Lessons from Medicaid postpartum care coverage advocacy efforts in Alabama with Alabama Arise

On April 7, Governor Kay Ivey (AL) signed into law an extension of Medicaid’s postpartum care coverage in her state. This is a tremendous win for health care advocates in the state, and, more broadly, across the South, who have long advocated for closing the insurance coverage gap for all. This policy change is an important step in improving health outcomes for new mothers and children, and reducing Alabama’s high maternal mortality rates, by extending Medicaid coverage from sixty days to a full year after birth.

I recently sat down with Robyn Hyden, Executive Director of Alabama Arise, one of the core members of the Cover Alabama coalition, to chat about her top learnings coming out of this legislative session and what she’s looking forward to in the year ahead.

Megan, Rx: Can you share with me a few lessons you’ve learned coming out of the latest legislative session, and off of the postpartum expansion policy win in particular?

Robyn, AL Arise: One lesson learned for me was about coalescing such a broad coalition around such a narrow policy. We’ve never had a conflict with the ultimate goal of the Cover Alabama coalition — to expand Medicaid — but we’ve now gotten into two years of driving towards expansion without a significant legislative victory and people are like “It’s time to get this, we can do this”. And I think listening to our partners, like the American Heart Association, March of Dimes, and the Women’s Foundation of Alabama, who were like “You really need to fight this, you can win this, we are able to do it”, that was a lesson learned. There was a lot of back and forth with the legislators. They did not want it to be a full year and we didn’t know why. At one point, there was an opportunity for us to say “six months is better than nothing” and just take what we could but our partners pushed back and said “No, we’re going to fight it and we’re going to get our legislative champions to actually come forward with legislation if it’s not in the budget”. A big turning point was that we not only had strong Democratic women, lawmakers who had advocated for postpartum expansion for years and have introduced the bill repeatedly, we also had a Republican woman from a rural county whose daughter had dealt with serious postpartum depression and wanted to bring the bill forward. So, they did.

Another lesson learned would be that we always need some sort of incremental win that we can push towards while we are climbing this big mountain. That was important too.
Finally, oftentimes with issues like this, we’re made to feel like the only way we can win is for us to get the very conservative voices at the table. And they were our allies. When we talked to them, they agreed, we should give new mothers healthcare. We also need to speak authentically and legitimately for ourselves and say this is also an issue for us about dignity, of supporting people from birth to death in our state. We don’t have to adopt some sort of persona that is not authentic to us, but we should lead with our values and talk about it more. We care about families, moms, kids, parents who don’t identify as moms and have babies. All of those people matter to us and are important. I think the conversation about healthcare in conservative states is “you have to find this right-wing frame for the values” and that was not the case for us. We had over 25 different groups recently submit organizational statements celebrating the victory, and one of the journalists shared on Twitter that “I’ve never seen so many organizations quoted in one release: Nonprofits, faith groups, community groups, all of AL’s major medical orgs, social justice folks, churches”. Everyone essentially agreed on this common-sense policy. That was a huge lesson about values and how we approach this work.

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Megan, Rx: What advice would you like to share with others who are organizing for progressive policy change and facing similar challenges in their states?

Robyn, AL Arise: I would just say to everyone fighting in whatever state context you are, I came to Alabama Arise almost ten years ago as a community organizer working on the ACA implementation. It has been over ten years of struggle to fully realize getting as many eligible people as possible covered. I remember going all over the state talking to some of the same advocates who are still fighting, and I think it takes a certain stick-to-it-ness to say even if we’re fighting, even if it’s a decades long fight, we know we will win. That’s why we keep fighting. So, I think a victory like the one we had, it was an outcome of many, many years of work by many, many dedicated leaders who did not give up on hope. I would hope that for anybody who’s feeling a sense of despair or loss because we fight really hard on things that we don’t always win to just keep at it because we’re not going to have healthcare for everyone tomorrow, but I believe that we will in my lifetime. And we had our forebears who believed that and laid the groundwork for us to do our work.

Megan, Rx: What are you most excited about when looking at the year ahead?

Robyn, AL Arise: We’re in a period of growth. Not just for our organization but for all of the progressive infrastructure in the South to make forward progress. We’ve been able to grow our team; I just got off a call with partners who are key in Alabama, who now have more people at the table with the resources to do the type of work we want to do. So, I’m feeling very positive about not only the potential for Medicaid expansion but also for patient-focused Medicaid reforms since we now have more people on Medicaid in our state than ever before because of the public health emergency. We have a tremendous opportunity to connect more with Medicaid members and say, “What can we do to make your healthcare better?” Alabama passed sweeping reforms about four or five years ago that just started to go into effect pre-pandemic, and it’s been very slow going. They have structure in place to make the care more coordinated around the patient’s needs. So, we have the opportunity to make Medicaid better and improve the outcomes for children on Medicaid, elderly folks, people with disabilities. We also have the opportunity as an organization to build worker power and voting rights with dedicated staff people. It’s a little bit daunting; but the more people who are at the table, who are moving in unison, the better we’re going to be.

Alabama Arise

A Building Capacity for Health Advocacy grant expanded the Cover Alabama initiative, adding dedicated field staff and substantially growing coalition membership.

Green Arrows

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