Resource: Personal Stories

‘I will leave this world better than I found it’

By Whit Sides
An adult woman stands in front of a wall of plants.
Angel Garrett spends many mornings at Alice Circle, a local cafe, bookstore and gift shop in her native Fort Payne. She is an outspoken advocate for protecting health coverage in Alabama. (Photo by Whit Sides)

Angel Garrett has friends everywhere she goes.

As she sat down in a local coffee shop to share her story, she greeted three friends visiting from the local Arc chapter. The Arc is a nationwide community-based organization that advocates for and with people with intellectual and developmental disabilities.

“I used to work there,” Angel said. “But now I can’t work as much or it affects my Medicaid waiver.”

Angel, 37, is a writer from DeKalb County in northeast Alabama. She was born with a rare condition called schizencephaly, which has affected her development and speech. After high school, Angel followed her passion for language to Birmingham, where she earned a degree in creative writing with a minor in sociology from UAB.

“Though I was very shy until I was 22, I have always had that voice inside that I was fortunate enough to develop,” she said. “Eventually, I gained the confidence to speak, and unlucky for everyone else, I haven’t shut up since.”

Angel’s adept ability to communicate and connect with people have opened many doors in her life. She now serves as an advocate for the Governor’s Office on Disability.

I first met Angel when she was taking the stage at the Fort Payne Opera House earlier this summer. Cover Alabama and the Progressive Women’s Action Coalition invited her to a town hall to share her experience with navigating Medicaid while living with a disability. She did so in a powerful way.

“People are surprised when I say it, but I consider myself lucky to be disabled,” she said.

The life-altering threats that federal cuts pose

Angel’s experiences have forged her into a fierce advocate of programs that have allowed her not just to have daily necessities, but also to maintain a high level of independence.

“I’m lucky because I’m a disabled person in the United States of America. I’m afforded the grace and opportunities to have my basic needs met. I’m given access to health care,” she said. “I qualify for programs like SNAP, LIHEAP and other forms of assistance that offer me peace and stability so I can live as healthily as possible.”

SNAP is the Supplemental Nutrition Assistance Program, which provides food assistance for tens of millions of Americans, including 1 in 7 Alabamians. LIHEAP is the Low Income Home Energy Assistance Program, which helps households with low incomes afford heating and cooling bills.

Both programs face substantial federal cuts under HR 1 – the so-called One Big Beautiful Bill Act – which was enacted into law in July. So does Medicaid, which provides health coverage for 1 in 5 Alabamians, mostly children, older adults, and people with disabilities.

The federal Medicaid cuts’ effects will be limited in Alabama because our state’s program is already bare-bones. But the law will limit Alabama’s ability to strengthen its health care system in the future.

Since HR 1 passed, Angel said people often ask what her life would be like without Medicaid. Without it, she said, she wouldn’t be able to get the care she needs to maintain her health and mobility.

“I wouldn’t be able to go to therapy every week,” she said. “I wouldn’t be able to get my medications, procedures, support, help, food, supplies or any other things that assist my quality of life.”

Advocating for herself and others

Angel said she recently has had issues with being reimbursed for out-of-pocket costs, including transportation to her doctor’s appointments. Medicaid offers many important services, and she said she knows states like Alabama stand to lose when budgets are cut.

“The non-emergency transportation program is supposed to reimburse my trips. I qualify now since my Medicaid waiver got approved. However, it isn’t a seamless process,” she said. “I haven’t had any luck coming up with a solution even though I’ve talked to both Medicaid and Medicare.”

An adult woman sits at a table.
Angel Garrett said she began finding her voice to advocate for Alabamians with disabilities at age 22. “I haven’t shut up since,” she said. (Photo by Whit Sides)

The unmet health care needs don’t stop there. Angel said she hears stories from the community about procedures being denied and about coverage losses for children with autism. She said she also believes dental care should be included with Medicaid and all other health coverage.

“I’m lucky enough to have dental coverage,” she said. “I feel like oral health is one of the most important factors in overall wellness, and Medicaid should cover that.”

While Medicaid always has had room for improvement, Angel said, any new cuts would be life-altering for Alabamians like her. She said she will continue to speak out about how vital Medicaid is for her life and her future.

“I feel that I would be wasting my life — and my mind, my thoughts, my voice — if I didn’t fight for what I have,” Angel said. “It’s disheartening that instead of fighting for expanding the programs that help people like me, I am having to speak up to protect and just keep the programs that allow myself and so many others to live. Not even live independently, but simply just live.”

‘Progression, not regression’

Medicaid provides essential protections for people whose voices often go unheard in policy debates, Angel said. She said she feels the program should aim for abundance and not austerity.

“Oftentimes, people with disabilities are infantilized. Not every person with a disability has a voice to say what they need,” she said. “It has always been a goal of mine to help progress the quality of life for people like me. Progression, not regression.”

An adult woman stands in front of a wall.
Angel Garrett is a writer who lives in DeKalb County and is an advocate for the Governor’s Office on Disability. Angel has schizencephaly, which has affected her development and speech. But the condition has not deterred her from speaking out about Medicaid’s vital importance for the lives and futures of her fellow Alabamians with disabilities. (Photo by Whit Sides)

As she alludes to with her “lucky to be disabled” mantra, Angel said she believes she often “turns lemons into lemonade” to help ensure she is not the only one to benefit from her advocacy.

“Because of my disability, people don’t take me as seriously as I need them to until I’m raising hell, cussing or flipping metaphorical tables,” she said. “However, I’ll continue to flip as many tables as I need to just to make a difference when things like Medicaid are on the line. I will leave this world better than I found it.”

About Alabama Arise and Cover Alabama

Whit Sides is the 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.

Virginia wants you to join her in protecting health coverage in Alabama

By Whit Sides
A woman sitting and smiling.
Virginia found a good job and health insurance that meets her needs after moving back to Alabama last year. But Congress is considering legislation that could send health care costs soaring for her and tens of thousands of other Alabamians. (Photo by Whit Sides)

Virginia would say things have been going well since moving back home to Birmingham a year ago – steady even. She said consistency has been key in staying healthy when life takes on unexpected changes.

And Virginia has had to navigate some unexpected changes recently. 

After graduating from Mountain Brook High School and attending the University of Montevallo, she got married and followed her military spouse out of state. Virginia became a federal employee on the base where they were stationed, working in health care administration.

One of the benefits of being in a military family was having health coverage through TRICARE. That allowed her to stay on top of her mental and physical health.

“I’ve been treated for depression, anxiety and ADHD since I was very young, about 14, so it’s important that I regularly go to counseling. It’s important to find medication that works and stick with it,” Virginia said. “The reason I’ve done so well with my mental health is because I’ve had access to great health coverage throughout my life.”

When she and her spouse decided to separate, Virginia moved home. Then she learned she had lost her TRICARE health coverage in November 2024. 

“I knew I had to be in Birmingham. It’s where I know people. It’s where my family is,” she said. “I wasn’t in the best space emotionally, but I knew if I could make it home, I could deal with whatever was next once I got there.”

Reconnecting with the community

Virginia began her job search the day she arrived back in Alabama. She soon started working at a grocery store. The work was brutal, with long hours on her feet and only 10-minute breaks. But she said she was grateful for the support system that helped her earn money and become plugged into her community again.

“When I told my friends I was looking for a job, so many people were incredibly helpful, and that’s how I heard about the navigators at Enroll Alabama,” she said.

Virginia mentioned to her roommate that she was living without insurance. Her roommate then suggested visiting healthcare.gov to explore the Marketplace created under the Affordable Care Act (ACA).

An enrollment navigator walked Virginia through the process. With her recent income and household changes, together they discovered that she was eligible for premium tax credits that reduced the cost of her monthly health insurance premiums.

“I did a lot of research to make sure the plan I chose covered most of what I needed to cover my regular medications and doctors and everything,” she said. “And honestly, it wasn’t the cheapest plan, but I could afford it now with the help.”

Shortly after Virginia enrolled in her new plan, she received more good news: She was offered a job working at a family-owned office downtown.

“I work at a small local office now, and the reason I could accept that job is because I already had insurance,” she said.

The budget debate becomes personal

Since moving back, Virginia said, she feels like starting over in Birmingham was the right decision. She has plugged into several social organizations and is making an effort to become involved in causes she was passionate about locally.

That’s when Virginia found out the U.S. House recently passed a budget reconciliation bill (HR 1) with proposed health care cuts that might affect her directly.

“I follow the news, and I’ve seen everything to do with the budget bill for a while now,” she said. “And understandably, a lot of the discussion focuses on Medicaid and Medicare, which is a really big issue. But sometimes navigating health policy is hard when I’m like, ‘OK, if Medicaid’s getting cut and Medicare is getting cut, does that include funding for the Affordable Care Act?”

A woman standing and smiling.
Virginia became more engaged in health care advocacy after attending a town hall that Alabama Arise co-hosted in Birmingham. She urges Alabamians to contact their lawmakers and tell them how proposed health care cuts would harm their families and communities. (Photo by Whit Sides)

Alabama Arise and Birmingham Indivisible co-hosted a community town hall at East Lake United Methodist Church on May 31 in Birmingham. Panelists discussed proposed federal cuts to food assistance and health coverage.

Virginia was one of the nearly 100 people in attendance that day. She heard Debbie Smith, Arise’s Cover Alabama campaign director, break down what HR 1 could mean for Alabamians who receive subsidies to help pay for their ACA plans. For people like Virginia.

“Someone on the panel said that there would be up to 75% cut of the premium tax credits,” Virginia said. “My heart sank, you know? I put my head in my head in my hands and may have literally gasped, ‘Oh, no!’”

How federal cuts would undermine health care across Alabama

The budget plan now moving through Congress would make health care more expensive and less accessible for people across Alabama and nationwide. One way it would do that is to allow enhanced tax credits for ACA Marketplace coverage to expire.

This expiration would cause out-of-pocket premium payments to increase by more than 75% on average for people enrolled in Marketplace plans, according to KFF. In Alabama, that increase would be 93% on average. And in a dozen other states, people would see their premium payments more than double on average. Most of them, like Alabama, have not expanded Medicaid to cover adults with low incomes.

The most significant Marketplace premium increases likely would hit older adults and enrollees with lower incomes, according to KFF. And those higher costs would play a huge role in driving up Alabama’s uninsured rate.

About 190,000 Alabamians would lose health coverage under the proposed new cuts and barriers to Medicaid and ACA coverage. The cuts also would increase the financial strain on many rural hospitals and clinics and ultimately would drive up health care costs for everyone, no matter what type of coverage they have. And all of the cuts would help finance tax breaks for wealthy households and highly profitable corporations.

For Virginia, the health care cuts would be personal. She said she receives close to $300 a month from the tax credits toward her health coverage costs.

“It’s only $3,100 a year, which is not a lot to these people working on the bill, but like, come on, man,” she said. “You’re going to take that from us, when it’s a 75% difference? That’s such a huge deal.”

Speaking out for herself and others

Virginia said she understands that our country needs a budget from year to year. But she said she hopes Alabama’s elected officials reject health care cuts that would harm so many people, including her.

“I’ve been making calls to lawmakers about other issues since before I even knew I was impacted,” Virginia said. “And so now I just start my day by calling [Sen.] Katie Britt and calling [Sen. Tommy] Tuberville. If I leave a voicemail, I call him ‘Coach,’ but sometimes, people actually answer and I have to work through my social anxiety.”

Virginia encourages anyone who might feel overwhelmed by advocacy to take it one step at a time, and to reach out to their lawmakers with their own story.

“I fundamentally disagree with everyone right now who says that it doesn’t matter if you make a call or show up at a town hall,” she said. “Because if we all say, ‘Nothing I do matters’ and we all sit here and do nothing, then we’re really going to be in trouble.”

About Alabama Arise and Cover Alabama

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

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

Medicaid helped save her daughter’s life. Angelica wants it to be there for other Alabamians, too

By Whit Sides
A woman and her two daughters have a photo shoot near what appears to be a creek. The mother, in a red dress, is bending down to kiss her daughter, in a yellow dress.
Irondale resident Angelica McCain plays with her daughters near the Cahaba River in fall 2024. Years of living in Alabama’s health coverage gap and advocating for her children’s health care needs motivated her to become an advocate for affordable health coverage for every Alabamian. (Photo courtesy of Angelica McCain)

By the time Angelica McCain was 17, she had moved out of her family’s home in St. Clair County, east of Birmingham. Since then, she has worked full time in the service industry, where health coverage never comes easily.

Now a single mother of two living in Irondale in eastern Jefferson County, McCain finds herself in a familiar struggle. She is fighting to ensure her children have access to the same Medicaid coverage that helped her growing up.

“I was on Medicaid with my brothers,” McCain said. “My mom worked three jobs, my dad didn’t work much, and that was the only way we could have health care.”

That early experience shaped her perspective and fueled her advocacy today. Working in the service industry for much of her adult life – where health insurance is rarely offered – Angelica often falls into Alabama’s health coverage gap. People in the gap have incomes too high to qualify for Alabama Medicaid, but too low to afford private coverage.

Angelica had coverage during her pregnancies, only to lose it shortly after giving birth.

“Medicaid would cover me while I was pregnant, then drop me afterward,” she said. “It’d be great if our country cared about parents after the babies are born.”

Alabama lawmakers in 2022 extended the postpartum Medicaid coverage period to one year after childbirth, up from the previous cutoff of just 60 days. It was a step in the right direction – but it wasn’t enough to ensure families can get the health care they need.

The life-saving importance of Medicaid coverage

A woman and her two daughters have a photo shoot near what appears to be a creek. They are holding hands.
Irondale resident Angelica McCain smiles for a photo with her children near the Cahaba River in fall 2024. Medicaid coverage paid for live-saving cancer treatment for her older daughter last year. (Photo courtesy of Angelica McCain)

In February, Angelica was able to obtain health insurance for herself for the first time in her adult life through the Marketplace created under the Affordable Care Act. She said it’s not cheap, but she’s got to take care of herself to be around for her daughters.

A recent health scare demonstrated just how important health insurance is for families like Angelica’s. Medicaid coverage proved life-saving when Angelica’s daughter needed major cancer surgery last year.

“First of all, I thought, ‘Oh my God, is Medicaid even gonna cover this because of how big it is?’” she said. “But it covered everything. They did it all. That saved me from being like $200,000 in debt from five days in the hospital.”

Her daughter, now 10, fully recovered. But Angelica said the experience reaffirmed the critical role that Medicaid plays for Alabama families, especially in rural communities.

Tired of the status quo

Angelica is outspoken about the misconceptions and stigmas that often surround federal programs serving Alabama families. She said that in the past, more than half of her paycheck would be spent on private insurance. She said her sister is still in the same situation, facing the choice between paying for groceries or health care.

“I get very, very tired of the status quo,” Angelica said. “I’ve worked in this state for 17 years, and I still didn’t have health care to show for it. It’s not about laziness. It’s about survival.”

A woman and her two daughters have a photo shoot near what appears to be a creek. They are laughing and playing in the water.
Irondale resident Angelica McCain plays with her children near the Cahaba River in fall 2024. Angelica works full time in the service industry and spent many years living in the health coverage gap, earning too much to qualify for Alabama Medicaid but not enough to afford private insurance. (Photo courtesy of Angelica McCain)

Angelica said she often feels like leaders in Washington, D.C., and Montgomery can’t relate to folks like her. When House Speaker Mike Johnson recently claimed to reporters that many young Americans on Medicaid are just “playing video games all day,” it struck a nerve with Angelica.

“He must be out of his mind,” she said bluntly. “They have no idea what’s happening to working-class folks underneath them.”

‘That emotional weight is crushing’

For Alabamians like Angelica, Medicaid is not just a lifeline. It’s a matter of dignity for working families. But the program faces numerous threats at the federal level.

The U.S. House voted 215-214 in May for a budget bill that would cut $800 billion from Medicaid and Marketplace coverage over the next decade. The bill now awaits Senate consideration. If these cuts are enacted, health coverage could become more expensive or inaccessible for tens of thousands of Alabamians.

The bill also would remove additional federal incentives for states to expand Medicaid to cover adults with low incomes. Alabama is one of 10 states yet to expand Medicaid, leaving nearly 200,000 people in the state’s health coverage gap.

Medicaid is an essential part of Alabama’s health care infrastructure. More than 1 million Alabamians – almost all of whom are children, older adults, or people with disabilities – receive their health coverage through Medicaid.

“Children… that’s my heart,” Angelica said. “And it breaks my heart to think there are kids out there who will potentially die, and then families will go under. That emotional weight is crushing.”

If Medicaid were to face cuts or further restrictions, Angelica said her family’s most basic needs could be jeopardized. When times are already tough, she said she doesn’t know if families like hers can take another hit.

“I’d fear their teeth falling out. I’d fear not being able to get my daughter glasses. And I’d fear going into debt just trying to keep them healthy,” she said.

An empowered advocate gets results

In February, Angelica accepted an invitation to share her story at an advocacy day that Cover Alabama and the American Cancer Society Cancer Action Network co-hosted at the State House in Montgomery. There, she met other Alabamians living in the coverage gap. She also spoke at a news conference, where her message to legislators was simple: Expand Medicaid and stop targeting vulnerable communities who are just trying to get by.

A woman speaks at a podium in a crowded room during a press conference or public event.
Irondale resident Angelica McCain (center, standing behind the lectern) speaks about her experience in Alabama’s health coverage gap during a news conference co-hosted by Cover Alabama and the American Cancer Society Cancer Action Network on Feb. 27 at the State House in Montgomery. Speaking at the event and meeting with lawmakers inspired Angelica to deepen her advocacy for affordable health coverage for every Alabamian. (Photo by Whit Sides)

Angelica met with state lawmakers to discuss how her family and others would suffer under a bill that originally would have removed thousands of children from their Medicaid coverage by placing unaffordable requirements on parents with low incomes. Thanks in part to Angelica’s in-person advocacy, the bill’s sponsor agreed to remove the most concerning language from the plan. The bill ultimately did not pass. (Read more here about Angelica’s crucial role in advocating against this legislation.)

Ever since, Angelica said, she has felt more empowered to share her story and help make a difference for working families and people with low incomes across Alabama.

“There are so many people that benefit from Medicaid who don’t fit the stereotype,” she said. “We live in rural Alabama, and we live in cities. We’re white, Black, it doesn’t matter. They’re people like me, just trying to do our best for our kids.”

About Alabama Arise and Cover Alabama

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

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

Medicaid Expansion Advocacy Day – Feb. 25, 2025

By Alabama Arise

Alabama Arise and Cover Alabama joined with the American Cancer Society Cancer Action Network to host a Medicaid Expansion Advocacy Day on Feb. 25 in Montgomery. Nearly 100 passionate supporters came to the State House to speak out in defense of Medicaid and the urgent need to close Alabama’s health coverage gap.

As federal threats to Medicaid persist, advocates stressed that expansion is essential both to cover more people and to protect against harmful cuts. Many described the devastation of losing Medicaid coverage and falling into the gap – earning too much to qualify for traditional Medicaid but too little to receive tax credits for private coverage.

Camden resident Kiana George and Birmingham resident Angelica McCain told their personal stories of how the coverage gap has affected their lives. Their testimonies, as well as those from faith leaders, business owners and others, highlighted the urgent need for expansion to ensure everyone has access to care. Thank you to everyone who showed up, spoke out and made a difference. Your voices matter, and we are making progress together.

Transcript:

[Voiceover] Alabama Arise and Cover Alabama joined with the American Cancer Society Cancer Action Network to host a Medicaid expansion advocacy day on Tuesday, February 25, in Montgomery. Nearly 100 passionate supporters came to the State House to speak out in defense of Medicaid and the urgent need to close Alabama’s health coverage gap. Several people spoke about the devastating experience of losing Medicaid coverage and falling into the gap — earning too much to qualify for Medicaid but too little to receive federal tax credits to help pay for health coverage. Their testimonies underscored the urgent need for Alabama to expand Medicaid so everyone can get the health care they need to survive and thrive.

[Debbie Smith] I’m here with many advocates from across the state to ask the Legislature and Gov. Ivey to close the coverage gap and expand Medicaid. Right now, around 200,000 of our friends, neighbors and family members are caught in the Medicaid coverage gap. They work hard — taking care of our children, serving our food, stocking our grocery store shelves — but they can’t afford to see a doctor when they’re sick. And when they can’t get the care they need, it doesn’t just hurt them, it hurts all of us. When people don’t have health coverage, they aren’t able to see a doctor for regular checkups or early treatment. That means preventable conditions turn into expensive emergencies.

[Kiana George] Hello, I’m Kiana George from Camden, Alabama, or as they call it, Wilcox County. My story is pretty simple. I lost coverage back in September 2023 when they did the whole [unwinding], and then I’ve been basically fighting for my life ever since. I’ve always had blood pressure issues since around 2015-2016. I called Medicaid, and they told me because I made more than $295 a month, that I didn’t qualify. And then I called the Marketplace, and I don’t make enough money to get an insurance plan. So what am I supposed to do? I started getting bills in the mail, and that discouraged me from going to the doctor because if I’m already in debt, I can’t pay you. If I don’t have the money for insurance, I don’t have the money to pay you for not having insurance. I stopped taking my medicine last year because it was making me sick, but I was too scared to go back to the doctor to get it changed because I thought they were going to make me pay for it. And after that — not a good idea. Because guess who ended up a month after turning 30, in ICU in the hospital with stroke-level blood pressure. I did. As a matter of fact, while Jackson was boycotting outside, I was inside the hospital. In ICU.

And didn’t even know it. I would really, really appreciate all the lawmakers, all the legislators, the governor… anybody. I have a 9-year-old. I want to see my baby grow up. If I don’t have coverage, I’m not going to be able to live. Thank y’all.

[Angelica McCain] I’m Angelica. I came down here from Birmingham. My story starts at birth. I was on Medicaid as a baby. When my parents first moved here, my mom worked three jobs while my dad didn’t work at all. Medicaid was the only way we survived as children. Fast forward 18 years, 19, I get dropped. I start working in the service industry. If you’re familiar with the service industry, they are not legally required to offer health insurance to anyone, so if you make your career in the service industry, you’re not going to get health insurance unless you pay an arm and a leg for it. So, ultimately, I resulted in having to get Medicaid for my daughters as they were born. Medicaid would only cover me while I was pregnant, and that was it. They cover my children now. It’s confusing for me about why they will cover my children to be born but they will not cover me to continue to be healthy, to be alive for them. On top of that, my 9-year-old was diagnosed with a soccer-ball-sized tumor last summer in her right ovary. And thankfully for Medicaid, I didn’t have to pay $200,000 for her to have her surgery. That was a really difficult time, and then also having to fight for that coverage for my children to live… It just doesn’t seem humane in a lot of ways. And a lot of people are having to fight just to provide for their children. We shouldn’t have to fight this hard for it. We’re just hoping Alabama can cover the Medicaid gap and help everybody actually just be able to exist healthily.

[David Silverstein] I’m a businessman from Birmingham. Why am I here? For two reasons. One, because I believe we can do better as a state. I’d love for my children and my children’s children to stay in the state and make it a better place to live, and work, and raise a family. But think of this: If we expanded Medicaid, it would have close to a $2 billion positive economic impact on this state. Think about that. Our rural hospitals would have a chance to survive.

[Smith] Alabama is losing billions of dollars that could have been invested in our health care system. It’s time to stop pointing fingers and start leading. The time for excuses is over. The time for action is now. Let’s expand Medicaid. Let’s save lives. Let’s cover Alabama.

‘It shouldn’t be like this’

By Whit Sides
Standing, posed photo of Florence Dutch
(Photo by Whit Sides)

Florence Dortch, 60, of Vredenburgh (Monroe County)

Florence has been uninsured for 22 years. Lately, she’s been receiving care from a rural health clinic in Monroeville, where she pays out of pocket for help with her arthritis, high blood pressure and monitoring her prediabetes. She has trouble affording her medications but is able to continue taking her prescriptions for now with help from her sister. 

“I make it work because I have to. I try not to think about how long I’ve been living like this, because it’s not great. It’ll get you down. I rely on a lot of help from the community, but it shouldn’t be like this, because I’m not the only one.”

Florence has a few more years until she’s eligible for Medicare. Because she works, she doesn’t meet Alabama’s stringent income eligibility requirements for Medicaid.

“If working people could get the coverage they deserve, we wouldn’t even be where we are now. Here in the Black Belt, or anywhere else.”

‘I just want to go to the doctor’

By Whit Sides

Standing, posed photo of Kiana George

Kiana George, 29, of Camden

“I felt like with Medicaid, I got the best care I’ve ever had, and I could afford the copays. I didn’t have to worry about racking up debt just for going to the doctor.”

Kiana is a child care provider working in Camden. She recently lost Medicaid coverage during the state’s “unwinding” period after learning she was “earning too much” at the day care center, leaving her in Alabama’s health coverage gap.

After she sought urgent care for polycystic ovarian syndrome, out-of-pocket bills for diagnostic labs and imaging left her with thousands of dollars in medical debt.

“I get these bills in the mail, and it’s so much stress. I don’t like owing people money. So I just don’t get help even when I’m in pain.”

Kiana visits free clinics offered at local health fairs but says the care is limited. She’s worried about needing care when she’s not close to home, or facing another medical emergency and collecting even more medical debt.

“I really wish Alabama would expand Medicaid. I just want to go to the doctor. I feel like without coverage, by the time I do get to the doctor, it is too late, and everything is way out of hand.”

‘Coverage needs to be affordable for everyone’

By Whit Sides
A standing, posed photo of Valerie Cochran.
(Photo by Whit Sides)

Valerie Cochran, 61, of Camden

“We’re all gonna get sick. That’s life. But coverage needs to be affordable for everyone.”

Valerie is disabled, living without health coverage in rural Wilcox County. After 30 surgeries, she’s got thousands of dollars in medical debt.

During a routine colonoscopy, doctors removed a tumor in Valerie’s stomach. After receiving the hospital bill, she became so worried about the cost of follow-up care at the cancer center that she chose to delay treatment. Valerie hopes to get Medicare coverage through SSDI after she turns 62 later this year. Until then, her options are limited.

“Medicaid expansion would make a world of difference for me, and other people like me. With my issues, I should be taking care of my health, not living in fear of how much it’s going to cost to take care of myself.”

From a childhood in the cancer ward to a lifetime in Alabama’s coverage gap

By Whit Sides

Lary Brooks is a fighter. 

At just 2 1/2 years old, he was diagnosed with acute lymphocytic leukemia, a bone and blood cancer that nearly took his life. Lary survived thanks to the life-saving treatment he received at St. Jude Children’s Research Hospital in Memphis, Tenn.

“I was a week from dying when they found it,” Lary recalled about his childhood cancer diagnosis. “From 1979 to 1982, I was under treatment — 1,800 units of chemo and radiation.”

Those intense treatments took a severe toll on his body that affected nearly every aspect of his life, even as an adult.

“I’ve had my L4, L5 vertebrae blown out because of so many spinal taps,” he said. Doctors used the painful procedure to monitor his progress throughout childhood.

Lary’s courage in the face of pain earned him the name “OK Kid.” When the doctors at St. Jude asked him how he felt during these intense procedures, he always responded, “I’m OK.”

But from the time he was young, Lary said, he felt like he hadn’t been able to live life to its fullest.

“At one time, I had my left arm in a full cast and my right arm in a half cast,” he said. “I stepped into a hole while playing with my sister and ended up breaking my wrist.”

Front-facing photo of white male with a shirt with a Batman logo.
Lary Brooks of New Hope, Ala., has dealt with health issues stemming from childhood cancer for his entire life. (Photo courtesy of Lary Brooks)

Today, at age 47, Lary lives with his family in New Hope, a small town southeast of Huntsville. He suffers from osteopenia and scoliosis. The lingering effects of his childhood cancer caused a loss of spine density and chronic pain that often leaves him unable to work.

‘I’m ready to go back to work now’

Over the years, Lary has found jobs in construction, as a waiter and as an automotive tech. But each job ended when he was injured or needed care.

Most recently, Lary suffered a fall that required major facial surgery to reconstruct his jaw. The surgery left him with more medical debt and yet another battle to get the care he desperately needed.

Originally, doctors told him he’d be recovering for six to eight weeks. But now it’s looking more like Lary won’t be able to work for six months.

“I’m ready to go back to work now, but I’ve got to get released from the doctors,” Lary said, anxious to return to his life. 

Yet with no health insurance, he can only access emergency care. That means he can’t see the specialists he needs to manage his everyday issues — or the crippling pain that comes from them.

Without access to the prescriptions he needs, Lary is left with few pain management options. They provide little to no relief.

“I don’t have insurance, so I can’t treat my problems as they come up, and everything just deteriorates,” he said. “The only thing I’m able to do … is over-the-counter pain medication, but it doesn’t work.”

Alabama’s failure to expand Medicaid to cover adults with low incomes has left nearly 200,000 residents like Lary in the health coverage gap, unable to afford private insurance but not eligible for Medicaid. Our state is one of only 10 yet to accept federal funds that would offer coverage to folks like Lary.

Without Medicaid expansion, Lary must either rely on expensive emergency room visits for temporary relief or continue to endure debilitating pain every day. As he recovers at home from his most recent surgery, he’s left with few options.

A life in pain

“I walk around with a pain level of 10, 24/7, seven days a week,” Lary said. “The only thing I can think about or stay focused on is my body pain because it’s like my brain will not allow me to focus on anything else.”

Lary said his pain is compounded by the limitations placed on health care providers due to the opioid crisis.

“I ask the doctors if there’s any way that I can get help to where I can still stay at work on a full-time basis,” he said. “But with the opiate crisis, they won’t prescribe chronic pain medication without me being established in a pain clinic. So I’m reduced to going down to part-time at work but struggling with my pain all the time.”

Lary’s mother, Brenda Brooks, said finding payment assistance through local hospitals for Lary’s care has become a part-time job itself. She often digs through past tax returns, prints out the past few months of bank statements and tracks down medical records from different doctors.

Brenda said that even with his extensive medical history, Lary has been denied for disability benefits many times. And it hasn’t been for a lack of his mother trying.

“Last time, the disability doctor told us Lary is able to work, as something like a truck driver? He’s not supposed to lift over 25 pounds. Tell me how that works,” Brenda asked.

A photo with film quality from the 1980's in which a mother is holding her son.
Brenda Brooks holds her son Lary in spring 1980. The picture was taken about six months after Lary was diagnosed with leukemia. (Photo courtesy of Brenda Brooks)

‘I just wait until I can’t stand it anymore’

So for now, Lary keeps trying to find work while not being able to afford coverage or consistent care. He said he manages by spacing out care, or sometimes avoiding it altogether.

“It’s mainly just choosing the right time to go to the doctor,” he said. “I mean, with my pain and everything, and me being a diabetic, I’m usually having to wait probably six months in order to go.”

Ideally, Lary should be able to go to the doctor monthly. But living in the coverage gap forces him to make tough decisions about whether to seek care when he needs it.

“I spread it out and then choose what pain level I’m in before I either go to the ER or I just wait until I can’t stand it anymore,” Lary said.

It’s a piecemeal plan for pain management caused by living in the coverage gap. When things do become unbearable, his mother said, it’s never without a cost.

“We still owe UAB Hospital for surgery, like $11,000,” Brenda said. “That’s not including the doctor visits. That’s just the surgery and the hospital time.”

On top of that, Lary said his debt at Huntsville Hospital, the closest to his home, is nearly $30,000.

A mother turned warrior

Lary said his mother has been his greatest advocate. A substitute teacher, she has taken up the fight to get her son the care he needs.

“I’ve called everyone — local lawmakers, even Gov. Kay Ivey,” Brenda said. “I’ll do whatever it takes to get him the care he deserves.”

Finally, she reached out to Cover Alabama to share her family’s story.

“I want everyone to understand that people in the gap like Lary just need fair coverage. They aren’t looking for a handout. He pays taxes, so I don’t think it should even be looked at that way,” Brenda said.

A tall man with arms crossed stands next to a woman who is a couple feet shorter.
Lary and Brenda Brooks pose inside their home in New Hope, Ala., in October 2024. (Photo by Whit Sides)

Medicaid expansion could help Lary access the specialists he needs without relying on the emergency room for short-term fixes.

“If I could get in to see a good doctor and stay with them, I’d be able to live a normal life,” he said.

For now, Lary’s lack of health coverage affects his freedom and autonomy as an adult, including his relationships.

For Lary, the effects of living without insurance extend beyond his physical health. He recently had to ask his uncle for $3,000 to pay for treatment. He said it was a tough blow mentally.

And romantically, he finds it difficult to find partners or companionship because he feels like “there’s always a catch.”

“I’ve met lots of women, but when I told them exactly what my story was, most of them decided to walk out because they thought it was too much trouble,” he said. “That’s why I’m 47 and still single.”

Hope for a better Alabama

Lary remains hopeful and tries to keep a positive outlook. But he said it’s important to be honest about the isolation he goes through daily.

“It messes with your confidence a little bit,” he said. “I want to be a productive member of society. I don’t want to feel like a burden.”

Medicaid expansion would help Lary live a more fulfilling life, free from the constant worry of mounting medical debt and inadequate care. It would give him and thousands of other Alabamians the chance to work rather than being sidelined by a lack of support.

“You’ve got all these people in this state alone living in the gap,” Lary said. “Imagine how many more in other states like Texas. If we can’t work, our state doesn’t get the tax money.”

For Lary, this is more than a political issue — it’s a matter of survival. As he continues to fight for his health, he holds on to the hope that the system will change one day. In the meantime, Brenda will keep advocating for her son, hoping her calls to lawmakers won’t fall on deaf ears.

“I’ve sent out so many emails and only ever got one response,” Brenda said. “They are supposed to represent people in their area, especially those who need the help. And they’re supposed to push to get what their constituents need, like expanding Medicaid.”

A man hugs a woman.
Lary and Brenda Brooks embrace inside their home in New Hope, Ala., in October 2024. (Photo by Whit Sides)

‘The honest way’

Lary said caring for him as a child and not being able to “fix it” was a traumatic experience for his family. He said that’s his constant motivation now: wanting to fix anything he can for others.

Even while recovering from surgery, Lary still finds time to help others. He’s a member of St. Jude’s alumni program, which allows cancer survivors like him to work with doctors to develop new treatments for kids living with bone cancers similar to the one he fought.

“I’m trying to do things the honest way,” Lary said. “I just wish there were systems to help me keep doing that.”

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.

Alabama enrollment navigators provide help, but options are limited without Medicaid expansion

By Whit Sides
A woman sits at a booth at an event.
Enroll Alabama navigator Rebecca Sylvester staffs a table at a community event in Huntsville. (Photo courtesy of Enroll Alabama)

Rebecca Sylvester spends her days answering phone calls from desperate Alabamians.

As an enrollment navigator for Enroll Alabama, a grant-funded organization dedicated to helping people find health coverage, she faces a daily battle with the harsh realities of Alabama’s health care system.

But despite her dedication to finding resources for everyone who calls, she is forced to deliver heartbreaking news to most of her callers: There might not be any options for them. Especially for people caught in Alabama’s health coverage gap, who earn too much to qualify for Medicaid but too little to qualify for insurance subsidies under the Affordable Care Act (ACA).

“I think that I can count one mom who was able to get back on Medicaid out of hundreds of people I spoke to,” Rebecca said.

Even then, this mother was a special exception. She was part of a brief window that allowed those who were enrolled in Medicaid during the COVID-19 pandemic to maintain coverage during the federal public health emergency (PHE). But because the PHE declaration ended in 2023, navigators are now hearing from people who are losing their Medicaid coverage during a process known as “unwinding,” or a return to pre-pandemic eligibility requirements.

Adults between ages 18 and 64 in Alabama have to meet some of the strictest income eligibility requirements in the country to have Medicaid coverage. Parents in a two-person household, for example, do not qualify for Alabama Medicaid if they make more than just $3,684 a year.

The wide range of people in Alabama’s coverage gap

The frustration in Rebecca’s voice is palpable. The coverage gap is a consequence of Alabama’s decision not to expand Medicaid to cover adults with low incomes under the ACA. That policy failure has left nearly 300,000 residents without affordable access to health care.

This means Rebecca talks to a very diverse group of people every day. They include young adults aging out of ALL Kids (Alabama’s Children’s Health Insurance Program). Many are working adults who don’t get insurance through their employer. Some are older adults who are approaching age 65 but are not yet eligible for Medicare.

Rebecca’s work is more than just finding coverage solutions. It involves discussing complicated and systemic failures with confused and often desperate callers who are learning about it for the first time.

“I don’t think I’ve had a single client where I’ve been like, ‘You’re in the Medicaid coverage gap,’ and they knew what that was,” she said.

The stories never stop coming

Two people at a booth speak with a person visiting that booth.
Enroll Alabama navigators answer questions at a community event in Montgomery. (Photo courtesy of Enroll Alabama)

Many people are shocked to learn how few resources exist for all the Alabamians living in the gap.

Rebecca discussed one conversation that was particularly hard. The caller not only had lost health coverage but also had become homeless and reached out for help.

“This person genuinely believed that there was some sort of help out there for people who really needed it,” Rebecca said.

She said the harsh truth is that, without Medicaid expansion, such public resources are virtually non-existent in our state. And while she tries to find free or sliding scale clinics to help, they can’t be the fix for everything.

Enroll Alabama helps people navigate the often confusing landscape when trying to find health coverage, but the resources they can offer are limited. Our state’s failure to expand Medicaid leaves hundreds of thousands of people scrambling to find a patchwork of temporary solutions to their health issues.

By not accepting federal funds that would ensure health coverage for those in the coverage gap, our state continues to deny Alabamians the peace of mind that folks in 40 other states have.

‘It’s heartbreaking’

One young woman Rebecca helped was attending community college and needed ongoing mental health support. She lost coverage when she turned 19, aging out of ALL Kids, and her small campus didn’t offer student health resources that larger universities do. Her mother received disability payments, and her family couldn’t afford private insurance premiums of more than $400 a month.

“She apologized to me for needing Medicaid,” Rebecca said. “I couldn’t believe it!”

Rebecca says navigators come face to face every day with stories like these every day. These situations highlight how stigma and misunderstanding surrounding public assistance programs hurt so many people across Alabama. Rebecca’s frustration is evident when she talks about not being able to assist everyone who reaches out for help.

“It’s heartbreaking to tell someone there’s nothing I can do for them,” she said. “They fall in the gap, and there are just no options available.” She said this sense of helplessness is shared among other navigators who see firsthand the gaps in the system.

A growing network of navigators

Mark Linn, assistant project director for Enroll Alabama, also does navigator work. He said that though navigators often hit roadblocks when working with folks in the coverage gap, they still keep their phones and schedules open for anyone who needs them.

A crowd of people pose for a photo.
The Enroll Alabama navigator team gathered at their 2023 annual meeting at the Tutwiler Hotel in Birmingham. (Photo courtesy of Enroll Alabama)

“Everyone is different, and no situation is permanent,” Mark said. “If we can, we’re going to find something for you.”

There are enrollment navigators all across Alabama, including nine navigators within United Way. Two other navigators work within hospitals (DCH in Tuscaloosa and East Alabama Medical Center in Opelika). Another navigator based at The Right Place serves individuals and families who have low incomes or face homelessness in Anniston.

And this year, resources are becoming available in areas where they weren’t before. New navigators are serving Black Belt communities, as well as areas in northeast Alabama like Fort Payne, Rainsville and Scottsboro.

Enroll Alabama’s partnership with 211 also makes it accessible for anyone in the state to reach out and get connected with clinics, programs or resources close to home.

“Our navigators are familiar with all the resources in their area and have a list right beside them,” Mark said. “So if someone calls from Chilton County, but I’m not there, I can plug them in with our navigator from that area… on top of them just calling 211. It’s really a great resource.”

Navigating unfamiliar territory together

Mark agreed with Rebecca that a lot of folks reaching out to navigators for help are in unfamiliar territory, facing not having coverage for the first time. Through a partnership with social workers at UAB, Mark said, he often helps patients in heart failure navigate their new situation. He also meets them where they are.

“I do make house calls and go out to hospitals. A lot of times, I’m meeting in the library or at McDonald’s,” he said.

Mark said a lot of Enroll Alabama’s work focuses on helping people submit Medicaid applications, or checking to see if they are eligible for tax credits through the ACA. But in Alabama, the income eligibility restrictions can make the path forward very narrow.

“Beyond that, when they’re in the coverage gap, sometimes the best we can do is give them a phone number and pass them along to charity care, which doesn’t feel great.” Mark said.

It’s also important for people to know that even if they don’t qualify for a special enrollment period, ACA tax credits or Medicaid, other community resources like low-cost clinics may be available. Mark still encourages everyone to call 211 or set up an appointment with a navigator directly if they are uncertain about finding care or resources.

“You are never bothering us. ‘Navigator’ is right there in the name,” he said. “We are always here to help.”

It’s time for Alabama to join our neighbors

The benefits of Medicaid expansion are clear. States like Arkansas and North Carolina that have expanded Medicaid report lower uninsured rates, improved access to care, and better health outcomes. Rural hospitals, which have been closing at alarming rates in non-expansion states like Alabama, have access to life-saving funds that allow them to stay open and serve their communities.

Recently, Alabama’s Joint Health Committee held a hearing where legislators spoke with lawmakers from Arkansas and North Carolina about their experiences with Medicaid expansion. The testimonies highlighted the positive impact, emphasizing how expansion has bolstered rural hospitals and provided vital health coverage to those who needed it.

Arkansas lawmakers shared that expansion has decreased their uninsured rate and improved overall health outcomes. And North Carolina officials pointed to the financial stability it has brought to rural health care facilities.

Expanding Medicaid in Alabama could have similar positive health and economic outcomes, a recent study by the Public Affairs Research Council of Alabama (PARCA) found. Medicaid expansion would create more than 20,000 local jobs and bring significant federal funding into Alabama’s economy, PARCA projected. Most importantly, it would ensure health coverage for nearly 300,000 Alabamians and save hundreds of lives every year.

Remaining hopeful for change

Rebecca said she still listens to everyone who calls asking for help, even when there aren’t many resources available. However, there is an important way that folks in the coverage gap can get involved. 

“We encourage anyone who is struggling to access health care to call their legislators and let them know the issues they’re having,” said Debbie Smith, Alabama Arise’s Cover Alabama campaign director.

“Legislators need to hear from real people that this is a real issue. It can be easy for legislators to overlook a statistic,” Debbie said. “It’s much more difficult to ignore when someone is suffering because they can’t access the medical care they need.”

Navigators play a vital role in the coalition of private partners, providers and nonprofits working every day to address the issues facing Alabamians in the coverage gap.

“We’re thrilled to partner with Enroll Alabama,” Debbie said. “We’re so thankful that there is an organization that can help people find the resources that are available to them even though our state has shamefully created gaps in coverage.”

If you or someone you love would like help navigating the health care marketplace, applying for Medicaid or finding a federally qualified health care clinic in your area, please visit Enroll Alabama’s website to set up an appointment with a navigator. You also can call them directly at 844-248-7698.

If you don’t always have access to a computer, you can download an application to print and share later 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.

‘I just thought things were the same everywhere’

By Whit Sides
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.