Alabama Arise’s work for equity, justice and opportunity persisted after the Legislature’s regular session ended. We’ll renew our commitment to those principles when Arise members choose 2022 issue priorities after the Sept. 25 annual meeting. And we’ll keep up the drumbeat when lawmakers return later this year for one or more expected special sessions.
Alabama’s overcrowded and antiquated corrections system – a decades-long humanitarian crisis – may prompt a special session this fall. Gov. Kay Ivey and many legislators hope to build and renovate multiple prisons. Alabama may seek federal permission to use COVID-19 relief money for those purposes.
Arise believes meaningful sentencing reforms should accompany any plan for new prisons. Repeal of the outdated Habitual Felony Offender Act would be one long-term step to reduce overcrowding. Parole reform and stronger investments in community corrections and reentry supports would help as well. Arise will advocate for these policy changes and others during any prison-related special session.
Redistricting is another likely focus of a special session. Legislators will use new Census data to draw new districts for the Legislature, state school board and U.S. House. Arise urges members to participate in public hearings that the Joint Reapportionment Committee will hold across Alabama this month. Click here for more information and a full hearing schedule.
Help us build a better, healthier Alabama for everyone! Alabama Arise is a proud 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.
Sign on to one of the letters of support and share them with your local elected leaders, businesses, faith communities, veterans and law enforcement at coveralabama.org/support.
Connect with an Alabama Arise organizer about opportunities to get involved in your community at al-arise.local/events.
Alabama should build a more equitable and inclusive future by using federal COVID-19 relief money for transformational investments in public health and economic opportunity, according to a letter that 42 churches and organizations across the state sent to Gov. Kay Ivey this week. Alabama Arise is among the groups that co-signed the letter.
The American Rescue Plan Act (ARPA) will provide Alabama $2.3 billion of federal assistance for education and other vital services. Local governments across the state will receive another $1.7 billion.
Affordable housing, education, nutrition and public transportation are a few key areas of need identified in the letter. The letter urges Alabama to use ARPA funds to expand Medicaid, increase broadband internet access in underserved areas and increase funding for child care, early childhood education and mental health care, among other investments.
“New funding at this scale can be transformative for our state, but only if we take a transformative approach to how we spend it,” the letter says. “For too long, Alabama’s leaders … have settled for poor outcomes in health, education, community development and other measures of shared prosperity, because they thought we couldn’t tackle such deep problems. The pandemic is challenging us to reclaim – and redefine – the common good. ARPA funding gives us a rare opportunity to meet the challenge, if we’re willing.”
The full letter, “To Strengthen the Common Good: Six Principles for Allocating Alabama’s ARPA Funding,” is available here.
Principles for effective, transparent use of ARPA money
COVID-19 and its associated recession exacerbated preexisting racial, gender and regional disparities that prevent Alabama from reaching its full potential. Enduring recovery will require breaking away from a mindset of scarce resources and limited opportunities, the letter says.
The letter encourages state leaders to allocate ARPA funds using these six principles as a framework:
Engage local communities at every step.
Aim for equity in outcomes.
Maximize well-being by addressing health in all policies.
Invest in existing assets and capacities to help funds work faster, go further and avoid duplication.
Think big and create a 21st-century infrastructure for the common good.
Build public trust and engagement by following the highest standards of documentation, transparency and accessibility of information about funding awards and expenditures.
Investments to increase equity, expand economic opportunity in Alabama
ARPA funds offer the state an opportunity to lift communities toward better health and broadly shared prosperity. They also can help Alabama address chronic challenges in education, health care, housing and other quality-of-life measures. Among the letter’s key recommendations for allocation of ARPA funds:
Expand Medicaid to save lives and ensure health coverage for more than 340,000 Alabamians with low incomes.
Invest in mobile mental health crisis services and expand mental health crisis centers and school-based mental health services.
Increase funding for in-home early childhood education and in-home services for older adults and people with disabilities.
Provide funding for the state’s Housing Trust Fund and Public Transportation Trust Fund.
Promote equity in high-speed internet access by targeting earmarked broadband funding to help providers expand into underserved areas.
Invest in workforce development by creating subsidized apprenticeships, two-year scholarship programs and subsidized certificate programs for workers with low incomes.
Provide a grocery tax rebate and other cash assistance to households with low incomes.
“Recovery from COVID-19 will require Alabama to go beyond a return to an inadequate status quo,” Alabama Arise executive director Robyn Hyden said. “Our elected officials must make better policy choices now to build thriving communities in the future, and ARPA funds offer a powerful pathway to help make that vision a reality. We urge the governor to seize this opportunity to increase public trust and build a brighter, more equitable future for all Alabamians.”
One of the darkest years in recent memory has put Alabama’s families, communities, health system, businesses – and our leaders at all levels – to the test. Thank you for all your efforts to keep Alabamians safe and secure during this unprecedented emergency. Now that a post-COVID world is dawning, the leadership test doesn’t end. Rather, it enters a critical new phase: Your vision and your actions will help determine what a post-COVID Alabama looks like, and history will record the results. Will the comfort of the familiar pull us back into “the way we’ve always done things”? Or will we count this ordeal as an awakening to bold new possibilities for our state?
For the organizations listed below, all signs point to the second option: The opportunity to address chronic problems that the pandemic has only worsened; a chance to inspire Alabamians with a recovery plan that lifts all communities toward a healthier, more prosperous future; and – most pragmatically – the power of $4 billion in new federal funding to turn vision into reality. We enclose for your consideration six principles that we believe can guide state and local leaders in the most productive, equitable and lasting use of these tax dollars.
The signers of this letter are advocates who work closely with the communities hit hardest by the COVID-19 health and economic crises. For these Alabamians, recovery from the pandemic must mean more than restoring the pre-COVID status quo. With courageous and creative leadership, community engagement across the state, and wise use of historic levels of funding, we have what we need to move Alabama forward and strengthen the common good.
We stand ready to answer any questions you may have about our recommendations.
Respectfully submitted,
The Undersigned Alabama Organizations
Signatories
The following organizations support a principled approach to American Rescue Plan Act funding that will strengthen Alabama’s common good:
ADAP
AIDS Alabama
Alabama Appleseed Center for Law and Justice
Alabama Arise
Alabama Coalition for Immigrant Justice
Alabama CURE
Alabama Possible
Alabama Solutions
Alabama State Conference of the NAACP
Bay Area Women Coalition, Inc.
Birmingham Society of Friends
BirthWell Partners Community Doula Project, Birmingham
Church & Society, Anniston First United Methodist Church
Community Enabler Developer, Inc.
Disabilities Leadership Coalition of Alabama
Disability Rights & Resources
The E.WE Foundation
Faith and Works Statewide Civic Engagement Collective
Grace Presbyterian Church (PCUSA), Tuscaloosa
Greater Birmingham Ministries
Hispanic Interest Coalition of Alabama
Hometown Action
Immanuel Presbyterian Church (PCUSA), Montgomery
Jobs to Move America
League of Women Voters of Alabama
Medical Advocacy & Outreach
The Nightingale Clinic, Birmingham
Nurse Practitioner Alliance of Alabama
Open Table United Church of Christ, Mobile
People First of Alabama
Project Hope to Abolish the Death Penalty
Restorative Strategies, LLC, Birmingham
Sisters of Mercy
Sisters of St. Joseph
The Sisters, Tuscaloosa
St. Luke’s Episcopal Church, Jacksonville
Unitarian Universalist Fellowship of Mobile
University of Montevallo Social Work Program
Volunteers of America Southeast
West Alabama Women’s Center
YMCA of Birmingham
YWCA of Central Alabama
Letter text
To Strengthen the Common Good: Six Principles for Allocating Alabama’s American Rescue Plan Act Funding
The COVID-19 crisis has created enormous new challenges for Alabama, while shining a harsh light on long-neglected ones. To strengthen and expedite recovery, the American Rescue Plan Act (ARPA), passed by Congress in March 2021, is pumping $4 billion into Alabama’s economy over the next three years. New funding at this scale can be transformative for our state, but only if we take a transformative approach to how we spend it.
The starting point is recognizing and breaking our old mindset of scarce resources, limited possibilities and patchwork policy solutions. For too long, Alabama’s leaders – and the voters who empower them – have settled for poor outcomes in health, education, community development and other measures of shared prosperity, because they thought we couldn’t tackle such deep problems. The pandemic is challenging us to reclaim – and redefine – the common good. ARPA funding gives us a rare opportunity to meet the challenge, if we’re willing. The undersigned organizations offer the following six principles as a framework for seizing this unprecedented opportunity to build a better Alabama for all.
Engage local communities at every step.
The COVID pandemic has hit people where they live, work, learn and play. The best use of ARPA funds will reflect the needs and goals identified by ordinary Alabamians through a process that solicits, accommodates and heeds public input.
Crucial question
How are local leaders, advocates and community members involved in identifying and prioritizing both needs and solutions?
Recommendations
Identify or create effective, inclusive, results-oriented, nonpartisan, community-based councils in each county or region to develop recommendations for local ARPA funding priorities. Potential lead organizations may include United Way, community foundation or Community Action Agency advisory bodies; children’s policy councils; university extension services; or community round tables convened by local governments. Make it a priority to engage segments of the community underserved by the status quo, such as Alabamians of color, people who work for low wages or have lost jobs, and those who lack adequate basic services.
Provide opportunities for broad public participation in developing and finalizing local, regional and state ARPA spending plans. State leaders should agree not to appropriate ARPA funds until the public engagement process is completed.
Review existing community and state needs assessments to identify common local concerns, as well as gaps in information and perspective.
Facilitate information-sharing and coordination among local, regional and state efforts to enhance efficiency, leverage capacity and avoid duplication.
Designate a statewide source of technical assistance, best practices and other aids to local and regional decision-making.
Aim for equity in outcomes.
Some regions, counties, municipalities and populations have suffered deeper blows than others from the pandemic because of chronic gaps in resources, infrastructure, services and opportunities. Rural Alabamians, people of color, people with disabilities, and women have faced disproportionate impacts from both the health and economic crises. Simply restoring the prior status quo is not transformation. ARPA funding decisions should take into account the un-level playing field of COVID recovery, targeting investment toward improving the basic standards of living for areas and people long left behind. Assistance to those most deeply impacted by COVID-19 should come with as little “red tape” and administrative delay as possible. Direct cash assistance to people with low incomes should be a priority.
Crucial question
How do proposed funding allocations contribute to the removal of historic barriers to individual, family and community well-being?
Recommendations
Within each jurisdiction (state, region, county, city), use socioeconomic indicators such as poverty, unemployment and workforce participation rates, and racial/ethnic health disparities to target strategic, expedited community investments.
Provide grants to minority- or women-owned small businesses, especially those that did not receive earlier federal business loan assistance.
Provide up to $13 per hour in bonus or “premium” pay – on top of their regular pay – to essential public and private workers, up to $25,000 per worker per year, as allowed under the Rescue Plan, for work performed during the public health emergency, awarding the largest bonuses to the lowest-paid workers.
Provide cash assistance to SNAP food assistance recipients with incomes below 50% of the Federal Poverty Level.
Provide a grocery tax rebate to households earning less than 200% of the federal poverty level.
Fund and train organizations that already help people access SNAP, Medicaid, tax credits and other supports as navigators for the full range of ARPA assistance, including the expanded federal Child Tax Credit.
Maximize well-being by addressing health in all policies.
What began as the COVID-19 health emergency quickly became an economic and social crisis. In turn, the toll the virus has taken on communities of color, people with disabilities and the uninsured revealed how deeply socioeconomic conditions are connected to health risks and outcomes. Nutrition, housing, transportation, education and other factors are widely recognized as social determinants of health, but Alabama has been slow to broaden our approach to health policy and funding. ARPA offers us the chance to apply the lessons of COVID-19 and design a recovery plan that puts eliminating health disparities and improving health at the center of investments in every sector.
Crucial question
How does this funding proposal advance the goal of a healthier Alabama?
Recommendations
Name it and claim it: There’s enough ARPA funding to achieve significant health improvement in Alabama if leaders set clear, ambitious goals and plan accordingly.
Engage public health experts to incorporate health goals and strategies across the full span of ARPA allocation planning.
Increase professional staffing at county health departments.
Strengthen our workforce, families and communities by using the generous ARPA incentives (an estimated $720 million) to expand Medicaid and close the coverage gap for 340,000 Alabamians with low incomes.
Invest in mobile mental health crisis services and expand mental health crisis centers.
Expand school nurse programs and school-based mental health services.
Fund Healthy Food Financing grants for fresh food markets, including mobile markets, as well as local worker-owned food cooperatives to boost local economies, provide jobs and expand availability of fresh foods in food apartheid areas (where healthy food access is hindered by racially discriminatory economic or political factors) and food swamp neighborhoods (where food and beverage sources like fast food outlets, convenience stores and liquor stores crowd out healthier food options).
Invest in existing assets and capacities to help funds work faster, go farther and avoid duplication.
Over recent decades, budget cuts to education, public health and other essential services – and our failure to expand Medicaid – have left Alabama unprepared for a prolonged emergency like COVID-19. Similarly, charitable nonprofit organizations across the state have faced unprecedented demand for their services during the pandemic and risen to the challenge. By directing ARPA funds to restoring critical services and supporting experienced, trusted charitable nonprofits, state and local governments can strengthen community resources, meet needs efficiently, avoid reinventing the wheel, and multiply the economic benefit.
Crucial question
What programs and organizations are already working to meet the goals of this ARPA funding proposal, and how can a partnership approach improve outcomes?
Recommendations
Fund organizations that are well-positioned to reach people with significant barriers to accessing support, such as immigrants, people with disabilities and people of color with low incomes.
Expand community schools in neighborhoods where the pandemic has taken a particularly heavy toll.
Provide additional funding for existing in-home early childhood education services like HIPPY, Parents as Teachers and Nurse-Family Partnership programs.
Increase support for school-based social and health services, particularly in high-poverty neighborhoods and districts.
Help children catch up on unfinished learning by expanding the teacher workforce through pay increases and other supports for early childhood teachers, child care workers and special education teachers who work in at-risk communities and schools.
Expand existing in-home and community-based services for the elderly and people with disabilities.
Expand or develop local alternatives to incarceration such as specialized courts, community correction programs, re-entry programs and services for people at risk of offending.
Invest in workforce development by creating subsidized apprenticeships, two-year scholarship programs, and subsidized certificate programs for low-income workers.
Think big and create a 21st-century infrastructure for the common good.
Alabamians have long recognized the human cost of inferior and outdated public works and services like sanitation, health care, transportation and information technology systems. But the monetary cost has kept our leaders from modernizing them. COVID has revealed the deadly consequences of that neglect, and ARPA includes massive funding aimed at moving states forward on all of these fronts, including a large share for education (not addressed in these recommendations because of specific earmarking). The opportunity calls for bold leadership and vision. Our spending plan must seek to coordinate local, regional and statewide investments for fundamental and long-lasting impact.
Crucial question
How will today’s investments benefit future generations of Alabamians?
Recommendations
Modernize and align state agency computer systems to create a “no wrong door” approach to streamlined eligibility and enrollment across benefit programs.
Modernize and improve state unemployment insurance (UI) technological infrastructure, application and payment systems.
Upgrade water and sanitation systems, prioritizing communities with a history of unsafe water quality and waste-water disposal.
Provide critical infrastructure and equipment (such as trucks, refrigeration, trainers, lift gates, etc.,) to local food banks and food pantries to expand emergency food distribution.
Expand Alabama’s affordable housing capacity, stabilize families and communities and reduce homelessness by seeding the Affordable Housing Trust Fund with $25 million and providing grants for eligible new construction, renovation and maintenance.
Recognizing that lack of reliable transportation is a major hindrance to health care, economic activity and workforce development in many areas of the state, seed the Public Transportation Trust Fund with $20 million and provide state match for increased federal public transportation funding.
Promote equity in high-speed internet access by targeting earmarked broadband funding to help local service providers expand into underserved areas and by ensuring community oversight of access and quality standards.
Provide state technical assistance to localities in consolidating, evaluating and negotiating broadband contracts to minimize the danger of approving projects with little public benefit.
Build public trust and engagement by following the highest standards of documentation, transparency and accessibility of information about funding awards and expenditures.
Spending taxpayer dollars is always a tremendous responsibility. When it comes to spending billions in a short time, the potential for slow uptake, poor decisions and misuse only increases. Alabama can ensure that the generous ARPA funds do their appointed job by establishing clear guidelines and full disclosure for the entire funding process, from eligibility of applicants to allocation decisions to project expenditures and results.
Crucial question
How will Alabamians be able to track the allocation, use and impact of their federal ARPA tax dollars in the state?
Recommendations
Create and maintain a public database of state and local ARPA funding allocations and expenditures, easily searchable and sortable by project or partner name, policy topic, service area, grant amount, award date, expenditure date and other key factors.
Adopt simple, accessible application and reporting requirements that allow grantees and recipients to establish their credibility and tell their story without jumping unnecessary bureaucratic hurdles.
Use local ARPA planning groups as conduits for ongoing reporting and feedback about plan implementation, obstacles, impact and sustainability. Build a robust outreach operation to help people access available federal, state and local aid.
How often have we gotten to say that it’s raining money in Alabama? That’s the image that comes to mind as the American Rescue Plan Act (ARPA), passed in March, begins to direct more than $4 billion in new federal funds into the state over the next three years.
The funding could help Alabama make historic progress in public health, education, family well-being and community viability if spent wisely and equitably. It also offers generous incentives that would more than offset the state’s initial cost to expand Medicaid. This new COVID-19 relief comes on top of $1.9 billion Alabama got under the CARES Act last year.
The state government will receive more than $2 billion under ARPA. Counties will get nearly $1 billion. Alabama’s 21 largest cities will receive more than $400 million, and other municipalities will get nearly $400 million as well. Both the state and localities may use funds to offset the pandemic’s strains on families, small businesses, public health and infrastructure like water and sewer systems and high-speed broadband networks.
Portions of ARPA money are earmarked for direct payments to local school districts. Other funds are dedicated to provide rental assistance and make child care more affordable and accessible.
The act also temporarily boosts the Child Tax Credit and Earned Income Tax Credit and temporarily increases food aid under the Supplemental Nutrition Assistance Program and WIC. In addition to these supports, ARPA also provides one-time cash payments ($1,400 each for most Americans). And it provides direct assistance for health care, funeral expenses and other essential needs.
Arise will continue to follow these funding streams with the goal of ensuring equitable distribution and transparency. And we will advocate to make the temporary improvements permanent in the next round of federal relief.
Advocacy barriers for Alabama Arise members were extraordinarily high during the Legislature’s 2021 regular session. The COVID-19 pandemic limited physical access to the State House and made a difficult policy landscape even rockier.
But Arise members were undeterred. They spoke out forcefully and repeatedly for justice and opportunity. And the result was real, meaningful progress on multiple issue priorities.
This year brought advances on criminal justice reform and internet access. It delivered stronger investment in early education and preserved funding for Medicaid and mental health care. And it saw efforts to chill free speech and erode the Department of Public Health’s effectiveness defeated.
Wins on expanding broadband, reforming civil asset forfeiture
Arise members made their presence known throughout the session. They gathered monthly for online Membership Monday events to stay engaged and connect with advocates across Alabama. On May 18, nearly 100 people attended a virtual recap event to debrief the session and prepare for next steps. And throughout the year, our supporters flooded email inboxes and rang phones off the hook, contacting legislators and Gov. Kay Ivey more than 14,000 times.
That advocacy worked. Lawmakers passed SB 215 by Sen. Del Marsh, R-Anniston, to promote broadband expansion to rural communities and other underserved areas. And legislators finally began to rein in civil asset forfeiture, a practice that allows law enforcement to seize property without a criminal conviction.
SB 210 by Sen. Arthur Orr, R-Decatur, doesn’t end civil asset forfeiture, but it makes some important initial improvements. Those changes include exempting some property from forfeiture and strengthening protections for innocent owners.
Successful defense against public health threats, anti-protest bill
Arise members also helped halt a threat to free speech. HB 445 by Rep. Allen Treadaway, R-Morris, would have expanded law enforcement’s powers to arrest protesters for “rioting” and imposed harsh mandatory minimum sentences on people convicted under the law. The bill passed in the House but died in the Senate.
The Legislature likely isn’t done this year. Lawmakers expect one or more special sessions to address unfinished business like redistricting, prison overcrowding and allocating federal relief funds. Whenever the next session may be, Arise members will be ready, advocating as always for a better, more inclusive Alabama.
Arise’s Robyn Hyden recaps the Alabama Legislature’s 2021 regular session. She discusses several policy wins that Arise members should celebrate, including the defeat of legislation that would limit the right to protest and passage of a bill to promote equitable access to broadband.
Medicaid expansion would increase access to life-saving health care while also advancing racial and gender equity in Alabama, according to a new report by the Georgetown University Center for Children and Families (CCF). Expansion also would ensure coverage for tens of thousands of essential workers in industries like health care, retail and construction.
“Everyone in Alabama has relied on these essential workers in some way during the COVID-19 pandemic,” Alabama Arise policy director Jim Carnes said. “Now it’s our turn to help them get reliable, affordable health insurance so they can continue to do their jobs and care for their families. It’s time for Alabama to accept generous federal funding to expand Medicaid to our state’s uninsured workers.”
Alabama is one of 12 states that have not yet expanded Medicaid to cover adults with low incomes. This inaction has denied hundreds of thousands of Alabamians access to quality, affordable health care.
Approximately 204,100 uninsured adults – 49% of Alabama’s uninsured adult population – would gain coverage if Alabama expands Medicaid, Georgetown CCF estimates. That estimate is in line with prior projections that Medicaid expansion would benefit more than 340,000 Alabamians who are uninsured or struggling to afford coverage.
These residents earn too much to qualify for Medicaid under the state’s stringent income limit but too little to qualify for subsidized marketplace plans under the Affordable Care Act. As a result, they are stranded in a health coverage gap.
Expanding Medicaid would save lives, advance racial and gender equity
Women and Black people account for a disproportionate share of low-wage uninsured working Alabamians, the Georgetown CCF report finds. Black people represent about 27% of Alabama’s overall population but 39% of the state’s low-wage uninsured workers. Women also are overrepresented in this category, making up 55% of low-wage uninsured Alabamians.
These uninsured residents work in vital but low-paid jobs. More than one-third of Alabamians working without health insurance (35.2%) are in the hospitality or retail industries, the report finds. Another one in five work in construction or in health care and social assistance.
Alabama’s uninsured rate for working people (12.1%) exceeds the national average. In 11 counties, more than 15% of working people are uninsured, Georgetown CCF finds. The highest rates are in DeKalb County (19.2%) and Dale County (18.2%).
The map below shows the range of uninsured rates for working adults across Alabama. Hover over the map to see the rate in your county.
Nearly seven in 10 Alabamians support expanding Medicaid to reduce these disparities, a statewide poll found in February. And the American Rescue Plan Act offers federal incentives that would more than offset Alabama’s initial cost to expand Medicaid.
If Gov. Kay Ivey agrees to expansion, the law would give the state a 5-percentage-point increase in federal funding for its traditional Medicaid coverage for two years. That would bring Alabama an additional $732 million over two years, based on an average of federal, state and independent estimates.
Rev. Robin Hinkle is the rector at St. Mary’s Episcopal Church in Jasper. Her ministry has greatly scaled up food assistance to the community to help ease financial suffering during the COVID-19 recession. (Photo courtesy of St. Mary’s Episcopal Church)
Walker County has gained notoriety in recent years as one of the epicenters for Alabama’s opioid epidemic. Overprescribing, lack of health care access and extreme poverty seemed to form a cursed trifecta leaving residents of the rural county to rebuild and recover.
Outside the headlines, community organizations and rural health advocates have been earning praise for their efforts to bring as many resources as possible to the northwest Alabama county of 67,000 people.
“If there’s a problem, you don’t have to look far for someone to help,” said Rev. Robin Hinkle of St. Mary’s Episcopal Church in Jasper.
Hinkle’s ministry has scaled up its food assistance to the community exponentially in the last year. The church went from distributing about 250 bags of food a week to more than 1,000 bags a day. Hinkle said the COVID-19 pandemic and its associated recession left more people than ever in need.
“The system is absolutely not working as it is, especially with the state and local governments,” she said.
Hinkle said many people she works with do receive Supplemental Nutrition Assistance Program (SNAP) benefits or other public assistance. But the income restrictions attached often force people to make painful decisions.
“I see it all the time,” Hinkle said. “When you lose your insurance and paycheck, what used to be $5 at the pharmacy is now $40. And the first thing you give up is medicine.”
‘A big, giant problem’
Hinkle said she has been offering more financial assistance than expected to families on the margins of the middle class. Many of these households have been hit hard by the pandemic, too. And resources can be scarce for families who make too much to qualify for public assistance, but still not enough to reliably pay the bills.
These are the families who are in Alabama’s health coverage gap. They make too much money to qualify for Medicaid under the state’s stringent eligibility limits but not enough to get a subsidy to help pay for a private insurance plan on the health care marketplace.
“This is a big, giant problem,” Hinkle said. “Once you lose a job or are forced to work minimum wage, it’s very hard to be poor because of all the gaps in our system.”
Medicaid expansion would relieve the burden on families and those deciding whether to pay for medicine or buy groceries, Hinkle said.
“If we had better access and treatment options, it’s better all around,” she said. “Every dollar counts. If we could just get the resources, we can work to solve the problem just like we’ve done before.”
Removing barriers and strengthening rural clinics
Over the past decade, community organizations have come together to form networks bringing more money and treatment options into the county. Spearheaded by the Walker County Community Foundation, the Healing Network of Walker County includes 25 organizations providing prevention, intervention, treatment and recovery resources for mental health and substance use disorders.
One of those partners is Capstone, a group of rural health clinics located across Walker and neighboring Winston counties.
“Over half of our patients are uninsured, and the majority of the others receive Medicare or Medicaid,” said Dr. F. David Jones, executive director of Capstone Rural Health in Parrish.
Dr. F. David Jones is executive director of Capstone Rural Health in Parrish. He said Medicaid expansion would allow clinics like his to grow and serve more people across Walker County. (Photo courtesy of Capstone Rural Health)
Capstone’s clinics often house primary care, dentistry, pharmacy, social work and mental health care under one roof. While this one-stop shop can be invaluable for rural communities, Jones said access barriers are always involved when someone is struggling to make ends meet.
“We do still need to see valid ID, a bill showing your current address, and proof of income, which can be hard to get if you’re unemployed or don’t have a license,” he said.
Jones said the clinic tries to treat everyone who comes in. But even with local help, they can’t do it all.
“Communities can keep casting off the poor by just ignoring all their problems or burdening the church, but they need us more than they realize,” he said.
Medicaid expansion’s life-saving potential in Walker County
An injection of money from Medicaid expansion could be a lifesaver, Jones said. The funding could ease the burden placed on community health centers and UAB to treat areas of Walker County with low access.
“Medicaid expansion is a no-brainer,” he said. “With that kind of money coming in, we would grow. We could bring professionals in, and it could prop up a lot of the other community health centers that do good work.”
Jones said he hopes Alabama can put aside partisan politics and finally take advantage of the taxes we already use to pay for Medicaid expansion in other states.
“I hope the governor will sign on,” he said. “It’s time for someone to stick up for us. We should’ve been at that table a long time ago.”
About Alabama Arise and Cover Alabama
Whit Sides is the story collection coordinator for Alabama Arise. Arise is a nonprofit, nonpartisan coalition of congregations, organizations and individuals promoting public policies to improve the lives of Alabamians with low incomes.
Arise is a founding member ofthe Cover Alabama Coalition. Cover Alabama is a nonpartisan alliance of more than 100 advocacy groups, businesses, community organizations, consumer groups, health care providers and religious congregations advocating for Alabama to provide quality, affordable health coverage to its residents and implement a sustainable health care system.
As vaccinations continue across Alabama, COVID-19’s viselike grip on our lives is loosening. The pandemic has caused immense physical, emotional and economic suffering, and those aftereffects will not fade quickly. But the American Rescue Plan Act – the federal relief package that President Joe Biden signed March 11 – includes many important policies to begin the healing.
Some of the most crucial investments come in health care. The law increases subsidies for marketplace health coverage under the Affordable Care Act. It also creates new incentives that would more than offset the cost of Medicaid expansion. The incentives would remove Alabama’s last financial barrier to extending coverage to more than 340,000 adults with low incomes.
If Gov. Kay Ivey agrees to expand Medicaid, Alabama would receive between $740 million and $940 million over two years. That would result from a 5-percentage-point federal funding increase for traditional Medicaid coverage.
“Medicaid expansion is the single biggest step Alabama can take to recover from the pandemic,” Alabama Arise campaign director Jane Adams said.
“Congress did their job. Now it’s time for the governor and state lawmakers to do theirs.”
The act also slashes poverty by boosting unemployment insurance and nutrition assistance benefits and expanding the Child Tax Credit and Earned Income Tax Credit. It funds rental and mortgage assistance to help prevent evictions and foreclosures. And it provides Alabama’s state and local governments with $4 billion of federal assistance to help avoid cuts to education and other vital services.
Persistent disparities – and how to end them
The relief package provides opportunities to begin dismantling longtime structural barriers in Alabama. Arise offers many such policy recommendations in our recent report, The State of Working Alabama 2021, which details how COVID-19 cost hundreds of thousands of Alabamians their jobs and fueled a rapid surge of hunger and hardship across our state.
COVID-19’s toll has been especially heavy for women and people of color, the report finds. The pandemic exacerbated Alabama’s preexisting racial, gender and regional disparities in health care, housing, nutrition and economic opportunity. These inequities – the legacy of bad policy decisions – prevent Alabama from reaching its full potential.
“Alabama’s economic, racial and gender inequities are preventable and reversible,” Arise policy director Jim Carnes said. “By making better policy choices now and in the future, we can chart a path toward a more equitable economy.”
