Alabama Arise and our members have worked for more than 35 years to push for state policies that improve the lives of people struggling to make ends meet. We advocate for policies to build an Alabama where everyone has the resources they need to reach their full potential. And we’ve always remained steadfast in this mission and our values, regardless of who holds public offices at any given time.
On Tuesday, Alabama voted. So today, we have a clearer vision of what we may face as we look toward the 2025 legislative session in February. The path to dignity, equity and justice for all has always been a long one in Alabama. None of us are strangers to this work, and we’re in it for the long haul.
To make positive change, we must work together. We all must lean into our relationships, communities and networks to find solidarity and grow our collective voice for change. As a member-based organization, we know power is built from the ground up. And Arise will continue our commitment to growing our people power to expand health care access, reduce hunger, reform Alabama’s upside-down tax structure and support working people across our state.
More than 150 Alabama Arise member groups and more than 1,500 individual members choose our legislative priorities each year. This process ensures that Alabamians most impacted by poverty have a seat at the table. Below are the priorities that our members selected for 2025.
For a PDF version of this document, click here or click the “Download” button above.
Tax reform – A more equitable tax system can help struggling people make ends meet. Alabama should untax groceries and ensure fair, sustainable funding for vital services.
Adequate state budgets – Strong public services broaden opportunity for all. Alabama must expand Medicaid and protect funding for public schools. Our state also should reduce hunger and hardship by supporting universal free breakfast in public schools.
Voting rights – Everyone deserves a say in our democracy. Alabama should pass no-excuse early voting and lift barriers to voting rights restoration for disenfranchised people.
Criminal justice reform – Our justice system must ensure fairness and justice for all. Alabama should improve its parole system, reform punitive sentencing laws and reduce reliance on fines and fees as a revenue source.
Maternal and infant health – The health and safety of families is paramount. Alabama should improve access to high-quality health care, ensure life-saving pregnancy care is not criminalized and extend paid parental leave for state employees and teachers.
Public transportation – Community connection is vital. Alabama should fund the Public Transportation Trust Fund so everyone can get to work, school, medical care and more.
Death penalty reform – All Alabamians deserve equal justice under the law. A key step in this direction would be to apply Alabama’s ban on judicial overrides of jury sentencing verdicts retroactively to people sentenced under this now-illegal policy.
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.”
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.
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.
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.”
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 forAlabama 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.
Expanding Medicaid and ending the state sales tax on groceries will remain top goals on Alabama Arise’s 2025 legislative agenda. The organization also will advocate for state funds to help public schools provide free breakfast to every student.
More than 450 members voted in the last week to affirm Arise’s legislative priorities. The seven priorities chosen were:
Adequate budgets for human services, including expanding Medicaid to make health coverage affordable for all Alabamians, supporting universal free breakfast in public schools and ensuring equitable public education funding for all students.
Tax reform to build a more just and sustainable revenue system, including eliminating the rest of Alabama’s state sales tax on groceries and replacing the revenue equitably.
Voting rights, including no-excuse early voting, removal of barriers to voting rights restoration for disenfranchised Alabamians, and other policies to protect and expand multiracial democracy.
Criminal justice reform, including legislation to improve Alabama’s parole system and efforts to reduce overreliance on exorbitant fines and fees as a revenue source.
Maternal and infant health investments to advance the health and safety of Alabama families, including legislation to ensure paid parental leave for state employees and teachers.
Public transportation to empower Alabamians with low incomes to stay connected to work, school, health care and their communities.
Death penalty reform, including a law to apply Alabama’s ban on judicial overrides of jury sentencing verdicts retroactively to people sentenced to death row under this now-illegal policy.
“Alabama Arise believes in dignity, equity and justice for everyone,” Alabama Arise executive director Robyn Hyden said. “Our 2025 legislative priorities would empower Alabamians of every race, income and background to reach their full potential. And they reflect our members’ commitment to building a healthier, more just and more inclusive Alabama for all.”
Alabama urgently needs to close the health coverage gap
An essential step toward a healthier future for Alabama is to ensure everyone can afford the health care they need. Arise members believe Medicaid expansion is a policy path to that destination, and research provides strong support for that position.
Alabama is one of only 10 states yet to expand Medicaid. Medicaid expansion would ensure health coverage for nearly 200,000 Alabamians caught in a coverage gap. Most of these residents earn too much to qualify for the state’s bare-bones Medicaid program but too little to afford private plans.
“Medicaid expansion would boost our economy, protect rural hospitals and improve life for people across Alabama,” Hyden said. “Closing the coverage gap also would improve access to mental health treatment and life-saving health care for mothers and babies. Our policymakers need to step up and to make this life-saving and job-creating investment in the people of our state.”
Universal school breakfast would help Alabama children learn and thrive
Another key step toward a healthier Alabama is to ensure every public school can offer free breakfast to every student. Hundreds of Alabama schools are providing free meals to all of their students through the Community Eligibility Provision, but some schools cannot participate in the program.
Arise will advocate for a state appropriation that local districts can use to match federal funds to offer free breakfasts. This funding would position Alabama to build on the success of Summer EBT, which will provide $40 in food benefits per summer month for more than 500,000 children starting in 2025. Legislators approved the necessary administrative funding for Summer EBT this year after determined advocacy by Arise members and partners.
Children and communities across Alabama would enjoy both immediate and long-term benefits from universal free breakfast in public schools. Universal school breakfast would reduce child hunger in a state where nearly 1 in 4 children face food insecurity. Extending the reach of school breakfast programs would help reduce behavioral problems and improve attendance and test scores. Reducing food insecurity for children also can help improve their mental health and overall health as teenagers and adults.
“It’s hard for children to focus in school when they’re hungry,” Hyden said. “Lawmakers can help ensure that every student across Alabama can start the day with a good meal and be ready to succeed both in the classroom and throughout their lives.”
Finish the job: Alabama needs to remove the rest of the state grocery tax
Arise members also renewed their decades-long commitment to another policy to reduce hunger: ending Alabama’s state grocery tax. That advocacy got results last year when legislators reduced the state sales tax on groceries by half. The law reduced the tax from 4 cents to 3 cents in 2023, but another 1-cent reduction did not happen this year because education revenues grew by less than 3.5%. That reduction will occur in the next year when revenues increase by that amount.
Ending the state grocery tax remains a core Arise priority because the tax makes it harder for people with low incomes to make ends meet. The tax adds hundreds of dollars a year to the cost of a basic necessity for families. And most states have abandoned it: Alabama is one of only 12 states that still tax groceries.
Lawmakers have options to remove the other half of the state grocery tax while protecting funding for public schools. Arise will continue to support legislation to untax groceries and replace the revenue by capping or eliminating the state income tax deduction for federal income taxes. This deduction is a tax break that overwhelmingly benefits the richest households. Arise also will support efforts to give local governments increased flexibility to decrease local grocery taxes if they determine it is feasible.
“Reducing the state grocery tax was an important step toward repairing Alabama’s upside-down tax system,” Hyden said. “By untaxing groceries and limiting the federal income tax deduction, legislators can help families keep food on the table while protecting funding for our children’s public schools. Alabama lawmakers should embrace this path to end the state grocery tax forever.”
Alabama Arise listens because we deeply value the input we get from members, partners 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.
We held two virtual statewide Town Hall Tuesdays this summer, and each featured three to four listening session breakouts. Arise staff either facilitated or were part of 20 additional listening sessions, both online and in person around the state. We engaged more than 500 people in a total of 27 listening opportunities.
Following are direct notes from the town halls and highlights from the other sessions. These notes and highlights are listed under the names of the Arise organizers who heard them.
Town Hall Tuesdays
A better Alabama is possible, July 16
We had four breakout rooms during this session. We asked folks in each group to discuss their thoughts on current issues and to share other priorities they had. Here’s what our organizers heard from participants:
Pres Harris:
Death penalty reform. We need to consider the impact that potential new appointees to the U.S. Supreme Court might have on this issue at the state level.
Concern about new school choice laws that divert funding from public education. There is special concern in rural areas where there are either no or very limited options to public education for children. Many participants said this is a way to take more money from funding public education. Several participants agreed with the education concern.
A sight-impaired participant lifted up education, voting rights and public transportation as key issues impacting people living with disabilities. There is a disparity in education among low-vision students. The disabilities community has been advocating for electronic voting so that sight-impaired people can vote with privacy. And lack of public transportation is a barrier to voting and other quality-of-life activities.
Concern about the maternal health crisis and subsequent infant health care needs. We need to improve access to maternal care and health care overall. We need to expand Medicaid.
One participant raised the need for people to have legal representation in civil issues like family issues, bankruptcy, school issues, etc. Another participant said the Alabama State Bar might be an ally in advancing such an issue.
Public transportation was highlighted again as a need and a quality-of-life issue.
In the main session, a participant raised the need to address a variety of veterans’ issues, with emphasis on veteran housing availability.
Stan Johnson:
More funding for education programs for children ages 0-3. For a better Alabama, we need to focus on early education. Alabama has a home visitation program called First Teachers, designed to support families at risk for poor developmental outcomes. They use a variety of models, including Parents as Teachers and First Family Partnership. They go and visit families with children 0-3 years of age. Alabama is not putting additional money into 0-3 education. A participant noted that the state budget has included such funding in the past, and he wants to ensure it stays there. We have appropriated a couple million dollars, but Alabama receives more from the federal government than what the state puts in for this service. Minnesota puts 10 times as much money into their program as Alabama. Missouri has universal access to 0-3 education.
Kids need to master their social and emotional milestones, and the ability to have a two-way productive interpersonal relationship. They need the ability to modulate their emotions appropriately in a group setting, to have a sense of curiosity and to have a sense of who they are. If they do not get the basic scaffolding in the first three years of life, then all the remediation in the world will not help them get through high school. Efficacy-based programs exist and have proved effective. Alabama is not doing enough about it.
A participant said she is a retired teacher and could tell the difference between kids who were read to, loved and cuddled. The first three years make a world of difference. She said this does not need to be a named Arise priority, but it should be addressed.
We have picked up momentum with Medicaid, but not nearly enough. Many participants said this needs to continue to be the No. 1 issue. Adequate health care is important for a better Alabama.
Participants said they want to help with Medicaid expansion. They understand all it would take is for the governor to sign it and it would be a done deal. They do not understand why people would say they do not want money from the feds. For every dollar we send, we get back $2.17.
Participants opposed turning back federal infrastructure money and ARPA money. The argument has no logic.
Rural hospitals and departments closed this year, including in Thomasville, Monroe County and Union Springs. What are the governor’s plans to help those areas? Some voters in those areas do not realize that state policies have caused them to lose their health care. We have been saying for years that lack of Medicaid expansion would cause hospitals to close.
Some women are now having to drive as far as 90 minutes away to get to an OB-GYN. We can see the harm that elected officials are causing to their constituents.
Unfortunately, people do not realize when they vote that they sometimes are voting for representatives who do not seem to have their best interest in mind. We have already lost $7 billion in funding by not expanding Medicaid.
One participant said the new teacher certification test is an issue for young or new teachers. What are some alternate ways toward certificates?
A participant said Congress should have passed a Medicaid expansion bill, the Save Rural Hospitals Act. This would have helped rural areas to reopen hospitals. The state chose to enhance the port in Mobile instead of providing funding to rural hospitals. The hospitals would have provided jobs and training for RNs, LPNs, CANs and other hospital staff, as well as other jobs once the hospitals opened.
We have to educate our decision-makers about looking at cost holistically and not just as a one-time investment. We are losing people due to not investing and not expanding Medicaid.
Adam Keller:
It’s hard to begin, because all of the issues are so interrelated and important.
Public transportation is so important to access to food and work. Several participants weighed in on public transportation.
One participant said crime is out of control and expressed concern about gun safety. They are concerned about gun violence and how Gov. Kay Ivey and lawmakers have loosened restrictions. They emphasized the need for citizen participation.
There are false narratives around crime. We need more community-based public safety.
A participant brought up the lack of Medicaid expansion, closing of rural hospitals and lack of OB-GYNs. She had a medical incident and only survived because she had immediate attention.
A participant said the secretary of state’s salary should be tied to voter registration. They also brought up bicycles as a help for transportation, as well as university bike share programs and bike grants. They said the state needs to grant more paroles and shouldn’t require people to pay a bunch of fees before voting rights are restored.
Formeeca Tripp:
It’s important to know the history of Alabama so we can understand the past and where we are going.
A longtime Alabama Arise member is eager to keep learning more. He believes the issues proposed are good, and we need to keep focusing on them.
One big supporter of Medicaid expansion believes it needs to keep being addressed in the legislative sessions. He also supports the end to the state grocery tax but is lost on “what else can we do?” He also has concerns with gun violence, along with other participants.
Another longtime member is a big supporter of Medicaid expansion and believes we need to keep working on the current list of priorities for the next legislative session.
Another participant believes payday and predatory lending should be addressed and a priority issue. Transportation, specifically for disabled veterans, is important and needs to be addressed, not just grouped under the general transportation umbrella. She also would like to see gun violence reduction as a priority issue and has a movement called “SWAG – Safer Without A Gun,” to buy back real and toy guns as well as educate on gun safety, conflict resolution and problem-solving skills, especially in underserved communities.
Medicaid expansion, transportation and gun violence were the dominant topics in our breakout room.
Building toward a better Alabama, Aug. 6
We had three breakout rooms during this session. We asked folks in each group to discuss what motivates them to act on issues and how Arise supports their actions. And we asked them to indicate their priority issues. Here’s what our organizers heard from participants:
Pres Harris:
Participants shared consensus about the need to expand Medicaid to address several health care concerns. These included rural hospital closures, maternal mortality rates in Alabama and support for mental health care needs.
Concern for the survival of our democracy with attacks on voting rights was expressed. Public education, affordable housing and public transportation also were highlighted. Several said it is hard to prioritize the current Arise issues, as they are all critical.
Participants shared what motivates them to action: hearing the stories of those directly impacted, knowing they are coming together with others to advocate, and the feeling of confidence they get because Arise has helped equip them with information and tools to act.
Stan Johnson:
We heard consensus that all the issues are important, and it is difficult to pinpoint which is a priority over another.
Jobs to Move America supports everything Arise does and wants to see a clawback of incentives to companies that violate child labor laws (e.g., Hyundai’s supply chain). We want to raise that up for consideration. These kids come from impoverished backgrounds in Mexico/Central America, and they send money back to their families. Sen. Merika Coleman and Rep. Neil Rafferty had a bill last year, and it passed in the Senate and House committee unanimously; we just ran out of time. We need to send these car manufacturers a message. They are working on a strategic direction proposal to submit.
We need to continue to grow the communication network throughout the state.
Alabama Arise is the most respected organization in the State House.
We need to make serious reforms to the state budgets and appropriations so we can take care of the people of Alabama, instead of Mercedes, etc. We do not have money to fund social programs, but corporations are receiving gigantic tax breaks. These are billions of dollars that could have helped the citizens of Alabama.
One organization is working on criminal legal reform in Alabama, especially looking at the death penalty.
A participant was very upset that Alabama does not participate in programs, and then the same government comes and says we do not have any money.
Several participants said transportation needs to improve in Alabama, which also helps people have access to jobs. Transportation is a big topic for people with disabilities. One participant said some of her clients are not able to get to appointments at UAB because of a lack of public transportation. Some transportation directors, on the other hand, do not see the need and want to make further cuts because of low ridership on the buses. Her clients are losing their jobs because of unreliable transportation. Decatur has Ride on Demand, where you must call in to request a ride. It can be a two-hour wait time. There are bus stops on busy roads, so it is dangerous for individuals in wheelchairs as well as able-bodied individuals. These are some of the reasons people do not use Decatur’s transportation system.
Another participant from Mobile said she has been working on Medicaid expansion and is glad we were able to get an extension on the coverage for postpartum maternity care. She is pushing health care as the main issue, along with the social determinants associated with health.
Adam Keller:
We need more mental health services, which will help reduce prison overcrowding and crime.
Alabama needs prison reform, including addressing the prison labor situation.
We heard affirmation of our current agenda, including specifically voting rights and Medicaid expansion.
We heard discussion of burnout and the importance of persistence (with the grocery tax as an example).
Some members shared that they wouldn’t be involved if it wasn’t for our help and said Arise gives them more hope for the state.
Additional listening sessions
This section highlights participants’ input from the 19 additional sessions recorded by the Arise organizing team. In general, all participants strongly affirmed Arise’s work on current legislative priorities. Many thought that Arise should continue to build on momentum it has around some of the current issues. Many also said we need to see more change in the existing priorities. Members seemed to affirm these sentiments, as no new issues were proposed for 2025. These notes lift up the other issues of concern that participants highlighted as we listened.
Pres Harris – Baldwin, Elmore and Mobile counties
Participants in these meetings affirmed the current Arise priorities, acknowledging that our issues are long-haul issues.
Other issues raised:
The need to address gun violence.
The need for parole reform was proposed by a group of women from the Julia Tutwiler Prison for Women who are sponsored by Arise member group Greater Birmingham Ministries. GBM submitted the issue as a strategic approach under the existing criminal justice reform issue.
Stan Johnson – Birmingham/Jefferson County and Tuscaloosa/West Alabama
Most of the participants in these meetings focused on the existing legislative priorities and discussed ways to continue the work toward progress.
A member group planned to submit a proposal for a strategic approach to getting more funding for the 988 mental health crisis hotline that connects folks to needed resources. This is not a new issue, but it would be part of Arise’s permanent priority of adequate state budgets.
Other issues raised: More needs to be done about payday loans, energy/solar power incentives and veterans in crisis.
Whit Sides, Arise’s Cover Alabama storyteller, participated in a session with disability advocates that involved listening to and sharing stories related to intellectual disabilities and neurodivergence/autism. Participants were interested in developing their stories for advocacy with policy and lawmakers.
Adam Keller – Northeast/Madison and Morgan counties
Most of the participants in these meetings strongly affirmed the current Arise priorities.
During further discussion, participants highlighted issues related to public education, child nutrition, paid parental leave and parole/probation reform.
Several conversations centered on how the work of Arise connected with labor and worker power.
Formeeca Tripp – Houston, Lee, Montgomery and Tallapoosa counties
Many participants in these meetings expressed appreciation for Arise’s work around our current issues, especially voting rights, health care and other safety net issues.
Other issues raised:
The lack of affordable housing that contributes to issues of homelessness.
Legislation that impacted the Black population historically and current laws and policies that lawmakers have passed.
Issues that negatively impact racial equity and inclusion.
The need to address gun violence and have programs for youth.
Alabama should do more to equip schoolchildren and teachers for success. Our state consistently ranks among the bottom five states for educational outcomes. And one essential school supply missing from several Alabama schools would immensely improve said outcomes: universal school breakfast. Below are a few of the positive effects that universal school breakfast would have for children across Alabama.
Reduce child hunger across our state. In Alabama, 23% of school-age children are food insecure, with a disparate impact among children of color. Universal school breakfast could guarantee a morning meal for all Alabama children during their required school day.
Improve adolescent mental health. Young adults who reported experiencing food insecurity during childhood also reported greater psychological distress in adulthood, according to National Health and Nutrition Examination Survey data.
Improve standardized testing and math scores.Alabama ranks 46th in average math ACT scores. Student academic achievement increases, especially for math, when accessible breakfasts are made available to school-age children.
Reduce the long-term cost of closing the health coverage gap. Given the chronic health conditions associated with hunger, like diabetes and heart disease to name a few, a state subsidy for universal school breakfast is a form of preventative care that could have a long-term impact on the projected cost of closing the coverage gap in Alabama.
Alleviate behavioral problems.The behavioral effects of hunger include impulsivity, hyperactivity, irritability, aggression, anxiety and a greater propensity to using rewarding narcotics, according to a study by the National Institutes of Health. Reducing hunger would reduce these behaviors.
Aid Alabama’s teachers in regulating their classrooms.Attrition rates among teachers have surged nationwide and statewide in recent years. Teachers spend roughly $300 per year of their own money to feed hungry students in their classrooms.
Address educator attrition rates. Nearly 40% of teachers who left the profession said they had better material support in their current roles when compared to teaching, according to a survey conducted by the Institute of Education Sciences. Universal school breakfast is a simple but powerful way to provide material support for Alabama’s teachers and students.
For questions regarding the implementation, impact and general importance of universal school breakfast, please contact Alabama Arise’s LaTrell Clifford Wood at latrell@alarise.org or Carol Gundlach at carol@alarise.org.
School breakfast helps kids learn: Children who start the day with breakfast learn better. They have better classroom participation and are less likely to skip school than kids who don’t get breakfast. But tight family budgets and stressful mornings mean many children arrive at school hungry. School breakfast can help fill this gap.
School, bus and family schedules make it difficult to serve breakfast before the school day begins: School breakfast participation declined nearly 8% nationally after pandemic-era free breakfast ended. Only half of the children who get lunch at school also get breakfast.
The solution – universal free breakfast: School districts across the country have found that breakfast served after the first bell increases participation and helps kids learn.
Paperwork is a barrier for hungry children: Federal funding for traditional school breakfast relies on school’s assessing students’ eligibility for meal subsidies and reporting on how many free, reduced and paid meals are served. The Community Eligibility Provision (CEP) can reduce the paperwork for schools that serve a high share of children with low incomes. But many schools either can’t make CEP work financially or worry about its impact on other federal grants.
What the Legislature can do: The Legislature can help feed Alabama’s schoolchildren by appropriating Education Trust Fund (ETF) money to match federal reduced and paid breakfast funds. Schools that want to offer free breakfast can use these matching funds to provide breakfast for all of their students at the start of the school day.
How this would work: The Legislature would appropriate money to match federal school breakfast grants. The Alabama State Department of Education would allow local schools to apply and would distribute these matching dollars. Schools that receive funding would report to, and be monitored by, the Department of Education.
The decision to offer free breakfast is optional: Whether to apply for matching funds would be totally voluntary for schools or systems. Those that want to participate can apply for the matching funds. Those that don’t think it will work for them can choose not to apply.
How this would interact with CEP: The Community Eligibility Provision allows eligible schools to provide free meals for all their students. But some Alabama schools that are technically eligible for CEP can’t make the federal reimbursement rate work for them. And other Alabama schools would like to offer free breakfast but don’t want to adopt CEP fully. This proposal would allow schools to be made whole if they do adopt CEP or would allow schools to offer universal breakfast without having to adopt CEP fully.
Bottom line
An ETF appropriation of approximately $14 million in 2023 dollars would allow every school in Alabama to offer breakfast to all of their students.
Where you live shouldn’t impact whether you get health care. But many women face preventable barriers to obtaining maternal health care in Alabama. Closing Alabama’s health coverage gap through Medicaid expansion is an essential part of the solution.
Alabama has experienced a steady rate of labor and delivery department closures in recent years, creating several maternity care deserts in Alabama.
A maternity care desert is defined as a county or area with a lack of access to maternity care resources. These areas often have no obstetric providers and no birth centers or hospitals offering obstetric care.
More than one-third of Alabama counties are maternity care deserts, with some people having to drive up to 100 miles to reach the nearest labor and delivery department. The lack of essential delivery and prenatal care in the Black Belt and other areas worsens the state’s maternal and infant health disparities, especially for women with low incomes.
The farther a woman travels to receive maternity care, the greater the risk of maternal morbidity and adverse infant outcomes, such as stillbirth and NICU admission.
Expanding Medicaid would help strengthen access to maternity care providers by improving rural hospitals’ overall finances, which could reduce the number of labor and delivery department closures in the state.
Research shows that a rural hospital being located in a Medicaid expansion state decreases the likelihood it will close by an average of 62%.
Rural hospitals in states that have expanded Medicaid coverage have more sustainable median operating margins compared with rural hospitals in non-expansion states.
Medicaid expansion would provide more women with access to regular prenatal checkups, leading to early detection and management of potential health issues for both the mother and the baby.
Research shows that adoption of Medicaid expansion is associated with lower rates of maternal mortality, and reduction in infant mortality as well.
Medicaid expansion also has been found to increase preconception health counseling, folic acid intake and postpartum contraception.
A state appropriation for Summer EBT will ensure $40 in food benefits per summer month for more than 500,000 eligible Alabama children ages 5-17.
1 in 4 Alabama children are food insecure.
Too many of our children don’t know where their next meal will come from. Because of systemic barriers to food access, a disproportionate amount of food-insecure children come from communities of color. The Summer EBT program has been shown to help alleviate this problem by both reducing hunger and supporting healthier diets among children.
500,000+ Alabama children will benefit starting in 2025.
In recent years, 94% of Alabama’s children who relied on free and reduced-price meals during the school year have not had access to these meals over the summer. The Summer EBT appropriation in the 2025 Education Trust Fund budget will help reduce hunger for hundreds of thousands of Alabama children in summer 2025.
Summer EBT could spur $100M each year in economic activity.
This federal nutrition program required a $10 million state match for administrative and setup costs. This funding will generate substantial economic benefits, both for families and for local retailers that accept EBT benefits. Also worth noting: The costs of operating this program likely will decrease in future years.
Preparing for Summer 2025
Summer EBT cards will be addressed to and in the eligible child’s name.
Children will be automatically eligible to receive Summer EBT benefits if at least one of these is true:
The child’s household receives assistance under Medicaid, the Supplemental Nutrition Assistance Program (SNAP), Temporary Assistance for Needy Families (TANF) and/or the Food Distribution Program on Indian Reservations (FDPIR).
The child is in foster care or experiencing homelessness.
Applications will be required for all other eligible children.
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
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.
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.
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.
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.
