Expanding Medicaid and ending the state sales tax on groceries will remain top goals on Alabama Arise’s 2024 legislative agenda. The group also will pursue a multifaceted approach to improving maternal and infant health in Alabama.
More than 500 members voted to determine Arise’s legislative priorities in recent days after the organization’s annual meeting Saturday. The seven priorities chosen were:
Adequate budgets for human services, including expanding Medicaid to make health coverage affordable for all Alabamians and protecting 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 reform punitive sentencing laws and efforts to reduce overreliance on exorbitant fines and fees as a revenue source.
Death penalty reform, including a law to require juries to be unanimous in any decision to impose a death sentence.
“Arise believes in dignity, equity and justice for everyone,” Alabama Arise executive director Robyn Hyden said. “Our 2024 legislative priorities reflect our members’ embrace of those values, and they underscore the need to enact policies that empower Alabamians of every race, income and background to reach their full potential. Together, we’re working to build a healthier, more just and more inclusive Alabama for all.”
The time is right to close Alabama’s health coverage gap
One 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.
“Medicaid expansion would boost our economy and improve the lives of hundreds of thousands of Alabamians,” Hyden said. “It’s time for Alabama’s policymakers to make this life-saving and job-creating investment in the people of our state. Ensuring Alabamians’ health and well-being now will help our state flourish for decades to come.”
Alabama became one of only 10 states yet to expand Medicaid after North Carolina enacted expansion in March. Medicaid expansion would ensure health coverage for nearly 300,000 Alabamians caught in the 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.
How Medicaid expansion would improve maternal and infant health
Medicaid expansion also would bolster health care access for Alabamians before, during and after pregnancies. This would be a critical life-saving move in Alabama, which has the nation’s worst maternal mortality rate. Those rates are even higher for Black women, who are twice as likely to die during birth as white women. Adding to the problem, more than two-thirds of Alabama counties offer little or no maternity care or obstetrical services.
“Alabama took an important step to help families stay healthy by extending Medicaid postpartum coverage last year,” Hyden said. “However, that step alone was not enough to meet our state’s numerous health care needs. Policymakers should pursue numerous solutions to make Alabama a better place for parents and babies. At the top of that list should be expanding Medicaid to ensure Alabamians of all ages can stay healthy before, during and after conception.”
New to Arise’s agenda this year is a comprehensive policy approach to safeguarding and expanding access to maternal and infant health care in Alabama. In addition to Medicaid expansion, this approach would promote seamless continuity of care between home and clinical settings. It would include coverage for contraception and midwifery services. And it would eliminate the specter of criminal penalties for doctors who provide care to pregnant people who are experiencing life-threatening complications.
Finish the job: Alabama should remove the rest of the state grocery tax
Arise advocacy got results this year when legislators voted unanimously to reduce Alabama’s state sales tax on groceries by half. The new law reduced the state grocery tax from 4 cents to 3 cents on Sept. 1. Another 1-cent reduction will occur in 2024 or the first subsequent year when education revenues grow by at least 3.5%.
Arise’s members have advocated for decades to untax groceries, and they renewed their commitment to continue that work in 2024. 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.
The state grocery tax brought in roughly 7% of the Education Trust Fund’s revenue in the last budget year. But 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.
“Reducing the state grocery tax was an important step toward righting the wrongs of Alabama’s upside-down tax system,” Hyden said. “By untaxing groceries and reining in the federal income tax deduction, lawmakers can do even more to empower families to keep food on the table. Closing this skewed loophole is an opportunity to protect funding for our children’s public schools and ensure Alabama can afford 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 three statewide online events this summer: two Town Hall Tuesdays and one public transportation listening session. And we facilitated eight additional listening sessions around the state, engaging a total of about 375 people.
The town halls happened on July 18 and Aug. 8, and the public transit event was Aug. 9. Other meetings took place throughout the summer. This year we are sharing the direct notes and highlights from each of the meetings as recorded during the sessions.
Town Hall Tuesdays & Public Transportation Listening Session
Building on our vision:We had three 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 we heard:
Group One: Participants generally thought Arise should continue working on the current issues. They noted that the issues are interconnected, and that makes it hard to prioritize. Concerns about criminal justice conviction practices were raised, along with the need for continued work on voting rights and Medicaid expansion. Other issues raised were the need for more affordable housing, paying a living wage versus a minimum wage, and the need to discuss the impact of the opioid epidemic on grandparents now raising children because their parents suffer with addiction. Participants also raised reapportionment as an important issue.
Group Two: Participants strongly believed all of the Arise priority issues are important and that we should continue to work on them. Some of the specific issues lifted up were transportation, voting rights, payday lending and Medicaid expansion. Some issues that are not current Arise priorities raised were housing, disability, mental health access and accountability and prison reform.
Group Three: Medicaid expansion received the most support for continued work. Several people voiced prisons and criminal justice as a concern, including the need for prison reform and bail reform. Voting rights and the concern about the many voter suppression bills was a high-priority topic. Participants discussed passionate concern about payday loans, and the group supported the present slate of issues.
Building on our hope: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. We also asked them to indicate their priority issues. Here’s what we heard:
Group One:
The discussion in the group was hot and heavy concerning voting rights and specifically the absentee ballot application. The group concluded that a no-excuse absentee ballot should be the norm and should be an Arise issue for 2024.
The group felt strongly that the 2023 Arise slate of issues should all remain on the 2024 list of Arise priority issues. Medicaid is an issue we need to keep fighting for, they said.
This group had a primary focus and lengthy discussion around voting rights.
Group Two:
All members of the group strongly believe all the Arise priority issues are important and that we should continue to work on them.
Members also strongly believe affordable housing and public transportation should receive a strong voice like Medicaid expansion.
Members said that to further our support of advocacy work, Arise can help unite nonprofits and grassroots organizations across the state to work together toward shared goals as opposed to working separately toward shared goals.
Members lifted up our education and lobbying work as essential to connecting the people to those who represent them in the Legislature.
Group Three: Voting rights emerged as a strong theme from this group’s discussion. Participants stressed the importance of voter education and folks making the connection between voting and the policies elected officials make that impact their lives. Other voting themes included restoration of voting rights and engaging younger and BIPOC voters. Other issues raised were around public transportation and the need to fund mental health services. One participant expressed appreciation for the storytelling work Arise does related to Medicaid expansion and urged similar storytelling to help move elected officials around other Arise issues.
Public Transportation Listening Session:We had three breakout rooms during this session. We asked folks in each group to discuss what’s needed to improve public transit in Alabama, what strategies are needed to move the issue forward and how public transit impacts quality of life in their communities.
Group One:
Private companies like Uber and Lyft are not equipped to serve the disability community, group members said. This is very important when talking about transportation for the disability community wherever they may be, rural or urban. In other words, the private companies are not a viable resource, participants said.
Rural linkage: Many rural counties have transportation-on-demand systems, but they only serve the county boundaries. Many health services reside in urban centers, and the rider needs to get from Blount County to UAB or Children’s Hospital in Birmingham. These riders are out of luck. Transfer hubs for rural to urban systems do not exist.
A state transportation planning system is needed to coordinate all the existing public systems, rural and urban. Participants hoped Arise’s forthcoming transit study will shine some light on the need for a statewide public transportation planning entity.
The group felt a need for massive public education around the benefits of public transportation. Somehow, Arise or a group of organizations should seek funding for an advertising budget, participants said.
The real cost of owning a car versus using public transportation. This kind of information should be available to the public.
The fact that public transportation is good for business development throughout the state should be targeted to legislators and local business councils and chambers of commerce.
Group Two:
This group believes public transportation is essential.
There is a need for more hubs and covered stops for locations that already have public transportation in place.
There is a need for more routes with more frequent buses each hour, as well as drivers who are paid livable wages.
Specific strategies discussed included working with for-profits, chambers of commerce, small businesses and corporations to improve transportation for their employees. Participants also suggested surveying the need for transportation by including a question on applications to ask if transportation is needed.
Public transportation impacts the quality of life across the board: health, food, employment, education, leisure, etc.
People have a right to comfort, dignity, pride and independence that public transportation can provide.
One member said reaching out to people who do not need or use public transportation is important to educate them that they can still benefit from it. It helps reduce traffic and road congestion, decreases likelihood of drinking and driving, and helps people out of desperate situations, which can help decrease poverty and crime.
A member of the Alabama Institute for the Deaf and Blind shared how losing the ability to drive caused depression. But oppression is felt when there are no options for transportation other than relying on friends or family if you have them, or simply being unable to go to doctor’s appointments, shop for groceries or pick up medications when needed.
Some members suggested a public Lyft/Uber service.
Group Three:
Needs: Money/state funding, alternative models, transit-oriented development at local levels, accessibility, buy-in from agencies like ALDOT, changed perception of public transit.
Strategies/tactics: Collect public transit stories, share statistics on earning power with vs. without good public transit and other data relevant to workforce development, and highlight workforce development as a theme for legislative lobbying. Participants discussed a license plate fee, tire fee or special license plate (like public schools have, for example).
Quality of life: A visually impaired participant described how a trip to the grocery store or polling place only a couple miles away is a $25 Uber ride one way. Another participant who works with clients described how their lack of access to public transit affects not just work but health appointments, visiting DHR to secure SNAP, applications for housing, etc. They also mentioned that even “low-cost” transit can be a barrier to low-income folks who may not have a dollar for a ride.
Additional listening sessions
Following are the brief notes/summaries from eight other sessions our organizers held during the summer. In general, all participants strongly affirmed Arise’s work on the current issue priorities. They also highlighted some other issues of concern.
Cullman, July 26 (Stan Johnson) – This was a well-informed group with a lot of comments and questions concerning criminal justice, public transportation, death penalty and new prison construction.
Opelika, July 26 (Formeeca Tripp) – This group discussed issues surrounding housing, transportation, food insecurity, health care and the legal system. Housing was a top issue.
Zoom, Aug. 3 (Formeeca) – A death penalty group discussed issues related to recent executions in Alabama, as well as upcoming executions nationwide. Participants said more attention and connections are necessary to bring more awareness to death penalty reform.
Tuscaloosa, Aug. 7 (Stan) – The most passionate suggestion from this meeting was the need for legislative action to provide funding for mental health.
Opelika, Aug. 17 (Formeeca) – Arise conducted listening sessions in the form of a series of small group meetings.
Group 1: Predominantly parents, people of the community and law enforcement. They supported all current issues but wanted to focus on housing and transportation.
Group 2: Predominantly school staff, counselors, superintendents, principals, resource providers, etc. They wanted resources for non-English-speaking families, housing, transportation and effective mental health services.
Group 3: Predominantly youth, teenagers and support staff. They wanted to learn more about their representatives and how to lift up their own voices, as well as better wages and job opportunities.
Montgomery, Aug. 17 (Formeeca) – This group discussed their strategic plan to add to the existing public transportation priority issue. They want to add a $1 fee to license plates to fund the Public Transportation Trust Fund.
Birmingham, Sept. 10 (Stan) – This group showed special interest in fair housing and criminal justice reform. Voting rights also was a concern to the group, specifically absentee voting bills that may be reintroduced in the upcoming session.
Auburn, Sept. 21 (Formeeca) – Students from an Auburn University class filled out a 2024 issue proposal survey form asking them to rank issues of priority. The top three issues that seemed to rank the highest were public transportation, voting rights and criminal justice reform.
Medicaid expansion is a proven solution to help people join and stay in the workforce, a new report from Community Catalyst spotlights. States that have expanded Medicaid have seen a greater increase in labor force participation among people with incomes below 138% of the poverty line than states – like Alabama – that have not expanded.
“Every Alabamian should be able to get the medical care they need to survive and thrive,” said Debbie Smith, Alabama Arise’s Cover Alabama campaign director. “Removing financial barriers to health care would make our workforce more robust and more productive. It’s time for Alabama policymakers to close the health coverage gap and invest in a healthier future for our state and for our people.”
Nearly half of Alabama workers do not get employer-sponsored health insurance, the Catalyst report finds. This forces tens of thousands of Alabama families to make tough decisions, either to forgo needed health care or take on thousands of dollars of medical debt. When Alabamians are delaying the care and treatment they need, that hurts their productivity and their well-being.
The need for expansion is especially urgent right now as state officials unwind COVID-19 pandemic-era Medicaid policies, leaving about 61,000 Alabamians at risk of losing their Medicaid. Without Medicaid expansion in the state, many more individuals and families will be left with no options for affordable health coverage.
Closing Alabama’s coverage gap could create an average of 20,083 new jobs per year and have an estimated positive economic impact of $11.36 billion over the next six years. Medicaid expansion would be one key solution to improving workforce participation across the state.
Alabamians at every income level should be able to get the health care they need to survive and thrive. Medicaid plays a vital role toward meeting that goal, providing health coverage for more than 1 million Alabamians with low incomes. But tens of thousands of Alabamians may lose their Medicaid coverage by June 2024 in a process called “unwinding.”
Alabama Arise is working to minimize coverage losses during this period. As part of those efforts, we created this toolkit to explain the Medicaid unwinding and help connect people with other affordable coverage options for which they may be eligible.
Below is a table of contents for the resources in this Medicaid unwinding toolkit. Email info@alarise.org if you have any questions or recommendations for additional resources.
On April 1, 2023, Medicaid ended a continuous coverage eligibility period brought on by the public health emergency during the COVID-19 pandemic. What followed was a return to traditional eligibility requirements. This return to normal rules is called “unwinding.”
Current Medicaid members will receive mailings to their home addresses from Alabama Medicaid discussing these changes. Enrollees should ensure their most current and up-to-date information is on file by visiting the recipient portal here.
Click here to make sure Medicaid has your current contact information. Answers to some common questions about the unwinding period are below.
(1) How will I know it is time to renew my Medicaid application?
Medicaid enrollees will receive a recorded phone message, text message and/or email when it is time to renew – if you have provided that contact information to the Alabama Medicaid Agency. These automated messages will not ask for a response.
Please call Medicaid directly at 800-362-1504 if you have questions or need assistance.
(2) How will I get my renewal packet?
Medicaid enrollees will receive a renewal packet by mail prior to their renewal month. Click here to find out your renewal month.
(3) What do I do when I receive my renewal packet?
Please complete your form and follow instructions to return it to Alabama Medicaid. If you need assistance, call Medicaid at 800-362-1504 or go in person to a local Medicaid office.
(4) How will I know if I keep my Medicaid benefits?
Alabama Medicaid will make a determination on your eligibility. The agency also may ask for more information if needed. You will receive a decision on your eligibility directly from Alabama Medicaid.
(5) Do I need to fill out the renewal form if I know I don’t qualify for Medicaid anymore?
You should fill out the renewal form – even if you think you don’t qualify anymore. You can fill out the paper form or go online to submit the information. Or you can call the Medicaid office in your area to renew. Once you submit your information, you will be considered for any of the Medicaid programs for which you are eligible.
(6) Where can I find some helpful unwinding resources from Alabama Medicaid?
Alabama Medicaid will make an eligibility determination and notify you of that decision. This notification will have a termination date if your benefits are ending.
(1) What if I received notice that I am no longer eligible for Medicaid?
(2) What if I want to stay on Medicaid but need to update my information?
Click here to reapply to Medicaid with your updated information.
(3) What If I believe the termination notice from Medicaid is incorrect?
The first step that you can take is to request a review of Medicaid’s decision or a conference to discuss your case. You or someone helping you must contact a Medicaid district office and request a review or conference. You may be asked to provide more information to Medicaid. A conference may be helpful when additional information is needed to support your eligibility claim.
(4) What do I do if Medicaid does not find me eligible after my review or conference?
The next step is to request a fair hearing. You must make your request in writing no later than 60 days from the date of your termination letter or 60 days from the decision of your review or conference. You must mail your request for a hearing to the following address:
Medicaid Agency – Central Office Alabama Medicaid Agency P.O. Box 5624 Montgomery, AL 36103-5624
Call Alabama Medicaid at 334-242-5741 for information on a fair hearing request.
Where to look for new coverage
Did you or someone you know lose health coverage due to the Medicaid unwinding? Other affordable coverage options may be available.
ContactEnroll Alabama for more information on enrolling in a plan through the Health Insurance Marketplace at healthcare.gov. Many Alabamians are eligible for Marketplace coverage at little or no cost thanks to subsidies under the Affordable Care Act.
How has the Medicaid unwinding affected you?
Alabama can protect families and make health coverage more affordable by expanding Medicaid to cover adults with low incomes. Your personal story can help influence legislators and inspire advocates to take action.
You’re not alone. Nearly 300,000 Alabamians who are uninsured or struggling to afford coverage would benefit from Medicaid expansion. When you share your story, you help make the issue real for people. And you help show what’s at stake if we don’t close Alabama’s health coverage gap.
Arise’s Cover Alabama storyteller Whit Sides is gathering and telling the stories of Alabamians living in the coverage gap. Click here to share your story.
Unwinding in the news
AL.com: Status of 129,000 Alabama Medicaid enrollees uncertain after post-pandemic emergency
Alabama Daily News: Alabama starts removing people off Medicaid, but won’t yet say how many
Alabama Reflector: Post COVID-emergency, Alabama not reporting how many people lost Medicaid coverage
CNN: Medicaid eligibility: More than a million people have lost their Medicaid coverage already. It’s far from over
Over the last year, Alabama Arise has collected the stories of some of the nearly 10,000 personal care workers who would benefit from Medicaid expansion in our state. We spent months getting to know folks in one of our state’s most vibrant industries. And we want to be sure you see the last few stories in this series.
Now, as we close the series, we’re lifting up even more stories that speak to a vital question: “How would life be better for so many people if Alabama expanded Medicaid?”
Stories from Alabama’s coverage gap
Like Kayla, a young stylist who is at the pinnacle of her career. Even so, she has reservations about becoming pregnant and having a child while she has no health insurance. There are some possibilities that she just can’t afford.
Kayla performs a color service on a client at her salon in downtown Birmingham. (Photo by Whit Sides)
Or Eryn Mullins, a new mom from Sumiton. She opened up to share her heart-wrenching story of navigating the mental health landscape in our state as a new stylist with no employer-provided health coverage. She needed help but couldn’t afford it.
A path forward to close the coverage gap in Alabama
Hundreds of thousands of Alabamians are in the health coverage gap. Most of them are working at low-paid but essential jobs. They’re folks we see every day but may not realize are living without access to health care. Medicaid expansion would ensure they have the health coverage they need to survive and thrive.
With so many working folks in the gap, Medicaid expansion is an essential solution to save lives and make Alabama a healthier place. It would help real people across our state. And it would be an enormous financial boost for workers and businesses.
We encourage y’all to share these stories with state leaders in your district, as well as Gov. Kay Ivey. There’s never been a better time to, as Mert said herself, create more revenue for local businesses and put more money into workers’ pockets.
It’s been a privilege to collect these powerful stories and share them with the world. And we can’t wait to tell even more stories in the months to come. Thank you for your support of Arise and for being part of our work to make life better for all Alabamians.
Just outside the Forecast Salon in Homewood is a gigantic mural painted along the wall. It features every color of the rainbow jumping out into the street. You’re up close with a 10-foot disco ball painted right beside a unicorn and two massive blue and purple manicured coifs.
Forecast’s owner Brittany McNaughton (friends call her Mert) chose the bright and welcoming mural as a manifestation of her personal philosophy.
“Big! Bold! Sunshine!” she says as we look at it. “The vibes are all there!”
The mural outside the Forecast Salon in Homewood, after its completion in February 2023. (Photo by Whit Sides)
Mert and Forecast’s co-owner, Mark Hyde, had a lot to look forward to in February 2020.
They had just reopened their salon in Homewood, just south of Birmingham, after an extensive expansion. Forecast had to shut its doors for three weeks. The renovations brought the space up to 16 chairs and almost doubled the original floorspace. The future looked bright.
Then the COVID-19 pandemic hit, and their world stopped.
“We’d been open for five years, but when 2020 happened, it felt like I had to go dark,” Mert said. “This massive adrenaline rush told me I had to stop expanding and keep my business afloat.”
Mert had just brought on some new stylists, and she said she probably could have hired even more. But soon she learned that the pandemic was shifting her focus from growth to her staff’s “mental capacity.”
Mert said that’s when she realized the shutdown would be longer than three weeks. And it wasn’t just about closing the physical doors to the shop.
“We went from managing everyone’s safety to all of a sudden seeing where our staff was just not doing so well,” she said.
More than just a paycheck
In a rare move in the salon industry, Forecast offers to pay for a portion of its stylists’ health insurance. After two years, they also contribute to employees’ 401(k) retirement accounts.
Another benefit that Mert said was useful during the pandemic was flexible scheduling. She said stylists are encouraged to take personal days off, especially for mental health.
“Whenever you have someone that’s not doing great personally or mentally outside of work, they bring that energy in with them into the workspace, and it can affect the people around you,” Mert said.
Mark Hyde serves a client at the Forecast Salon in Homewood. (Photo by Whit Sides)
Gov. Kay Ivey allowed barbershops and salons to reopen in May 2020 after the initial wave of pandemic shutdowns. It was a first step toward returning to business as usual. But for stylists, that meant getting up close and personal again – and many weren’t ready.
“We work in such an intimate space,” said Mark, Forecast’s co-owner. “We’re up close, touching our clients. It sometimes takes years for these young stylists to build up trust but also build up a shell that can protect them from negative energy or venting clients day in and day out.”
A focus on mental health
Mark and Mert decided to shore up the salon’s career development offerings beyond just continuing education on hair. They brought in local therapists, healers and self-help experts to discuss mental health. Their goal was to help teach stylists how not to take the stresses of personal care work home with them.
“Moving out of the pandemic, I saw a need to bring in programming focusing specifically on mental health and not just hair,” Mert said.
Mark and Mert agree that they can’t do it all. But they said they try their hardest to provide as much as they can for their staff.
“Nowhere is perfect,” Mert said. “I set standards for mental health here in the salon, but I’m not trained to treat anyone’s problems. I’m trained to do hair. That’s where therapists and doctors come in.”
More money in the pocket for both stylists and salon owners
Mert said she hopes that one day all salons will offer health insurance and other benefits. But she also said she knows that’s not a realistic option for all salons. And unfortunately, that means many stylists will have no affordable option for health coverage unless Alabama expands Medicaid.
Across Alabama, about 10,000 stylists and other personal care workerswould benefit from Medicaid expansion. More than 220,000 Alabamians are caught in the coverage gap, unable to afford health insurance. Another 120,000 or more are stretching to pay for private or employer-based insurance.
Part of Forecast’s recent renovation was expanding to hire more younger stylists and apprentices into their already robust education program. Not everyone at Forecast would qualify for coverage under Medicaid expansion, but most newer stylists likely would, Mert said.
Both owners agree that it would be nice to be able to pay stylists an extra $200 to $400 every month. That amount could help cover their groceries or a car payment.
“It’s expensive to provide insurance as a business. That’s why a lot of people don’t do it,” Mert said. “Medicaid expansion would end up creating more revenue for the business and put more money into that stylist’s pocket.”
Mert McNaughton smiles behind her desk in the Forecast Salon in Homewood. (Photo by Whit Sides)
I asked Mert what Forecast Salon would do with the extra money when the day finally comes.
“As a business owner, I already know what I’m gonna do with that money,” she said. “Invest it right back into our people.”
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.
Eryn Mullins (left) smiles alongside her husband, Zach. Eryn is a hairstylist from Sumiton who struggled to afford mental health care after becoming uninsured at age 26. (Photo courtesy of Eryn Mullins)
Social media can be overwhelming. Like a lot of people, I’ve found myself stepping back from it lately. There is one thing I will never scroll past, though: baby pictures. (Well, that and jokes.)
And Eryn Mullins is good for both.
Eryn is a new mom and hairstylist from Sumiton, a small town in Walker County in northwest Alabama.
I spoke to her the week she returned to work after her maternity leave. Thanks to her husband’s insurance, she and her baby were well cared for during labor, delivery and the postpartum period.
The smiles in her family photos jump through the screen. It’s hard not to think she’s got it all together.
But Eryn will be the first to tell you that it wasn’t always this way. Things were much different for her just a few years ago.
‘A million things to worry about’
“Straight out of beauty school, there’s a million things to worry about,” Eryn said. “When I was 20, I suffered from extreme panic attacks, and I needed to be hospitalized. After that, it still took eight months and four or five different medications to get to a steady place.”
Eryn was diagnosed with a panic disorder that gave her “anxiety that you couldn’t just fix.” Her condition required regular doctor’s visits and consistent medication. Thanks to her dad’s insurance, she was able to keep everything under control.
“I was on my dad’s insurance, and then suddenly, I wasn’t. I was uninsured for three years after that,” Eryn said.
“I got a hospital bill for $2,500, and that’s when I decided I was going to try my hardest to not go to the doctor ever again.”
Cold turkey
One thing Eryn didn’t plan for was having to come off all her medications immediately. For her, “cold turkey” meant no prescription refills. It also meant no talk therapy and no visits with a psychiatrist to manage her mental health.
“I experienced so many adverse side effects that put me back in the hospital, suffering from withdrawal,” she said. “We all have brains; not all of them are healthy. Mine wasn’t.”
Any way Eryn looked at it, she was paying hundreds of dollars out of pocket every few months. Sometimes it was for a hospital stay. Once, she spent $400 for just one routine visit with a mental health provider.
“I worked in a high-stress environment my first year as a stylist,” she said. “It’s a vicious cycle. I needed mental help but couldn’t afford it.”
Being uninsured is expensive. And without consistent medical or mental health coverage, those expenses mount for many stylists. After facing a $2,500 medical bill while uninsured, Eryn told herself she would do whatever she could to avoid going to the doctor.
Unfortunately, Eryn is not alone in receiving eye-popping medical bills while uninsured. Most of her coworkers are uninsured, she said, and seeing them navigate that is heartbreaking. More than 22% of people in Walker County are facing medical debt along with her right now.
In all, 6,108 people in Walker County do not have health coverage. That number would drop by more than halfif Alabama expanded Medicaid to cover adults with low incomes.
Across Alabama, about 10,000 stylists and other personal care workers would benefit from Medicaid expansion. More than 220,000 Alabamians are caught in the coverage gap, unable to afford health insurance. Another 120,000 or more are stretching to pay for private or employer-based insurance.
‘Hanging up the apron’
Hairstylists often can set their own schedule, but that means income fluctuates. And especially in the beginning, they are paying for all their own supplies and losing a lot of money.
“Starting off as a new stylist is the hardest part,” Eryn said. “There’s no method to the madness.”
Eryn said it is becoming more common to see coworkers “hang up their apron.” That’s code for leaving the hair business altogether, often to train in another industry.
“It’s exhausting,” she said. “I feel like everyone I know is always putting money back, for every little (and big) thing. And you have to be really lucky to even have any left over for medical bills.”
Eryn said she loves what she does and doesn’t plan on quitting anytime soon, though she jokes about it sometimes.
“There are days where I debate working at Big Lots or Walmart. It’s steady, and they probably get insurance at full time,” she said.
A path forward
After seeing so many friends walk away from behind the chair, Eryn said she didn’t know how she would make it as a mom and a stylist.
“We were expecting our first baby soon, and I had no idea how I would handle maternity leave,” she said. “I was able to make a deal on my booth rental, but that’s it. If I didn’t have the support of my husband, I don’t know if I could even afford a child.”
Eryn Mullins (right) enjoys a moment with her husband, Zach, and their newborn child in March 2023. (Photo courtesy of Eryn Mullins)
Through it all, Eryn said she still would choose to become a stylist all over again.
“I’m glad I stuck with it,” she said. “It was a rough few years, but now I get to coordinate my life and schedule the way I want, which is much better for my mental health. I think that’s probably true of any career.”
Eryn said she hopes discussing her experiences can help improve life for hairstylists and other Alabamians living without health coverage.
“I wanted to share my story because it’s worth it to me if even one person feels less alone,” she said.
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.
The grocery tax bill passed. After more than three decades of persistent advocacy, Alabama Arise members turned that longstanding vision into reality this year. Every Alabamian will benefit as a result, and the benefits will be greatest for families struggling to make ends meet.
This breakthrough highlighted a 2023 regular session during which Arise members made a difference on numerous priorities at the Legislature. Our advocacy helped an important criminal justice reform become law and helped block efforts to undermine voting rights.
What the grocery tax bill will do
Alabamians will begin paying a lower state grocery tax this Labor Day weekend. HB 479, sponsored by Rep. Danny Garrett, R-Trussville, will cut the state sales tax on groceries from 4% to 2% in two steps. The reduction will apply to all items defined as food under the Supplemental Nutrition Assistance Program (SNAP). When fully implemented, the law will save Alabamians the equivalent of about a week’s worth of groceries every year.
The first step will take effect Sept. 1, when the state grocery tax will drop from 4% to 3%. The next reduction, from 3% to 2%, will come in September 2024, as long as Education Trust Fund (ETF) revenues have grown by at least 3.5% over the previous year. If they haven’t, the reduction will occur in the first year when revenue growth does meet that threshold.
HB 479 also allows (but does not require) cities and counties to reduce their sales taxes on groceries. The law allows localities that reduce their grocery tax to reverse some or all of that reduction later. But localities cannot increase local grocery taxes above their current rate.
Garrett’s bill emerged late in the session but quickly gained overwhelming bipartisan support. The House passed the bill 103-0 on May 25, and the Senate followed with a 31-0 vote June 1. Gov. Kay Ivey signed the bill into law June 15.
Garrett joined with Sen. Andrew Jones, R-Centre, and Lt. Gov. Will Ainsworth to guide HB 479 through the Legislature. But the bill’s passage also rests on the foundation laid by many other legislative champions through the years. They include former Rep. John Knight, D-Montgomery; former Sen. Hank Sanders, D-Selma; Sen. Merika Coleman, D-Pleasant Grove; and Reps. Laura Hall, D-Huntsville, Penni McClammy, D-Montgomery, and Mary Moore, D-Birmingham.
What comes next in our work to untax groceries
HB 479 is a watershed moment in Arise’s work for tax justice. That work will continue. The bill doesn’t eliminate the entire 4% state grocery tax, and it doesn’t replace the revenue. The state grocery tax is an important funding source for public education, bringing in about $600 million annually. That is about 7% of this year’s ETF budget.
“Revenues are strong enough for now to reduce the grocery tax without causing severe harm to education funding,” Arise executive director Robyn Hyden said. “But history tells us that good economic times won’t last forever.”
Legislators this year created a study commission to recommend sustainable ways to eliminate the rest of the state grocery tax. HJR 243, sponsored by McClammy, requires the commission to report its findings and recommendations by November 2026.
Arise will seize that opportunity to push lawmakers to close tax loopholes skewed in favor of wealthy people and highly profitable corporations. One such loophole is the state income tax deduction for federal income taxes (FIT). Alabama is the only state that still allows a full FIT deduction.
The state grocery tax is a cruel tax on survival that drives many Alabamians deeper into poverty. Arise is committed to building on this year’s success and ending this tax forever. With our members’ continued advocacy and support, that is another vision we’ll turn into reality together.
2023 was a momentous session on Alabama Arise priorities
June 6 ended one of the most significant legislative sessions ever for Alabama Arise and our supporters. Through timely and persistent advocacy, Arise members helped build a better, more equitable Alabama.
While our work continues, we want to highlight the many important strides this year in our movement for a better Alabama for all – and celebrate Arise members’ role in advancing that goal. This article summarizes some of the key bills on Arise priorities during the Legislature’s 2023 regular session. For information on all bills we tracked this year, visit the Bills of Interest page on our website.
Tax reform
Lawmakers proposed many significant tax reform bills this session. But none will have more lasting significance to Alabamians than reducing the state sales tax on groceries, a longstanding Arise priority. Thanks to phenomenal member advocacy, our state is finally removing part of this regressive tax.
HB 479, sponsored by Rep. Danny Garrett, R-Trussville, became law this year. This legislation will cut the state grocery tax by half in the coming years. This huge victory for tax justice resulted from decades of hard work by Arise members.
Adequate state budgets
Alabama’s 2024 General Fund (GF) and Education Trust Fund (ETF) budgets are both significantly larger than 2023. The GF budget is about $3 billion and includes a 2% pay raise for state employees. It also includes significant funding increases for Medicaid, mental health care and other state services. The 2024 ETF budget is nearly $8.8 billion, half a billion dollars more than the previous year’s ETF.
HB 295 and SB 202,known as the PRICE Act, were sponsored by Rep. Ernie Yarbrough, R-Trinity, and Sen. Larry Stutts, R-Tuscumbia. These bills would have allowed parents to take tax dollars that otherwise would support local public schools and use them to pay for private schools or home schooling. Arise and other advocates helped defeat this legislation, protecting nearly $600 million of public education funding.
Voting rights
HB 209, sponsored by Rep. Jamie Kiel, R-Russellville, did not pass this session. This bill would have criminalized many efforts to assist voters with absentee ballot applications or completed ballots. Arise and other groups successfully stopped this bill, which passed the House but never reached the Senate floor.
Criminal justice reform
SB 154,sponsored by Sen. Will Barfoot, R-Pike Road, became law this year. This legislation will make it harder for the state to suspend people’s driver’s licenses for failure to pay traffic tickets. Arise and our partners at Alabama Appleseed strongly supported this bill.
HB 24,sponsored by Rep. Reed Ingram, R-Pike Road, passed despite Arise’s opposition. This bill will criminalize asking for money on the side of roads, punishing many Alabamians facing housing insecurity. Federal courts have found similar laws unconstitutional in recent years.
HB 229,sponsored by Rep. Chris England, D-Tuscaloosa, would have allowed resentencing of certain incarcerated individuals sentenced to life imprisonment without parole under Alabama’s Habitual Felony Offender Act. This bill passed the House and gained Senate committee approval, but it never reached the Senate floor. Arise supported this bill and expects a similar one to be filed next session.
Death penalty reform
England’s HB 14 would have required a unanimous jury sentence to impose the death penalty. The bill also would have made the state’s judicial override ban retroactive. This bill received a public hearing but did not leave the committee. Arise supported this bill and expects a similar one to be filed next session.
Other issues
SB 196,sponsored by Sen. Arthur Orr, R-Decatur, would have increased government transparency by improving Alabama’s open records process. This bill passed the Senate and gained House committee approval but did not pass in the House. Arise supported this bill and expects a similar one to be filed next session.
SB 242,sponsored by Sen. Keith Kelley, R-Anniston, would have undermined tenant protections by removing the cap on the amount of the security deposit that landlords can charge to renters. Arise opposed this bill, and it died without reaching the Senate floor.
Cover Alabama has built powerful momentum to expand Medicaid and close the state’s health coverage gap in recent months. In March, Alabama Arise’s Cover Alabama campaign held its first in-person Medicaid expansion lobby day. With the participation of 80 passionate individuals, this event created a powerful platform for advocating Medicaid expansion.
Alabamians living in the coverage gap – who earn too much to qualify for Medicaid but not enough to qualify for financial help to buy private insurance – shared their personal stories during the rally before engaging in meaningful conversations with their lawmakers. The event garnered great press attention, shining a spotlight on our state’s urgent need to expand health care access.
Arise board member Kenneth Tyrone King speaks to the importance of expanding Medicaid to ensure affordable health coverage for nearly 300,000 Alabama adults with low incomes.
Other recent wins
In an encouraging development, the House Health Committee held a hearing this year specifically focused on the benefits of closing the coverage gap. This hearing came on the heels of Cover Alabama’s rally. And it marked a significant milestone, as the first time legislators formally discussed Medicaid expansion in a committee hearing. The hearing provided an important platform to educate lawmakers and the public about the positive impact Medicaid expansion can have on our communities.
Meanwhile, we also celebrated the recent success of North Carolina, which passed Medicaid expansion in March. That move means Alabama is now one of only 10 states that has not yet expanded its Medicaid program.
We are determined to change that. We will continue advocating for our state to join others in providing vital health care access to those in need.
Looking forward
In April, Arise and Cover Alabama partnered with Doctors for America to conduct a highly engaging half-day advocate training session. Fifty people attended the event in Birmingham or online on a Saturday morning. This event equipped our advocates with the knowledge and tools needed to advocate effectively for Medicaid expansion, empowering them to make a difference.
Thank you to each and every one of you for your unwavering support, dedication and passion for health justice. 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.
Allen v. Milligan ruling is a shot in the arm for democracy
Alabamians received good news this month with the U.S. Supreme Court’s decision in Allen v. Milligan. This decision upholds key parts of the Voting Rights Act and requires Alabama to draw new congressional districts by July 21. The Legislature likely will hold a special session in July to approve two majority-Black (or close to majority-Black) districts. Alabama has had only one majority-Black district for decades, diluting the voting power of Black residents.
The ruling came a decade after Shelby County v. Holder, a decision that gutted the Voting Rights Act’s preclearance protections. As we commemorate this anniversary, we are reminded of why protecting Black voting power in Alabama is so critical to achieving our vision of a strong, participatory democracy.
Alabama Arise salutes our partners at Alabama Forward, Alabama NAACP, Greater Birmingham Ministries and ACLU of Alabama for their hard work and vision in the Milligan case. Arise will continue working to advance legislation to protect and strengthen voting rights. And we will keep fighting to ensure that every vote counts and elected officials are accountable to their constituents.
Leave a lasting legacy
By Jacob Smith, development director | jacob@alarise.org
Alabama Arise has set long-term goals like a fairer state tax system and state budgets that provide opportunities for all. Together, we have made meaningful steps toward these goals. And our members – with monthly or one-time gifts – help us keep up the momentum every day. We are so grateful.
However, this vision won’t happen overnight. There’s a type of gift that you probably haven’t considered – one that will ensure you continue to join us in Alabama Arise’s work even past your lifetime. That’s leaving us in your will.
Regardless of your income, making a will is an important step to ensure your end-of-life wishes are known. There are online tools that can help. And consulting a financial planner would be a great idea, too. You don’t even have to tell us that you included us. (Though we would be glad if you did!)
We would love to share sample language or chat about the legacy you want to leave Alabama. Reach out to me at jacob@alarise.org.
Thank you for your ongoing work and contributions to building a better Alabama.
Arise Legislative Day: Making the state grocery tax cut a reality!
We were excited to see more than 120 people participating in Arise’s 2023 Legislative Day on April 11 in Montgomery. Arise’s longtime push to decrease the state sales tax on groceries took center stage, and our members’ energy was palpable. Our supporters’ passionate advocacy, this year and in so many previous years, got the bill across the finish line! Top: Arise’s McKenzie Burton (left) and Whitney Washington (right) pose for a photo with longtime Arise member Helen Rivas. Next: Arise’s Robyn Hyden (right) and Carol Gundlach (left) and Anna Pritchett of AARP Alabama meet with Sen. Andrew Jones, R-Centre, to thank him for championing the fight to untax groceries. Next: Policy analyst Mike Nicholson speaks about criminal justice reform.
Cover Alabama has built powerful momentum to expand Medicaid and close the state’s health coverage gap in recent months. In March, Alabama Arise’s Cover Alabama campaign held its first in-person Medicaid expansion lobby day. With the participation of 80 passionate individuals, this event created a powerful platform for advocating Medicaid expansion.
Alabama Arise’s Cover Alabama coalition held its first lobby day on March 21 in Montgomery. More than 80 people came to the State House to support our movement for Medicaid expansion. Attendees show signs in support of expanding Medicaid during a news conference.
Alabamians living in the coverage gap – who earn too much to qualify for Medicaid but not enough to qualify for financial help to buy private insurance – shared their personal stories during the rally before engaging in meaningful conversations with their lawmakers. The event garnered great press attention, shining a spotlight on our state’s urgent need to expand health care access.
Other recent wins
In an encouraging development, the House Health Committee held a hearing this year specifically focused on the benefits of closing the coverage gap. This hearing came on the heels of Cover Alabama’s rally. And it marked a significant milestone, as the first time legislators formally discussed Medicaid expansion in a committee hearing. The hearing provided an important platform to educate lawmakers and the public about the positive impact Medicaid expansion can have on our communities.
Arise board member Kenneth Tyrone King speaks to the importance of expanding Medicaid to ensure affordable health coverage for nearly 300,000 Alabama adults with low incomes.
Meanwhile, we also celebrated the recent success of North Carolina, which passed Medicaid expansion in March. That move means Alabama is now one of only 10 states that has not yet expanded its Medicaid program.
We are determined to change that. We will continue advocating for our state to join others in providing vital health care access to those in need.
Looking forward
In April, Arise and Cover Alabama partnered with Doctors for America to conduct a highly engaging half-day advocate training session. Fifty people attended the event in Birmingham or online on a Saturday morning. This event equipped our advocates with the knowledge and tools needed to advocate effectively for Medicaid expansion, empowering them to make a difference.
Thank you to each and every one of you for your unwavering support, dedication and passion for health justice. 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.
Medicaid expansion would improve women’s health and expand access to maternal health care across Alabama, a new Georgetown University Center for Children and Families (CCF) report found. Expansion also would help reduce racial disparities, improve infants’ health and strengthen rural health care access, the report found.
Nearly one in six Alabama women (15.9%) of reproductive age (18-44) lack health insurance, CCF found. That rate is significantly higher than the national average (11.7%). And uninsured rates are sharply higher among Hispanic (41.5%) and Native American (46.7%) women in Alabama. Medicaid expansion would help by ensuring health coverage for tens of thousands of Alabama women who cannot afford it.
Alabama policymakers took an important step forward for women’s health last year by extending the Medicaid postpartum coverage period. That extension ensured coverage for a full year after childbirth, up from the previous cutoff of just 60 days afterward. But much work remains to protect women’s health in the state, Alabama Arise’s Cover Alabama campaign director Debbie Smith said.
Alabama Arise story collection coordinator Whit Sides speaks at a March 9, 2022, rally in Montgomery to support extending postpartum Medicaid coverage. Arise joined the American Heart Association and other Cover Alabama partners at the event.
“State leaders showed they’re willing to address Alabama’s maternal health crisis when they extended Medicaid postpartum coverage last year,” Smith said. “However, these findings show that this step alone is not enough to help mothers and families stay healthy. Alabama should take the next logical step to protect women’s health and expand Medicaid coverage for adults with low incomes. We urge Gov. Kay Ivey and legislators to make Alabama a better place for parents and babies by expanding Medicaid.”
Medicaid expansion would save lives, protect rural health care access
The consequences of being unable to afford timely medical care can be deadly. Alabama had the nation’s third-worst maternal mortality rate between 2018 and 2020, the report found. The state’s rate (36.2 maternal deaths per 100,000 live births) was significantly higher than the national average (20.4 per 100,000) in those years.
Alabama’s infant mortality rate (7.2 infant deaths per 1,000 live births) also was much higher than the national average (5.4 per 1,000) in 2020. Black babies died at an even higher rate in Alabama that year (11.1 per 1,000 live births).
A decades-long decline in access to maternity and obstetric care in rural Alabama is compounding these terrible statistics. Twenty-nine of Alabama’s 54 rural counties lost hospital obstetric care providers between 1980 and 2019, CCF found. These closures required women in these counties to travel farther to providers elsewhere. That, in turn, can reduce the timeliness of care and increase barriers for women with limited transportation options.
Medicaid expansion is associated with lower maternal and infant mortality rates, with the greatest benefits for Black women and infants. Expansion also promotes health improvements throughout pregnancy and into children’s early years, CCF found. In addition, Medicaid expansion would decrease the costs of uncompensated care significantly, allowing more rural hospitals and providers to remain open to continue treating pregnant Alabamians.
“Research shows that stable health coverage for women before, during and after pregnancy can save moms and babies’ lives,” said Joan Alker, executive director of the Georgetown University Center for Children and Families. “Medicaid expansion is an essential investment in the health of Alabamians and builds a solid foundation for the state’s future.”
