New report profiles essential workers most likely to lack health coverage in Alabama

Medicaid expansion would increase access to life-saving health care while also advancing racial and gender equity in Alabama, according to a new report by the Georgetown University Center for Children and Families (CCF). Expansion also would ensure coverage for tens of thousands of essential workers in industries like health care, retail and construction.

“Everyone in Alabama has relied on these essential workers in some way during the COVID-19 pandemic,” Alabama Arise policy director Jim Carnes said. “Now it’s our turn to help them get reliable, affordable health insurance so they can continue to do their jobs and care for their families. It’s time for Alabama to accept generous federal funding to expand Medicaid to our state’s uninsured workers.”

Alabama is one of 12 states that have not yet expanded Medicaid to cover adults with low incomes. This inaction has denied hundreds of thousands of Alabamians access to quality, affordable health care.

Approximately 204,100 uninsured adults – 49% of Alabama’s uninsured adult population – would gain coverage if Alabama expands Medicaid, Georgetown CCF estimates. That estimate is in line with prior projections that Medicaid expansion would benefit more than 340,000 Alabamians who are uninsured or struggling to afford coverage.

These residents earn too much to qualify for Medicaid under the state’s stringent income limit but too little to qualify for subsidized marketplace plans under the Affordable Care Act. As a result, they are stranded in a health coverage gap.

Expanding Medicaid would save lives, advance racial and gender equity

Women and Black people account for a disproportionate share of low-wage uninsured working Alabamians, the Georgetown CCF report finds. Black people represent about 27% of Alabama’s overall population but 39% of the state’s low-wage uninsured workers. Women also are overrepresented in this category, making up 55% of low-wage uninsured Alabamians.

These uninsured residents work in vital but low-paid jobs. More than one-third of Alabamians working without health insurance (35.2%) are in the hospitality or retail industries, the report finds. Another one in five work in construction or in health care and social assistance.

Alabama’s uninsured rate for working people (12.1%) exceeds the national average. In 11 counties, more than 15% of working people are uninsured, Georgetown CCF finds. The highest rates are in DeKalb County (19.2%) and Dale County (18.2%).

The map below shows the range of uninsured rates for working adults across Alabama. Hover over the map to see the rate in your county.

Nearly seven in 10 Alabamians support expanding Medicaid to reduce these disparities, a statewide poll found in February. And the American Rescue Plan Act offers federal incentives that would more than offset Alabama’s initial cost to expand Medicaid.

If Gov. Kay Ivey agrees to expansion, the law would give the state a 5-percentage-point increase in federal funding for its traditional Medicaid coverage for two years. That would bring Alabama an additional $732 million over two years, based on an average of federal, state and independent estimates.

Federal relief package will reduce Alabamians’ unmet health needs, hunger, housing instability and other hardships

The American Rescue Plan Act of 2021 will reduce poverty while expanding health care, housing and nutrition protections across Alabama, according to analyses by Alabama Arise and other research organizations. President Joe Biden signed the new federal COVID-19 relief package into law Thursday.

The law will slash poverty by expanding tax credits to struggling households and boosting unemployment insurance (UI) benefits. It also will provide Alabama $2.3 billion of federal assistance to help avoid cuts to education and other vital services. Local governments in Alabama will receive another $1.7 billion in federal funding.

Some of the relief package’s most transformative investments will come in health care. The law will increase the affordability of health coverage through the marketplace created under the Affordable Care Act (ACA). And it will create new federal incentives that would more than offset the state’s cost to expand Medicaid, providing health coverage to hundreds of thousands of Alabama adults with low incomes.

“The American Rescue Plan Act throws Alabama’s struggling families a much needed lifeline,” Alabama Arise executive director Robyn Hyden said. “And it offers budgetary breathing room for policymakers to tackle chronic problems, address longstanding racial and gender inequities and build an economy that works for every Alabamian. Medicaid expansion should be at the very top of our legislators’ to-do list.”

A new pathway to Medicaid expansion in Alabama

The relief package could bring overdue peace of mind to some 300,000 Alabamians living in the health coverage gap. They earn too much to qualify for Medicaid under the state’s stringent income limit but too little to qualify for subsidized ACA marketplace plans.

Nearly seven in 10 Alabamians support expanding Medicaid to cover these adults, a statewide poll found last month. If Gov. Kay Ivey agrees to expansion, the law would give the state a 5-percentage-point increase in federal funding for its traditional Medicaid coverage for two years.

That would bring Alabama an additional $940 million over two years, the Center on Budget and Policy Priorities (CBPP) estimates. And it would remove any remaining financial barrier to Medicaid expansion, said Jane Adams, the Cover Alabama campaign director for Alabama Arise.

“This law is a much-needed step toward closing the health coverage gap in Alabama. We have no time to waste,” Adams said. “Tens of thousands of people have died in the South ‒ my home ‒ because they couldn’t afford to get the health care they needed.

“Medicaid expansion is the single biggest step Alabama can take to weather and recover from the COVID-19 pandemic and move our state forward. Congress did their job. Now it is time for Governor Ivey and our state lawmakers to do theirs and immediately expand Medicaid in Alabama.”

Enhancements to existing Medicaid, marketplace coverage

The relief package also makes multiple coverage improvements for tens of millions of Americans with Medicaid or ACA marketplace plans. Among other changes, the law:

  • Reduces or eliminates marketplace premiums through 2022. Subsidies will increase across the board, and no one will pay more than 8.5% of income for their health plan.
  • Eliminates COBRA premiums through September 2021.
  • Protects against tax liability on premium assistance because of income fluctuation.
  • Increases funding for COVID-19 testing and vaccine distribution.
  • Gives Alabama the option to increase the income limit and coverage period for postpartum Medicaid coverage.
  • Increases federal funding for home- and community-based Medicaid long-term care services.
  • Increases federal funding for substance abuse prevention and treatment and a broad spectrum of mental health services.

Child Tax Credit, EITC expansions will reduce poverty across Alabama

Poverty rates will fall nationwide thanks to tax credits and stimulus payments in the American Rescue Plan Act, studies predict. One of the greatest gains will result from a Child Tax Credit (CTC) expansion that could cut the U.S. child poverty rate in half, a Columbia University analysis found.

The relief package makes the full CTC available to children living in families with low or no earnings. It increases the credit’s maximum amount to $3,000 per child and $3,600 for children under age 6. And it extends the credit to 17-year-olds. This CTC expansion will help four in five Alabama children (or nearly 1.1 million), as well as nearly 1 million adults, the Institute on Taxation and Economic Policy (ITEP) estimates.

Direct payments and expanded tax credits will help Alabamians make ends meet as well. Among other changes, the law:

  • Provides a one-time payment of $1,400 per person for individuals making up to $75,000 and couples making up to $150,000. Individuals with incomes up to $80,000 and couples with incomes up to $160,000 are eligible for partial payments. These stimulus payments will benefit 91% of adults (3.1 million) and 92% of children in Alabama, ITEP estimates.
  • Raises the maximum Earned Income Tax Credit (EITC) for working adults without children from roughly $530 to roughly $1,500. The law also increases the income limit for these adults to qualify from about $16,000 to at least $21,000.
  • Expands the age range of EITC-eligible workers without children. Younger adults aged 19-24 who are not full-time students can qualify now, as can people 65 and over.
  • Helps more than 280,000 Alabamians with the EITC improvements mentioned above, CBPP estimates. The vast majority of the Alabamians who will benefit (205,200) have annual incomes below $20,400, according to ITEP.

Boosts to SNAP, unemployment, housing assistance to help Alabamians make ends meet

The American Rescue Plan Act includes additional provisions to keep more households fed and housed. Most urgently, it extends until Sept. 6 the supplemental $300 federal UI benefits that were set to expire this weekend. This extension more than doubles Alabama’s maximum total weekly benefit to $575, or roughly 60% of median household income.

The law also provides $37 billion nationwide in rental and mortgage assistance to help prevent evictions and foreclosures. For Alabama, this would mean an increase of more than 1,400% from 2020 Emergency Solutions Grant funding if states receive funding proportionate to their populations.

In addition, the package continues a 15% boost to food assistance under the Supplemental Nutrition Assistance Program (SNAP) through September. This increase will help nearly 800,000 Alabamians and bring $64 million in additional SNAP benefits into Alabama, CBPP finds.

The plan takes many other steps to alleviate hardship. Among other changes, the law:

  • Provides Alabama with $10 million in emergency pandemic Temporary Assistance for Needy Families (TANF) funding. This money is usable for one-time benefits like cash assistance, rental assistance or clothing allowances.
  • Allows states to continue Pandemic EBT (P-EBT) benefits through early September. P-EBT replaces the value of meals that children miss when schools are closed.
  • Increases the monthly allocation for fruits and vegetables in the Women, Infants and Children (WIC) program from $9 to $35 for four months.
  • Makes the first $10,200 of UI benefits non-taxable for households with incomes below $150,000.
  • Excludes discharged student loan amounts from taxable income calculation through 2026.

“Everyone should know the security of having food on the table and a roof overhead,” Hyden said. “The American Rescue Plan Act will help ease Alabamians’ suffering during the COVID-19 pandemic. And it will lay a foundation to build a stronger, more inclusive Alabama in its aftermath.”

Policies to advance racial, gender equity key to Alabama workforce’s COVID-19 recovery, new Alabama Arise report shows

State of Working Alabama logo

Alabama should rebuild from the COVID-19 recession by lifting policy barriers to economic opportunity and charting a path toward a more equitable and inclusive future, according to The State of Working Alabama 2021, a new report that Alabama Arise released Monday.

Medicaid expansion and a state law guaranteeing paid sick leave both would help strengthen Alabama’s workforce, the report says. Other policy recommendations include higher funding for nutrition and housing assistance and improvements to the state’s unemployment insurance (UI) system.

The Alabama Legislature moved quickly to pass “pro-business” bills in the opening days of the 2021 regular session. These measures included a new law providing a broad range of civil immunity against claims related to coronavirus exposure. As lawmakers return to Montgomery after a weeklong break, their policymaking focus should shift toward addressing their constituents’ urgent needs during and beyond the COVID-19 pandemic, Alabama Arise executive director Robyn Hyden said.

“Legislators spent the first two weeks of this session protecting the interests of corporations,” Hyden said. “They should spend the rest of the session protecting the interests of the people of Alabama. And Arise’s State of Working Alabama report provides a blueprint for how to do just that.”

COVID-19’s toll has fallen heavily on women, Black and Hispanic/Latinx Alabamians

Arise’s seven-section report examines economic challenges – both old and new – that Alabamians have faced over the last year. Health coverage, housing, hunger, wages and working conditions for front-line workers are among the topics covered in The State of Working Alabama 2021. The report also highlights how the pandemic has exacerbated preexisting racial, gender and regional disparities in our state.

COVID-19 job losses hit Black workers nearly twice as hard as other Alabamians. Black workers made up 25% of Alabama's workforce in 2020 but 47% of Alabama's unemployment insurance claimants in 2020.

“When the COVID-19 pandemic hit Alabama in March 2020, it didn’t just cause massive human suffering and economic disruption,” the Arise report says. “It also revealed suffering and disruption that have long existed and that policymakers have long neglected – or even perpetuated.”

Past policy decisions left Alabama inadequately prepared to respond to the pandemic, the report finds. They also created and maintained racial and gender disparities that prevent our state from reaching its full potential. Among the report’s major findings:

  • Alabama’s “essential workers,” hailed as pandemic heroes, often lack the basic protections of a living wage, health insurance, paid sick leave and family medical leave.
  • COVID-19 has caused disproportionate unemployment for Black people and women in Alabama. Economically disadvantaged counties in the Black Belt and other parts of Alabama also have lagged behind in unemployment recovery.
  • Before the pandemic, 62.2% of Alabama’s white workers had health insurance through their jobs. The same was true for only 46.4% of Black workers and just 35.5% of Hispanic/Latinx workers. The pandemic has widened those racial/ethnic disparities in health coverage.
  • Hunger has been widespread in Alabama’s communities of color during the COVID-19 recession. Early in the pandemic, nearly 21% of Black residents and 19% of Hispanic/Latinx residents said they didn’t have enough food.
  • Black and Hispanic/Latinx Alabamians are at higher risk of eviction for inability to pay rent. Even basic apartments are out of financial reach for low-wage workers everywhere in Alabama.

Policies to increase equity, expand economic opportunity for working Alabamians

Alabama’s policy legacy has exacerbated the damage that COVID-19 has wreaked on working people across the state, the report finds. The State of Working Alabama 2021 outlines a policy agenda to repair that damage and promote broadly shared prosperity. Among the report’s key recommendations:

  • Expand Medicaid to ensure more than 300,000 Alabamians with low incomes can afford treatment for COVID-19 and other health problems.
  • Guarantee permanent paid sick leave for all working Alabamians, so that no one has to choose between earning a paycheck and going to work sick.
  • Roll back the 2019 cuts to Alabama’s UI benefits and create a modernized claims system capable of handling future crises.
  • Provide state support for the Alabama Housing Trust Fund and abandon efforts to impose harmful limits on safety net programs.
  • Expand high-speed, affordable broadband technology, targeting rural and low-income communities and explicitly addressing racial equity in broadband access.

Hispanic and Black Alabamians are more likely to lack health coverage. 32.8% of Hispanic/Latinx residents were uninsured in the spring/early summer stage of the pandemic, and 20.7% were uninsured in the late summer/fall stage. The corresponding rates for Black residents were 17.8% and 13.5%. For white residents, the rates were 11.7% and 11.5%.

“The economic, racial and gender inequities in Alabama are preventable and reversible,” Alabama Arise policy director Jim Carnes said. “These disparities are the direct result of bad policy choices in the past. By making better choices now and in the future, we can chart a path toward a more equitable economy. The power to build a stronger, more inclusive Alabama is in the hands of our lawmakers – and all of us.”

About The State of Working Alabama 2021

Click here to read the executive summary of The State of Working Alabama 2021. Links to each of the report’s seven sections are available at the bottom of the page. You also can jump directly to a section using the links below.

  1. Introduction: The high cost of failing to protect the common good
  2. Unequal by design: COVID-19 and Alabama’s policy legacy
  3. Assessing the damage: COVID-19 and Alabama’s labor market
  4. Praised but underprotected: Front-line workers in the pandemic
  5. Why coverage matters: Health care in the time of COVID-19
  6. The ugly reality: Alabama’s hunger problem during the pandemic
  7. No place to call home: Housing insecurity amid COVID-19

69% of Alabama voters support Medicaid expansion, new poll finds

Sixty-nine percent of Alabamians, including 64% of Republican voters, support expanding Medicaid when told about arguments for and against the idea, according to a new poll that the Cover Alabama Coalition released Wednesday.

The poll, conducted for Cover Alabama in January by Cygnal, shows support for Medicaid expansion across all demographics, including age, gender, income, education and geography. Alabama Arise is a founding member of Cover Alabama.

Cover Alabama logo

The poll also reveals the popularity of various funding sources for Alabama’s required 10% match for Medicaid expansion. Respondents expressed the most support for legalizing a state lottery and using part of the revenue to expand Medicaid. Proposed funding sources that won an overall majority or plurality of support were:

  • Legalizing a state lottery.
  • Increasing the state tobacco tax.
  • Legalizing and taxing medical marijuana.
  • Eliminating the federal income tax deduction for state income taxes.

Growing support and growing opportunities to expand coverage

Participants responded strongly when informed that more than 5,000 veterans (and 8,000 of their family members) do not have health coverage in Alabama. A full 70% of respondents were more likely to support expanding Medicaid when presented with that information. Respondents also were more likely to support expansion when informed that Alabama taxpayers have paid $4 billion in federal taxes since 2014 to help support Medicaid expansion in other states.

Both Republican and Democratic respondents were more likely to support Medicaid expansion with increased financial support from the federal government. A U.S. House bill would offer a dramatic increase in federal incentives for states like Alabama to expand Medicaid. If enacted, the legislation would provide an additional $940 million in federal money to Alabama over two years if the state expanded Medicaid. Medicaid expansion would benefit more than 340,000 Alabamians who are uninsured or struggling to afford coverage.

The overwhelming polling support reflects an ever-growing group of individuals, organizations and businesses that support expanding Medicaid in Alabama. This group includes the Alabama Hospital Association, the Alabama Chapter of the American Academy of Pediatrics, the Alabama Department of Health’s Maternal Mortality Review Committee, the Medical Association of the State of Alabama and 100 nonprofits, faith-based groups and medical advocacy organizations in Alabama.

Federal legislation would leave ‘no financial barrier’ to Medicaid expansion in Alabama

Photo of Jane AdamsJane Adams, campaign director of Alabama Arise and director of the Cover Alabama Coalition, said in a statement:

“This poll shows that Medicaid expansion is popular and that both Republican and Democratic voters support using federal funds or revenue from a lottery to pay for Medicaid expansion. For four years, Governor Ivey has said the obstacle to expanding Medicaid in Alabama is the cost. Last week, the House Energy and Commerce Committee passed a provision that is on track to pass both chambers of Congress and become law. This provision would offer states that have not yet expanded Medicaid significant financial incentives to do so.

“If Governor Ivey expands Medicaid, Alabama will receive an estimated $940 million of federal money over two years to help Alabama expand. There is no financial barrier or obstacle to overcome. Now is the time for Governor Ivey to save lives, create jobs and protect rural hospitals by expanding Medicaid.”

Dr. John Meigs, president of the Medical Association of the State of Alabama, said in a statement:

“The Medical Association of the State of Alabama commends the work of the Cover Alabama Coalition in its efforts to expand Medicaid. Without question, increasing access to quality care improves health outcomes for patients. While this obviously has a positive impact on individuals, the benefits also trickle up through families and communities, ultimately bettering our entire state. We are pleased to support ‒ along with a majority of Alabamians as the poll shows ‒ the expansion of Medicaid.”

Advocates will continue working to establish wide support for Medicaid expansion across the state and across political lines. And they will look toward Gov. Kay Ivey and state lawmakers to act accordingly.

The full poll results are available here.

Alabama Arise condemns insurrection, demands protection and expansion of voting rights

Alabama Arise executive director Robyn Hyden released the following statement Friday on this week’s events in Washington, D.C.:

“The assault on the U.S. Capitol this week was a violent and racist attack on the very idea of democracy. It was an effort by white nationalists and other extremists to reject the results of a free and fair election and to tear the fabric of our shared freedoms. Alabama Arise condemns this disgraceful, reprehensible insurrection in the strongest possible terms.

“The peaceful transfer of power is essential to the continuation of our representative democracy. Everyone’s freedoms are jeopardized when lawmakers attempt to disregard the results of free and fair elections or when mobs attempt to overrule those elections by force.

“Arise denounces incitements to violence and insurrection by elected leaders and political extremists. We also denounce the white supremacist ideologies that fuel attempts to reject legitimate votes from people of color.

“Alabama has a painful history of overturning legitimate election results by disregarding the will of Black voters. Similar strategies were used to ratify our racist 1901 state constitution, which disenfranchised Black voters and explicitly aimed to establish white supremacy under the law.

“Our ability to progress as a state and a nation will be limited as long as any person or group is unable to exercise their constitutional right to vote. We call upon all of our elected officials to acknowledge and affirm the 2020 election results. And we demand that everyone involved in carrying out or inciting Wednesday’s insurrection be held accountable for their actions.

Steps toward a better, more inclusive future

“Arise applauds the grassroots organizers and elected leaders who have worked for years to expand access to free and fair elections. In recent months, we have witnessed amazing levels of mobilization and grassroots engagement to ensure that all eligible voters can participate in deciding their political future. The fact that nearly 160 million Americans voted despite a pandemic, a crushing recession and rampant voter suppression efforts is a testament to these organizers’ work.

“Ensuring that every eligible voter can access the ballot must be a top priority to protect our democratic republic. We call upon Congress to strengthen the Voting Rights Act of 1965 and provide protections from further attempts to suppress votes. And we urge Alabama lawmakers to protect and expand voting rights by instituting automatic voter registration and lifting barriers to voting rights restoration.”

Medicaid expansion would save Alabama mothers from preventable deaths, boost treatment resources for mental health and substance use disorders

Alabama Arise and Cover Alabama partner organization logos

Nearly 70% of Alabama’s pregnancy-related deaths in 2016 were preventable, according to a report this month from the state Department of Public Health and Maternal Mortality Review Committee. The committee recommended that Alabama improve maternal health by expanding Medicaid coverage and increasing resources and services for women with mental health and substance use disorders. The report also recommended improving Medicaid reimbursement for providers and encouraging broader education of mothers and families regarding the various health issues identified as maternal death risk factors and their warning signs.

Partner organizations in the Cover Alabama Coalition released the following statements Thursday in response:

Jane Adams, Campaign Director, Alabama Arise:

“Thirty-six Alabama mothers died in 2016 from causes linked to their pregnancies. Their children will go to bed tonight – and every night – without their birth mother there to tuck them in. And for 70% of these kids, their mother’s death was preventable. This report is a haunting reminder that poverty and access to health insurance are significant drivers of maternal mortality in Alabama. We encourage Gov. Kay Ivey, Commissioner Stephanie Azar and our legislators to save lives and protect families by expanding Medicaid to cover mothers before, during and after pregnancy.”

Jada Shaffer, Government Relations Regional Director, American Heart Association:

“We urge the Legislature and Governor Ivey to immediately implement the reforms the Maternal Mortality Review Committee recommends. In 2016, cardiovascular-related conditions were the leading underlying cause of pregnancy-related deaths in Alabama. When women lack health insurance, they are less likely to get treatment for preexisting conditions and are much more likely to die during or after pregnancy. Improving maternal health outcomes will require expanding Medicaid and equitably providing access to care for all Alabama families.”

Dr. John S. Meigs, President, Medical Association of the State of Alabama:

“The Medical Association of the State of Alabama commends the Maternal Mortality Review Committee (MMRC) for its diligence in researching the factors that impact maternal deaths, in hopes to mitigate and prevent future maternal deaths. It is very concerning for physicians throughout the state that 70% of the deaths reviewed by the MMRC were preventable and that women of color are disproportionately affected. Alabama mothers deserve the best medical care that we can offer. To that end, the Medical Association supports the MMRC’s recommendation of expanding Medicaid coverage for women postpartum beyond where it is today, as well as informing our communities that mental health and substance abuse issues can contribute to maternal mortality. Physicians have a responsibility to help mothers get the medical care that they need and deserve.”

Dr. Nadia Richardson, Executive Director, No More Martyrs:

“In Alabama, Black women are dying at three to four times the rate of white women from pregnancy-related complications. In 2016, thirty-six mothers died because they did not have consistent access to care. We fail mothers when they are forced to drive two counties over to see their OB-GYN for a check-up because they live in one of 29 Alabama counties that have lost obstetrical services.

“Now is not the time to turn a blind eye to health disparities rooted in injustice and indifference. Now is not a time to ignore the impact that this continued neglect has on the mental, physical and holistic wellness of Black women in our state. Now is not the time to pretend that these inequities are not remnants of a history that we have yet to come to terms with – a history of racism and sexism that remains embedded throughout our health care system. Now is the time to demand more. Alabama leaders must accelerate progress on ending maternal mortality by investing in access to quality and affordable health care.”

Britta E. Cedergren, MPH, MPA, Associate Director, Postpartum Care, March of Dimes:

“The health of a society is measured by the health of its moms and babies. In Alabama, we are not only facing the crisis of one in eight babies being born too sick, too soon, but mothers dying from potentially preventable causes. In the inaugural report by the Alabama Maternal Mortality Review Committee, we found that two-thirds of women die between 43 and 365 days postpartum. When moms have access to high-quality, equitable and uninterrupted care, outcomes can improve. Fully expanding, or even extending Medicaid for a full year postpartum, while only one step in combating the crisis of moms dying from pregnancy related causes, is a big step that can improve the health and well-being of all Alabamians.

Rev. Carolyn Foster, Faith in Community Coordinator, Greater Birmingham Ministries:

“It is our moral responsibility to care for one another. ‘Do unto others as you would have them do unto you’ is a mandate in many of our faith traditions. It is the most basic command in our religious tradition. We cannot stand by or look the other way or cross on the other side when people suffer. To do so is to turn one’s back on God because ‘when you do it to the least of these, you do it to me.’ Access to health care would be life-giving to many who are vulnerable. We are our sister’s and brother’s keepers. And we must bear one another’s burdens. Dr. Martin Luther King Jr. said, ‘Our lives begin to end the day we become silent about things that matter.’ We strongly urge the Legislature and Gov. Kay Ivey to increase access to quality affordable health insurance by expanding Medicaid.”

Holly Caraway McCorkle, Executive Director, Alabama Council for Behavioral Healthcare:

“The Alabama Council for Behavioral Healthcare urges policymakers to act quickly to increase access to coverage by expanding Medicaid in Alabama. Sadly, the Alabama Maternal Mortality Review Committee found that mental health and substance use disorders were identified as key contributors in almost half of pregnancy-associated and pregnancy-related deaths. These deaths are preventable, and Medicaid expansion will offer women who suffer from mental health and substance use disorders life-saving coverage and access to critically needed resources and services before, during and after pregnancies.”

Kim Cochran, Vice President, External Affairs, The Women’s Fund of Greater Birmingham:

“A recent report by Alabama’s Maternal Mortality Review Committee revealed that the maternal mortality rate is rising in the United States. Alabama’s rate is the second highest in the nation and disproportionately affects Black women. Even more alarming, 70% of the maternal deaths in Alabama were deemed preventable. As identified by the Maternal Mortality Review Committee, Medicaid expansion could reduce Alabama’s maternal deaths and change the narrative for women. A region, state or county’s ability to keep women and children alive during and after childbirth speaks volumes about our economic, social and political fabric. I urge our lawmakers to stand up for women and expand Medicaid to help reduce our state’s maternal mortality rate and provide health care coverage for an additional 152,000 women.”

ACA lawsuit could end health coverage for 122,000 Alabamians

At least 122,000 Alabamians would lose health coverage if the U.S. Supreme Court strikes down the Affordable Care Act (ACA), according to a new analysis from the nonpartisan Urban Institute. The state’s uninsured rate would increase by 25% as a result.

That number also doesn’t include hundreds of thousands of uninsured or underinsured adults with low incomes who would gain coverage if Alabama expands Medicaid. If the lawsuit succeeds, the ACA’s 9-to-1 federal funding match for Medicaid expansion would disappear.

“Repealing the ACA would throw our health care system into chaos in the middle of a pandemic and a deep recession,” Alabama Arise executive director Robyn Hyden said. “Tens of thousands of Alabamians would lose health coverage when they need it most. And hundreds of thousands would pay more for coverage or lose protections for their preexisting conditions.”

The White House and 18 states, including Alabama, are asking the Supreme Court to strike down the entire ACA. Oral arguments before the Supreme Court are scheduled for Nov. 10.

More than 21 million Americans would lose coverage in 2022 if the ACA falls, according to the Urban Institute. Coverage losses could be even larger next year, as the COVID-19 pandemic and recession likely still will be ongoing.

“The ACA has been a health lifeline for many Alabamians during the pandemic,” Hyden said. “It provides coverage options for people who have lost their jobs or seen sharp reductions in their income. And it ensures people aren’t denied insurance just because they got sick.”

Ending the ACA would undermine racial equity, harm people with preexisting conditions

The ACA made important progress in reducing racial disparities in health care that often stem from structural racism. But large coverage losses from ending the ACA would reverse many of those gains, the Urban Institute finds. Overturning the ACA would strip health coverage from nearly one in 10 Black and Latino Americans under age 65. More than one in 10 Native Americans nationwide would become uninsured.

Ending the ACA also would eliminate protections for people with preexisting conditions. This would allow insurers to charge higher rates to people with conditions like asthma, cancer, diabetes or COVID-19. Insurance companies also could refuse to offer them coverage at any price. One in three Alabamians under age 65 have a preexisting condition that would have been “declinable” before the ACA.

ACA repeal would harm people who have health insurance through their jobs, too. Their plans could reintroduce annual and lifetime coverage limits. Requirements for plans to cover essential benefits and provide free preventive services would disappear. So would the requirement for insurers to allow young adults to be covered through their parents’ plans.

Striking down the ACA would be a tax windfall for wealthy people, large corporations

Wealthy people and some large corporations would be among the few winners if the lawsuit succeeds. They would get billions of dollars in tax cuts, the nonpartisan Center on Budget and Policy Priorities finds:

  • The highest-income 0.1% of households would receive tax cuts averaging about $198,000 per year. This group has annual incomes of more than $3 million. A portion of these tax cuts would come at the expense of the Medicare Trust Fund, which would lose about $10 billion in revenue each year.
  • Pharmaceutical companies would pay $2.8 billion less in taxes each year. Meanwhile, millions of seniors could pay billions of dollars more for prescription drugs annually. That’s because eliminating the ACA could reopen the “donut hole” gap in Medicare’s prescription drug benefit.

“The ACA has left Alabama better equipped to fight COVID-19 and rebuild our economy after the recession,” Hyden said. “And those benefits would be even greater if Alabama would adopt Medicaid expansion.

“Striking down the ACA would harm the Alabamians who have suffered the most during the pandemic and the recession. It would deprive our state of the opportunity to save lives and strengthen our health care system by expanding Medicaid. And it would shower huge tax cuts on rich people while making life harder for everyone else. Alabama officials should stop seeking to undermine the ACA and start investing in a healthier future for our entire state.”

Alabama Arise unveils members’ 2021 roadmap for change

Sentencing reform and universal broadband access are two new goals on Alabama Arise’s 2021 legislative agenda. Members voted for Arise’s issue priorities this week after nearly 300 people attended the organization’s online annual meeting Saturday. The seven issues chosen were:

  • Tax reform, including untaxing groceries and ending the state’s upside-down deduction for federal income taxes, which overwhelmingly benefits rich households.
  • Adequate budgets for human services like education, health care and child care, including Medicaid expansion and extension of pre-K to serve all eligible Alabama children.
  • Criminal justice reform, including repeal of the Habitual Felony Offender Act and changes to civil asset forfeiture policies.
  • Voting rights, including automatic universal voter registration and removal of barriers to voting rights restoration for disenfranchised Alabamians.
  • Payday and title lending reform to protect consumers from getting trapped in debt.
  • Death penalty reform, including a law to require juries to be unanimous in any decision to impose a death sentence.
  • Universal broadband access to help Alabamians who have low incomes or live in rural areas stay connected to work, school and health care.

“Arise believes in dignity, equity and justice for all Alabamians,” Alabama Arise executive director Robyn Hyden said. “And our 2021 issue priorities would break down many of the policy barriers that keep people in poverty. We can and will build a more inclusive future for our state.”

Graphic naming Alabama Arise's 2021 issue priorities

The urgent need for criminal justice reform

Alabama’s criminal justice system is broken and in desperate need of repair. The state’s prisons are violent and dangerously overcrowded. Exorbitant court fines and fees impose heavy burdens on thousands of families every year, taking a disproportionate toll on communities of color and families who are already struggling to make ends meet. And Alabama’s civil asset forfeiture policies let law enforcement seize people’s property even if they aren’t charged with a crime.

Arise will continue to seek needed reforms in those areas in the coming year. The organization also will work for repeal of the Habitual Felony Offender Act (HFOA), the state’s “three-strikes” law. The HFOA is an unjust driver of sentencing disparities and prison overcrowding in Alabama. The law lengthens sentences for a felony conviction after a prior felony conviction, even when the prior offense was nonviolent. Hundreds of people in Alabama are serving life sentences for non-homicide crimes because of the HFOA. Thousands more have had their sentences increased as a result. Repealing the law would reduce prison overcrowding and end some of Alabama’s most abusive sentencing practices.

Universal broadband access would help struggling Alabamians stay connected

The COVID-19 pandemic has illustrated the essential role that the internet plays in modern life. Remote work, education, health care and shopping are a reality for millions in our state today. But far too many Alabamians, especially in rural areas, can’t access the high-speed broadband that these services require. These access challenges also reveal a racial disparity: About 10% each of Black and Latino households have no internet subscription, compared to 6% of white households.

Policy solutions can facilitate the investments needed to ensure all Alabamians can stay connected. Lawmakers can help by guaranteeing that all communities have the right to own, operate or deploy their own broadband services. The Legislature also can enact targeted and transparent tax credits to promote broadband for underserved populations.

Pandemic EBT renewal a good first step, but families still need comprehensive COVID-19 relief

The U.S. Senate this week approved a continuing resolution that extended Pandemic EBT (P-EBT) benefits through September 2021. The resolution was enacted Thursday. Alabama Arise policy analyst Carol Gundlach issued the following statement Friday in response:

“The extension of Pandemic EBT through September 2021 is welcome news for families struggling to make ends meet. P-EBT has been a powerful, flexible tool to fight child hunger during an era of remote learning. The program has helped feed more than 400,000 Alabama children while school buildings are fully or partially closed. Its renewal will help tens of millions of American families keep food on the table.

“P-EBT’s renewal was an important step to help struggling parents afford food during a deep recession and high unemployment. But families still need and deserve a comprehensive relief bill that truly meets the size and scope of suffering that the COVID-19 pandemic has inflicted across Alabama and across our country.

“An adequate relief package would provide enough federal relief to help states avoid cuts to vital services like education and Medicaid. It would renew the $600 weekly federal increase to unemployment insurance benefits. And it would boost nutrition and housing assistance to help millions who are at risk of hunger and homelessness. The House passed legislation that would do those things months ago, and the Senate should do the same.

“The pandemic won’t go away anytime soon. Struggling families need a relief bill that takes meaningful, long-term action to address this health crisis and ease financial suffering. Senators should pass such a bill quickly, and their constituents should accept nothing less.”

U.S. Senate still needs to do its job and pass meaningful COVID-19 relief

The U.S. Senate on Thursday failed to advance an inadequate COVID-19 relief plan. Alabama Arise executive director Robyn Hyden issued the following statement Thursday in response:

“The bill that failed in the Senate this week was wholly inadequate to meet the size and scope of suffering that the COVID-19 pandemic has inflicted across Alabama and across our country. Lawmakers shouldn’t leave Washington without approving an adequate, long-term deal to help struggling Americans make ends meet.

“This plan offered nowhere near enough federal relief to help states avoid cuts to vital services like education and Medicaid. It would have cut the previous $600 weekly federal increase to unemployment insurance benefits in half, even though jobs remain hard to find. And it included no nutrition or housing assistance to help millions who are at risk of hunger and homelessness.

“Congress needs to step up and do its job by protecting people from harm. Last month’s executive actions were nothing more than a Band-Aid over a gaping economic wound. And any so-called relief bill that doesn’t help people keep food on the table and a roof over their heads is no relief bill at all.

“The pandemic isn’t going away anytime soon. Struggling families need a relief bill that takes meaningful, long-term action to address this health crisis and ease financial suffering. Senators should pass such a bill quickly, and their constituents should accept nothing less.”