The workforce benefits of Medicaid expansion in Alabama

For nearly a decade, Alabama has been outside looking in on a good deal. While hundreds of thousands of Alabamians continue to struggle without health insurance, state leaders have failed to expand Medicaid. A few loud voices have politicized an issue that never should have been political. And our state has paid the price in lost dollars, lost jobs and lost lives.

Strong evidence suggests that having reliable access to health care encourages folks to work and keeps workers healthy. That’s one reason 39 states and the District of Columbia have recognized the importance of Medicaid expansion. They have chosen to ensure their residents can afford necessary medical care. They have prioritized a healthy populace and a stronger workforce over partisan politics.

Alabama is one of 11 states that has yet to expand Medicaid. And that inaction has left more than 220,000 Alabamians in a health coverage gap. A family of three must make less than $4,475 a year ‒ just 18% of the federal poverty level ‒ for the parents to qualify for Alabama Medicaid. But unless that family makes at least $24,860 a year, they will not qualify for subsidies to buy a private plan on the marketplace created under the Affordable Care Act.

Medicaid expansion would end that injustice and close that large coverage gap for adults with low incomes. It is the single best solution available for lawmakers to strengthen Alabama’s ailing health care system. And it is one of the best solutions to help cure many of our state’s economic and workforce woes.

Medicaid expansion would help Alabamians stay in the workforce

Some state officials have expressed concerns about Alabama’s labor force participation rate, which is lower than in many neighboring states. Fortunately, Medicaid expansion is a proven solution to help people join and stay in the workforce. States that have expanded Medicaid have seen a greater increase in labor force participation among people with incomes below 138% of the poverty line than states that have not expanded. These are the very people Alabama would help by closing the coverage gap.

As lawmakers grapple with how to increase workforce participation, it’s worth considering how many Alabamians have had to leave their jobs due to ailments that access to adequate health care could help prevent or solve. One in three adults in Alabama have a disability, according to 2022 CDC data, including nearly two out of every five veterans. Here, too, Medicaid expansion would help. People with disabilities are more likely to be employed in states that have expanded Medicaid than in states that haven’t.

The personal and economic harms of being uninsured are all too real. For many folks, going without health coverage means going without treatment for manageable illnesses and injuries. Those conditions often turn into long-term problems that prevent them from living healthy lives or returning to work. For example, imagine being an uninsured person with diabetes, a condition affecting nearly one in seven Alabamians. While severe, diabetes is detectable and treatable with regular care. However, if untreated, it can cause disability or long-term and permanent damage like foot amputation or vision loss.

That person is now living a more difficult life, and returning to work is now more difficult, if not impossible. These are the kinds of situations that uninsured Alabamians face every day. And expanding Medicaid coverage could prevent this type of needless suffering.

Health care policy is workforce policy

As Alabama works hard to attract industries and new workers, adequate health coverage is essential infrastructure. Why would a family move to Alabama (instead of elsewhere) for employment opportunities when our state refuses to invest in workers’ health like so many other states do? And how long will businesses keep relocating to Alabama if our workforce isn’t healthy enough to fill vacant jobs? They could just as easily go to Arkansas, Louisiana, Kentucky, Missouri, Oklahoma, Virginia or West Virginia instead.

These mostly conservative Southern states all recognized the importance of a healthy workforce and chose to expand Medicaid. That’s because it is impossible to separate health care policy from workforce policy. In fact, health care policy is workforce policy.

Medicaid expansion would help working Alabamians stay healthier and more productive. Expansion also likely would boost labor force participation in Alabama, as it has in other states. Arguments to the contrary lack strong evidence and rely on false stereotypes about low-wage workers.

Many of the Alabamians who stand to benefit most from Medicaid expansion are working folks caught in the coverage gap. Having access to health insurance, regardless of the source, doesn’t keep people from working. But you know what does? Having an unhealthy workforce with folks who struggle to afford health care and are forced to work when they’re sick. Or worse: being pushed out of the workforce entirely due to ailments that worsen or go unaddressed because people can’t afford treatment for them.

Medicaid expansion would keep a wide range of workers healthier

Alabamians work hard every day to provide for themselves and their families. But hundreds of thousands of them aren’t paid enough to afford health coverage. Fast food workers, cashiers, carpenters and hotel desk clerks are just a few examples of the people who work hard at low-paying but essential jobs that often don’t provide health insurance. They are among the Alabamians who would benefit most from expanding Medicaid.

Graphic of the top nine occupations that would benefit from expanding Medicaid in Alabama: food service, sales, construction, cleaning and maintenance, office and administrative support, production, transportation, personal care and support, and installation and repair.

The false belief that expanding health coverage would somehow disincentivize work is insulting to Alabamians who work every day to provide for their families but don’t receive health insurance through their employers. Improving health care access is workforce development, and having health insurance makes working possible.

Likewise, the unfounded notion that many people would drop out of the workforce after gaining health coverage is not grounded in reality. In fact, it is fundamentally rooted in outdated, false stereotypes about people with low incomes. And it takes an absurdly reductive view of the economic realities of everyday life.

Health insurance helps people get health care, but it doesn’t pay for other needs like food, clothing or housing. Indeed, many Alabamians who want a job can’t enter the workforce ‒ or have to leave it ‒ because they can’t afford the health care they need to stay healthy enough to work.

Other states have shown Medicaid expansion is an economic boost

For 12 years, Alabama has failed to accept generous federal incentives to expand Medicaid to cover adults with low incomes. In that time, our lawmakers have watched as other fiscally conservative states (including Kentucky, Louisiana, Montana and Utah) expanded Medicaid and remained budgetarily sound. For a decade, expansion states have enjoyed budget savings, revenue gains and overall economic growth after expansion.

National research has shown no significant increases in spending from state funds as a result of Medicaid expansion. These positive effects occurred in expansion states even as Medicaid enrollment growth initially exceeded projections in many states.

Examples abound. Studies in Louisiana and Montana showed that expansion pumped large amounts of federal money into those states’ economies and produced significant state budget savings. In Kentucky, Medicaid expansion infused $1.16 billion into the state’s health care system and overall economy in the first year of expansion. Similarly, after Medicaid expansion, Louisiana also showed increases in overall state and local tax receipts.

Every year that Alabama has refused to expand Medicaid, Alabamians’ federal tax dollars have helped foot the bill for Medicaid expansion in other states. More than 220,000 Alabamians remain caught in a health coverage gap that expansion would close. Another 120,000 who would benefit from expansion continue to stretch to pay for coverage they can’t truly afford. All the while, our tax dollars are being used to fund expansion elsewhere.

Medicaid expansion would make economic sense for Alabama

Expansion opponents sometimes acknowledge the financial benefits of expanding Medicaid. But they often underplay the magnitude of these potential gains. Medicaid expansion could save Alabama nearly $400 million a year over the next six years, a report by the Public Affairs Research Council of Alabama (PARCA) found.

Those savings ‒ from the federal government covering expenses that Alabama now pays ‒ would be more than enough to cover the state cost for expansion, according to PARCA. Medicaid expansion also would generate nearly $2 billion of annual economic growth for Alabama during those six years, PARCA projected.

The benefits wouldn’t stop there. Medicaid expansion also would support more than 20,000 new jobs a year on average, PARCA projected. It would extend health coverage to more than 220,000 folks who don’t have it. And most importantly, it would save lives.

A graph showing the economic impact of Medicaid expansion, including saving the state nearly $400 million per year.

Expanding Medicaid would save the state money, boost economic growth and create jobs. For many newly insured Alabamians, Medicaid coverage would help them stay healthy enough to keep working. For others, it would provide the medical security they need to join or rejoin the workforce.

Alabama can’t afford not to expand Medicaid

Alabamians with low incomes pay twice the share of income in state and local taxes that the wealthiest households pay. Adding to that injustice, Alabama’s overall tax system raises much less money for vital public services than most other states. In 2019, only about 38% of our state revenue came from state taxes ‒ one of the lowest percentages in the nation. Meanwhile, Alabama gets almost as much of its revenue (nearly 37%) from federal funds.

Federal funds are already a significant source of state revenue in Alabama and have been for decades. That money has helped us meet vital needs like educating our children, maintaining our roads and keeping our water clean.

Medicaid expansion would meet another vital need for our state: saving and improving lives. When it comes to expansion, Alabama would be getting a fantastic deal: a 9-to-1 federal match of state funds. That’s nearly 20 percentage points higher than the matching rate Alabama usually gets for other Medicaid services. And as already mentioned, Medicaid expansion could save Alabama enough money on other services to cover most or all of the state cost.

Why not take the 90% the federal government is offering to fund Medicaid expansion in exchange for a 10% state match? Why not invest in a healthier future for Alabama?

Alabamians across the political spectrum agree: It’s time to expand Medicaid

While some have tried to make Medicaid expansion into a partisan issue, it simply isn’t. Several other Southern states, and conservative states elsewhere in the country, already have expanded Medicaid. Some even did so by bypassing their state legislatures through ballot measures (an option we lack in Alabama). This isn’t a partisan issue, though many in our state want to make it one.

Graphs showing support for Medicaid expansion in Alabama.

To argue that we shouldn’t help our neighbors see a doctor based on the false premise that it might encourage them not to work is deeply troubling. Is that the state we want to be: one that pits the health of its people against cynical political posturing? That’s not what Arise wants, and it’s not what the vast majority of Alabamians want either.

Alabama is one of only 11 states that have not yet accepted the generous federal incentives to expand Medicaid. Most people across our state want that to change. More than seven in 10 Alabamians (71.5%) support Medicaid expansion, an Arise poll found last year. That includes nearly two-thirds of Republican voters.

Alabama needs to do the right thing by prioritizing the health of our people and our workforce over the political gamesmanship that so often dictates state decision-making. It’s time to ensure health coverage for all of our neighbors who can’t afford it.

It’s the only decision that makes sense, and it’s a choice that would help make this the state our people deserve. Let’s put the people of Alabama first and expand Medicaid.

Highlights from Cover Alabama’s health fair in Fort Payne

Cover Alabama and Alabama Arise hosted a health fair and a panel on Medicaid expansion in Fort Payne in November 2022. Hear from Arise’s Cover Alabama campaign director Debbie Smith and other community members about why we held the health fair and why Medicaid expansion would save and improve lives in DeKalb County and across Alabama.

Vote ‘Yes’ on Alabama’s recompiled state constitution!

We’re less than a week away from the general election! One of the most important issues on the ballot in Alabama is the Constitution of Alabama of 2022. This recompilation of the current constitution would clean up and consolidate the document and delete racist language and illegal provisions.

In a new video, Arise policy analyst Mike Nicholson explains the importance of this ballot measure to remove racist language from Alabama’s constitution. Watch the video below for more on why Alabama Arise urges a “Yes” vote on the recompiled state constitution on Nov. 8, 2022. And read Mike’s blog post for even more information.

Learn about Hunger Free Alabama

Alabama Arise is proud to have joined with groups across the state as partners in the Hunger Free Alabama coalition. Our goal is bold and essential: to prevent and eliminate hunger and malnutrition in Alabama through advocacy for better public policies.

In our new video, coalition members Drew Glover and Celsa Allende Stallworth discuss Hunger Free Alabama’s work and the vision that drives it. Visit to learn how you can join in advocating for change!

Congress should make the Child Tax Credit expansion permanent

Good public policy is vital in the fight against poverty, and U.S. Census data released last month demonstrates its importance. The 2021 Child Tax Credit (CTC) expansion is uplifting proof of how better policies can reduce poverty and ease suffering. And Congress needs to renew this expansion when it returns to Washington, D.C., after the general election.

Many of the people-first policies in the American Rescue Plan Act (ARPA) swiftly combated economic insecurity during the COVID-19 pandemic. And the CTC expansion was the most resounding success. It heavily contributed to a major decline in child poverty rates nationwide, with the Supplemental Poverty Measure (SPM) for children dropping by nearly half, falling from nearly 10% to about 5%.

ARPA’s one-year CTC expansion increased the maximum credit for children under age 6 to $3,600, and for all other children to $3,000. It made the full CTC available to children living in families with low or no earnings. And it extended the credit to 17-year-olds, who previously were ineligible. Congress so far has failed to renew the expansion for 2022, but lawmakers should revisit that decision later this year.

The SPM differs from the official poverty measure in that it provides a fuller, more realistic understanding of economic insecurity. The SPM includes the effects of non-cash benefits like housing subsidies and the CTC. And the data shows the CTC expansion alone kept more than 5 million Americans above the poverty line.

CTC expansion reduced racial disparities

Importantly, this impact was especially significant for people of color. Hispanic children saw a dramatic nationwide reduction in poverty, with SPM rates falling from about 15% in 2020 to 8.4% in 2021. SPM rates for Black children saw similar improvement, falling from 18% to 8% during the same period.

Black and Hispanic children are still more likely to experience poverty than white children, but the expanded CTC shows the power of public policy to reduce racial disparities, promote broadly shared prosperity and create a more economically equitable society. The Census Bureau graph below demonstrates the expanded CTC’s dramatic effect on child SPM rates by race.

Graph of child poverty rates under the Supplemental Poverty Measure by race from 2009 to 2021. See the graph at

While the CTC expansion isn’t yet permanent, its impact was clear, immediate and overwhelmingly positive. The expansion’s benefits speak volumes for the power of strong, deliberate public policy to reduce economic insecurity and racial disparities.

People-first public policy works. Just ask the 5.3 million Americans kept out of poverty by the expanded Child Tax Credit. It’s time for Congress to step up to the plate and make the CTC expansion permanent.

Alabama Arise resources for the 2022 general election

The 2022 general election will be held Tuesday, Nov. 8 – less than three weeks from today. Alabamians will vote on a range of local, state and federal offices, including the governor, state legislators, a U.S. Senate seat and U.S. House members. Voters also will decide on a proposed recompilation of the state constitution and 10 proposed statewide constitutional amendments.

Are you registered to vote? Have you made a plan to vote in this year’s general election? Alabama Arise has information below about how to register and how voters can cast a ballot. We share resources that could help if you face barriers to voting. And we explain why we urge Alabamians to vote YES on the recompiled state constitution.

A Black woman holds a voting button. Text: "You have the power. Use it. Vote!"

What you need to know about voter registration

  • Alabama’s voter registration deadline for the 2022 general election is Monday, Oct. 24. That is the deadline both for new voters to register and for current voters to update their voting information if they have moved to another location within Alabama.
  • Register to vote or update your information online here.
  • People who have faced domestic violence, or guardians of people who have faced domestic violence, may submit a form to protect their residential and mailing addresses from appearing on the public list of registered voters. Download that form here (opens as a PDF).
  • Alabamians are not officially registered to vote until their county board of registrars reviews and approves their application.
  • Check your voter registration status here.

What you need to know for the election

What to do if you face barriers to voting

If you face any intimidation, threats or other barriers to voting, trained volunteers are ready to help. You can call the nonpartisan Election Protection hotlines here:

  • English: 866-OUR-VOTE (866-687-8683)
  • Spanish: 888-VE-Y-VOTA (888-839-8682)
  • Asian languages: 888-API-VOTE (888-274-8683)
  • Arabic: 844-YALLA-US (844-925-5287)

Read our blog post to learn more about volunteering as a poll monitor with the nonpartisan Election Protection network.

Why Alabama Arise supports the recompiled constitution

A graphic stating: Vote Yes on the recompiled state constitution

From our blog:

“Alabama Arise is committed to recognizing, teaching about and repairing the damage that state lawmakers perpetrated for generations through codifying racism and racist practices. Racist language and the harmful provisions flowing from it have no place in our state’s most important legal document. That is why we urge Alabamians to vote ‘Yes’ on the recompiled state constitution on Nov. 8, 2022.

“Examples of deleted racist language [in the recompilation] include references to separate schools for Black and white children and prohibition of interracial marriages. The recompilation also strengthens Alabama’s prohibition of slavery by removing language that allows involuntary servitude ‘for the punishment of crime.’

“Alabama voters will decide whether to authorize those changes by adopting the recompiled state constitution. Arise recommends voting ‘Yes’ on the recompilation, which will appear on the ballot as the Constitution of Alabama of 2022.”

Read more about the recompiled constitution here.

A sincere thank you

As I reflect on our 2022 Annual Meeting and dive into planning for our 2023 agenda, I simply want to say thank you for your generous contributions, advocacy and support.

This July marked the beginning of my fifth year as executive director, and next year will mark 35 years since Alabama Arise was founded. The COVID-19 years have stretched us to adapt in new ways. I couldn’t be more grateful for the ways our dynamic staff, supporters and board leaders have navigated these changes as we continue learning, growing and doing new things together.

As we look ahead to fall and winter, we’re doubling down on hybrid opportunities to engage members and grassroots constituents. We’re looking at how we engage the broadest base possible to achieve our goals. And we’re striving to meet the needs and goals identified by you, our members.

Thank you for charting our agenda and joining us to continue our forward momentum. When we push together, change is on the horizon.

Together, our members make a difference!

There’s something about the approaching winter holidays that brings out the generous nature in all of us. We all want to do our part and work together to build community and a better Alabama.

At Arise, we’re grateful for your giving. Almost 13% of our financial support comes from members like you. When you give, we have the flexibility needed to focus on you and your priorities. We believe people from every community must be engaged in the state and federal policymaking process to effect real and lasting change.

Will you help us grow our membership? If you haven’t already, join or renew your membership with a gift. There are so many ways to give:

  • A one-time or monthly gift online at
  • A check mailed to P.O. Box 1188, Montgomery, AL 36101.
  • A gift of stock.
  • A gift from an IRA, 401(k) or other tax-deferred savings account.

Once you’ve given, invite your friends, family and network to join you in making a difference! Or invite a group you’re in to join as a member group! Share why you’re a part of Arise and how you partner with us.

If you would like more information, please email me at Thank you for your generosity in this end-of-year season.

Why Alabama Arise urges a ‘Yes’ vote on the recompiled state constitution

The stain was there from the start. In his opening remarks, the president of Alabama’s 1901 constitutional convention declared a major goal of the event was “within the limits imposed by the federal Constitution, to establish white supremacy in this state.”

The resulting document effectively removed the voting rights of African Americans and poor white people. Federal courts have overturned most of the discriminatory provisions, but the shameful evidence of this legacy persists in Alabama’s constitution.

Alabama Arise is committed to recognizing, teaching about and repairing the damage that state lawmakers perpetrated for generations through codifying racism and racist practices. Racist language and the harmful provisions flowing from it have no place in our state’s most important legal document. That is why we urge Alabamians to vote “Yes” on the recompiled state constitution on Nov. 8, 2022.

A graphic stating: Vote Yes on the recompiled state constitution

In 2020, Alabama voters overwhelmingly approved an amendment authorizing the Legislative Services Agency to clean up and consolidate the constitution and remove explicitly racist content and illegal provisions that have since been repealed. The Legislature approved the proposed revisions in the 2022 regular session without a dissenting vote.

Examples of deleted racist language include references to separate schools for Black and white children and prohibition of interracial marriages. The recompilation also strengthens Alabama’s prohibition of slavery by removing language that allows involuntary servitude “for the punishment of crime.”

Arise’s recommendation: Vote ‘Yes’

On Nov. 8, 2022, Alabama voters will decide whether to authorize those changes by adopting the recompiled state constitution. Arise recommends voting “Yes” on the recompilation, which will appear on the ballot as the Constitution of Alabama of 2022.

The changes in the recompilation wouldn’t address all of the problems with Alabama’s constitution, including harmful limits related to tax policy and local governance. But they still would move Alabama, and our constitution, in the right direction. Arise urges Alabamians to vote “Yes” to help move our state forward.

Here’s what Alabama Arise heard from you in summer 2022!

We deeply value the input we get from Alabama Arise members, our allies and most importantly, those directly affected by the work we do together. We depend on what we hear to help guide our issue work and our strategies.

Despite the ongoing challenges of connecting in person, we kept working at finding ways to listen. We did another series of three statewide online Town Hall Tuesdays. And we held seven additional listening sessions around the state, engaging about 200 people.

The town halls happened every two weeks, starting July 12 and ending Aug. 9. Other meetings took place throughout the summer. Below are summaries of what we heard in those meetings.

Town Hall Tuesdays

Food and health

Most participants deeply cared about Medicaid expansion. They discussed how it would help many people, including rural communities struggling with access to care. Many were frustrated that Gov. Kay Ivey has not yet expanded Medicaid in Alabama. Others discussed the connection between health and access to healthy food and nutrition. Some participants noted that other barriers like transportation also directly impact health, nutrition and employment.

Related issues raised were the needs to address the racial wealth gap and increase wages for front-line workers. Many people expressed appreciation for food banks and pantries but acknowledged that they cannot meet all food security needs. Participants encouraged Arise to remain vigilant about the threat to impose stringent work requirements for Medicaid and SNAP food assistance. Many participants also mentioned untaxing groceries as a way to improve food security.

Democracy and justice

Many participants expressed concerns about legislative attempts to suppress voting rights and said Election Day should be a state holiday. Others also expressed concerns about ballot access for people with disabilities, limited numbers of voting precincts and gerrymandering. Bottom line: We should make it easier to vote, as ballot access is key to a strong democracy.

Several participants expressed concerns about the need for more services for people leaving incarceration. We need to expand community corrections programs, enact real prison reform and get rid of unjust fines and fees.

Some participants identified language accessibility as a potential barrier to receiving many services and participating fully in our democracy. Others were concerned about allocation of American Rescue Plan Act funds and wanted more funding for the Housing Trust Fund.

The path forward

This town hall was an opportunity to talk about any issues of concern people wanted to highlight. Participants raised the following needs and concerns:

  • Expand Medicaid in Alabama now and address health disparities, including women’s health issues.
  • Untax groceries and improve our regressive tax system.
  • Improve voting access, including restoration of voting rights for people who were formerly incarcerated.
  • Address environmental issues, including working to improve air quality in schools.
  • Improve affordable housing access and language access, fully fund the child home visitation program and address gun violence.

Group and regional listening sessions

Session participants around the state strongly affirmed Arise’s work on the current 2022 issue priorities. They also emphasized the ongoing work to be done in those areas. Current issues highlighted were Medicaid expansion, criminal justice reform (particularly in the area of unjust fines and fees), more funding for child care and first class pre-K, public transportation and death penalty reform.

Session participants also discussed issues that aren’t on the Arise agenda but are of concern to them and their communities. Some of those issues include:

  • Affordable housing, with a focus on increased funding and availability. One example was discussion of whether to limit the number of vacation rental properties one person could own in an area, as this can contribute to the shortage of affordable housing. Many renters also discussed the soaring prices of rent.
  • Automatic organ donor registration linked to getting and renewing driver’s licenses.
  • Broadband internet extension to reach more rural households and Alabamians with low incomes.
  • Constitutional reform.
  • Government intrusion on private medical decisions. One example shared was concern over lawmakers interfering with rights of transgender teens to seek medical care. Another concern raised was doctors being able to provide medical care during pregnancy and decide the right time to intervene on a pregnancy that threatens the life of the mother.
  • Gun violence prevention.
  • Marijuana sentencing reform.