment rate. But they also are bemoaning our state’s associated low rate of labor force participation. For more Alabamians to return to work during and after the pandemic, the state must ensure they have essential work supports. Not the least of these is transportation to and from a job or school.

Lawmakers can help people reenter the job market by investing $20 million in ARPA funds and $10 million in GF dollars in the state Public Transportation Trust Fund. These dollars would go a long way toward ensuring that people, especially those in rural areas, can get to a job and to job training. They also would help Alabama match other federal transportation dollars that can benefit the entire state.

It’s time to expand Medicaid and close Alabama’s health coverage gap

By Jim Carnes

For years, Gov. Kay Ivey and legislators have said cost is the barrier to covering Alabamians with low incomes through Medicaid. Thanks to federal COVID-19 relief funding with incentives for Medicaid expansion, any concerns about that barrier are gone. Now more than ever before, we have the opportunity to ensure no Alabamian has to choose between going to the doctor and putting food on the table.

Nearly 70% of Alabamians support Medicaid expansion, including 64% of Republican voters, according to a January 2021 poll. As we continue to struggle with the COVID-19 pandemic, extending Medicaid coverage to adults with low incomes is the single biggest step Alabama can take to restore health, save our rural hospitals and boost our state’s economic recovery.

Who would gain coverage under Medicaid expansion?

Medicaid expansion would ensure coverage for more than 340,000 Alabamians, including:

  • People who work low-wage jobs and can’t afford private coverage
  • Workers who are between jobs
  • Adults who are caring for children or older family members at home
  • People who have disabilities and are awaiting SSI determinations
  • Adult college students
  • Uninsured veterans

How would Medicaid expansion keep people healthier?

Medicaid expansion would help Alabamians stay healthy by ensuring pathways to:

  • Regular primary care and preventive checkups
  • Earlier detection and treatment of serious health problems
  • Regular OB/GYN visits without referral
  • Less dependence on costly emergency care
  • Better health and greater financial peace of mind

How would Medicaid expansion reduce health disparities?

Medicaid expansion would promote health equity in Alabama by:

  • Reducing the racial/ethnic disparities in health coverage
  • Lowering the high rate of Black infant deaths
  • Lowering the high rate of Black maternal deaths
  • Covering chronic health conditions that disproportionately affect people of color and make them more vulnerable to COVID-19 complications

How would Medicaid expansion boost the economy?

Medicaid expansion would bring our federal tax dollars home to support:

  • Healthier families, workers and communities
  • Stronger rural hospitals and clinics
  • Stronger community mental health and substance use disorder services
  • A needed boost in jobs and revenue for state and local economies

Bottom line

Medicaid expansion would save lives, create jobs and strengthen Alabama’s health care system. Closing the health coverage gap is one of the biggest policy changes available to move our state forward. The governor and the Legislature should embrace this opportunity to build a brighter, healthier future for Alabama.

Join our Cover Alabama campaign!

An end to Alabama’s coverage gap is within reach. Through our Cover Alabama campaign, Alabama Arise is working to ensure that every Alabamian can afford to get the health care they need when they need it. Visit coveralabama.org to learn more and add your name to our ever-growing list of supporters.

Funding surge is a path for Alabama to untax groceries, expand Medicaid

By Carol Gundlach

Alabama’s broken tax system usually starves our state of money to fund education, public health and other basic responsibilities adequately. But 2022 may be different. Record tax revenues and a surge of federal recovery dollars could allow lawmakers to address longstanding state needs and inequities – if they have the political courage:

  • Tax revenues for our schools and universities went up more than 16% in 2021.
  • Tax revenues for services not related to education grew more than 11% in 2021.
  • Alabama still has more than $1.6 billion in federal recovery funds that must be budgeted in 2022 and 2023, with more on the way.

Arise’s proposed uses for federal recovery dollars can be found at alarise.org/rescueplan. Here are a few of our recommendations for budgeting state revenue increases:

  • Untax groceries. Alabamians with low and moderate incomes already pay a disproportionate share of their income in state taxes. Ending or rebating the state grocery tax while protecting education funding would help them make ends meet.
  • Raise the income tax threshold. Alabama should help people with low incomes by creating or increasing individual and child deductions or credits.
  • Expand Medicaid. Federal recovery dollars can’t be spent directly on expansion, but they can be spent on other needs. This will free up state money to expand Medicaid.
  • Make the criminal justice system more just. Lawmakers should increase funding for reentry services and for alternatives to incarceration like specialized courts and community correction programs.

Bottom line

This year’s budget landscape offers an opportunity to make Alabama better for generations to come. Thoughtful, transformative funding choices can bring that vision to life.

Funding boosts bring opportunity to invest in Alabama’s future

By Carol Gundlach

Alabama’s broken tax system usually starves our state of money to fund basic responsibilities adequately. But 2022 may be different. Record tax revenues and a surge of federal recovery dollars could allow lawmakers to address longstanding state needs and inequities – if they have the political courage.

State revenues that pay for our schools, including income taxes earmarked for teacher salaries, went up 16% in 2021, according to the Legislative Services Agency. Internet sales taxes and other revenues for non-education programs grew more than 11% in 2021. Alabama also has received federal funds under the American Rescue Plan Act (ARPA) to aid recovery from the COVID-19 recession. Alabama has $580 million remaining in 2021 ARPA funds, plus another $1.06 billion coming in 2022.

Coming fast behind ARPA are federal infrastructure dollars for roads, bridges and public transportation. And if the U.S. Senate passes it, the Build Back Better Act will include new funds for child care, health care and senior services.

Transformative changes for a better Alabama

Legislators already have begun talking about how to spend this money. Alabama Arise believes wise use of these funds can make Alabama a better place for generations to come. Many of our recommendations are in our statement of principles for spending recovery dollars. A few key Arise recommendations include:

  • Untax groceries. Tax cuts should help struggling Alabamians who already pay a disproportionate share of state taxes. Ending the state grocery tax is a good place to start.
  • Expand Medicaid. Federal recovery dollars can help free up state money for Medicaid expansion. This would save hundreds of lives and ensure affordable health coverage for more than 340,000 Alabamians every year.
  • Make the criminal justice system more just. Legislators just made a misguided decision to spend $400 million of ARPA money on new prison construction. They now should invest in meaningful policy changes like sentencing reform and other alternatives to incarceration.

Alabama lawmakers have a chance to make far-reaching and lasting changes in 2022. Arise and our members will work hard to ensure they seize this opportunity.

A year to strengthen our communities

By Robyn Hyden

We can’t even begin to summarize all the momentous federal policy advances realized in 2021 in one newsletter. This year brought passage of the American Rescue Plan Act (ARPA) and the infrastructure package. It brought expansion of the Child Tax Credit. And we hope it will bring the forthcoming passage of the Build Back Better (BBB) Act. That means 2022 will be a year of working diligently to advocate for fair, equitable implementation of these new investments in Alabama.

ARPA provided millions of new dollars in incentive funding to support Medicaid expansion. It also provided $2.1 billion for state COVID-19 relief and $1.9 billion for local governments. Check out our ARPA toolkit at alarise.org for resources to ensure ARPA funding goes to the priorities we all share to strengthen our communities.

If the Senate passes BBB this month, we anticipate more than 220,000 Alabamians gaining immediate access to no-cost health insurance via healthcare.gov for the next three years. Then the work of enrollment will begin! It’s not a permanent solution to our state’s health care coverage gap, but it would be a major step forward for Alabamians with low incomes. Stay tuned for alerts and ways you can support – and celebrate! – when the time comes.

Recovering from Alabama’s costly mistake on COVID-19 recovery funds

By Dev Wakeley

This post originally appeared on the Economic Policy Institute’s blog.

When the Alabama Legislature gathered for a special session in September, it made a shortsighted and costly mistake. Lawmakers chose to allocate $400 million in American Rescue Plan Act (ARPA) money ‒ about 20% of Alabama’s federal COVID-19 relief funds ‒ to help finance a $1.3 billion prison construction plan.

Alabama prisons are decrepit, dangerous and massively overcrowded. The U.S. Department of Justice (DOJ) has sued the state over the unconstitutional conditions in the institutions. Moreso, raiding funds designed to help people and communities recover from pandemic-related economic distress will do nothing to make Alabama more humane and inclusive. That is particularly true when Black Alabamians are three times more likely to be incarcerated than white Alabamians due to discriminatory practices in policing and incarceration.

The state has a better path to build a more sensible criminal justice system and avert a looming federal takeover. New buildings to house the same old problems won’t get us there. Real change will require meaningful changes to sentencing and reentry policies.

Sentencing reform is vital to build a more humane criminal justice system in Alabama

Alabama’s sentencing scheme still relies on outdated ideas about punishment and limits availability of services shown to improve reentry. One example is the state’s Habitual Felony Offender Act (HFOA), which increases sentences for even minor offenses. Like other mandatory minimum laws, it is a relic of earlier racially motivated “tough on crime” practices and leads to higher rates of incarceration throughout the South.

The Legislature made minor improvements to the HFOA in 2015 but refused to make them retroactive. That failure has left hundreds of Alabamians still serving sentences for convictions that today would result in less time under current presumptive sentencing guidelines.

Alabama Arise supports full repeal of the broken HFOA. Until then, the state at minimum should ensure people aren’t serving wildly different sentences for the same conviction.

Those efforts have been an uphill battle for reform advocates. During September’s special session, lawmakers failed to pass a bill to allow some people to petition for resentencing under current standards. Legislators also have failed in recent years to expand medical release and releases for older people who have aged out of reasonable likelihood of recidivism. Efforts to expand and improve diversion programs have stalled as well.

All of these policies would save Alabama money in the long run. They also would demonstrate respect for the humanity of incarcerated people. But legislators have chosen not to act.

This persistent refusal to engage in meaningful reform may cost Alabama dearly. Failure to take even small steps to reduce overcrowding and improve atrocious conditions may spur the DOJ to conduct a wholesale takeover of the state’s prison system. If that happens, the Legislature will have only its own inaction to blame.

How federal aid should help Alabamians

The consequences of prioritizing bad spending go beyond federal intervention in the broken prison system. ARPA relief funds represent an opportunity to move Alabama forward in many areas that would increase opportunity and stability for people across the state.

Provide health care to hundreds of thousands of uninsured Alabamians

More than 220,000 Alabamians live in a Medicaid coverage gap. They make too much to qualify for Medicaid under the state’s bare-bones eligibility limits but too little to qualify for subsidized coverage through the Affordable Care Act. Another 120,000 Alabamians have stretched their finances seriously to pay for coverage they can’t truly afford.

Federal ARPA funds would allow Alabama to expand Medicaid. Alabama could use these dollars to meet other critical spending priorities. This would free up state funds to pay for the startup of an expanded Medicaid program to cover adults left out of coverage.

Update infrastructure and invest in equity

Alabama should use ARPA funds to update and expand infrastructure and support services. Economic fallout from the COVID-19 pandemic has placed a disproportionately heavy burden on women, Black Alabamians and communities with few resources upon which to fall back. Investments in child care, expanded early childhood education and long-term postpartum health coverage would deliver major improvements in quality of life for people hit hardest during the pandemic.

Federal relief should be used both to lessen the pandemic’s immediate harm and to break the pattern of long-term, intentional disinvestment in the Black Belt and other areas. Community-based organizations offer valuable connections and expertise to guide investment to where it is needed. The state should ensure these groups have the capacity and pathways to provide input on best uses for relief money.

Finish implementing solutions on housing and public transportation

ARPA funds also represent an opportunity to take steps forward where lack of political will has hindered full implementation of state solutions. Within the past decade, the Legislature created both the Public Transportation Trust Fund and the Affordable Housing Trust Fund (AHTF). It also has failed to provide a single dollar for either.

Transportation investment would improve quality of life for everyone. Robust public transit creates long-term, high-wage jobs and enables people to get to work reliably and inexpensively. It is a vital public good that helps older people and people with disabilities fully participate in public life.

Housing investment would help alleviate the state’s severe affordable housing shortage. State AHTF funding would increase community resilience by allowing struggling families to spend less of their incomes to keep a roof over their heads. It also could help speed up rental assistance and prevent evictions during future recessions.

Increase transparency and modernize technology

Alabama’s technological infrastructure has lagged behind contemporary standards. Early in the pandemic, this resulted in major delays of unemployment insurance payments. The patchwork of IT systems at all levels of state government has contributed to public confusion and delays. Technology investments would reduce duplication of effort and increase public access to the public’s information.

A new path forward

ARPA provides a generational opportunity to begin remedying policy shortcomings that have held back progress, perpetuated inequality and furthered Alabama’s history of racist policy choices. This chance is too valuable to waste by doubling down on past failures like foolish and overly punitive criminal justice policy.

The Legislature’s recent misuse of $400 million is inexcusable, but this bad decision has not blocked the path forward. The remaining ARPA funds are a chance to invest in adequate resources and transparent, responsive government. Our state must seize this opportunity to improve life significantly for every Alabamian.

When Alabama’s coverage gap hit home for my family

By Whit Sides

This story originally appeared on AL.com.

Our borders have become irregular as COVID-19 closes in on almost every part of our lives. The pandemic has made all of us realize how the shapes of our families are becoming irreparably different.

This summer, the shape of my own life changed.

Cathy Parker was one of my mom’s lifelong best friends. They grew up together near the border of Blount, Jefferson and Walker counties, in a small community appropriately called Corner.

Cathy Parker (right) and her husband, Chuck. (Photo courtesy of Chuck Parker)

Cathy was small in stature but had a raspy, larger-than-life voice. She also had a kind, wide-open laugh that made you feel special and heard. She was a rescuer: of plants, animals and even children.

After retirement, my parents began to spend more time with Cathy and her husband, Chuck. Early in the pandemic, they were part of a tiny pod of people with whom my parents visited. My younger sister has special needs, and my mother has asthma, so they kept their circle tight to reduce exposure.

When vaccines started to open the world earlier this year, my daughter began to spend more time with my parents again. That meant more time with Cathy, too.

Cathy was like an aunt to me. My daughter called her “Mamaw.” She loved spending weekends at Cathy’s house in Hayden.

The phone call

One morning as spring turned into summer, my mother called me. She was crying. She said in a small, scared voice that Cathy was sick. Cathy had a tumor in her lungs, and it had spread to her brain.

I couldn’t process the news for days. To be honest, I still haven’t.

I didn’t know how I was going to tell my daughter. I didn’t know how I could help my mother.

Unfortunately, I didn’t have much time to think about any of that. Cathy Parker died in late July after a painfully short battle with Stage 4 cancer.

With her gone, everything feels smaller. I can’t imagine how that feels for my parents, after knowing her for almost a lifetime. The shape of the world changed.

The coverage gap

If you ask my mother what the biggest change has been since, she’ll tell you it’s the anger. Cathy’s death reminds us every day that in Alabama, those who need help the most are often the last to get it.

Cathy was one of hundreds of thousands of people in Alabama without health insurance. That includes about 32,000 older adults (50 to 64 years old) who are in the Medicaid coverage gap.

Cathy did not qualify for Medicaid under the state’s stringent income limits. And her husband, Chuck, said her income was too low to qualify for a subsidized plan under the Affordable Care Act. She was three years shy of Medicare eligibility.

Chuck is a former Marine and Vietnam veteran. He receives benefits through the Department of Veterans Affairs for himself. But Chuck said he was turned away whenever he asked about extending them to his wife. The premium for the cheapest marketplace plan available to Cathy was more than $800 a month, Chuck said. That was more than they could afford.

They paid out of pocket to doctors who helped Cathy as much as they could. Even so, the question haunts us: Was Cathy’s time cut short because she was uninsured?

I believe so. Things easily could have been different.

A bad situation gets worse

Lack of coverage meant lack of access to lots of specialists. And it meant traveling more than an hour to find doctors who would take a patient paying out of pocket. Cathy and Chuck’s pockets often came up empty as the medical bills increased.

Compounding the tragedy, COVID-19 made access to life-saving care increasingly difficult. Several times, Cathy and Chuck drove to the hospital in the middle of the night. They waited hours in the emergency department, hoping for a bed that never materialized.

Chuck recalls that one night shortly before she died, Cathy had a seizure as the tumor grew larger in her brain. He immediately called 911.

They rode in an ambulance for more than an hour, only to be turned away by two hospitals diverting all incoming patients. They were overwhelmed by the overload of COVID-19 cases. Cathy eventually found a bed at a third Birmingham hospital. She passed soon afterward.

COVID-19’s burden on Alabama’s health care system has been enormous. In early September, near the delta variant’s peak, anywhere from 10 to 80 people a day in Alabama were waiting for an ICU bed “that is not there,” Dr. David Kimberlin of UAB told NPR. (Those numbers have improved since, with the Alabama Hospital Association reporting 167 ICU beds available statewide in early October.)

Adding to the challenges of pandemic response, our state has lost eight rural hospitals in the last decade. We surely could have used those resources during the pandemic. And we still might have them if Alabama had expanded Medicaid.

The what-ifs that haunt us

My family is one of thousands haunted by what-ifs resulting from Alabama’s failure to expand Medicaid.

What if Medicaid coverage had been available to Cathy?

It’s not hard to imagine a different outcome.

Cathy was born in Illinois, one of 38 states that expanded Medicaid to adults with low incomes. More than 600,000 people in Illinois now have coverage as a result, including many in Cathy’s family.

Chuck and Cathy considered moving to Illinois so she could get insurance through Medicaid expansion. But her illness progressed so quickly that moving was not an option. If Cathy had returned to Illinois before she started feeling sick, she might have qualified for expanded Medicaid. Doctors might have found her cancer more quickly. And that early detection might have saved her life.

But that’s not what happened. Instead, Chuck still opens the mailbox wondering what bill will arrive today. The last one he received was for $22,000, detailing charges for his wife’s end-of-life care.

Cathy did ultimately make it back to Illinois. Her friends and family honored her request to scatter her ashes there after she passed.

Expand Medicaid to prevent suffering

Cancer patients living in states that failed to expand Medicaid are more likely to die than those in states that have expanded, new research shows. In Medicaid expansion states, patients are more likely to get earlier-stage diagnoses and receive earlier interventions.

Medicaid expansion lowers mortality rates. It saves lives.

Alabama’s leaders have the resources and tools to expand Medicaid. But they keep passing the buck, blaming it on money or politics. Each day, struggling Alabamians are the victims.

Gov. Kay Ivey can begin the process of expanding Medicaid today. It would prevent death for so many people living in the coverage gap. And it’s the single most important public health intervention available to uplift Alabama’s hospitals, doctors and patients after the pandemic.

For now, we’re left with the irregular borders closing in on us. Our families are growing smaller, and especially after the year we’ve had, it’d be easy to feel like there’s nothing we can do. But that’s just not true. We can expand Medicaid. And we must.

It’s too late for Cathy. But it’s not too late for the governor to protect other Alabama families from enduring the pain we’ve experienced. All it takes is the stroke of a pen.

About Alabama Arise and Cover Alabama

Whit Sides is the story collection coordinator 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 more than 110 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.

Alabama Arise unveils members’ 2022 roadmap for change

By Chris Sanders

Sentencing reform and voting rights expansion are two key goals on Alabama Arise’s 2022 legislative agenda. Members voted for Arise’s issue priorities this week after nearly 300 people attended the organization’s online annual meeting Saturday. The seven issues chosen were:

  • Tax reform, including untaxing groceries and ending the state’s upside-down deduction for federal income taxes, which overwhelmingly benefits rich households.
  • Adequate budgets for human services like education, health care and child care, including Medicaid expansion to make health coverage affordable for all Alabamians.
  • Voting rights, including automatic universal voter registration and removal of barriers to voting rights restoration for disenfranchised Alabamians.
  • Criminal justice reform, including retroactive application of state sentencing guidelines and repeal of the Habitual Felony Offender Act.
  • Death penalty reform, including a law to require juries to be unanimous in any decision to impose a death sentence.
  • Payday and title lending reform to protect consumers from getting trapped in debt.
  • Public transportation to help Alabamians with low incomes stay connected to work, school, health care and their communities.

“Arise believes in dignity, equity and justice for all Alabamians,” Alabama Arise executive director Robyn Hyden said. “Our 2022 issue priorities would break down many of the policy barriers that keep people in poverty. We must build a more inclusive future for our state. And together, we will.”

Graphic listing Alabama Arise's 2022 issue priorities

The urgent need for criminal justice reform

Alabama’s criminal justice system is broken, and its prisons are violent and dangerously overcrowded. Exorbitant court fines and fees impose heavy burdens on thousands of families every year, taking a disproportionate toll on communities of color and families who already struggle to make ends meet. And Alabama needs investments in mental health care, substance use disorder treatment, community corrections and diversion programs to help stem the tide of mass incarceration.

Lawmakers’ plan to spend hundreds of millions of dollars on new prisons is not an adequate solution to these problems. Alabama must enact meaningful sentencing and reentry reforms to make its corrections system more humane and effective. Legislators took a good first step during this week’s special session by passing a bill by Rep. Jim Hill, R-Moody, to provide supervised release for everyone leaving prison in Alabama.

Many other needed changes still remain on the Legislature’s plate, however. One important priority is Hill’s proposal to allow judges to apply Alabama’s new sentencing guidelines retroactively. The House declined to vote on that bill this week, but Hill has promised to file it again in 2022. Hundreds of people would be eligible to apply for a reduced sentence if the measure passes.

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

Protect and expand voting rights so every voice is heard

Arise members provided a resounding endorsement of efforts to protect and expand voting rights in Alabama. This includes support of federal legislation to prevent voter suppression and strengthen the Voting Rights Act. And it includes calls for numerous state-level improvements to promote greater civic engagement and increase access to voting.

One such improvement would be automatic voter registration (AVR) across Alabama. AVR would use information the state already has to register or update registrations electronically for hundreds of thousands of Alabamians. Another important step would be to ensure people who struggle to make ends meet are not denied the right to vote simply because they cannot afford court fines and fees.

“Our ability to progress as a state will be limited as long as any person or group is unable to exercise their constitutional right to vote,” Hyden said. “We urge Alabama lawmakers to protect and expand voting rights by instituting automatic voter registration and lifting barriers to voting rights restoration.”