“I try not to go until I absolutely have to”, said Katie Franklin, a single mother of two, working fulltime as a nail technician and front office manager at a salon outside of Birmingham, Alabama. Franklin is referring to delaying necessary and preventive medical care, since she currently does not qualify for Medicaid coverage. Without health insurance, Franklin delays seeking care until she absolutely has to because privately paying often means accruing hefty medical debt.
Alabama is one of ten states that has not yet expanded Medicaid. As a result, hundreds of thousands of Alabamians like Franklin, who work full time but are still uninsured, fall in the health coverage gap – they cannot afford private health insurance but are ineligible for Medicaid coverage due to income qualifications. In Franklin’s case, for a family of three, she would have to make less than $4,145 a year to qualify for Medicaid.
Nationwide, Franklin is one of 2.3 million people in America who would gain access to health coverage if the ten remaining states – Alabama, Florida, Georgia, Kansas, Mississippi, South Carolina, Tennessee, Texas, Wisconsin, and Wyoming – expanded Medicaid eligibility in 2024 under the Affordable Care Act, according to a new report issued last week (Oct-23-2023) by the Robert Wood Johnson Foundation (RWJF) and the Urban Institute (UI).
One key finding from their report was that if eligibility were granted to individuals with incomes up to 138% of the federal poverty level, “non-Hispanic Black people, young adults, and women, particularly women of reproductive age” are among the populations with the highest gains in coverage. For instance, non-Hispanic black women of reproductive age “would see a 51.3% reduction in uninsurance” rates, the “largest change of any group” RWJF and UI analyzed.
In light of this new report emphasizing the need for Medicaid expansion, we want to highlight three of our state partners in Alabama, Mississippi, and Tennessee, all of whom are strong and vocal advocates for high-quality, affordable, and accessible healthcare.
In Alabama, nearly 300,000 people fall into the health coverage gap. Restaurant servers, cashiers, carpenters, landscapers, office clerks, tailors, bus drivers, barbers, mechanics and more all are living and working without affordable or accessible high-quality healthcare.
One of the leading advocates for Medicaid expansion in the state is Alabama Arise, a member-led organization advancing public policies to improve the lives of Alabamians who are marginalized by poverty. Their membership includes faith-based, community, nonprofit and civic groups, grassroots leaders and individuals from across the state.
Alabama 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.
Most recently, in response to Cover Alabama’s advocacy efforts, the State extended, on a pilot-project basis, postpartum Medicaid coverage from 60 days to one year. That’s a major achievement, as about 30,000 births in Alabama are covered by Medicaid annually, and many postpartum health problems occur after 60 days.
However, the State has yet to pass overall Medicaid expansion. There’s a lot more work to do. This September, a new Georgetown University Center for Children and Families released a report confirming that expansion would improve women’s health outcomes and expand access to maternal health care across the state, as currently one in six Alabama women of reproductive age are uninsured. Living without health insurance can be fatal, as Alabama ranked the third-worst in maternal mortality between 2018 and 2020, and infant mortality rates were 33% higher than the national average.
Alabama Arise’s Cover Alabama campaign director, Debbie Smith said, “State leaders showed they’re willing to address Alabama’s maternal health crisis when they extended Medicaid postpartum coverage last year. However, these findings show that this step alone is not enough to help mothers and families stay healthy. Alabama should take the next logical step to protect women’s health and expand Medicaid coverage for adults with low incomes”.
To make matters worse, rural hospital closures have left women without readily accessible maternity or obstetric care. Transportation barriers and reduced timeliness of care result in increased barriers for women and potentially life-threatening consequences. Medicaid expansion would not only extend health coverage to tens of thousands of Alabama women who currently cannot afford or access care, but has the potential to avert future rural hospital closures that make healthcare accessible to the masses.
For women like Katie Franklin, having Medicaid coverage would mean no longer having to choose between forgoing or delaying medical care, or accruing medical debt when seeking it. “Every Alabamian should be able to get the medical care they need to survive and thrive,” said Debbie Smith. “Removing financial barriers to health care would make our workforce more robust and more productive. It’s time for Alabama policymakers to close the health coverage gap and invest in a healthier future for our state and for our people.”
Alabama Arise and the Cover Alabama coalition will continue to fight and advocate for a future where all Alabamians have a chance to thrive, regardless of their income or background.
Mississippi Health Advocacy Program
Mississippi Health Advocacy Program (MHAP) has served as a convener, and played an integral part in all of the major consumer health policies in Mississippi since its inception over 28 years ago. Today, MHAP continues to shape the debate on issues that affect low-income families in Mississippi, with a specific focus on Medicaid education and advocacy, by working within partnerships and building consensus about health policy issues.
In Mississippi, MHAP is a leading voice in the fight for Medicaid expansion, as a co-chair of the Care4Mississippi Coalition. This Coalition is made up of dozens of organizations united in their efforts to extend access to quality, affordable health coverage and care.
Like Alabama, Mississippi is one of ten states that has yet to expand Medicaid. As a result, “Hundreds of thousands of Mississippians are struggling without health insurance,” Roy Mitchell, Executive Director of MHAP, recently shared in an interview. “Until Medicaid is expanded, Mississippi will continue to pay the price in lost dollars, lost jobs and lost lives.”
According to KFF, if Medicaid coverage were to be expanded to adults with incomes up to 138% of the Federal Poverty Level, nearly 166,600 uninsured Mississippians would become immediately eligible for healthcare coverage, a majority of which are people of color.
Recent survey findings of everyday Mississippi residents, conducted by Altarum’s Healthcare Value Hub in partnership with the Mississippi Health Advocacy Program, revealed that 63% of people have been forced to decide between delaying or forgoing medical care due to finances in the last 12 months. In response to their findings, Roy Mitchell shared “it’s time for our lawmakers and policy leaders to listen to us and act accordingly. The health of the people in our state cannot wait. We can no longer stand by and watch while families and communities experience adverse health outcomes that could be treated or prevented with health coverage.”
Earlier this year, Mississippi joined 29 other states when extending coverage for new mothers, postpartum, up from 60 days to one year. Health advocates had long cited the state’s increasing maternal mortality rate, and highest infant mortality rate in the country, as evidenced-based reasons to extend coverage and improve health outcomes for babies and mothers. Still, Mississippi remains without overall expansion.
Polls conducted last August showed strong favorability for overall Medicaid expansion, with 72% in favor. MHAP and the Care4Mississippi Coalition remain steadfast in their commitment to creating access to affordable and quality healthcare, so that all Mississippians can get the health coverage and care they need.
Tennessee Health Care Campaign
Tennessee Health Care Campaign is a statewide, volunteer-led, nonprofit that believes all Tennesseans deserve affordable, high-quality, and equitable access to healthcare. Their mission is to advocate for policies and programs that improve the health and wellbeing of Tennesseans.
One of their three statewide goals is to increase access to care through Medicaid expansion through mobilizing and engaging consumers, volunteers, and communities; providing policy analysis, education, and advocacy; and building coalitions and strategic alliances with stakeholders, including serving on the TennCare Advocates Coalition, among other key strategies.
In 2021, THCC’s Rural Health Equity Committee and its partners at Vanderbilt University Medical Center released a report on Rural Hospital Closures to identify contributing factors and resulting effects in an effort to prevent future closures, and to offer strategies and booster advocacy to reestablish healthcare infrastructure across the state. According to the report, “since 2010, Tennessee has had the second highest number of hospital closures in the nation, and the highest number of closures per population”. As a result, 25% of Tennessee counties have no hospital, and 20% have no emergency room services.
The state’s failure to expand Medicaid has resulted in over 300,000 low-income Tennesseans without health insurance, including many rural residents, who are often older and have more chronic health conditions requiring monitoring and treatment. For them, hospital closures are an added burden. Without readily accessible care in their counties, low-income residents, the elderly, chronically ill, and mothers and newborns have to travel up to 60 miles away for specialty or emergency care, or experience extended ambulance times. As one rural Tennessean shared with THCC, “the ambulance is our emergency room”.
Hospital closures also stall or altogether halt job creation, as it becomes harder to attract employers, residents, or retirees when you don’t have accessible healthcare services in your county. As one focus group respondent shared with THCC, when “you take 150 jobs out of a small county, it has a big economic effect”.
Non-expansion states are especially vulnerable to hospital closures. In a recent Families USA report, “Medicaid expansion is one of the best steps non-expansion states can take to address looming uncompensated care increases [at rural hospitals]”, a phenomena created when uninsured people, without any other options or access to care, visit rural hospitals for treatments.
To address these interlocking issues, THCC is leading the Campaign for Rural Health Improvement, lifting up stories of Tennesseans who struggle with access to care, spotlighting innovation and successes in rural communities, and providing action alerts and dialogue on rural health policies at the state and federal levels among Tennesseans and with lawmakers. The campaign is open to all who live, work, play or pray in rural Tennessee, including business leaders, health professionals, and people with lived experience with the healthcare system.
The Tennessee Health Care Campaign is calling for better health policies in Tennessee to protect its rural communities, and banding together its residents to advocate for improved rural health.
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