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Reflections from State of the South: Closing the Healthcare Coverage Gap in Alabama

In November, State of the South held its fourth convening in Birmingham, Alabama. Meeting over lunch, community members, nonprofit leaders, business owners, policymakers, and artists gathered to discuss the benefits of and barriers to closing the health insurance coverage gap in Alabama.

Following the event, we invited panelists and participants to reflect on their experiences.  We’re honored to share with you this reflection from Debbie Smith and Whit Sides at Alabama Arise.

Stories at MDC event reveal Medicaid expansion’s life-changing potential in Alabama

Medicaid expansion would empower nearly 300,000 uninsured and underinsured Alabamians to access the health care they need to survive and thrive. Alabama Arise and Cover Alabama were proud to attend a Nov. 6 community discussion in Birmingham titled “Closing the Healthcare Coverage Gap in Alabama.”

The panelists – including Dr. Khalilah Brown, vice president of medical affairs and patient advocacy at Southern Research, and Jane Adams, government relations director at the American Cancer Society Cancer Action Network – discussed how expanding Medicaid would bring federal funding into Alabama. They also spoke about how closing the coverage gap would create jobs in health care and related sectors, bolstering local economies and reducing uncompensated care costs for hospitals and providers. Both speakers made a compelling economic and budgetary case for why Alabama should expand Medicaid as soon as possible.

The need to center people when discussing Alabama’s health coverage gap

However, the focus wasn’t just about how Medicaid expansion would save our state money, improve our healthcare system and improve our state’s economy. The dialogue also drove home the importance of centering people in the Medicaid expansion policy debate.

That’s why we’re glad that personal stories of directly impacted people were featured heavily throughout the MDC event. Personal stories, like those shared through the Cover Alabama coalition, break down walls that keep policymakers and the public away from seeing the real experiences of people affected by our state’s failing healthcare policies.

These lived experiences are powerful. They help people understand and empathize, going beyond just talking about money and instead seeing how the coverage gap affects real lives.

For example, Kenneth King shared during the panel discussion about his experience living in the health coverage gap. Kenneth is an underemployed resident of Birmingham, where he lives with his wife and daughter. He chooses the term “underemployed” carefully, as a testament to the difficulty of finding and keeping work in the face of chronic health challenges, some life-threatening.

After facing health issues while uninsured, Kenneth has been left with more than $100,000 in medical debt. As a contractor, Kenneth hasn’t been able to get employer-provided health insurance. He makes too much for Medicaid but can’t afford coverage through the Health Insurance Marketplace. (In Alabama, a parent in a family of three only qualifies for Medicaid coverage if their annual income is below 18% of the federal poverty level. That’s just $4,475 a year.)

How the coverage gap harms Alabamians with cancer

Jenny Fine, originally from Enterprise, Alabama, also shared how the coverage gap hit home for her. Jenny recently lost her sister to pancreatic cancer. Navigating care can be hard even in the best of times for those with a cancer diagnosis. But Jenny’s sister also faced long waits to see a doctor and a lack of treatment options when their local hospital became overwhelmed.

Smaller regional hospitals bear the brunt of uncompensated care, adding up to $13.4 million in 2021 in Coffee County, where Jenny’s family calls home. Expanding Medicaid would reduce that county’s adult uninsured rate by nearly half (42%), and it would add $68.2 million to the local economy in the first year alone. That would mean nearly 2,000 people like Jenny’s sister in that county alone would gain the life-saving coverage they need under expansion.

One of the most powerful moments of the event came when attendee Callie Greer shared the story of her daughter Venus. Venus was in the coverage gap and received her breast cancer diagnosis too late because she did not have access to the preventive care she needed. Venus only received help after countless expensive visits to the emergency room.

Callie told the audience that on one of Venus’ final desperate ER visits, a doctor walked in the room and asked, “What’s that smell in here?” Venus replied, “It’s my breast!” Her breast was literally rotting away from cancer. She went through a radical mastectomy and started chemo, then radiation. The treatment helped for a few months, but it proved too late to save her life.

The path to making Medicaid expansion a reality in Alabama

Personal stories like these, paired with grassroots action, are ultimately how Medicaid expansion is going to become a reality in Alabama. Finally closing the coverage gap depends on highlighting these stories of real Alabamians and working together to push our state leaders for change. As we reflect on these poignant stories shared at the MDC event, it’s crystal clear that Medicaid expansion isn’t just a policy discussion. It’s about lives, families, and communities.

The time to act is now. Together, we can urge policymakers to listen to these stories, to recognize the human cost of inaction, and take the necessary steps to close Alabama’s health coverage gap. You can help us: Contact your legislators, share your story, and join the Cover Alabama campaign.

Let’s ensure that no one else suffers the tragic consequences of being left in the coverage gap. Join us in demanding a healthier, more equitable future for all Alabamians.

Debbie Smith is the campaign director of Alabama Arise’s Cover Alabama campaign. Whit Sides is the storyteller for Alabama Arise’s Cover Alabama campaign. Visit for more information on how you can get involved.

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