Issue: Medicaid Expansion

Here’s what Alabama Arise heard in 2024!

By Presdelane Harris

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.

Expand Medicaid to save moms and babies in Alabama

By Debbie Smith

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.
  • Since October 2023, at least four hospitals have closed their labor and delivery departments.

The closure of accessible labor and delivery departments is dangerous for mothers and babies.

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.

Alabama has the highest maternal mortality rate in the nation. Similarly, Alabama’s infant death rates are higher than those in most other states. Alabama has the nation’s third highest infant death rate.

Medicaid expansion can help address the high maternal mortality rate and health disparities in Alabama by ensuring continuous coverage before, during and after pregnancy.

  • 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.

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.

Summer EBT, Legislative Day energy highlight busy, tough 2024 session in Alabama

By Chris Sanders

You made a difference! Alabama Arise members played a decisive role this year in securing summer food assistance for more than 500,000 children starting in summer 2025. Summer EBT funding brought an uplifting conclusion to the Alabama Legislature’s 2024 regular session, which ended May 9.

The Summer EBT victory showed the power of Arise’s policy analysis, organizing and advocacy. After the House passed an education budget without Summer EBT funding, Arise ramped up pressure on the Senate. Our policy team and lobbyists educated lawmakers about the program’s benefits. Our communications team generated dozens of media stories to build public support. And our organizers rallied Alabamians to speak out.

Ultimately, folks like you got Summer EBT funding across the finish line. Arise advocates flooded lawmakers with more than 2,700 emails, calls and personal visits urging support. And it worked: Senators added Summer EBT to the budget, and Gov. Kay Ivey signed it into law.

Our members also displayed their passion for change during Arise’s annual Legislative Day on April 2. More than 230 people packed the State House in support of our Cover Alabama campaign to close Alabama’s health coverage gap.

Lawmakers dealt setbacks to several Arise legislative priorities this year but made important progress on others. Through it all, our members kept speaking out for policies to improve the lives of Alabamians marginalized by poverty.

An infographic showing more than 8,900 Arise members took action this legislative session. 2,713 contacts on Summer EBT; 1,633 contacts on closing the health coverage gap; 1,555 contacts on workers' rights; 930 contacts on the CHOOSE Act; 688 contacts on protecting voting rights; and 1,417 contacts on other legislation.

Setbacks on school funding, voting rights, racial equity

Early in the session, legislators enacted three harmful new laws, all of which Arise opposed. One was the CHOOSE Act (HB 129 by Rep. Danny Garrett, R-Trussville). Over time, this law could divert hundreds of millions of dollars annually from public schools to private schools and homeschooling.

Another bad bill rushed into law was SB 1 by Sen. Garlan Gudger, R-Cullman, which criminalizes several forms of assistance with absentee ballot applications. Arise and other advocates fear this law could have a chilling effect on good-faith efforts to assist people who need help exercising their voting rights.

A third shortsighted new law is SB 129 by Sen. Will Barfoot, R-Pike Road. The act forbids state agencies and public schools and universities from sponsoring numerous diversity, equity and inclusion (DEI) programs. It also authorizes firings of employees found to violate the act knowingly. In late May, Jacksonville State University became the first university to close its DEI office in response to this law.

Later, legislators passed two new laws that undermine worker protections. SB 53 by Sen. Arthur Orr, R-Decatur, removes the requirement for an eligibility to work form for 14- and 15-year-olds. And Orr’s SB 231 makes companies ineligible for state or local tax incentives if they voluntarily recognize a union.

Good new laws on child care, housing, criminal justice reform

One positive workers’ rights law this year was SB 119 by Sen. Robert Stewart, D-Selma, which increases penalties for child labor violations. The Legislature also created tax credits designed to increase access to child care (HB 358 by Rep. Anthony Daniels, D-Huntsville) and workforce housing (HB 346 by Rep. Cynthia Almond, R-Tuscaloosa). And Orr’s SB 270 improved access to public records.

Lawmakers also enacted two good criminal justice and due process reforms. Almond’s HB 275 will increase pay for many lawyers representing indigent defendants. And HB 188 by Rep. Terri Collins, R-Decatur, requires a uniform hearing process and hearing rights for students suspended or expelled from public K-12 schools.

The work continues

Several other Arise-backed bills made major progress but came up just short of passage. HB 29 by Rep. Chris England, D-Tuscaloosa (allowing resentencing hearings for some defendants convicted under the Habitual Felony Offender Act) won House committee approval. Orr’s SB 62 (removing state sales tax from many infant and maternity products) passed the Senate but never reached the House floor. And HB 309 by Rep. Ginny Shaver, R-Leesburg (providing paid parental leave for state employees) passed the House but died on the Senate calendar.

With your support, Arise will keep advocating for important policy changes like these in 2025 and beyond. We will keep working to expand Medicaid and eliminate the state grocery tax. And we will keep strengthening our movement for a better, more inclusive Alabama.

Building momentum for closing the coverage gap

By Debbie Smith

Alabama Arise and the Cover Alabama coalition have built powerful momentum to expand Medicaid and close the state’s health coverage gap in recent months.

Arise held a news conference with our partners at the March of Dimes and Alabama Rural Health Association during our annual Legislative Day in April. The event highlighted how Medicaid expansion could improve infant and mortality rates in our state and keep rural hospitals open. More than 230 individuals from across the state attended and spoke up in support of the nearly 300,000 Alabamians who need health coverage.

In another encouraging development, the House and Senate Health Committees held a joint meeting in late April to hear from other states about their efforts to close the health coverage gap. This hearing was a platform for legislators and experts to explore potential solutions, drawing insights from successful initiatives in Arkansas and North Carolina.

A woman speaks while standing at a podium with several people behind her.
Alabama Arise’s Cover Alabama campaign director Debbie Smith speaks during Arise Legislative Day on April 2, 2024, at the State House in Montgomery.

‘Their loved one is now getting help’

Key figures from North Carolina, such as state Sen. Jim Burgin, shared their state’s journey in closing the coverage gap. Burgin, a vocal opponent of Medicaid expansion in the past, highlighted the overwhelming gratitude from individuals receiving assistance.

“I live in a very rural and very conservative area,” Burgin said during the hearing. “I have not had one person that has come up to me and told me, ‘Jim, you shouldn’t have done that, and we’re against you for doing that.’ But I’ve had hundreds of people come up to me and thank me because their loved one is now getting help.”

The meeting seemed to drive a shift in attitudes among some conservative legislators. Many have expressed an openness to exploring avenues for closing the coverage gap.

Meanwhile, we also celebrated the progress that Mississippi made in its efforts to close the coverage gap. In February, the Mississippi House voted 99-20 to expand Medicaid. While that bill ultimately did not pass in the Senate, Mississippi made incredible progress by bringing conservative lawmakers on board and making Medicaid expansion a hot topic in the state. Alabama legislators took notice, and Mississippi’s progress will put pressure on our legislators to move forward as well.

Looking forward

In the coming months, Cover Alabama will continue to beat the drum in support of Medicaid expansion. We are so grateful for your continued support. Together, we are making significant strides toward Medicaid expansion in Alabama.

Let’s continue to raise our voices, engage with lawmakers and advocate for equitable health care access for every Alabamian.

Close the health coverage gap for Alabama’s veterans

By Suhas Kellampalli

Many Alabama veterans face preventable barriers to obtaining health care. Closing our state’s health coverage gap through Medicaid expansion is an essential part of the solution.

Approximately 10,000 Alabama veterans are uninsured.

  • In 2022, half of Alabama veterans who were uninsured had an income below 138% of the federal poverty level (FPL), which is the income eligibility limit for coverage through Medicaid expansion.
  • In addition to uninsurance and other barriers to accessing health care that veterans face, VA health coverage is limited as well. This is due to eligibility based on service-connected disability, income status and other service-related factors. Distance to a VA facility also poses a significant barrier that can prevent enrollment in VA health care.
  • Lack of health coverage most greatly affects the veterans who need it most. Veterans with previously existing disabilities have a higher uninsured rate than veterans in general.

In 2022, 3,004 Alabamians on active duty for training in the National Guard or Reserves were uninsured and had an income under 138% FPL.

Expanding Medicaid would empower more of our brave service members and veterans with low incomes to access health care.

  • In states that expanded Medicaid at the time, 50% of the veterans who were uninsured in 2013 received health coverage by 2015. In Alabama, only a little more than 1 in 3 uninsured veterans obtained coverage in the same time period.
  • In 2021, half of all uninsured veterans were from the 14 states that had not expanded Medicaid at that time.
  • One veteran explained the stakes of Medicaid coverage in a KFF report: “If I didn’t have Medicaid, it would be all downhill because there are not a lot of places that can afford to supply the medications that I need. Hypertension killed both my parents, so I need to take care of myself and see the doctor regularly.”

Medicaid expansion would promote employment among veterans.

  • The employment rate for veterans will be higher in states that expand Medicaid than in states that do not, as indicated by Urban Institute projections for 2024.
  • About 1 in 7 veterans (14.2%) are employed in the service industry, while 13.7% work in construction and maintenance. These are among the professions where the most workers would benefit from Medicaid expansion. Closing Alabama’s coverage gap would allow more veterans to obtain and retain employment by improving their health and productivity.

Medicaid expansion would allow veterans to have more options to receive health care.

  • Expanding Medicaid would ensure veterans have more freedom to seek health care outside of the VA system. This would allow them to receive care more promptly while reducing wait times in VA facilities for other veterans.
  • The number of VA health system outpatient visits would decrease by 12% if all states expanded Medicaid.

Arise legislative update: April 29, 2024

By Matt Okarmus

Arise’s Akiesha Anderson provides an update on where things stand in the final days of the Alabama Legislature’s 2024 regular session. Unfortunately, we received unfavorable news last week on public transportation funding and legislation that would discourage employers from voluntarily recognizing a union. But we also have good news: Alabama lawmakers heard Medicaid expansion success stories from Arkansas and North Carolina officials last week, and your determined advocacy for funding Summer EBT is making a difference! Check out more by visiting alarise.org and clicking on “Take Action.”

Full transcript below:

Hi there. Akiesha Anderson here, policy and advocacy director for Alabama Arise. Per usual, I am here to provide you with another legislative update. With only five legislative days left this session, there is a lot left to get done before the clock runs out. Before we get into what’s left to do, however, let’s briefly discuss what happened at the State House last week.

Last week began with Alabama Arise calling a public hearing in the Senate Finance and Taxation [Education] Committee on HB 145. HB 145 is the Education Trust Fund budget. During the public hearing that took place last week, we spoke about the importance of the Legislature including funding for Summer EBT for 2025 in the Education Trust Fund budget. Currently there is no funding for Summer EBT for either this summer nor next. Thus, we are trying to do everything in our power to ensure that next summer, the half a million kids that rely on school meals don’t go hungry during their summer break. We were grateful to be joined by several of our Hunger Free Alabama partners, including VOICES for Alabama’s Children, who testified about the importance of Summer EBT last week. And we look forward to seeing what unfolds this week regarding this issue.

Last week, we also saw HB 376 by Rep. Yarbrough pass out of the House Public Safety and Homeland Security Committee. If passed into law, this bill would allow local law enforcement to serve as a proxy for ICE and potentially target and racially profile many of our immigrant neighbors while trying to enforce federal immigrant laws.

Last week, we also saw SB 91 by Sen. Linda Coleman-Madison, which would have added an additional license tax fee as a mechanism to fund the Alabama Public Transportation Fund. Unfortunately, this bill received a 6-7 vote and thus failed to pass out of committee, Thankfully, however, Sen. Coleman-Madison has expressed a commitment to come back next year in pursuit of funding for public transit.

Last week, we also saw SB 231 by Sen. Arthur Orr pass out of the House. This is the bill that would strip companies of tax incentives if they voluntarily recognize their workers’ decision to form a union. This bill is one like Rep. Yarbrough’s bill that we are opposed to, and it is now slated to be back in the Senate and to potentially have a conference committee to discuss some of the amendments that were placed on it in the House.

Lastly, last week the House and Senate held a Joint Health Committee meeting, which was designed to discuss solutions for closing the health coverage gap. During this hearing, lawmakers heard from both Arkansas and North Carolina legislators or lawmakers, who shared with our lawmakers details about their quasi-Medicaid expansion plans that have been rolled out in each of their respective states.

Last week was a lot. Again, we are racing against a clock, so let’s move forward to what’s going to be on the tap for this week.

This week is slated to be a budget-heavy week. In the Senate, the General Fund, a supplemental General Fund, a cost-of-living increase for state employees, the Education Trust Fund and a supplemental Education Trust Fund will all be deliberated in committee on Tuesday.

We are optimistic that Sen. Arthur Orr will prove to be a hero to the half a million kids that I referenced earlier by ensuring that there is funding for Summer EBT in the Education Trust Fund budget this week. Also in committee this week will be SB 312 by Sen. Barfoot. This is a bill that will be deliberated by the House Judiciary Committee on Wednesday, and if passed, it will give people in prison an opportunity to attend their parole hearings virtually.

Lastly, neither here nor there, the Legislative Council will be meeting this Wednesday afternoon to discuss the State House construction project which is currently underway.

My friends, there is quite a bit left this legislative session, quite a bit slated for this week. However, as the clock continues to tick down, I’ll be sure to be here to continue to provide you with weekly updates. In the meantime, take care.

Arise legislative update: April 22, 2024

By Matt Okarmus

Arise’s Akiesha Anderson brings you up to speed on all that happened last week at the State House plus gets you ready for the upcoming week. As the session is nearing an end, we still have action to take on securing public transportation funding and increasing penalties for child labor violations. We also are trying to curb anti-union and anti-immigration legislation. See more at alarise.org and clicking “Take Action.”

 

Full video transcript:

Hi there, Akiesha Anderson here, Policy and Advocacy Director for Alabama Arise here to give you yet another legislative update for the week of April 22.

Last week, quite a bit happened but I’m going to start with the Education Budget. So as you know, we are down to just a few legislative days left. Tomorrow when legislators go into the State House they will be on the 24th out of 30 legislative days. And it is essential that the legislature passes the Education Budget as well as the General Fund Budget. So last week we did see the Education Budget make it out of the House to be sent over to the Senate. One unfortunate reality about the Education Trust Fund budget is that unfortunately the $15 million needed for Summer EBT was not included in the House’s version of the budget. This is really unfortunate. We are still going to continue to push to see if we can get that money added to the budget in the Senate but I do want to make note that the House felt to allocate this money even despite the fact that there was a $15 million surplus or $15 million bucket of money that was set aside for Birmingham Southern back when the state intended on giving it a loan to bail it out of its financial trouble. There was $15 million that was previously allocated for Birmingham Southern that instead was allocated to a quasi slush fund for legislators basically to give out community grant money. And so Arise believes that this $15 million would be much better used ensuring that over half a million children have summer meals when school is out and so we are hopeful that we can make that argument in the Senate and we can ensure that children get fed over the summer.

Also related to budgets, last week HB 358, which is a bill sponsored by House Minority Leader Anthony Daniels. This piece of legislation was a childcare tax credit bill and it passed out of the House and so that is good news. It means that women and others that occasionally are forced out of the workplace to do caregiving for children might have some alternative ways to be in the workforce and ensure that they also have child care available. Some unfortunate yet also some good movement on several bills related to workers rights was seen last week. However, I will talk about that in more detail when I talk about what we’re watching this week at the State House.

But also last week we saw quite a bit of movement on some criminal justice related bills. So the judicial override bill sponsored by Rep. England as well as a bill requiring a unanimous jury before sentencing someone to the death penalty sponsored by Sen. Hatch, these both died in committee last week. So that was really unfortunate to see that the death penalty legislation that we were watching did not make it out of committee either in the senate or in the House Judiciary Committee last week. Despite that, however, there were some good parole bills that passed out of committee. This included HB 299 by Rep. England which essentially would create an appeal process for some people whose parole is denied. There also was movement on SB 312 by Sen. Barfoot. This piece of legislation also passed out committee and this would allow people to attend their parole hearings virtually. So that was really nice to see that there is some positive traction with regard to some parole bills. However, it remains to see be seen how much time is left in session whether or not these bills can make it over the finish line. Another piece of legislation that’s quasi criminal justice related a bit more education related, however, and that does have time to make it throughout the through the whole process for certain are some pieces of legislation introduced by Sen. Smitherman as well as Rep. Collins that would provide due process rights to students in K-12 Public Schools. So essentially if these pieces of legislation pass K-12 public school students will not be able to be suspended or expelled without certain due process criteria being met, essentially allowing them to tell their side of the story before they face those really harsh consequences that the school wants to impose.

Now, moving forward to this week. There are quite a few things that we are watching.

So first and foremost on Wednesday at 9 a.m. there is a Joint Health Committee meeting in which there will be a hearing on solutions for closing the health care coverage gap. And so we are super excited about that. This is only the second time in years that the legislature has spent time actually talking about the need for Medicaid expansion or addressing the health care coverage gap that we currently have in the state of Alabama so we’re looking forward to seeing what happens at that hearing. But we will definitely be in attendance and we hope that you are there as well if not able to make it in person definitely stream it online.

Also happening this week, SB 91 will be up in Finance and Taxation General Fund Committee in the Senate at 11:00 a.m. on Wednesday. This piece of legislation will be deliberated and for those of you who recall this is legislation that’s designed to create a source of funding for the Public Transportation Trust Fund. So we are super excited to see that this piece of legislation is getting a chance to be heard in committee this week.

A piece of legislation that we’re a bit concerned about this week is HB 376 which is introduced by Rep. Yarbough and this piece of legislation is an anti-immigration bill that essentially allows localities to enter into contracts with the federal government to become quasi agents of I.C.E. for a lack of better terms. And so proxies for I.C.E. and so this is a piece of legislation that we are fearful will cause a chilling effect on how included, how welcomed, how included yeah our neighbors feel here in the state of Alabama. And so we are hopeful that when that bill comes up in Public Safety and Homeland Security Committee at 9:00 a.m. on Wednesday that it will not make it out of committee.

The good thing about today’s update is that time is running out to pass harmful legislation and so even if that piece of legislation does make it out of committee we are hopeful that it will not make it throughout the process with there being only seven legislative days left in the process. Time is definitely running out. However, we are closely monitoring the final weeks of session and some bills that we do anticipate being deliberated on the full House floor this week include those workers rights bills that I referenced earlier.

So SB 231 for example, which is an anti-union bill that penalizes companies for voluntarily recognizing workers that decide to unionize, that piece of legislation is first on the special order calendar in the House tomorrow which means that when the House gets ready to deliberate legislation this will be the first piece of legislation that they deliberate. And this is a piece of legislation that we strongly oppose. Another piece of legislation related to workers rights that will be on the House floor tomorrow if the legislature makes it that far is SB 119 and this is a piece of legislation that would increase penalties for child labor violations. And so that is something that we are excited to see only has one more favorable vote needed before it will make its way to the governor’s desk. And so we are hopeful that that piece of legislation passes tomorrow and also hopeful that SB 231 fails.

And so that my friends is what is happening this week, that is what happened last week and we will be sure to keep you posted on things that continue to happen at the State House for as long as the legislature is in session. Take care.

Alabama Arise Action Legislative Day 2024

By Matt Okarmus

Arise held our 2024 Legislative Day on Tuesday, April 2. More than 230 supporters joined us in Montgomery to urge their lawmakers to close Alabama’s Medicaid coverage gap, invest in public transportation and fund a summer nutrition program for children. Thank you to everyone who spoke out for a better Alabama for all!

 

Full video transcript below:

Alabama Arise Action was thrilled to see so many people come out to our 2024 Legislative Day. More than 200 of our members attended to have their voices heard as they took our message of a better Alabama for all to the State House. The day featured a membership briefing where Arise provided updates on our policy priorities, including Medicaid expansion, funding Summer EBT, funding public transportation and supporting workers’ rights. After a news conference featuring representatives from Cover Alabama, which is an Arise-led coalition dedicated to pushing for Medicaid expansion, our members visited their legislators at the State House. We want to again thank everyone for coming and showing how important these issues are to the people of our state.

We’re excited to have more than 200 supporters here with us today at our annual Legislative Day. Give yourselves a round of applause. (*applause*) We’re here today to tell our lawmakers that it’s time to close Alabama’s
Medicaid coverage gap once and for all. (*applause*) This is an investment in Alabama’s future. It will create thousands of jobs and generate billions of dollars of economic activity. It would help rural hospitals stay open to serve everyone in their communities. And the most important thing it will do: It will save lives. (*applause*)

Closing the coverage gap is a sensible solution that will result in a healthier Alabama and reduce health care costs associated with pregnancy outcomes. Thank you for investing in healthy moms and strong babies.

And I can tell you that we are in as bad of shape as we’ve ever been. Our hospitals are at risk. It’s something to the order of 80% of our rural hospitals now have operating losses, and so they are in critical shape. It’s time to put politics aside for the well-being of our people. This isn’t about party lines or partisan agendas. It’s about doing what’s right for Alabama. (Yes.) Gov. Ivey, the time for action is now. (*applause*) We can no longer afford to delay or debate. We need concrete steps to close the coverage gap and ensure that every Alabamian has access to the health care that they deserve. Together, we can close the health coverage gap and ensure a healthier, more prosperous future for all Alabamians. Thank you. (*applause*)

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

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

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

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

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

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

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

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

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

Closing the coverage gap is vital for rural Alabama

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

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

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

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

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

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

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

Continuous coverage would save lives of parents and infants

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

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

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

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

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

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

An investment in greater workforce participation

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

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

Cover Alabama is a nonpartisan alliance of more than 130 advocacy groups, businesses, community organizations, consumer groups, health care providers and religious congregations advocating for Alabama to provide quality, affordable health coverage to its residents and implement a sustainable health care system.

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

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

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

‘The time for action is now’

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

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

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