230+ Alabama Arise supporters urge lawmakers to close state’s Medicaid coverage gap

A crowd of hundreds of smiling people gathered behind and to both sides of a lectern inside a committee room in the Alabama State House.
More than 230 Alabamians gathered to show their support for Medicaid expansion during Arise Legislative Day on April 2, 2024, in Montgomery. (Photo by Julie Bennett)

Alabama should save lives, create jobs and boost workforce participation by closing the state’s Medicaid coverage gap, Alabama Arise members told lawmakers Tuesday.

More than 230 Arise supporters from across Alabama gathered Tuesday at the State House in Montgomery to urge Gov. Kay Ivey and legislators to make this investment in a healthier Alabama. Expanding Medicaid to cover adults with low incomes would ensure health coverage for nearly 300,000 Alabamians who are uninsured or struggling to afford coverage.

Representatives from March of Dimes Alabama, the Alabama Rural Health Association and Arise’s Cover Alabama campaign joined Arise members to make the case for closing the health coverage gap. Alabama Arise board president Clyde Jones spoke passionately about the benefits of Medicaid expansion.

“We believe that everyone in our state should be able to get medical care they need to be able to survive and thrive. We’re here today to tell our lawmakers that it’s time to close Alabama’s Medicaid coverage gap once and for all,” Jones said.

“This is an investment in Alabama’s future. It would create thousands of jobs and generate billions of dollars of economic activity. It would help rural hospitals stay open to serve everyone in their communities. And the most important thing it would do: It would save lives.”

A bearded Black man wearing a black suit jacket, white dress shirt and yellow tie speaks behind a lectern. Alabama Arise supporters stand behind and to either side of him.
Alabama Arise board president Clyde Jones emphasizes the health and economic benefits of Medicaid expansion during Arise Legislative Day on April 2, 2024, in Montgomery. (Photo by Julie Bennett)

The news conference was part of Arise’s annual Legislative Day. Photos from the event are available here. A video of the news conference is available here.

Closing the coverage gap is vital for rural Alabama

Alabama is one of only 10 states yet to expand Medicaid to cover adults with low incomes. And the state’s Medicaid eligibility limit is one of the nation’s lowest. A parent in a three-person household who earns just $5,000 a year makes too much to qualify for Alabama Medicaid.

Closing this coverage gap would strengthen workforce participation and boost local economies across Alabama, studies show. It also would help the state’s rural hospitals remain open to serve everyone in their communities, Alabama Rural Health Association president Farrell Turner said Tuesday.

“When a hospital shuts down, it’s not just health care that’s lost. It’s other health services such as pharmacies and lost jobs. It’s access to essential services, and it’s a blow to the very fabric of our communities,” Turner said. “By closing the coverage gap, we can reduce the burden of unpaid costs on health care providers and reinforce their ability to serve our communities.”

A white man with glasses, white hair and a white mustache stands behind a lectern. He is wearing a black suit jacket, a white dress shirt and a red tie. Alabama Arise supporters stand behind and to either side of him.
Farrell Turner, president of the Alabama Rural Health Association, urges Medicaid expansion to prevent rural hospital closures during Arise Legislative Day on April 2, 2024, in Montgomery. (Photo by Julie Bennett)

Nineteen of Alabama’s 52 rural hospitals are at immediate risk of closure, according to the Center for Healthcare Quality and Payment Reform. The harmful fallout from those closures would extend far beyond the hospital walls, Turner said.

Hospital closures erode a community’s quality of life and limit its prospects for economic growth, Turner said. He urged lawmakers to act quickly to save people across Alabama from facing that fate.

“We cannot afford to wait until it’s too late. Every day that passes without action puts more hospitals at risk and threatens the health and well-being of rural Alabamians,” Turner said. “Our hospitals, health centers and rural health clinics are at risk. Our communities are in crisis, and the time for action is now. Together, let’s work to close the coverage gap and secure a healthier future for rural Alabama.”

Continuous coverage would save lives of parents and infants

Medicaid expansion also would improve health for parents and children across the state. This is a vital need for Alabama, which has the nation’s worst maternal death rate.

Honour Hill, director of March of Dimes’ maternal and infant health initiatives in Alabama, said Tuesday that closing the coverage gap for all adults with low incomes is an essential step to save lives.

“The health of mom and baby are intrinsically intertwined, and addressing chronic conditions before a woman becomes pregnant is critical,” Hill said. “In Alabama, women of childbearing age need coverage before and between pregnancies, in addition to prenatal and postpartum coverage.”

A white woman with blonde hair wearing a white suit jacket and a black blouse speaks behind a lectern. Alabama Arise supporters stand behind and to either side of her.
Honour Hill, director of March of Dimes’ maternal and infant health initiatives in Alabama, highlights the life-saving benefits of Medicaid expansion during Arise Legislative Day on April 2, 2024, in Montgomery. (Photo by Joscie Cutchens)

Lawmakers in 2022 sought to reduce Alabama’s maternal death rate by extending postpartum Medicaid coverage to a full year after childbirth, up from the previous 60 days. Policymakers should build on that progress by ensuring Alabamians with low incomes can continue to receive care without an interruption due to loss of health coverage, Hill said.

“Lack of care before pregnancy can lead to poor pregnancy outcomes,” she said. “Our state is paying much more money to address women’s health issues during or between pregnancies than it would be if lawmakers enacted a policy to close the coverage gap.”

An investment in greater workforce participation

For hundreds of thousands of Alabamians, the health coverage gap is not an abstraction but a reality of everyday life. Alabama Arise’s Cover Alabama campaign director Debbie Smith spoke Tuesday about the difficult decisions that many families must make because Alabama’s refusal to expand Medicaid has left them with no option for affordable health insurance.

“People are facing unimaginable challenges because they lack access to health care,” Smith said. “Families are forced to make impossible choices between putting food on the table and seeking medical treatment. Individuals are delaying necessary care until it’s too late, all because they can’t afford it.”

Cover Alabama is a nonpartisan alliance of more than 130 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.

A smiling white woman with blonde hair wearing a light red blouse speaks behind a lectern. Alabama Arise supporters stand behind and to either side of her.
Debbie Smith, Alabama Arise’s Cover Alabama campaign director, discusses the growing momentum for Medicaid expansion in Southern states during Arise Legislative Day on April 2, 2024, in Montgomery. (Photo by Julie Bennett)

Smith highlighted how closing the health coverage gap would allow more people to seek and keep employment. Alabama has one of the nation’s lowest workforce participation rates, she said, and one of the top factors that unemployed Alabamians cite as a barrier is personal illness or disability.

“Closing the coverage gap is both a moral imperative and a workforce issue,” Smith said. “Access to health care is fundamental for a thriving workforce. When individuals are healthy and cared for, they can contribute fully to our economy. The absence of health care access in Alabama undermines our ability to attract and retain talent, hindering our economic potential.”

‘The time for action is now’

Momentum for closing the coverage gap is growing in the South. Last year, North Carolina became the 40th state to expand Medicaid to cover adults with low incomes. And in February, the Mississippi House voted overwhelmingly in favor of Medicaid expansion. Lawmakers there are now working to resolve differences between House and Senate proposals.

Alabama can and should act to close its coverage gap as well, Smith said. Under the American Rescue Plan Act, the state would get a two-year federal signing bonus worth more than $600 million for adopting expansion. In addition, the state would receive a permanent 9-to-1 federal match under the Affordable Care Act for covering people newly enrolled under Medicaid expansion. Alabama could close the coverage gap either through legislation or through an executive order by Gov. Kay Ivey.

“It’s time to put politics aside for the well-being of our people,” Smith said. “This isn’t about party lines or partisan agendas. It’s about doing what’s right for Alabama. Governor Ivey, the time for action is now.”

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

  1. Nearly 300,000 Alabamians with low incomes would benefit from Medicaid expansion.

  • People in the coverage gap earn too much to qualify for Medicaid, but not enough for an affordable private health insurance plan on the Marketplace. This leaves them in the health coverage gap.
  • The vast majority of people who would gain coverage through Medicaid expansion are working. More than 100,000 Alabamians in the coverage gap hold jobs that are important but pay low wages. Thousands more are self-employed, serve as caregivers or attend school.
  1. We can afford it. Closing the health coverage gap comes with a $619 million signing bonus.

  • States that close their coverage gap will receive a 5-percentage-point increase in the federal match rate for Medicaid for two years. This is thanks to an incentive in the American Rescue Plan Act.
  • An increased federal match rate would bring $619 million to Alabama over the next two years.
  • The state’s cost to close the gap in the first two years would be roughly $423 million. That means nearly $200 million in additional federal funding would come to our state above and beyond the cost to extend Medicaid coverage up to hard-working Alabamians.
  1. Closing the coverage gap helps workers stay employed.

  • Nearly half of Alabama workers do not get employer-sponsored health insurance. Closing the coverage gap could help employees get access to the health care services they need.
  • States that have closed the coverage gap have seen a greater increase in labor force participation among people with low incomes than in non-expansion states.
  • Injuries or manageable illnesses like diabetes can get so severe for those without health coverage that they prevent people from working or leading healthy lives.
  1. Nineteen rural hospitals are at immediate risk of closing. Medicaid expansion can keep them operating.

  • Alabama’s rural hospitals are on life support, but research shows that a rural hospital being located in a Medicaid expansion state decreases the likelihood it will close by an average of 62%.
  • Expanding Medicaid will help more rural residents afford health care services and reduce the financial losses experienced at hospitals from serving uninsured patients or providing uncompensated care.
  1. 5,000 Alabama veterans have no military insurance and can’t afford health coverage.

  • It’s a common misconception that people who serve in the U.S. military automatically receive lifetime eligibility for health coverage and other benefits. In reality, veterans’ health benefits depend on their length of service, military classification, type of discharge and other factors.
  • 14.2% of veterans are employed in the service industry, while 13.7% work in construction and maintenance. These are among the professions that would most benefit from Medicaid expansion.

Arise legislative update: March 25, 2024

While the Alabama Legislature is on spring break this week, Arise’s Akiesha Anderson takes some time to update everyone on what’s happened recently and what’s on the horizon when lawmakers return next week. Akiesha also talks about our upcoming Legislative Day, scheduled for Tuesday, April 2.

Full video transcript

Hi there. Akiesha Anderson here, policy and advocacy director for Alabama Arise, and I am excited to to be here today to give you another legislative update.

So to start this week, the Legislature is on a spring break, so — yay — we get a bit of a reprieve from some of the things that we have been seeing this session that just have not been ideal for, you know, us and the people that we are working for, including you and yourself.

And so some of the things that happened last week that were a bit disappointing do include the fact that SB 1, which is the piece of legislation that would make it harder for people to help others voting absentee, that bill was signed into law by the governor, and so was SB 129, which is the piece of legislation that was designed to basically get rid of diversity, equity and inclusion departments on college campuses and in other state-funded entities. And so those pieces of legislation were signed into law.

Also disappointing last week was the fact that HB 32, which was the felony murder rule legislation introduced by Rep. Chris England, that piece of legislation did die in committee last week. So that means that that piece of legislation  would not move any further this legislative session. And so hopefully that’s something that we can come back to fight for again next legislative session, but it is done for this session.

Some other things that happened last week were a few pieces of bad legislation were introduced, and a lot of new pieces of legislation were introduced. So we’re still combing through a lot of the bills that were introduced last week. We’re still trying to get a grasp of what many of them do, which ones we want to bring to your attention, and we will definitely have more updates for you in the coming weeks.

But two bills that I do want to put on your radar are SB 231 and SB 232. These are two bills that we are extremely concerned about at Alabama Arise. And so SB 231, if passed, would make it harder for companies to unionize. So what this piece of legislation could do is it could penalize companies for voluntarily recognizing employers that decide to unionize. And so that is something that we are extremely concerned about. And SB 232, if passed, could provide people with access to a health insurance plan that we believe would be a “junk” insurance plan. And we refer to this as a junk insurance plan because we believe that people would be paying premiums in exchange for health insurance, only to find out when they get to the doctor or wherever medical entity that they end up at that their insurance does not cover much of what it is that they would expect to be covered in other insurance plans. And so those are two pieces of legislation that we are extremely concerned about that we did see come up last week.

Some other things that happened last week were that HB 309, which is a bill to give state employees parental leave, passed out the House. It also passed out of committee in the House, and so we are excited that that bill is moving. It hopefully will come up in the Senate as early as next week after they are back from their spring break. We also did have some really good conversations last week, and so did some of our partner organizations — Alabama Voices, SPLC and others — about Summer EBT, so we are hopeful that our budget chairs will appropriate about $15 million so that Alabama can participate in Summer EBT for summer 2025. And so those are some conversations that we have begun having that we are hopeful we can continue having and that will be fruitful.

But then also last week, we noticed that not much happened with gambling, and so that is something that we are monitoring. Although we do not have a position on gambling, we do know that a lot of legislators have put their faith in this legislation passing in in terms of whether or not they believe other budget requests can be fulfilled or can be appropriated as a result of gaming and what happens there. And so we are monitoring just to see what happens with gaming just to see if that impacts any of our legislative asks as well. And so that is pretty much in a nutshell what has happened over the last week.

Since the Legislature again is on spring break this week, there isn’t much happening this week. You all will receive some action alerts from us. We hope that you can reach out to your legislators if you receive one.

But other than that, the only other thing that I want to put on your radar is that today, March 25, is the last day to register for our upcoming advocacy day. And so our advocacy day is next Tuesday, April 2, from 10 a.m. until the early afternoon, and so we really hope that you can join us in Montgomery at the State House for this event.

We are excited about you joining us to talk to legislators about Medicaid expansion. Public transportation, Summer EBT and other workers’ rights issues are things that might be on the radar, and so we definitely hope that you can join us. Do know again that today is the deadline to register, so if you have not already, please visit our website alarise.org to go ahead and register for our advocacy day. We do need a head count so we know how many people we need to provide lunch for, etc. And there is a space limitation in the room, and so again if you’re coming, please register. But also if you have any questions about our advocacy day, please do not hesitate to reach out to our organizing director. That’s Pres Harris, and her email address is pres@alarise.org.

I look forward to hopefully seeing you next week, and I will be back to give you a legislative update in the coming weeks. Take care.

‘I just thought things were the same everywhere’

A close-up photo of a white woman's face. She has dark hair and is wearing glasses.
Medicaid coverage was a vital lifeline for Saraland resident Jolene Dybas as she recovered from a health emergency. But after losing that coverage during the Medicaid unwinding period, she has had to go without needed health care. (Photo courtesy of Jolene Dybas)

When I first spoke with Jolene Dybas, 2023 was coming to an end. Lots of people were attending in-person events confidently and hoping the worst of the COVID-19 pandemic was firmly behind us.

Jolene, however, was still coming to terms with a new reality after moving to Mobile from Florida in 2019.

“I barely go out,” she said. “And when I do, I don’t want people to see me like this.”

I asked her why she preferred to keep such a low profile. That’s when she shared the full story of what it’s like living in Alabama’s health coverage gap. This gap includes nearly 300,000 people who earn too much to be eligible for Medicaid but not enough to afford private health coverage. Alabama’s Medicaid income eligibility limit for adults is one of the country’s most stringent.

“I’ve lived in many other states, and I never saw a person with no teeth until I moved here. I never thought that it could happen to me, but here we are,” she said in disbelief.

The toll of a medical emergency

Jolene’s story begins with good news. Her daughter was accepted to the University of South Alabama (USA) to study nursing. Jolene moved to Saraland, right outside Mobile, to help support her.

Soon after, though, a medical emergency threw a wrench in her family’s new beginning. 

Jolene woke up one day and realized something was off. When she began experiencing heavy bleeding, her fears were confirmed. She rushed to the hospital and was told she needed an emergency hysterectomy to save her life. Jolene also would need intensive treatments, and she would have to stop working while she recovered.

“I quit counting after 10 ER visits and two hospital visits,” she said, describing her new reality of living with chronic pain and recovering from surgery.

Jolene soon lost health coverage when she was no longer able to work full-time as a customer service agent. Her financial situation got so bad that debt collectors began issuing threats of wage garnishment.

“My hours dropped down to part-time. I couldn’t afford emergency medical bills,” she said. “I’m in a place where I’m no longer self-sufficient, and it is killing me.” 

When the hospital bills and prescription costs started to pile up, one of Jolene’s doctors at the USA Hospital encouraged her to apply for financial assistance through the hospital.

“I want people to know that I had a medical emergency and needed blood transfusions,” she said. “If it weren’t for USA Hospital taking up my case, I wouldn’t be here today.”

A temporary lifeline

Thanks to USA Hospital’s financial assistance programs, Jolene received assistance with her medical debt. She also learned she was eligible for a lifeline: Medicaid coverage. Since she was a parent who was too sick to work and had no income, she was one of the few working-age adults eligible for Medicaid under Alabama’s restrictive guidelines.

“Not many good things came out of the pandemic, but hey, it allowed me to get the help I needed and stay on Medicaid when I needed it most,” she said. “That all came crashing down, though.”

After the COVID-19 public health emergency ended in 2023, Jolene found out her health coverage was about to end. Like thousands of other Alabamians, she was rolled off Medicaid coverage during a process known as “unwinding,” or a return to pre-pandemic eligibility requirements.

Jolene had resumed working part-time as her health allowed – and that small amount of income made her ineligible under Alabama’s bare-bones Medicaid eligibility limits. Parents in a two-person household, for example, do not qualify for Alabama Medicaid if they make more than just $3,684 a year.

Jolene said she felt like she had just gotten to a good place managing her health, but losing Medicaid coverage left her with no other options for affordable health insurance. The worst thing about her ordeal wasn’t her surgeries or learning to live with chronic pain, she said. It was finding out she could no longer afford daily medications or dental care.

“Losing Medicaid will leave me with no choice but to go to the ER when my conditions get worse because I can’t afford my medications,” she said.

‘I don’t want them to see me like this’

Living without coverage means making more sacrifices than Jolene had imagined.

“When I lost my insurance, I wasn’t able to go to the dentist,” she said. “My teeth got worse and worse. I only have four teeth left because all I can do is get them pulled when I have a problem.”

Jolene hasn’t visited family since moving to Alabama.

“I can’t even go home to visit because I can’t show them the shape I’m in. I don’t want them to see me like this,” she said. “Where I come from, you don’t see people with no teeth in their head, but in Alabama, I can’t even afford dentures.”

Jolene has lived in several other states before, including Minnesota, Mississippi and North Dakota. She said Alabama’s refusal to expand Medicaid creates unnecessary hardship for its residents.

“If people were well in Alabama, they’d be able to work more. I know I would,” she said.

Minnesota has chosen to expand Medicaid and make other investments in its residents’ well-being. In 2021, lawmakers there passed a historic dental health package that helped ensure Medicaid participants could access dental care and eased administrative burdens for providers.

“They just don’t see things like this,” Jolene said of living in other states with more access to health care and coverage. “There’s no support [in Alabama]. I just thought things were the same everywhere.”

Jolene said living in the coverage gap in a state that hasn’t expanded Medicaid has her missing home.

“If I went home to Minnesota, there is no way I would have this problem,” she said.

‘It can be different’

Jolene’s experience has turned her into an advocate for all Alabamians facing the same problems she does.

“A lot of people in this state don’t know that it can be different. You deserve more,” she said. “Your state leaders are failing.”

Alabamians’ quality of life is suffering the longer we wait to expand Medicaid, Jolene said.

“This has got to be the most expensive place I’ve ever lived. Alabama has taught me a really hard lesson: They don’t care about us,” she said.

Living in other states has offered Jolene a window into the costs of Alabama’s failure to ensure health care access for all of its residents.

“I feel like the death rate is higher here because we all have to wait for adequate care until it’s too late,” she said. “So instead of taking care of that, we’re letting our money slip out of our hands to pay for expansion in other states.”

Jolene said she believes shifting our state’s policy priorities is crucial.

“Why does Alabama still have a grocery tax? I’ve never had to pay that before. Then, we don’t have Medicaid expansion but they’re worried about building bridges and prisons?” she said. “It’s very, very selfish.”

Taking action for a brighter future

After learning nearly 300,000 other Alabamians like her would benefit directly from Medicaid expansion, Jolene started reaching out to lawmakers urging change.

“I’ve written letters to my legislators and Governor Ivey. I’ve called TV stations. I don’t know how they can’t afford to expand Medicaid because people are desperate,” she said. “What does money matter when it’s already there and it is costing lives not to use it?”

One of the states Jolene previously lived in, Mississippi, recently saw meaningful progress toward closing its coverage gap. The Republican-led Mississippi House passed a bill in February to extend Medicaid coverage to more than 200,000 adults with low incomes. That legislation now awaits consideration in the Senate.

Expanding Medicaid is “a topic that should transcend politics,” Mississippi House Medicaid Committee Chairwoman Missy McGee told reporters. “Sometimes, it’s OK to do the right thing because it’s the right thing.”

Jolene said her daughter will graduate soon, and she thinks her family’s time in Alabama is coming to an end. Jolene said the cost of waiting on our state to expand Medicaid is simply too high.

“I thought Mississippi was bad, but it’s not this bad,” she said. “I’m sick of Alabama not caring. If they can’t get their act together, I’m not staying here.”

About Alabama Arise and Cover Alabama

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

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

Arise legislative update: Feb. 6, 2024

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

Full video transcript:

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

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

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

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

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

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

Take care.

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

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

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

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

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

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

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

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

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

Building a life despite uncertainty

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

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

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

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

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

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

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

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

The stress of being uninsured during pregnancy

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

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

So she faced it alone.

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

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

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

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

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

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

‘I shouldn’t have ever been left behind’

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

About Alabama Arise and Cover Alabama

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

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

Stories at MDC event reveal Medicaid expansion’s life-changing potential in Alabama

This post originally appeared on MDC’s website.

By Debbie Smith, Cover Alabama campaign director at Alabama Arise, and Whit Sides, Cover Alabama storyteller at Alabama Arise

Medicaid expansion would empower nearly 300,000 uninsured and underinsured Alabamians to access the health care they need to survive and thrive. Alabama Arise and Cover Alabama were proud to attend a Nov. 6 community discussion in Birmingham titled “Closing the Healthcare Coverage Gap in Alabama.”

The panelists – including Dr. Khalilah Brown, vice president of medical affairs and patient advocacy at Southern Research, and Jane Adams, government relations director at the American Cancer Society Cancer Action Network – discussed how expanding Medicaid would bring federal funding into Alabama. They also spoke about how closing the coverage gap would create jobs in health care and related sectors, bolstering local economies and reducing uncompensated care costs for hospitals and providers. Both speakers made a compelling economic and budgetary case for why Alabama should expand Medicaid as soon as possible.

The need to center people when discussing Alabama’s health coverage gap

However, the focus wasn’t just about how Medicaid expansion would save our state money, improve our health care system and improve our state’s economy. The dialogue also drove home the importance of centering people in the Medicaid expansion policy debate.

That’s why we’re glad that personal stories of directly impacted people were featured heavily throughout the MDC event. Personal stories, like those shared through the Cover Alabama coalition, break down walls that keep policymakers and the public away from seeing the real experiences of people affected by our state’s failing health care policies.

These lived experiences are powerful. They help people understand and empathize, going beyond just talking about money and instead seeing how the coverage gap affects real lives.

For example, Kenneth King shared during the panel discussion about his experience living in the health coverage gap. Kenneth is an underemployed resident of Birmingham, where he lives with his wife and daughter. He chooses the term “underemployed” carefully, as a testament to the difficulty of finding and keeping work in the face of chronic health challenges, some life-threatening.

After facing health issues while uninsured, Kenneth has been left with more than $100,000 in medical debt. As a contractor, Kenneth hasn’t been able to get employer-provided health insurance. He makes too much for Medicaid but can’t afford coverage through the Health Insurance Marketplace. (In Alabama, a parent in a family of three only qualifies for Medicaid coverage if their annual income is below 18% of the federal poverty level. That’s just $4,475 a year.)

How the coverage gap harms Alabamians with cancer

Jenny Fine, originally from Enterprise, Alabama, also shared how the coverage gap hit home for her. Jenny recently lost her sister to pancreatic cancer. Navigating care can be hard even in the best of times for those with a cancer diagnosis. But Jenny’s sister also faced long waits to see a doctor and a lack of treatment options when their local hospital became overwhelmed.

Smaller regional hospitals bear the brunt of uncompensated care, adding up to $13.4 million in 2021 in Coffee County, where Jenny’s family calls home. Expanding Medicaid would reduce that county’s adult uninsured rate by nearly half (42%), and it would add $68.2 million to the local economy in the first year alone. That would mean nearly 2,000 people like Jenny’s sister in that county alone would gain the life-saving coverage they need under expansion.

One of the most powerful moments of the event came when attendee Callie Greer shared the story of her daughter Venus. Venus was in the coverage gap and received her breast cancer diagnosis too late because she did not have access to the preventive care she needed. Venus only received help after countless expensive visits to the emergency room.

Callie told the audience that on one of Venus’ final desperate ER visits, a doctor walked in the room and asked, “What’s that smell in here?” Venus replied, “It’s my breast!” Her breast was literally rotting away from cancer. She went through a radical mastectomy and started chemo, then radiation. The treatment helped for a few months, but it proved too late to save her life.

The path to making Medicaid expansion a reality in Alabama

Personal stories like these, paired with grassroots action, are ultimately how Medicaid expansion is going to become a reality in Alabama. Finally closing the coverage gap depends on highlighting these stories of real Alabamians and working together to push our state leaders for change. As we reflect on these poignant stories shared at the MDC event, it’s crystal clear that Medicaid expansion isn’t just a policy discussion. It’s about lives, families and communities.

The time to act is now. Together, we can urge policymakers to listen to these stories, to recognize the human cost of inaction and to take the necessary steps to close Alabama’s health coverage gap. You can help us: Contact your legislators, share your story and join the Cover Alabama campaign.

Let’s ensure that no one else suffers the tragic consequences of being left in the coverage gap. Join us in demanding a healthier, more equitable future for all Alabamians.

Debbie Smith is the campaign director of Alabama Arise’s Cover Alabama campaign. Whit Sides is the storyteller for Alabama Arise’s Cover Alabama campaign. Visit coveralabama.org for more information on how you can get involved.

Medicaid ‘unwinding’ hits halfway mark in Alabama

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

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

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

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

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

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

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

Maternal, infant health care debuts as an Alabama Arise priority

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

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

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

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

Read our news release for more information about each priority.

A safer and healthier Alabama for parents and children

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

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

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

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

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

Three strategies to boost Alabama’s workforce

State of Working Alabama logo

Alabama leaders and policymakers are stressing about one big issue going into the 2024 legislative session: labor force participation.

Alabama’s labor force participation rate is among the nation’s lowest. Only 57% of working-age adults reported they were actively working or looking for jobs as of September 2023. We also have a severe worker shortage, with nearly 100,000 more job openings than workers available to fill them.

This situation gives Alabama workers increased power to negotiate better wages, benefits and working conditions. It also leaves state leaders and employers scratching their heads. Aren’t we supposed to be among the most “business-friendly” states in the country? How can we attract and retain industry if businesses can’t hire workers? And why aren’t more people applying for openings as the cost of living continues to increase?

Consistent barriers to workforce participation

If you want to know why people are leaving the workforce, you need to ask them. Thankfully, we have data to understand what is happening.

Workers who are underemployed or dropped out of the workforce cited three major, consistent concerns, according to multiple recent surveys from the Governor’s Office of Education and Workforce Transformation:

  1. No transportation.
  2. Inadequate pay or work schedule. (Workers are looking for full-time work or higher pay.)
  3. Illness or disability prevented them from working. (Indeed, disability is one of the main driving forces in Alabama’s extremely low workforce participation rates.)

One would hope we would see more of this data informing the conversation about the workforce. But unfortunately, it appears many lawmakers still haven’t seen the data.

Alabama Arise worker policy advocate Dev Wakeley participated in a recent discussion with lawmakers about barriers to workforce entry. He shared Arise’s policy prescription to address this issue, based on clear and direct feedback we’ve heard from workers.

1. Fund the Public Transportation Trust Fund to help workers get to jobs.

Alabama is one of only three states that has no state funding set aside to support public transportation. The Bipartisan Infrastructure Law of 2021 made massive federal boosts in public transit money available across the country. But with no local or state resources to match, cities and counties across Alabama cannot harness those federal matching funds.

Multiple survey groups cited transit access as their top barrier. It’s time for Alabama to join the rest of our Southeastern neighbors by boosting public transportation investments.

2. Stop incentivizing employers who fail to deliver on promises to provide good-paying jobs.

Alabama lawmakers passed “The Game Plan” earlier this year to renew several key economic incentive packages for large employers. Legislators also strengthened some reporting requirements via the Enhancing Transparency Act. These enhancements were critical, as Alabama still ranks among the least transparent states when it comes to economic incentives and tax expenditures.

We applaud efforts to hold businesses accountable for the promises they make when applying for these major tax breaks. But lawmakers must do more to enforce accountability and ensure the investment is paying off. While our state defers millions of dollars in tax revenue for vague incentives with unclear deliverables, many workers are still struggling to access the promised jobs because we have failed to invest in the necessary state infrastructure. And too often, the jobs simply don’t measure up to the promised wages and hiring goals.

3. Expand Medicaid to keep working-age adults healthy and in the workforce.

Investing in Alabama’s health care infrastructure is not just an avenue to create more health care jobs. It’s also a way to keep workers healthy and in the workforce.

Nearly 300,000 working Alabamians fall into the health coverage gap. Many are employed in high-demand but low-paying industries including service, retail, personal care or construction jobs. Consistent health care for low-wage workers can help prevent or control chronic disabling conditions. It also can give workers a lifeline when they are struggling with addiction, substance use disorders or mental illness.

Workers ideally would find good-paying jobs that provide flexible and inclusive family benefits. But they also should retain access to health coverage if they have to take a break from work to handle caregiving duties, manage a health or family crisis, go back to school or start their own business.

Temporarily losing a job with health coverage should not spiral further into permanent, preventable disability or untreated illness. Medicaid expansion would ensure many Alabamians still can get the health care they need during difficult times.

A prescription for a stronger workforce

We applaud House Speaker Nathaniel Ledbetter and the House Commission on Labor Shortage for expressing an interest in looking more deeply into the data around labor force participation. We were also glad to hear multiple lawmakers cite issues including affordable housing, wages and child care. All of these are critical supports to empower people to obtain and maintain employment.

To us, the message is clear: Investing more in work supports like public transportation and health care while ensuring more transparency and accountability for workforce incentives is a key, data-supported strategy to keep more Alabamians working and thriving.