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.
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.
Setbacks on school funding, voting rights, racial equity
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.
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.
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.”
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.
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.
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.
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.
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’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’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.
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*)
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.”
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.”
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)
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.”
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.
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.”
Nearly 300,000 Alabamians with low incomes would benefit from Medicaid expansion.
People in the coverage gap earn too much to qualify for Medicaid, but not enough for an affordable private health insurance plan on the Marketplace. This leaves them in the health coverage gap.
The vast majority of people who would gain coverage through Medicaid expansion are working. More than 100,000 Alabamians in the coverage gap hold jobs that are important but pay low wages. Thousands more are self-employed, serve as caregivers or attend school.
We can afford it. Closing the health coverage gap comes with a $619 million signing bonus.
States that close their coverage gap will receive a 5-percentage-point increase in the federal match rate for Medicaid for two years. This is thanks to an incentive in the American Rescue Plan Act.
An increased federal match rate would bring $619 million to Alabama over the next two years.
The state’s cost to close the gap in the first two years would be roughly $423 million. That means nearly $200 million in additional federal funding would come to our state above and beyond the cost to extend Medicaid coverage up to hard-working Alabamians.
Closing the coverage gap helps workers stay employed.
Nearly half of Alabama workers do not get employer-sponsored health insurance. Closing the coverage gap could help employees get access to the health care services they need.
States that have closed the coverage gap have seen a greater increase in labor force participation among people with low incomes than in non-expansion states.
Injuries or manageable illnesses like diabetes can get so severe for those without health coverage that they prevent people from working or leading healthy lives.
Nineteen rural hospitals are at immediate risk of closing. Medicaid expansion can keep them operating.
Alabama’s rural hospitals are on life support, but research shows that a rural hospital being located in a Medicaid expansion state decreases the likelihood it will close by an average of 62%.
Expanding Medicaid will help more rural residents afford health care services and reduce the financial losses experienced at hospitals from serving uninsured patients or providing uncompensated care.
5,000 Alabama veterans have no military insurance and can’t afford health coverage.
It’s a common misconception that people who serve in the U.S. military automatically receive lifetime eligibility for health coverage and other benefits. In reality, veterans’ health benefits depend on their length of service, military classification, type of discharge and other factors.
14.2% of veterans are employed in the service industry, while 13.7% work in construction and maintenance. These are among the professions that would most benefit from Medicaid expansion.
While the Alabama Legislature is on spring break this week, Arise’s Akiesha Anderson takes some time to update everyone on what’s happened recently and what’s on the horizon when lawmakers return next week. Akiesha also talks about our upcoming Legislative Day, scheduled for Tuesday, April 2.
Full video transcript
Hi there. Akiesha Anderson here, policy and advocacy director for Alabama Arise, and I am excited to to be here today to give you another legislative update.
So to start this week, the Legislature is on a spring break, so — yay — we get a bit of a reprieve from some of the things that we have been seeing this session that just have not been ideal for, you know, us and the people that we are working for, including you and yourself.
And so some of the things that happened last week that were a bit disappointing do include the fact that SB 1, which is the piece of legislation that would make it harder for people to help others voting absentee, that bill was signed into law by the governor, and so was SB 129, which is the piece of legislation that was designed to basically get rid of diversity, equity and inclusion departments on college campuses and in other state-funded entities. And so those pieces of legislation were signed into law.
Also disappointing last week was the fact that HB 32, which was the felony murder rule legislation introduced by Rep. Chris England, that piece of legislation did die in committee last week. So that means that that piece of legislation would not move any further this legislative session. And so hopefully that’s something that we can come back to fight for again next legislative session, but it is done for this session.
Some other things that happened last week were a few pieces of bad legislation were introduced, and a lot of new pieces of legislation were introduced. So we’re still combing through a lot of the bills that were introduced last week. We’re still trying to get a grasp of what many of them do, which ones we want to bring to your attention, and we will definitely have more updates for you in the coming weeks.
But two bills that I do want to put on your radar are SB 231 and SB 232. These are two bills that we are extremely concerned about at Alabama Arise. And so SB 231, if passed, would make it harder for companies to unionize. So what this piece of legislation could do is it could penalize companies for voluntarily recognizing employers that decide to unionize. And so that is something that we are extremely concerned about. And SB 232, if passed, could provide people with access to a health insurance plan that we believe would be a “junk” insurance plan. And we refer to this as a junk insurance plan because we believe that people would be paying premiums in exchange for health insurance, only to find out when they get to the doctor or wherever medical entity that they end up at that their insurance does not cover much of what it is that they would expect to be covered in other insurance plans. And so those are two pieces of legislation that we are extremely concerned about that we did see come up last week.
Some other things that happened last week were that HB 309, which is a bill to give state employees parental leave, passed out the House. It also passed out of committee in the House, and so we are excited that that bill is moving. It hopefully will come up in the Senate as early as next week after they are back from their spring break. We also did have some really good conversations last week, and so did some of our partner organizations — Alabama Voices, SPLC and others — about Summer EBT, so we are hopeful that our budget chairs will appropriate about $15 million so that Alabama can participate in Summer EBT for summer 2025. And so those are some conversations that we have begun having that we are hopeful we can continue having and that will be fruitful.
But then also last week, we noticed that not much happened with gambling, and so that is something that we are monitoring. Although we do not have a position on gambling, we do know that a lot of legislators have put their faith in this legislation passing in in terms of whether or not they believe other budget requests can be fulfilled or can be appropriated as a result of gaming and what happens there. And so we are monitoring just to see what happens with gaming just to see if that impacts any of our legislative asks as well. And so that is pretty much in a nutshell what has happened over the last week.
Since the Legislature again is on spring break this week, there isn’t much happening this week. You all will receive some action alerts from us. We hope that you can reach out to your legislators if you receive one.
But other than that, the only other thing that I want to put on your radar is that today, March 25, is the last day to register for our upcoming advocacy day. And so our advocacy day is next Tuesday, April 2, from 10 a.m. until the early afternoon, and so we really hope that you can join us in Montgomery at the State House for this event.
We are excited about you joining us to talk to legislators about Medicaid expansion. Public transportation, Summer EBT and other workers’ rights issues are things that might be on the radar, and so we definitely hope that you can join us. Do know again that today is the deadline to register, so if you have not already, please visit our website alarise.org to go ahead and register for our advocacy day. We do need a head count so we know how many people we need to provide lunch for, etc. And there is a space limitation in the room, and so again if you’re coming, please register. But also if you have any questions about our advocacy day, please do not hesitate to reach out to our organizing director. That’s Pres Harris, and her email address is pres@alarise.org.
I look forward to hopefully seeing you next week, and I will be back to give you a legislative update in the coming weeks. Take care.
Medicaid coverage was a vital lifeline for Saraland resident Jolene Dybas as she recovered from a health emergency. But after losing that coverage during the Medicaid unwinding period, she has had to go without needed health care. (Photo courtesy of Jolene Dybas)
When I first spoke with Jolene Dybas, 2023 was coming to an end. Lots of people were attending in-person events confidently and hoping the worst of the COVID-19 pandemic was firmly behind us.
Jolene, however, was still coming to terms with a new reality after moving to Mobile from Florida in 2019.
“I barely go out,” she said. “And when I do, I don’t want people to see me like this.”
I asked her why she preferred to keep such a low profile. That’s when she shared the full story of what it’s like living in Alabama’s health coverage gap. This gap includes nearly 300,000 people who earn too much to be eligible for Medicaid but not enough to afford private health coverage. Alabama’s Medicaid income eligibility limit for adults is one of the country’s most stringent.
“I’ve lived in many other states, and I never saw a person with no teeth until I moved here. I never thought that it could happen to me, but here we are,” she said in disbelief.
The toll of a medical emergency
Jolene’s story begins with good news. Her daughter was accepted to the University of South Alabama (USA) to study nursing. Jolene moved to Saraland, right outside Mobile, to help support her.
Soon after, though, a medical emergency threw a wrench in her family’s new beginning.
Jolene woke up one day and realized something was off. When she began experiencing heavy bleeding, her fears were confirmed. She rushed to the hospital and was told she needed an emergency hysterectomy to save her life. Jolene also would need intensive treatments, and she would have to stop working while she recovered.
“I quit counting after 10 ER visits and two hospital visits,” she said, describing her new reality of living with chronic pain and recovering from surgery.
Jolene soon lost health coverage when she was no longer able to work full-time as a customer service agent. Her financial situation got so bad that debt collectors began issuing threats of wage garnishment.
“My hours dropped down to part-time. I couldn’t afford emergency medical bills,” she said. “I’m in a place where I’m no longer self-sufficient, and it is killing me.”
When the hospital bills and prescription costs started to pile up, one of Jolene’s doctors at the USA Hospital encouraged her to apply for financial assistance through the hospital.
“I want people to know that I had a medical emergency and needed blood transfusions,” she said. “If it weren’t for USA Hospital taking up my case, I wouldn’t be here today.”
A temporary lifeline
Thanks to USA Hospital’s financial assistance programs, Jolene received assistance with her medical debt. She also learned she was eligible for a lifeline: Medicaid coverage. Since she was a parent who was too sick to work and had no income, she was one of the few working-age adults eligible for Medicaid under Alabama’s restrictive guidelines.
“Not many good things came out of the pandemic, but hey, it allowed me to get the help I needed and stay on Medicaid when I needed it most,” she said. “That all came crashing down, though.”
After the COVID-19 public health emergency ended in 2023, Jolene found out her health coverage was about to end. Like thousands of other Alabamians, she was rolled off Medicaid coverage during a process known as “unwinding,” or a return to pre-pandemic eligibility requirements.
Jolene had resumed working part-time as her health allowed – and that small amount of income made her ineligible under Alabama’s bare-bones Medicaid eligibility limits. Parents in a two-person household, for example, do not qualify for Alabama Medicaid if they make more than just $3,684 a year.
Jolene said she felt like she had just gotten to a good place managing her health, but losing Medicaid coverage left her with no other options for affordable health insurance. The worst thing about her ordeal wasn’t her surgeries or learning to live with chronic pain, she said. It was finding out she could no longer afford daily medications or dental care.
“Losing Medicaid will leave me with no choice but to go to the ER when my conditions get worse because I can’t afford my medications,” she said.
‘I don’t want them to see me like this’
Living without coverage means making more sacrifices than Jolene had imagined.
“When I lost my insurance, I wasn’t able to go to the dentist,” she said. “My teeth got worse and worse. I only have four teeth left because all I can do is get them pulled when I have a problem.”
Jolene hasn’t visited family since moving to Alabama.
“I can’t even go home to visit because I can’t show them the shape I’m in. I don’t want them to see me like this,” she said. “Where I come from, you don’t see people with no teeth in their head, but in Alabama, I can’t even afford dentures.”
Jolene has lived in several other states before, including Minnesota, Mississippi and North Dakota. She said Alabama’s refusal to expand Medicaid creates unnecessary hardship for its residents.
“If people were well in Alabama, they’d be able to work more. I know I would,” she said.
Minnesota has chosen to expand Medicaid and make other investments in its residents’ well-being. In 2021, lawmakers there passed a historic dental health package that helped ensure Medicaid participants could access dental care and eased administrative burdens for providers.
“They just don’t see things like this,” Jolene said of living in other states with more access to health care and coverage. “There’s no support [in Alabama]. I just thought things were the same everywhere.”
Jolene said living in the coverage gap in a state that hasn’t expanded Medicaid has her missing home.
“If I went home to Minnesota, there is no way I would have this problem,” she said.
‘It can be different’
Jolene’s experience has turned her into an advocate for all Alabamians facing the same problems she does.
“A lot of people in this state don’t know that it can be different. You deserve more,” she said. “Your state leaders are failing.”
Alabamians’ quality of life is suffering the longer we wait to expand Medicaid, Jolene said.
“This has got to be the most expensive place I’ve ever lived. Alabama has taught me a really hard lesson: They don’t care about us,” she said.
Living in other states has offered Jolene a window into the costs of Alabama’s failure to ensure health care access for all of its residents.
“I feel like the death rate is higher here because we all have to wait for adequate care until it’s too late,” she said. “So instead of taking care of that, we’re letting our money slip out of our hands to pay for expansion in other states.”
Jolene said she believes shifting our state’s policy priorities is crucial.
“Why does Alabama still have a grocery tax? I’ve never had to pay that before. Then, we don’t have Medicaid expansion but they’re worried about building bridges and prisons?” she said. “It’s very, very selfish.”
Taking action for a brighter future
After learning nearly 300,000 other Alabamians like her would benefit directly from Medicaid expansion, Jolene started reaching out to lawmakers urging change.
“I’ve written letters to my legislators and Governor Ivey. I’ve called TV stations. I don’t know how they can’t afford to expand Medicaid because people are desperate,” she said. “What does money matter when it’s already there and it is costing lives not to use it?”
One of the states Jolene previously lived in, Mississippi, recently saw meaningful progress toward closing its coverage gap. The Republican-led Mississippi House passed a bill in February to extend Medicaid coverage to more than 200,000 adults with low incomes. That legislation now awaits consideration in the Senate.
Expanding Medicaid is “a topic that should transcend politics,” Mississippi House Medicaid Committee Chairwoman Missy McGee told reporters. “Sometimes, it’s OK to do the right thing because it’s the right thing.”
Jolene said her daughter will graduate soon, and she thinks her family’s time in Alabama is coming to an end. Jolene said the cost of waiting on our state to expand Medicaid is simply too high.
“I thought Mississippi was bad, but it’s not this bad,” she said. “I’m sick of Alabama not caring. If they can’t get their act together, I’m not staying here.”
About Alabama Arise and Cover Alabama
Whit Sides is the Cover Alabama storyteller forAlabama Arise, a statewide, member-led organization advancing public policies to improve the lives of Alabamians who are marginalized by poverty. Arise’s membership includes faith-based, community, nonprofit and civic groups, grassroots leaders and individuals from across Alabama. Email: whit@alarise.org.
Arise is a founding member of the Cover Alabama coalition.Cover Alabama is a nonpartisan alliance of advocacy groups, businesses, community organizations, consumer groups, health care providers and religious congregations advocating for Alabama to provide quality, affordable health coverage to its residents and implement a sustainable health care system.
