Alabama Arise and Cover Alabama co-hosted a Medicaid town hall in Jasper on April 10, 2023. Speakers discussed the importance of Medicaid expansion and how our state can afford it, as well as the cruelty of the Medicaid coverage gap. To learn more and join our movement to expand Medicaid in Alabama, visit coveralabama.org.
Resource: Personal Stories
Cover Alabama Lobby Day 2023
The Cover Alabama coalition held its first Lobby Day on March 21 on the steps of the State House in Montgomery. Faith leaders, community advocates and people living in Alabama’s health coverage gap spoke about the importance of Medicaid expansion for their families and communities. Advocates then met with lawmakers to urge them to save lives and create jobs by expanding Medicaid.
Brewton community event on Medicaid expansion in Alabama
“Our rural hospital is the first line of care for the people in our community. If someone’s really sick, they need to be stabilized. They can be stabilized here quickly and efficiently. If our hospital closed … people will die.”
That was the blunt reality that Dr. Marsha Raulerson shared at a health care panel that Alabama Arise co-hosted Feb. 27 in Brewton. As we heard from her and many other people that night, Medicaid expansion is a crucial step to save lives and protect health care access in Escambia County and throughout Alabama.
See The Gap: ‘Possibilities that we just can’t afford’
Kayla is a talented, young hairstylist who has built up a successful clientele in one of Birmingham’s hippest salons. She’s been a stylist for 12 years and said she loves the independence it gives her. She sees dozens of clients every week and takes great pride in her work.
“It’s a great industry, but it’s not taken as seriously as it needs to be,” Kayla said. “Especially relative to the number of people that come through our doors to get their hair done.”
Kayla grew up in a small town in Walker County but started her career in an “Over the Mountain” suburb south of Birmingham. The salon served a wealthier clientele, but it didn’t offer many benefits to stylists. Among the benefits she didn’t have: employer-provided health insurance.
Kayla said lack of access to care is the norm in an industry where health coverage is often an afterthought.
“People love to say that college is too expensive now, so you should go into a trade,” she said. “Maybe the more dangerous trades offer benefits, but when you go into something like hair, we’re kind of left behind.”
Kayla said not many of her clients know she is working full-time while uninsured. And most don’t know how it affects her future in more ways than just going to the doctor.
“No one is talking about why we don’t have health coverage. They don’t usually even care if we have it in the first place,” she said. “No one has ever asked me. You’re the first one.”
When the cost is simply too high
During the COVID-19 pandemic, Kayla decided she needed a change and moved to a new salon. She was thrilled to learn that it offers health insurance to its stylists.
But when she and her husband ran the numbers, it just didn’t work for them. The cost was simply too high. She couldn’t justify the risk of adding such high expenses to her already stretched budget.
Kayla said she still considers herself lucky, though.
“I know I can’t afford it, but at least they offer it. Most places don’t,” she said. “None of the salons back in my rural hometown offered insurance. I don’t imagine that’s changed much since when I started in the industry.”
Kayla explored other options, but nothing panned out.
“The last time I looked at buying a plan online, I put in what I earned and it was still $600 a month,” she said. “I’m not rich. I can’t afford that.”
‘A pragmatic decision’
Kayla is one of more than 220,000 people in Alabama’s Medicaid coverage gap. She is ineligible for Alabama Medicaid or subsidized Marketplace coverage under the Affordable Care Act. And she is also unable to afford premiums for private insurance.
Kayla said she often gets anxious when she thinks about what would happen in an emergency. She said she researches what people do when they need emergency care or surgery and don’t have insurance.
Those long nights researching and worrying about costs led Kayla and her husband to the choice not to have children.
“We’re not going to have children,” she said. “I don’t even know how I’d do it, especially in Alabama.”
The budget is tight for Kayla and her husband. She said she feels it’s not fair to bring a child into the world without the resources to support one.
“Babies are just so expensive. I made a pragmatic decision to not have kids,” she said. “I’m uninsured, and these are all possibilities that we just can’t afford.”
Coverage gaps for prospective new mothers in Alabama
Kayla said she’s heard it’s easier in other states for newer moms. She’s right.
Women in Medicaid expansion states are more than twice as likely to already have coverage prior to becoming pregnant compared to women in non-expansion states, according to the Kaiser Family Foundation. Being enrolled in Medicaid throughout pregnancy means more consistent prenatal care. That leads to healthier pregnancies and reduced risk of complications or death.
An added risk in Alabama is that prospective mothers generally can’t qualify for Medicaid until they’ve confirmed they are pregnant. That means they are unable to access valuable prenatal care until later in the pregnancy.
In Alabama, Medicaid only covers pregnant people with an income up to 146% of the federal poverty level, or around $1,300 monthly for a couple. Working-age adults with no children and no disability do not qualify for Alabama Medicaid, no matter how little they make. This leaves Kayla and 50,000 other uninsured Alabama working women without any options for affordable health coverage.
Some good news for those in Kayla’s situation is that even though our state has some of the most restrictive income eligibility limits for adults, most children in Alabama are eligible for ALL Kids coverage. ALL Kids insures tens of thousands of Alabama children whose low- and middle-income households do not qualify for Medicaid.
Gov. Kay Ivey and lawmakers also recently extended postpartum Medicaid coverage for up to one year after childbirth. This would be great news for Kayla, if workers like her were eligible for ongoing Medicaid coverage. But without employer-sponsored health insurance or Medicaid expansion, Kayla said she and her husband can’t afford the high costs of prenatal care and childbirth.
‘I don’t know what I’m gonna do’
For now, Kayla said she is focusing on taking care of herself. She’s been healthy so far, but she wants to work on a plan for when she might not be
“I bought dental and vision insurance recently,” she said. “I can afford the small stuff, not the big stuff, you know?”
Kayla also sought out a clinic north of town that will work with her on copays for when she needs care for the occasional cold or injury.
“I can do $70 at a time, even though that’s kind of a lot,” she said. “That’s my only real plan. Otherwise, I don’t know what I’m gonna do.”
ABOUT ALABAMA ARISE AND COVER ALABAMA
Whit Sides is the Cover Alabama storyteller for Alabama Arise, a statewide, member-led organization advancing public policies to improve the lives of Alabamians who are marginalized by poverty. Arise’s membership includes faith-based, community, nonprofit and civic groups, grassroots leaders and individuals from across Alabama. Email: whit@alarise.org.
Arise is a founding member of the Cover Alabama coalition. Cover Alabama is a nonpartisan alliance of advocacy groups, businesses, community organizations, consumer groups, health care providers and religious congregations advocating for Alabama to provide quality, affordable health coverage to its residents and implement a sustainable health care system.
See the Gap: ‘A bigger problem in our industry’
Barbers and stylists in Alabama often work for themselves, and that comes with a cost. One Birmingham barber in the state’s health coverage gap said he decided against getting health insurance because premiums were close to $1,000 monthly.
In his own words: “Me personally? I don’t go to the doctor. I think it’s part of a bigger problem in our industry. We all just accept that care is too expensive, so we put it off. As a small business owner, that’s scary, especially with a family.”
Medicaid expansion would help this barber – and more than 220,000 other uninsured Alabamians – get the health care they need to survive and thrive. Read more stories of people living in Alabama’s coverage gap here.
See the Gap: ‘You’ve got to be able to deliver when folks need you to’
Trent Thomas, 42, has been doing hair for a while now. And the first thing he’ll tell you is how much of a good thing he’s got going.
“I love it here for a million reasons – some superficial – but it really is such a great place to be,” he said, showing off his boss’s massive plant collection visible from the street outside.
Trent was able to keep his job and his paycheck at Orbit Salon, in Birmingham’s Five Points South neighborhood, even when the world slowed down in 2020.
“This neighborhood’s always been so cool and aspirational,” he said. “I think that’s what a lot of stylists look for when going into the industry and what a lot of clients look for in a salon, too.”
Trent said he is grateful for their support and knows not everyone is so lucky.
“It’s not every day you get full-time benefits,” he said. “It’s not a normal thing to have insurance through a salon, like I do. It’s incredibly expensive, and not every salon or stylist in town can afford it.”
Pre-ACA: Life in the coverage gap
Things weren’t always so good, particularly when it came to health coverage. Trent decided to attend cosmetology school in his 30s and started getting insurance at work shortly before he turned 40.
Before then, Trent spent many years without health insurance. After aging out of his parents’ plan in 2003, he spent the next 15 years without employer-provided benefits.
“I grew up in the Birmingham punk scene, and I learned to find resources as close to the ground and as close at hand as I possibly could,” he said. “You make it work from within.”
Trent has worked many jobs, including punk rock show promoter and clerk at an art supply store. His story of making things work through sacrifice is one of many – and one that resonates with many stylists.
After the Affordable Care Act was signed into law, Trent found a plan that worked for him and paid out of pocket for premiums. That came after more than a decade of putting off care or finding help through non-traditional means.
Even with ACA coverage, he still lacked dental or vision coverage.
“Everything was always out of pocket,” Trent said. “I paid out of pocket in full for glasses. I used coupons when I could. I used the UAB School of Dentistry for a few fillings and extractions.”
He said the school is an amazing resource for uninsured patients in Birmingham. But he also said the services still require payment up front.
Trent’s biggest sacrifice healthwise came when he suffered a hernia and needed it repaired. He waited years to get surgery to ease the pain.
Access to care for LGBTQ beauty workers in Alabama
Trent also had to find a way to get his daily medications regularly without prescription coverage. Many workers in the beauty industry identify as LGBTQ, and that includes Trent. He’s a gay man who takes PrEP to help protect against HIV, which disproportionately affects gay men.
Pre-exposure prophylaxis (or PrEP) is highly effective for preventing HIV when taken as prescribed. PrEP reduces the risk of getting HIV from sex by almost 99%, according to the Centers for Disease Control and Prevention (CDC). The medication is much less effective when not taken as prescribed, so interruptions in access could raise risk.
During his time in the coverage gap, Trent signed up for clinical research trials to gain access to the life-saving drug. Fortunately, access to PrEP is much easier these days. A few years ago, the manufacturer, Gilead, began offering the drug at low or no cost for anyone who has a prescription.
Patients in central Alabama also can pick up PrEP at local health clinics that offer LGBTQ-focused care. Trent regularly gets his primary care at a practice called the Magic City Wellness Center. The center’s mission is to meet the needs of and reduce disparities in care for LGBTQ people in central Alabama. It is affiliated with Birmingham AIDS Outreach.
Trent made it through the pandemic relatively unscathed until he finally caught COVID-19 in December. He said being able to get regular care from his primary care physician has been a godsend during his recovery.
“I was lucky enough to find a doctor that treats LGBTQ folks like myself for free or on a sliding scale,” he said.
Having health coverage and regular access to preventive care has allowed Trent to recover from COVID-19 on his own time. It also has reduced his risk of becoming more ill or losing his job.
The COVID-19 pandemic forces reevaluations
Trent said recovering from COVID-19 both physically and functionally will be a steep learning curve not just for him, but for the beauty industry as a whole.
“Working on commission, you’ve got to be able to deliver when folks need you to,” he said. “COVID, just like any other disabling condition stylists deal with, comes with nuances that make that sometimes impossible.”
Many stylists are reevaluating their schedules, Trent said. Some are cutting down to three or four days a week. Many are spending less time on their feet whenever they have a spare moment. Striking a balance even when healthy is hard, he said.
“It’s not like doing one haircut is all that taxing. It’s when you’re at the end of the day and you’ve done seven or eight of them,” he said. “Your shoulders and back start to scream at you.”
Many stylists are leaving their jobs or quitting the industry altogether because of rough physical conditions, Trent said. He said he is happy to see more salons working to accommodate disabled and older workers in response. He also called it a “timbre of the times” to see some younger workers organizing for better conditions.
How expanding Medicaid could help an expanding industry
It’s not all sacrifice. There’s plenty of success to go around.
Trent said the future is bright for young stylists. But that better tomorrow will require investments in the industry’s most important assets: people and their health. Trent said he believes full-time benefits and health coverage should be the norm and not the exception for stylists.
About 10,000 stylists and other personal care workers across Alabama would benefit from Medicaid expansion. In total, more than 220,000 Alabamians are caught in the coverage gap, unable to afford health insurance. Another 120,000 or more are stretching to pay for private or employer-based insurance.
Trent said he sees how other states and even other countries ensure their residents can get health care. And he wishes Alabama would step up, too.
“I feel like if our state really did expand Medicaid, it would mean money in the pockets of salons and stylists all over,” Trent said.
He said he believes state leaders should do everything they can to support working Alabamians, including expanding Medicaid.
Trent said the Alabama mindset is often hampered by a “pull yourself up by the bootstraps” philosophy, but state officials aren’t doing enough to equip people to thrive.
“I think that we live in the richest country in the world, and I wish we funded our health care system properly so we weren’t so reliant on for-profit businesses to take care of us,” Trent said. “If there’s money on the table to expand and we’re just letting it sit there, who does that benefit?”
About Alabama Arise and Cover Alabama
Whit Sides is the Cover Alabama storyteller for Alabama Arise, a statewide, member-led organization advancing public policies to improve the lives of Alabamians who are marginalized by poverty. Arise’s membership includes faith-based, community, nonprofit and civic groups, grassroots leaders and individuals from across Alabama. Email: whit@alarise.org.
Arise is a founding member of the Cover Alabama coalition. Cover Alabama is a nonpartisan alliance of advocacy groups, businesses, community organizations, consumer groups, health care providers and religious congregations advocating for Alabama to provide quality, affordable health coverage to its residents and implement a sustainable health care system.
See the Gap: ‘Someone’s got to do something for working folks’
When I first met Katie Franklin, she was juggling requests from three guests at the same time.
I’ve been visiting Nail World II, right outside Birmingham, for nearly 20 years, but this visit was different. Someone new was greeting me at the door.
Katie is a presence who is not easily forgotten. I learned she was the new salon manager. Honestly, it felt like she was right at home.
She made greeting 25 to 30 customers an hour look easy. Her maternal aura and gregarious nature shone bright through all the hustle and bustle.
It was Homecoming Week for many high schools in the Over the Mountain suburbs of Birmingham. Her salon’s clients were stacked back to back for several days in preparation for the big games and dances. And this was on top of the steady stream of walk-ins like me.
“I mean, I’m here all day, every day,” she said. “There’s no days off for me.”
Working full time but still uninsured
Katie is a mother of two who lives in Morris, about 20 miles north of Birmingham. She recently earned her license as a nail technician. A natural extrovert, she soon became a supervisor in one of metro Birmingham’s busiest nail salons.
“I needed a new start. I’m good at it and I get to help people, which is what I love,” Katie said with an infectious grin. “It’s my passion. If I can make someone feel better, then it’s all worth it.”
We exchanged numbers, and over the next month, she shared her story with me.
Katie is one of more than 220,000 Alabamians in the state’s health coverage gap. Like all of them, she cannot afford private health insurance but is ineligible for Medicaid coverage.
Katie is a single mom, working to take care of two teenagers as well as her parents. Both of her children are eligible for health care through ALL Kids, the Children’s Health Insurance Program (CHIP) in Alabama. But since she earns about $2,000 a month, she’s left in a lurch.
Even though Katie works full-time hours, she doesn’t receive benefits like health insurance. Caretakers like her only qualify for Alabama Medicaid if their income is less than 18% of the federal poverty line. For a family of three, that amount is just $4,145 a year.
“I don’t know who makes these numbers, but I’m not rich. Suddenly earning $1,000 every two weeks doesn’t mean I can afford hundreds of dollars a month for health insurance,” Katie said about Alabama’s stringent Medicaid income eligibility guidelines.
‘Imagine the difference this would make’
When Katie needs medical care, she puts off doctor’s visits and treats at home. But sometimes, it’s not enough. That’s when she goes where many other uninsured folks around Birmingham end up: UAB’s emergency room.
“I try not to go unless I absolutely have to,” she said.
Katie said she wishes there were more options for patients paying out of pocket.
She has been to urgent care centers before but dreads the bills that arrive weeks later in the mail.
“I actually spent my COVID stimulus check paying off medical debt,” she said. “I hate debt, and I’m not the kind of person who doesn’t pay my bills.”
Katie said Alabama’s leaders have to do more to support those in need of health care and coverage.
“Someone’s got to do something for working folks,” she said. “I feel like the middle class doesn’t get any of the help that these big companies get.”
She said Medicaid isn’t perfect, but just knowing her kids can see a doctor without her having to sacrifice money for bills or groceries is a big relief. Katie said she hopes Gov. Kay Ivey will expand Medicaid sooner rather than later.
“If all it takes is a stroke of a pen, then I’m all for it,” Katie said. “Imagine the difference this would make for small businesses like mine, struggling to make ends meet.”
About Alabama Arise and Cover Alabama
Whit Sides is the Cover Alabama storyteller for Alabama Arise, a statewide, member-led organization advancing public policies to improve the lives of Alabamians who are marginalized by poverty. Arise’s membership includes faith-based, community, nonprofit and civic groups, grassroots leaders and individuals from across Alabama. Email: whit@alarise.org.
Arise is a founding member of the Cover Alabama coalition. Cover Alabama is a nonpartisan alliance of advocacy groups, businesses, community organizations, consumer groups, health care providers and religious congregations advocating for Alabama to provide quality, affordable health coverage to its residents and implement a sustainable health care system.
See the Gap: How Medicaid expansion would improve life for Alabama’s hairstylists and barbers
Throughout our lives, there are many milestones.
We go to school dances. We graduate, and we get married.
But we don’t get to those moments alone.
When we look back at the photos to relive our happiest moments, we see the faces of our friends and family smiling back. But there were other folks who aren’t always pictured.
They’re the hairstylists, barbers and nail techs who listened as we unloaded our anxieties. They always took our call when we realized (at the last minute!) we needed to do something a little extra to look and feel our best. And they deserve the security of knowing they can get affordable health care in their own times of need.
More than just a haircut
It was summer 2018. I was on a new medicine that solved my medical issues but had a gnarly side effect: I started losing my hair in chunks. I spent hours crying in the shower. After a few weeks of trying to convince myself I was a hat girl, I took a radical step and shaved my head. I didn’t dare do it myself. I barely had enough energy to pick up the phone and book the appointment. But when I showed up: There was Jamie.
From the minute I sat in her chair, I felt at ease. My nerves were shot, but her calm demeanor convinced me everything would be OK. Jamie turned what was a disaster into a new identity for me.
When Jamie moved out of state shortly after, I was crushed. We’d been through so much. It was like dating: I didn’t want to put myself out there all over again for a completely new person.
A few weeks (and several Instagram searches) later, I found Madison Tidwell.
Madison was a lot like me. She loved houseplants, grew up in a small town and stayed on top of trends.
It’s been two years, and I don’t trust anyone else to touch my hair. We’ve been through growing out a pixie, evening out mullets – even going purple, green and yellow!
My experience is not uncommon. Many folks trust their hairstylists and barbers with their deepest secrets. And when you find someone you trust, you soon depend on them for more than just a haircut.
Living in the gap: How we got here and how we can fix it
Over the past few months, I’ve met with more than 30 beauty professionals in Alabama.
Some work at busy, upscale salons. Others rent booths in hometown shops. Some created their own business model by joining collectives of small, independent suites.
All have something in common: They all are uninsured or paying out of pocket for medical treatment. And along with nearly 10,000 other personal care and support workers, they would benefit from Medicaid expansion.
Because our state has failed to expand Medicaid, more than 220,000 Alabamians are caught in the coverage gap, unable to afford health insurance. Another 120,000 or more are stretching to pay for private or employer-based coverage.
Stylists usually work six or seven days a week, with little fanfare and long hours on their feet. They open early and stay late, especially on weekends when customers need them. However, most beauty professionals have no safety net in case of their own emergency. Most stylists don’t get health insurance through their employers. And even those who are self-employed often don’t earn enough to afford private premiums.
Like so many working Alabamians, these stylists and beauty professionals still don’t have health coverage or access to affordable care. I want to cover their stories in my See the Gap series. Our series will begin next week and continue over the coming months.
It’s important to share the sacrifices those in the service industry often make in their own lives to take care of everyone else. These stories will show what life is like in the coverage gap: from finding health care services and paying out of pocket for medical expenses to providing for a family when you work for yourself.
Working families in the gap are all around us. Their stories matter.
First, we’ll hear from beauty professionals about what works and what doesn’t. Some of them have graciously offered me a deep glimpse into life in one of the most physically demanding and emotionally taxing fields.
We also will discover what having health care coverage would mean for hairstylists, barbers and their families. And we will talk to workers and salon owners about how simple policy changes – like Gov. Kay Ivey expanding Medicaid – could improve these folks’ lives exponentially.
Nearly every stylist I’ve spoken with says they chose their profession so they could change lives. They center their work around people but are often left unsupported by employers and Alabama’s leaders.
Investing in the health of Alabama’s working families should be a priority for all of us. Why don’t our state’s elected officials expand Medicaid? It’s a question that deserves an answer.
Working people in Alabama are paying the price every day for our state’s failure to expand Medicaid. Imagine what investing in those who do so much for our communities could do for all of us. Imagine what would happen if we see the gap and make life better for those living in it.
Please follow @AlabamaArise and @CoverAlabama on social media to make sure you don’t miss our See the Gap series. And sign up for Arise’s action alerts so you can be ready to speak out for Medicaid expansion and other needed policy changes in Alabama.
About Alabama Arise and Cover Alabama
Whit Sides is the Cover Alabama storyteller for Alabama Arise, a statewide, member-led organization advancing public policies to improve the lives of Alabamians who are marginalized by poverty. Arise’s membership includes faith-based, community, nonprofit and civic groups, grassroots leaders and individuals from across Alabama. Email: whit@alarise.org.
Arise is a founding member of the Cover Alabama coalition. Cover Alabama is a nonpartisan alliance of advocacy groups, businesses, community organizations, consumer groups, health care providers and religious congregations advocating for Alabama to provide quality, affordable health coverage to its residents and implement a sustainable health care system.
Postpartum Medicaid extension brings a glimmer of hope for new mothers in Alabama
This story originally appeared on AL.com.
On Mother’s Day in 2014, I found out I was pregnant. For me, the existential dread set in just as deeply as the morning sickness.
Motherhood and its crushing weight had been drilled into me my entire life. I told myself it was too hard, that I just wasn’t strong enough to handle parenthood and all its pressures. And I feared that my family’s legacy would repeat itself.
One summer day in 1932, while pregnant with her 14th child, my great-grandmother Maude Wakefield finally reached her breaking point. She set off behind her home in Winston County and climbed high into a tree on my family’s land. She had been pregnant regularly since 1906 and decided enough was enough.
So she offered an ultimatum: She would return to her infinite load of daily household duties only if my great-grandfather would promise that this was it – no more babies. Not long after what would become her infamous last stand, she passed away due to a stroke worsened by postpartum hypertension. My grandmother was left to live without her mother at age 12.
Nearly a century later, during a routine blood pressure check, I was deemed high risk for the same life-threatening condition that killed my great-grandmother.
I didn’t want that same lonely future for my daughter.
The life-saving power of health coverage
Fortunately, I had health insurance. My blood pressure continued to rise to dangerous levels as my pregnancy progressed. After reviewing my family history, my doctor decided it was best for both me and the baby to deliver early under supervision to prevent preeclampsia, a condition that can lead to maternal death during or after delivery.
Because I had access to care, I was easily treated, and it ended up saving my life. Now, when I take my blood pressure pill every morning, I can’t help but think how things could have been different for my great-grandmother.
Hope can be hard to come by in Alabama. Stories like mine remind us how far we’ve come. But when you’re left without coverage, it’s never as simple as a pill and a copay.
Medicaid covers about half of all births in Alabama. And for many new moms, health coverage expires shortly after the baby is born.
Medicaid postpartum coverage extension is a step in the right direction
Some good news could be coming as soon as this fall. On April 7, Gov. Kay Ivey signed a new General Fund budget into law. It includes an extension of postpartum Medicaid coverage from 60 days of coverage to 12 months. This life-saving change will provide thousands of families consistency in care during the critical time after childbirth.
Alabama has the nation’s third-worst maternal death rate. Each year, roughly 40 new mothers in the state die within one year after delivery. Nearly 70% of those deaths are preventable, the state Maternal Mortality Review Committee found. And the toll on Black mothers is nearly three times that on white moms.
In Alabama, children living in households with low or middle incomes are widely eligible for coverage through Medicaid or ALL Kids, Alabama’s Children’s Health Insurance Program (CHIP). For adults, it is much harder to qualify for Medicaid. Just 17% of Medicaid participants in Alabama are adults under age 65 who do not have a disability.
Our state has some of the most stringent income limitations for Medicaid. For example, a single parent of two without a disability is ineligible if they make more than $346 a month. These harsh Medicaid eligibility limits mean affordable health insurance is simply not an option for many people in our state.
Medicaid expansion would ensure coverage for more than 340,000 Alabamians, including those left uninsured by these tight limits. These folks do not qualify for Medicaid, but they are unable to afford a marketplace plan or other private coverage. However, the new postpartum coverage extension means there will now be a brief inclusive window during and after pregnancy.
A lifeline in a time of need
Moms like my friend Brittany Kendrick of Blountsville call this coverage a lifeline.
Brittany lost her fiance, Dylan, in a car accident two months before her daughter Khaleesi was born. They had everything planned out, but her health insurance expired after Dylan’s death. Brittany turned to Medicaid to cover the costs.
Then, in August 2021, she made the hour-long drive to Children’s Hospital in Birmingham, where she found out her newborn had contracted COVID-19. After getting emergency care, her baby made a recovery. But as soon as they got home, Brittany tested positive and started to feel worse.
Being able to see a doctor and seek treatment quickly was just the blessing they needed during what Brittany calls the hardest year of her life.
“Medicaid paid for all of our hospital and doctor bills,” Brittany said. “It gave me a chance to use the money I had in savings for a safer car and a new apartment for me and the baby.”
Brittany hopes she will be among those eligible for the new postpartum extension. Having consistent care has brought balance to her life in more ways than one. “I can take medicine for anxiety and depression now. I need that, to stay strong for her,” she said.
‘Why not offer this to all mothers?’
Extending Medicaid coverage doesn’t just support new or single parents.
Sarita Edwards of Madison is a mother of five and founder of the E.WE Foundation, a health care advocacy organization. She began her foundation after receiving a rare prenatal diagnosis of Edwards’ Syndrome (trisomy 18) for her son Elijah. The high mortality rate associated with her son’s diagnosis meant her family racked up thousands in medical debt before baby Elijah was even born.
Sarita says every day with Elijah has been a juggling act. Elijah’s condition is terminal, and his care can be exhausting and expensive. She now spends her time advocating for more equitable treatment and access in health care. She knows our leaders can do more, because she’s seen it firsthand.
“I know what our state can do when offering care to mothers and children with rare diseases,” Sarita said. “Why not offer this to all mothers?”
The new General Fund budget includes more than $8 million to extend Medicaid coverage for 12 months after childbirth. But the funding is guaranteed only for one year – on a trial basis.
This year marked another Mother’s Day when Alabama mothers are still dying from pregnancy and childbirth at twice the national rate. Reliable health coverage – and the access to care that comes with it – can prevent many of those deaths. Sarita sees no reason to hold off on making Medicaid’s postpartum coverage extension permanent.
“Our babies are taken care of, but what about the mothers?” Sarita asked. “I don’t know why it takes Alabama so long to do the right thing sometimes.”
About Alabama Arise and Cover Alabama
Whit Sides is the story collection coordinator for Alabama Arise, a statewide, member-led organization advancing public policies to improve the lives of Alabamians who are marginalized by poverty. Arise’s membership includes faith-based, community, nonprofit and civic groups, grassroots leaders and individuals from across Alabama. Email: whit@alarise.org.
Arise is a founding member of the Cover Alabama Coalition. Cover Alabama is a nonpartisan alliance of more than 115 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.
When Alabama’s coverage gap hit home for my family
This story originally appeared on AL.com.
Our borders have become irregular as COVID-19 closes in on almost every part of our lives. The pandemic has made all of us realize how the shapes of our families are becoming irreparably different.
This summer, the shape of my own life changed.
Cathy Parker was one of my mom’s lifelong best friends. They grew up together near the border of Blount, Jefferson and Walker counties, in a small community appropriately called Corner.
Cathy was small in stature but had a raspy, larger-than-life voice. She also had a kind, wide-open laugh that made you feel special and heard. She was a rescuer: of plants, animals and even children.
After retirement, my parents began to spend more time with Cathy and her husband, Chuck. Early in the pandemic, they were part of a tiny pod of people with whom my parents visited. My younger sister has special needs, and my mother has asthma, so they kept their circle tight to reduce exposure.
When vaccines started to open the world earlier this year, my daughter began to spend more time with my parents again. That meant more time with Cathy, too.
Cathy was like an aunt to me. My daughter called her “Mamaw.” She loved spending weekends at Cathy’s house in Hayden.
The phone call
One morning as spring turned into summer, my mother called me. She was crying. She said in a small, scared voice that Cathy was sick. Cathy had a tumor in her lungs, and it had spread to her brain.
I couldn’t process the news for days. To be honest, I still haven’t.
I didn’t know how I was going to tell my daughter. I didn’t know how I could help my mother.
Unfortunately, I didn’t have much time to think about any of that. Cathy Parker died in late July after a painfully short battle with Stage 4 cancer.
With her gone, everything feels smaller. I can’t imagine how that feels for my parents, after knowing her for almost a lifetime. The shape of the world changed.
The coverage gap
If you ask my mother what the biggest change has been since, she’ll tell you it’s the anger. Cathy’s death reminds us every day that in Alabama, those who need help the most are often the last to get it.
Cathy was one of hundreds of thousands of people in Alabama without health insurance. That includes about 32,000 older adults (50 to 64 years old) who are in the Medicaid coverage gap.
Cathy did not qualify for Medicaid under the state’s stringent income limits. And her husband, Chuck, said her income was too low to qualify for a subsidized plan under the Affordable Care Act. She was three years shy of Medicare eligibility.
Chuck is a former Marine and Vietnam veteran. He receives benefits through the Department of Veterans Affairs for himself. But Chuck said he was turned away whenever he asked about extending them to his wife. The premium for the cheapest marketplace plan available to Cathy was more than $800 a month, Chuck said. That was more than they could afford.
They paid out of pocket to doctors who helped Cathy as much as they could. Even so, the question haunts us: Was Cathy’s time cut short because she was uninsured?
I believe so. Things easily could have been different.
A bad situation gets worse
Lack of coverage meant lack of access to lots of specialists. And it meant traveling more than an hour to find doctors who would take a patient paying out of pocket. Cathy and Chuck’s pockets often came up empty as the medical bills increased.
Compounding the tragedy, COVID-19 made access to life-saving care increasingly difficult. Several times, Cathy and Chuck drove to the hospital in the middle of the night. They waited hours in the emergency department, hoping for a bed that never materialized.
Chuck recalls that one night shortly before she died, Cathy had a seizure as the tumor grew larger in her brain. He immediately called 911.
They rode in an ambulance for more than an hour, only to be turned away by two hospitals diverting all incoming patients. They were overwhelmed by the overload of COVID-19 cases. Cathy eventually found a bed at a third Birmingham hospital. She passed soon afterward.
COVID-19’s burden on Alabama’s health care system has been enormous. In early September, near the delta variant’s peak, anywhere from 10 to 80 people a day in Alabama were waiting for an ICU bed “that is not there,” Dr. David Kimberlin of UAB told NPR. (Those numbers have improved since, with the Alabama Hospital Association reporting 167 ICU beds available statewide in early October.)
Adding to the challenges of pandemic response, our state has lost eight rural hospitals in the last decade. We surely could have used those resources during the pandemic. And we still might have them if Alabama had expanded Medicaid.
The what-ifs that haunt us
My family is one of thousands haunted by what-ifs resulting from Alabama’s failure to expand Medicaid.
What if Medicaid coverage had been available to Cathy?
It’s not hard to imagine a different outcome.
Cathy was born in Illinois, one of 38 states that expanded Medicaid to adults with low incomes. More than 600,000 people in Illinois now have coverage as a result, including many in Cathy’s family.
Chuck and Cathy considered moving to Illinois so she could get insurance through Medicaid expansion. But her illness progressed so quickly that moving was not an option. If Cathy had returned to Illinois before she started feeling sick, she might have qualified for expanded Medicaid. Doctors might have found her cancer more quickly. And that early detection might have saved her life.
But that’s not what happened. Instead, Chuck still opens the mailbox wondering what bill will arrive today. The last one he received was for $22,000, detailing charges for his wife’s end-of-life care.
Cathy did ultimately make it back to Illinois. Her friends and family honored her request to scatter her ashes there after she passed.
Expand Medicaid to prevent suffering
Cancer patients living in states that failed to expand Medicaid are more likely to die than those in states that have expanded, new research shows. In Medicaid expansion states, patients are more likely to get earlier-stage diagnoses and receive earlier interventions.
Medicaid expansion lowers mortality rates. It saves lives.
Alabama’s leaders have the resources and tools to expand Medicaid. But they keep passing the buck, blaming it on money or politics. Each day, struggling Alabamians are the victims.
Gov. Kay Ivey can begin the process of expanding Medicaid today. It would prevent death for so many people living in the coverage gap. And it’s the single most important public health intervention available to uplift Alabama’s hospitals, doctors and patients after the pandemic.
For now, we’re left with the irregular borders closing in on us. Our families are growing smaller, and especially after the year we’ve had, it’d be easy to feel like there’s nothing we can do. But that’s just not true. We can expand Medicaid. And we must.
It’s too late for Cathy. But it’s not too late for the governor to protect other Alabama families from enduring the pain we’ve experienced. All it takes is the stroke of a pen.
About Alabama Arise and Cover Alabama
Whit Sides is the story collection coordinator for Alabama Arise, a statewide, member-led organization advancing public policies to improve the lives of Alabamians who are marginalized by poverty. Arise’s membership includes faith-based, community, nonprofit and civic groups, grassroots leaders and individuals from across Alabama. Email: whit@alarise.org.
Arise is a founding member of the Cover Alabama Coalition. Cover Alabama is a nonpartisan alliance of more than 110 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.