Over the last year, Alabama Arise has collected the stories of some of the nearly 10,000 personal care workers who would benefit from Medicaid expansion in our state. We spent months getting to know folks in one of our state’s most vibrant industries. And we want to be sure you see the last few stories in this series.
Now, as we close the series, we’re lifting up even more stories that speak to a vital question: “How would life be better for so many people if Alabama expanded Medicaid?”
Stories from Alabama’s coverage gap
Like Kayla, a young stylist who is at the pinnacle of her career. Even so, she has reservations about becoming pregnant and having a child while she has no health insurance. There are some possibilities that she just can’t afford.
Kayla performs a color service on a client at her salon in downtown Birmingham. (Photo by Whit Sides)
Or Eryn Mullins, a new mom from Sumiton. She opened up to share her heart-wrenching story of navigating the mental health landscape in our state as a new stylist with no employer-provided health coverage. She needed help but couldn’t afford it.
A path forward to close the coverage gap in Alabama
Hundreds of thousands of Alabamians are in the health coverage gap. Most of them are working at low-paid but essential jobs. They’re folks we see every day but may not realize are living without access to health care. Medicaid expansion would ensure they have the health coverage they need to survive and thrive.
With so many working folks in the gap, Medicaid expansion is an essential solution to save lives and make Alabama a healthier place. It would help real people across our state. And it would be an enormous financial boost for workers and businesses.
We encourage y’all to share these stories with state leaders in your district, as well as Gov. Kay Ivey. There’s never been a better time to, as Mert said herself, create more revenue for local businesses and put more money into workers’ pockets.
It’s been a privilege to collect these powerful stories and share them with the world. And we can’t wait to tell even more stories in the months to come. Thank you for your support of Arise and for being part of our work to make life better for all Alabamians.
Just outside the Forecast Salon in Homewood is a gigantic mural painted along the wall. It features every color of the rainbow jumping out into the street. You’re up close with a 10-foot disco ball painted right beside a unicorn and two massive blue and purple manicured coifs.
Forecast’s owner Brittany McNaughton (friends call her Mert) chose the bright and welcoming mural as a manifestation of her personal philosophy.
“Big! Bold! Sunshine!” she says as we look at it. “The vibes are all there!”
The mural outside the Forecast Salon in Homewood, after its completion in February 2023. (Photo by Whit Sides)
Mert and Forecast’s co-owner, Mark Hyde, had a lot to look forward to in February 2020.
They had just reopened their salon in Homewood, just south of Birmingham, after an extensive expansion. Forecast had to shut its doors for three weeks. The renovations brought the space up to 16 chairs and almost doubled the original floorspace. The future looked bright.
Then the COVID-19 pandemic hit, and their world stopped.
“We’d been open for five years, but when 2020 happened, it felt like I had to go dark,” Mert said. “This massive adrenaline rush told me I had to stop expanding and keep my business afloat.”
Mert had just brought on some new stylists, and she said she probably could have hired even more. But soon she learned that the pandemic was shifting her focus from growth to her staff’s “mental capacity.”
Mert said that’s when she realized the shutdown would be longer than three weeks. And it wasn’t just about closing the physical doors to the shop.
“We went from managing everyone’s safety to all of a sudden seeing where our staff was just not doing so well,” she said.
More than just a paycheck
In a rare move in the salon industry, Forecast offers to pay for a portion of its stylists’ health insurance. After two years, they also contribute to employees’ 401(k) retirement accounts.
Another benefit that Mert said was useful during the pandemic was flexible scheduling. She said stylists are encouraged to take personal days off, especially for mental health.
“Whenever you have someone that’s not doing great personally or mentally outside of work, they bring that energy in with them into the workspace, and it can affect the people around you,” Mert said.
Mark Hyde serves a client at the Forecast Salon in Homewood. (Photo by Whit Sides)
Gov. Kay Ivey allowed barbershops and salons to reopen in May 2020 after the initial wave of pandemic shutdowns. It was a first step toward returning to business as usual. But for stylists, that meant getting up close and personal again – and many weren’t ready.
“We work in such an intimate space,” said Mark, Forecast’s co-owner. “We’re up close, touching our clients. It sometimes takes years for these young stylists to build up trust but also build up a shell that can protect them from negative energy or venting clients day in and day out.”
A focus on mental health
Mark and Mert decided to shore up the salon’s career development offerings beyond just continuing education on hair. They brought in local therapists, healers and self-help experts to discuss mental health. Their goal was to help teach stylists how not to take the stresses of personal care work home with them.
“Moving out of the pandemic, I saw a need to bring in programming focusing specifically on mental health and not just hair,” Mert said.
Mark and Mert agree that they can’t do it all. But they said they try their hardest to provide as much as they can for their staff.
“Nowhere is perfect,” Mert said. “I set standards for mental health here in the salon, but I’m not trained to treat anyone’s problems. I’m trained to do hair. That’s where therapists and doctors come in.”
More money in the pocket for both stylists and salon owners
Mert said she hopes that one day all salons will offer health insurance and other benefits. But she also said she knows that’s not a realistic option for all salons. And unfortunately, that means many stylists will have no affordable option for health coverage unless Alabama expands Medicaid.
Across Alabama, about 10,000 stylists and other personal care workerswould benefit from Medicaid expansion. More than 220,000 Alabamians are caught in the coverage gap, unable to afford health insurance. Another 120,000 or more are stretching to pay for private or employer-based insurance.
Part of Forecast’s recent renovation was expanding to hire more younger stylists and apprentices into their already robust education program. Not everyone at Forecast would qualify for coverage under Medicaid expansion, but most newer stylists likely would, Mert said.
Both owners agree that it would be nice to be able to pay stylists an extra $200 to $400 every month. That amount could help cover their groceries or a car payment.
“It’s expensive to provide insurance as a business. That’s why a lot of people don’t do it,” Mert said. “Medicaid expansion would end up creating more revenue for the business and put more money into that stylist’s pocket.”
Mert McNaughton smiles behind her desk in the Forecast Salon in Homewood. (Photo by Whit Sides)
I asked Mert what Forecast Salon would do with the extra money when the day finally comes.
“As a business owner, I already know what I’m gonna do with that money,” she said. “Invest it right back into our people.”
ABOUT ALABAMA ARISE AND COVER ALABAMA
Whit Sides is the Cover Alabama storyteller for Alabama Arise, a statewide, member-led organization advancing public policies to improve the lives of Alabamians who are marginalized by poverty. Arise’s membership includes faith-based, community, nonprofit and civic groups, grassroots leaders and individuals from across Alabama. Email: whit@alarise.org.
Arise is a founding member of the Cover Alabama coalition. Cover Alabama is a nonpartisan alliance of advocacy groups, businesses, community organizations, consumer groups, health care providers and religious congregations advocating for Alabama to provide quality, affordable health coverage to its residents and implement a sustainable health care system.
Eryn Mullins (left) smiles alongside her husband, Zach. Eryn is a hairstylist from Sumiton who struggled to afford mental health care after becoming uninsured at age 26. (Photo courtesy of Eryn Mullins)
Social media can be overwhelming. Like a lot of people, I’ve found myself stepping back from it lately. There is one thing I will never scroll past, though: baby pictures. (Well, that and jokes.)
And Eryn Mullins is good for both.
Eryn is a new mom and hairstylist from Sumiton, a small town in Walker County in northwest Alabama.
I spoke to her the week she returned to work after her maternity leave. Thanks to her husband’s insurance, she and her baby were well cared for during labor, delivery and the postpartum period.
The smiles in her family photos jump through the screen. It’s hard not to think she’s got it all together.
But Eryn will be the first to tell you that it wasn’t always this way. Things were much different for her just a few years ago.
‘A million things to worry about’
“Straight out of beauty school, there’s a million things to worry about,” Eryn said. “When I was 20, I suffered from extreme panic attacks, and I needed to be hospitalized. After that, it still took eight months and four or five different medications to get to a steady place.”
Eryn was diagnosed with a panic disorder that gave her “anxiety that you couldn’t just fix.” Her condition required regular doctor’s visits and consistent medication. Thanks to her dad’s insurance, she was able to keep everything under control.
“I was on my dad’s insurance, and then suddenly, I wasn’t. I was uninsured for three years after that,” Eryn said.
“I got a hospital bill for $2,500, and that’s when I decided I was going to try my hardest to not go to the doctor ever again.”
Cold turkey
One thing Eryn didn’t plan for was having to come off all her medications immediately. For her, “cold turkey” meant no prescription refills. It also meant no talk therapy and no visits with a psychiatrist to manage her mental health.
“I experienced so many adverse side effects that put me back in the hospital, suffering from withdrawal,” she said. “We all have brains; not all of them are healthy. Mine wasn’t.”
Any way Eryn looked at it, she was paying hundreds of dollars out of pocket every few months. Sometimes it was for a hospital stay. Once, she spent $400 for just one routine visit with a mental health provider.
“I worked in a high-stress environment my first year as a stylist,” she said. “It’s a vicious cycle. I needed mental help but couldn’t afford it.”
Being uninsured is expensive. And without consistent medical or mental health coverage, those expenses mount for many stylists. After facing a $2,500 medical bill while uninsured, Eryn told herself she would do whatever she could to avoid going to the doctor.
Unfortunately, Eryn is not alone in receiving eye-popping medical bills while uninsured. Most of her coworkers are uninsured, she said, and seeing them navigate that is heartbreaking. More than 22% of people in Walker County are facing medical debt along with her right now.
In all, 6,108 people in Walker County do not have health coverage. That number would drop by more than halfif Alabama expanded Medicaid to cover adults with low incomes.
Across Alabama, about 10,000 stylists and other personal care workers would benefit from Medicaid expansion. More than 220,000 Alabamians are caught in the coverage gap, unable to afford health insurance. Another 120,000 or more are stretching to pay for private or employer-based insurance.
‘Hanging up the apron’
Hairstylists often can set their own schedule, but that means income fluctuates. And especially in the beginning, they are paying for all their own supplies and losing a lot of money.
“Starting off as a new stylist is the hardest part,” Eryn said. “There’s no method to the madness.”
Eryn said it is becoming more common to see coworkers “hang up their apron.” That’s code for leaving the hair business altogether, often to train in another industry.
“It’s exhausting,” she said. “I feel like everyone I know is always putting money back, for every little (and big) thing. And you have to be really lucky to even have any left over for medical bills.”
Eryn said she loves what she does and doesn’t plan on quitting anytime soon, though she jokes about it sometimes.
“There are days where I debate working at Big Lots or Walmart. It’s steady, and they probably get insurance at full time,” she said.
A path forward
After seeing so many friends walk away from behind the chair, Eryn said she didn’t know how she would make it as a mom and a stylist.
“We were expecting our first baby soon, and I had no idea how I would handle maternity leave,” she said. “I was able to make a deal on my booth rental, but that’s it. If I didn’t have the support of my husband, I don’t know if I could even afford a child.”
Eryn Mullins (right) enjoys a moment with her husband, Zach, and their newborn child in March 2023. (Photo courtesy of Eryn Mullins)
Through it all, Eryn said she still would choose to become a stylist all over again.
“I’m glad I stuck with it,” she said. “It was a rough few years, but now I get to coordinate my life and schedule the way I want, which is much better for my mental health. I think that’s probably true of any career.”
Eryn said she hopes discussing her experiences can help improve life for hairstylists and other Alabamians living without health coverage.
“I wanted to share my story because it’s worth it to me if even one person feels less alone,” she said.
ABOUT ALABAMA ARISE AND COVER ALABAMA
Whit Sides is the Cover Alabama storyteller for Alabama Arise, a statewide, member-led organization advancing public policies to improve the lives of Alabamians who are marginalized by poverty. Arise’s membership includes faith-based, community, nonprofit and civic groups, grassroots leaders and individuals from across Alabama. Email: whit@alarise.org.
Arise is a founding member of the Cover Alabama coalition. Cover Alabama is a nonpartisan alliance of advocacy groups, businesses, community organizations, consumer groups, health care providers and religious congregations advocating for Alabama to provide quality, affordable health coverage to its residents and implement a sustainable health care system.
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.
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.
“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.
Kayla performs a color service on a client at her salon in downtown Birmingham. (Photo by Whit Sides)
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.
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.”
Trent Thomas is a stylist at Orbit Salon in Birmingham. He receives health insurance through his job, but he spent more than a decade before then living without coverage. Being uninsured meant enduring pain and deferring needed care. (Photo by Whit Sides)
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 Thomas styles his client Jason’s hair at Orbit Salon in Birmingham. (Photo by Whit Sides)
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
Trent stands outside Orbit Salon in Birmingham’s Five Points South neighborhood. (Photo by Whit Sides)
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 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.
Katie Franklin is a mother of two who works as a nail technician and front office manager at a salon outside Birmingham. She works full time but cannot afford health insurance. Medicaid expansion could empower her to get medical care when she needs it. (Photo courtesy of Katie Franklin)
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 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.
