Issue: Health

Closing the health coverage gap: Alabama must enact policies to save lives

By Alabama Arise

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By Jennifer Harris, senior health policy advocate, and Debbie Smith, Cover Alabama campaign director

As Alabama enters the 2026 legislative session, Medicaid expansion and maternal health will be central to the state’s health equity conversations. Recent federal policy changes have made these conversations more urgent and more complex.

Alabama Arise will continue to support health investments to save lives, create jobs and protect rural residents across our state. This will include advocacy to close the state’s health coverage gap through Medicaid expansion. We also will urge lawmakers to approve legislation to protect and expand access to comprehensive maternal health care.

Federal policy changes are reshaping Medicaid financing

Alabama remains one of only 10 states yet to expand Medicaid. As a result, hundreds of thousands of Alabamians are caught in the state’s health coverage gap, earning too much to qualify for Medicaid but too little to qualify for Marketplace insurance subsidies under the Affordable Care Act (ACA).

HR 1, the so-called One Big Beautiful Bill Act, eliminated a two-year increase in the federal Medicaid match rate that was available to states that expanded Medicaid. This increased match rate was an additional incentive for states that had not yet expanded Medicaid to cover adults
with low incomes to do so.

For Alabama, the federal incentive eliminated under HR 1 would have brought an estimated $619 million in federal funding for two years. That would have been enough to cover at least the first two years of Medicaid expansion.

Without this incentive – which would have been in addition to the ongoing 90-10 federal match rate for covering residents under Medicaid expansion – expanding Medicaid will cost more. It also will require identifying new, sustainable financing sources.

Provider tax changes create additional budget constraints

Federal changes under HR 1 also restrict how states can use provider taxes to finance Medicaid. Under HR 1, Alabama would be required to reduce Medicaid provider tax collections if it expanded Medicaid in the future.

This provision could result in Alabama losing more than $100 million in health care revenue annually if the state expanded Medicaid. Arise will continue making the case that lawmakers should not pit current Medicaid enrollees against people who need coverage but cannot afford it.

Affordable coverage through Healthcare.gov remains at risk

At the same time, affordability challenges are growing for people who receive health coverage through the ACA Marketplace. Enhanced premium tax credits (ePTCs) have helped nearly 500,000 Alabamians afford coverage through Healthcare.gov. But the ePTCs expired Dec. 31, and Congress has yet to renew them.

As a result, many Alabamians’ monthly health coverage premiums will double – or increase by even more. An estimated 130,000 Alabamians are expected to lose their health coverage because of this change.

Persistent gaps in health coverage and outcomes

Nearly 200,000 adults remain stuck in Alabama’s coverage gap. And that number unfortunately is expected to grow since the ePTCs expired.

At the same time, Alabama continues to rank poorly on key health outcomes, including infant and maternal mortality. These realities make clear that coverage policy and maternal health outcomes cannot be addressed in isolation.

Building on progress to improve maternal health

Despite these systemic challenges, Alabama has made strides in improving maternal health in recent years. extending Medicaid postpartum coverage. These steps have included removing paperwork obstacles to maternity Medicaid coverage and ensuring paid family leave for state employees, K-12 teachers and two-year college workers. Lawmakers also eliminated the state sales tax on many maternity and infant items.

Here are Arise’s recommendations for next steps that legislators can take to improve maternal health care outcomes in our state:

  • Increase provider access for new moms. Alabama should act now to close maternal health deserts throughout our state. Moms in rural areas need access to birth workers, including doctors, midwives and doulas.
  • Protect access to contraceptives. Contraceptives are important to reproductive health and meeting family planning needs. These contraceptives should be readily available and affordable.
  • Ensure doctors can perform life-saving procedures and preserve fertility without fear of criminalization. Moms need safe, appropriate health care during pregnancy when complications are present. Doctors should not have to fear prosecution over providing such essential life-saving care.
  • Ensure a healthier start for newborns. Arise advocates for policies that promote a healthier start for newborns and their families. This includes support for HB 54, known as the Women’s CARE Act. This bill by Rep. Rolanda Hollis, D-Birmingham, would allow many pregnant moms sentenced to incarceration to serve supervised probation until 12 weeks after childbirth.

Bottom line

Alabama faces many difficult but important decisions about Medicaid expansion, health care affordability and maternal health. Federal policy changes have made inaction more costly, while coverage gaps and poor health outcomes continue to affect families across the state.

By addressing financing challenges, protecting access to coverage and building on recent maternal health progress, Alabama has an opportunity to move toward a more equitable health care system that better supports moms, babies and communities statewide.

Building on our momentum for the new year

By David Stout

As we close out 2025, Arise members and member organizations can reflect on a very successful year. Reducing the state sales tax on groceries from 3% to 2% and guaranteeing more students in public schools get a free breakfast with a $7.3 million budget appropriation were two of the biggest highlights worth celebrating. 

Improvements were also made in maternal health, including tax cuts passed for maternal and infant care products as well as those that fell under the “pink tax” such as diapers, baby formula and feminine hygiene products. Expecting mothers became eligible for Medicaid during the early days of their pregnancy, creating an increased opportunity for healthy pregnancies and babies. For the first time, a progressive model for parental leave for education employees and state workers became law. 

Arise aggressively fought to ensure SNAP benefits remained intact among federal changes. These successes come from the dedicated and engaged members who have remained steadfast in Arise’s mission to make Alabama more responsive to its citizens.

The 2026 legislative session, the last session of the quadrennium before lawmakers will face the public at the voting booth, is gearing up to be another busy time for Arise. Below is our roadmap for how we will prepare for the challenges ahead.

Health equity

Arise will continue our commitment to expand Medicaid and ensure health care for more Alabamians. With the growing lack of access to maternal health care, we will also continue the fight to protect and improve access for life-saving maternal care and contraception. In the realm of improving our current Medicaid coverage, Alabama is ranked 49th for dental care. We will work to expand access to adult dental benefits for Medicaid members.

Hunger relief

While 2025 saw a significant step forward in no-cost school meals, almost 30 percent of students still lack access to school breakfast or lunch. Arise will work to protect and expand funding for school meals as well as the Summer EBT program (now SUN Bucks) for low-income students. Arise will also be a voice of reason to block ill-intended limitations on the purchase of certain items under SNAP guidelines.

Adequate state budgets

With the constant waste of lucrative tax incentives going to big corporations, we must remain vigilant to protect our budgets from excessive giveaways, ill-conceived tax exemptions and tax credits. The biggest threat to the Education Trust Fund is the relatively new tax credit for private school students from the CHOOSE Act that allows up to $7,000 per student, a drain on public school resources. 

If income caps are removed, more than $500 million in school tax dollars could go to previously enrolled private school students. In 2026, Arise will continue to oppose any expansion of the CHOOSE Act.

Alabama does not currently provide any state funds for the Housing Trust Fund to support more affordable housing for low-income, elderly, and disabled citizens. Equally insufficient is the state’s failure  to fund the Public Transportation Trust Fund, which could secure up to an 80% percent match in federal funds. Arise will continue to fight to fund the Alabama Housing Trust Fund and the Public Transportation Trust Fund.

Inclusive democracy

The constant effort to suppress voting in Alabama demands we expand voting rights with comprehensive legislation, including allowing people to cast an absentee ballot without unnecessary, trivial restrictions. We will work to remove barriers for people who have been banned from voting because of a criminal conviction. We will also continue to oppose laws attacking the inclusion of immigrants, Black Alabamians and other racial and ethnic minorities in our society. 

Justice reform

In 2018, Arise worked to eliminate judicial override, a policy that allowed judges to impose a death sentence against the will of the jury. Unfortunately, the law was not retroactive. With nearly 30 people still on death row because of this outdated and now illegal policy, it’s time to make judicial override retroactive and seek justice for those condemned.

We must also work to reform Alabama’s three-strikes law, which disproportionately impacts low-income defendants. Under this law, a person could be serving a life sentence because of a series of minor infractions. Adding to the burden of prison overcrowding, Alabama’s parole system has been plagued by unworkable guidelines, driving our prison overcrowding crisis and making our system more punitive, not restorative. It’s time to make the parole system more fair, transparent and efficient.

Tax reform

Faced with tariffs and increasing food costs, there’s never been a better time to fully eliminate Alabama’s tax on groceries. A larger share of the burden falls on those with lower incomes, who spend more of their income on food than the wealthy. Arise supports a more progressive and fair income tax that recognizes the inequities in our tax rates.          

Worker power

The newest priority on our 2026 legislative agenda is supporting worker power legislation in partnership with organized labor. Our primary goal will be to remove tax incentives from companies that employ child labor and violate workers’ rights. We will also work to expand paid parental leave policies to cover more state employees, teachers and other workers. Often, the person most abused is the temporary worker, who has no rights. Arise will work to pass workplace protections in a Temp Workers’ Bill of Rights to improve on-the-job conditions, along with a pathway for full-time jobs.

Long federal road ahead for SNAP, health care

By Alabama Arise

By Carol Gundlach, senior policy analyst, and Debbie Smith, Cover Alabama campaign director

Alabama Arise believes that society should care for the most vulnerable in our nation—children, the elderly, those who are disabled and those who have fallen on temporary hard times. Since the Great Depression, Americans have been assured that, no matter how hard times get, our basic nutritional needs would be met by our government.

But 2025 has been a head-spinning and traumatic year for the 750,000 Alabama recipients of SNAP food assistance (commonly called Food Stamps), a stable pillar in America’s response to poverty and hunger. For 60 years, through multiple federal shutdowns, budget crises and wars, SNAP assistance has reliably fed hungry Americans. 2025 was different. 

Bill doesn’t help those who need it

HR1, the budget reconciliation bill (or “One Big Beautiful Bill”) passed by Congress in July, made it harder for people to receive food assistance and reduced the amount of assistance available, even as grocery costs rose. Existing time limits and burdensome paperwork requirements for some SNAP recipients were expanded to include unhoused people, veterans, children aging out of foster care and elderly recipients. 

Non-citizens and refugees legally in the U.S. were denied food assistance. And states, for the first time, will have to pay for some SNAP benefit costs. By mid-2027, Alabama will have to come up with approximately $175M to pay for our existing SNAP program.

Shutdown deepened impact

The October federal government shutdown only made the food crisis worse. The United States Department of Agriculture (USDA) refused to use its emergency funds and instead cut off food assistance to 42 million Americans, including all SNAP recipients in Alabama. 

Food banks and pantries, bolstered by small state grants, tried to fill the gap but many of our neighbors faced hunger as the holidays approached. The ending of the shutdown allowed the Department of Human Resources to get SNAP benefits out in record time, but legal immigrants face immediate termination of SNAP benefits. And many more people face new, draconian time limits that began in December. 

And many of the same people face huge increases in the cost of their health care.

Health costs will soar

As of this writing, Congress has not extended enhanced premium tax credits (ePTCs), which lower monthly premiums for nearly 500,000 Alabamians who get their coverage through the ACA Marketplace. As a result, 130,000 Alabamians are expected to lose coverage. This decision threatens to roll back the significant progress Alabama has made in reducing its uninsured rate.

The enhanced tax credits have played a central role in that progress. Lowering premiums opened Healthcare.gov plans to workers who had long been locked out of affordable coverage. Nearly half of Alabama’s Healthcare.gov enrollees fall into income ranges that would qualify them for Medicaid expansion if they lived in the 40 states that have expanded. Without the credits, many will face premiums they simply cannot pay, increasing the number of uninsured at a time when families are already navigating high costs of living.

This shift will place additional pressure on Alabama’s health care system, especially rural hospitals and clinics that already struggle with staffing shortages, rising uncompensated care, and service reductions. 

HR 1 complicates health care access

Federal changes under HR 1 create additional challenges. The law eliminates financial incentives meant to help states like Alabama adopt Medicaid expansion, including extra federal funding that would have supported expansion startup costs for the first two years. It also places new restrictions on increasing provider taxes, which Alabama uses to help fund its share of Medicaid. These limits would become more restrictive if Alabama chose to expand Medicaid in the future, and even now, they place a long-term cap on our state’s flexibility to finance Medicaid as health care costs continue to rise.

HR 1 also shifts new SNAP funding responsibilities to states. This will strain the state budget at a time when food insecurity is rising and families are struggling to meet basic needs.

Taken together, these issues ensure that health care and food access will be unavoidable priorities in the 2025 legislative session. The coming year will bring real challenges, but it also offers Alabama lawmakers an opportunity and a responsibility to strengthen the state’s health and nutrition safety nets at a moment when Alabamians need them most.

Las prioridades legislativas de Alabama Arise para 2026

By Alabama Arise

Más de 150 grupos miembros de Alabama Arise y más de 1,500 miembros individuales eligen todos los años nuestras prioridades legislativas. Este proceso garantiza que los habitantes de Alabama más afectados por la pobreza participen de las decisiones. A continuación se enumeran las prioridades que nuestros miembros eligieron para 2025.

Para obtener una versión de este documento en PDF, haga clic aquí o en el botón de “Descargar” (Download) arriba.

Equidad en salud – Alabama debe salvar vidas, crear trabajo y proteger la salud rural cerrando la brecha de cobertura de Medicaid y mejorando el acceso a atención de maternidad de alta calidad.

Alivio del hambre – Alabama debe ayudar a las familias a prosperar al asegurar que todas las escuelas públicas puedan ofrecer comidas gratuitas para todos sus estudiantes y al proteger programas de nutrición vitales.

Presupuestos estatales adecuados – Los servicios públicos robustos amplían las oportunidades para todos. Alabama debe proteger la financiación para las escuelas públicas e invertir en vivienda asequible y transporte público.

Democracia inclusiva – Todos merecen tener su opinión en nuestra democracia. Alabama debe permitir el voto en ausencia sin excusas y eliminar barreras para la restauración de los derechos de voto para personas que no están involucradas.

Reforma de justicia – El sistema de justicia de Alabama debe enfocarse en rehabilitación, no en crueldad. Nuestro estado debe dejar de ejecutar a personas sentenciadas a muerte contra la recomendación de un jurado. Alabama también debe reformar la libertad condicional y las sentencias.

Reforma impositiva – Un sistema impositivo más equitativo puede ayudar a las personas en dificultades a llegar a fin de mes. Alabama debe quitar los impuestos a artículos básicos y asegurar financiamiento justo y sostenible para servicios vitales.

Poder trabajador – Alabama debe apoyar a la gente trabajadora quitando incentivos de impuestos a las empresas que violan las leyes de empleo de menores, extendiendo la licencia por paternidad/maternidad a más trabajadores y mejorando las salvaguardias para trabajadores temporarios.

Alabama Arise 2026 legislative priorities

By Alabama Arise

More than 150 Alabama Arise member groups and nearly 2,000 individual members choose our legislative priorities each year. This process ensures that Alabamians most impacted by poverty have a seat at the table. Below are the priorities that our members selected for 2026.

For a PDF version of this document, click here or click the “Download” button above.

Health equity –Alabama should save lives, create jobs and protect rural health care by closing the Medicaid coverage gap and improving access to high-quality maternity care.

Hunger relief – Alabama should help families thrive by ensuring all public schools can offer free school meals for all of their students and by protecting vital nutrition programs.

Adequate state budgets – Strong public services broaden opportunity for all. Alabama should protect funding for public schools and invest in affordable housing and public transportation.

Inclusive democracy – Everyone deserves a say in our democracy. Alabama should allow no-excuse absentee voting and lift barriers to voting rights restoration for disenfranchised people.

Justice reform – Alabama’s justice system should focus on rehabilitation, not cruelty. Our state should stop executing people sentenced to death against a jury’s recommendation. Alabama also needs to reform parole and sentencing.

Tax reform – A more equitable tax system can help struggling people make ends meet. Alabama should untax groceries and ensure fair, sustainable funding for vital services.

Worker power – Alabama should support working people by removing tax incentives from companies that violate child labor laws, extending paid parental leave to more workers and improving safeguards for temp workers.

What Alabamians need to know about Healthcare.gov tax credits and open enrollment for 2026

By Debbie Smith

Hundreds of thousands of Alabamians will face higher health care costs if Congress does not act to extend the Enhanced Premium Tax Credits (ePTCs) that make Healthcare.gov coverage more affordable. These tax credits reduce monthly premiums based on how much money a family makes. That helps families who don’t have access to health insurance through their jobs pay less for their coverage.

The ePTCs have helped hundreds of thousands of families across Alabama access care, fill prescriptions and stay healthy. With open enrollment beginning Saturday, Nov. 1, many Alabamians already have started seeing 2026 premiums that no longer include these extra savings, which are set to expire on Dec. 31, 2025.

Health coverage through Healthcare.gov has made a life-changing difference for families across Alabama. Today, more than 400,000 Alabamians pay lower monthly premiums thanks to these enhanced tax credits.

A smiling man wearing a white coat and holding a clipboard speaks with a woman wearing an orange blouse and blue jeans. Both are sitting in chairs. Text: "Alabama Arise blog post: What Alabamians need to know about Healthcare.gov tax credits and open enrollment."

Why this matters so much in Alabama

Because Alabama has not expanded Medicaid, our state relies heavily on the Healthcare.gov Marketplace to fill the health coverage gap and help working people get the care they need. Losing ePTCs would mean hundreds of thousands of Alabamians could no longer afford coverage. This would widen the gap between those who can see a doctor and those who cannot.

In fact, 51% of Healthcare.gov enrollees in Alabama would qualify for Medicaid if they lived in one of the 40 states that have expanded Medicaid. In the absence of Medicaid expansion, ePTCs are the only realistic path to affordable coverage for these Alabamians.

What’s at stake for Alabama

Who would be hit the hardest

  • Small business owners and self-employed workers. More than 65,000 Alabamians in this group rely on Marketplace coverage.
  • Older adults and families with modest incomes. A 60-year-old Alabama couple making $85,000 could see annual premiums for a standard plan jump from $6,970 to more than $27,000.
  • Households with low incomes. Individuals earning around $16,000 or families of four earning around $33,000 could be priced out of coverage entirely.

What to know for 2026 open enrollment

Open enrollment for Healthcare.gov plans runs from Nov. 1, 2025, through Jan. 15, 2026. This is the time for new and returning enrollees to shop for the coverage that best fits their needs and budgets. There is no one-size-fits-all option, but here are some key things every Alabamian should know:

  • Choose your plan by Dec. 15 for coverage starting Jan. 1, 2026. You can make changes through Jan. 15 if needed.
  • Update your information. If you have Healthcare.gov coverage now, review your contact details and income estimate to make sure your plan and tax credits are accurate. If your premium goes up, please let us know about it. We need to document how much costs have risen so we can advocate for you. Visit coveralabama.org/share or email coveralabama@alarise.org.
  • Stay informed. If Congress acts to extend ePTCs, premiums may decrease later in open enrollment, so check back in December for updates. Even if Congress does not extend ePTCs, most Marketplace consumers still will receive some level of help in 2026. But this amount likely will be far less than participants may have received before.
  • Get free local help. Talk to a navigator with Enroll Alabama for trusted, no-cost enrollment assistance. Navigators can help you compare plans, understand your options and sign up for coverage. Visit EnrollALA.com or call 844-248-7698.
  • Beware of junk insurance plans. Plans sold outside Healthcare.gov, such as short-term, association or health-sharing plans, may look cheaper, but they often do not cover essential services like prescriptions, mental health, maternity care or hospital stays. They also may not cap your out-of-pocket costs, leaving you exposed to medical debt if you get sick or injured.

What you can do

Alabamians should not have to choose between health care and basic needs. Extending the ePTCs would protect coverage for more than 400,000 Alabamians and help keep health care costs down for everyone.

You can help protect affordable coverage and make your voice heard:

What Alabamians need to know about SNAP during the federal shutdown

By Carol Gundlach

People should not have to choose between food, health care and other basic needs. But the White House’s decision to delay issuing food assistance benefits means millions of struggling families are about to be forced to make exactly that choice as the holidays approach.

The U.S. Department of Agriculture (USDA) last week officially notified Alabama and other states that it would not issue food assistance benefits under the Supplemental Nutrition Assistance Program (SNAP) at the beginning of November. These benefits, which for now are 100% federally funded, are sometimes referred to as food stamps. The Department of Human Resources (DHR) confirmed Monday that SNAP participants in Alabama will see their benefits delayed.

More than 750,000 Alabamians – 1 in 7 people in our state – participate in SNAP. Nearly 40% of SNAP participants are children, according to the Food Research and Action Center. Alabama provided an average of $194 each in SNAP assistance to each participant in July. That means an average Alabama family of three participating in SNAP will lose nearly $600 next month.

Withholding these benefits will increase hunger and hardship across our state. It also could be financially devastating for grocery stores and other retailers, especially those serving large numbers of SNAP participants.

What SNAP participants should know

SNAP benefits still could be released later in November, either because the USDA changes its policy or because the budget standoff is resolved. If that happens, DHR will try to get November food assistance out as quickly as possible. But delays may occur, especially for people who get money added to their SNAP EBT cards early in the month.

If you are a SNAP participant, you still should be able to spend any money you already have on your EBT card after Nov. 1. But you will not see any additional money added to the card in November (or until this situation is resolved).

If you are scheduled to recertify your eligibility in November or to submit any paperwork to DHR, you should do that to avoid any further delays. And if you believe you are eligible for SNAP, you should go ahead and apply now. DHR is still processing applications, and eligible applicants will receive SNAP benefits retroactively to the date they applied once this situation is resolved.

To find emergency food from a food bank or food pantry, call 2-1-1 or visit Feeding Alabama’s food finder.

USDA can and should fund SNAP benefits for November

The USDA is using SNAP as a bargaining chip in the debate over the federal budget. The agency blames its decision to delay November SNAP benefits on the federal government shutdown. But the truth is that the USDA maintains a SNAP contingency fund with enough money in it to cover most of the November benefits for the entire country.

USDA officials already have spent some reserve money from that fund to help states cover their SNAP administrative costs. But the USDA now claims it cannot legally use this money to help struggling families. This claim is contrary to both the plain language of federal law and the White House’s own prior practice.

The USDA already has dipped into some of its reserve funds to help farmers during the shutdown. While we support our farmers, we also support helping hungry families, especially with Thanksgiving approaching. Some states are scrambling to find enough state money to cover SNAP benefits through November. But the USDA has announced that, unlike in previous shutdowns and unlike for other federal programs, it will not reimburse states for any money spent for food assistance.

How you can fight hunger and speak out for change

Donate to a food bank or food pantry. Hunger is about to soar due to the SNAP benefit delay. Please consider generously donating to your local food bank or food pantry. Unlike most shoppers, food banks buy food in bulk and at a discount, so financial gifts can feed far more people than direct gifts of food. But food banks and food pantries appreciate every donation and will use them to help our neighbors and communities.

Demand action from your federal officials. Food banks play an essential role in relieving hunger, but they cannot replace SNAP. The USDA’s decision to delay November SNAP benefits will increase hardship for families across our country. This policy also is a part of an effort to pressure Congress to discontinue enhanced premium tax credits that make Marketplace health coverage more affordable for millions of Americans, including nearly 500,000 Alabamians.

You can speak out now to help protect food assistance and health care access for people across Alabama:

People and families need both food and health care. No one should have to make a choice between seeing a doctor and keeping food on the table, and Congress should support both food assistance and affordable health insurance.

‘I will leave this world better than I found it’

By Whit Sides
An adult woman stands in front of a wall of plants.
Angel Garrett spends many mornings at Alice Circle, a local cafe, bookstore and gift shop in her native Fort Payne. She is an outspoken advocate for protecting health coverage in Alabama. (Photo by Whit Sides)

Angel Garrett has friends everywhere she goes.

As she sat down in a local coffee shop to share her story, she greeted three friends visiting from the local Arc chapter. The Arc is a nationwide community-based organization that advocates for and with people with intellectual and developmental disabilities.

“I used to work there,” Angel said. “But now I can’t work as much or it affects my Medicaid waiver.”

Angel, 37, is a writer from DeKalb County in northeast Alabama. She was born with a rare condition called schizencephaly, which has affected her development and speech. After high school, Angel followed her passion for language to Birmingham, where she earned a degree in creative writing with a minor in sociology from UAB.

“Though I was very shy until I was 22, I have always had that voice inside that I was fortunate enough to develop,” she said. “Eventually, I gained the confidence to speak, and unlucky for everyone else, I haven’t shut up since.”

Angel’s adept ability to communicate and connect with people have opened many doors in her life. She now serves as an advocate for the Governor’s Office on Disability.

I first met Angel when she was taking the stage at the Fort Payne Opera House earlier this summer. Cover Alabama and the Progressive Women’s Action Coalition invited her to a town hall to share her experience with navigating Medicaid while living with a disability. She did so in a powerful way.

“People are surprised when I say it, but I consider myself lucky to be disabled,” she said.

The life-altering threats that federal cuts pose

Angel’s experiences have forged her into a fierce advocate of programs that have allowed her not just to have daily necessities, but also to maintain a high level of independence.

“I’m lucky because I’m a disabled person in the United States of America. I’m afforded the grace and opportunities to have my basic needs met. I’m given access to health care,” she said. “I qualify for programs like SNAP, LIHEAP and other forms of assistance that offer me peace and stability so I can live as healthily as possible.”

SNAP is the Supplemental Nutrition Assistance Program, which provides food assistance for tens of millions of Americans, including 1 in 7 Alabamians. LIHEAP is the Low Income Home Energy Assistance Program, which helps households with low incomes afford heating and cooling bills.

Both programs face substantial federal cuts under HR 1 – the so-called One Big Beautiful Bill Act – which was enacted into law in July. So does Medicaid, which provides health coverage for 1 in 5 Alabamians, mostly children, older adults, and people with disabilities.

The federal Medicaid cuts’ effects will be limited in Alabama because our state’s program is already bare-bones. But the law will limit Alabama’s ability to strengthen its health care system in the future.

Since HR 1 passed, Angel said people often ask what her life would be like without Medicaid. Without it, she said, she wouldn’t be able to get the care she needs to maintain her health and mobility.

“I wouldn’t be able to go to therapy every week,” she said. “I wouldn’t be able to get my medications, procedures, support, help, food, supplies or any other things that assist my quality of life.”

Advocating for herself and others

Angel said she recently has had issues with being reimbursed for out-of-pocket costs, including transportation to her doctor’s appointments. Medicaid offers many important services, and she said she knows states like Alabama stand to lose when budgets are cut.

“The non-emergency transportation program is supposed to reimburse my trips. I qualify now since my Medicaid waiver got approved. However, it isn’t a seamless process,” she said. “I haven’t had any luck coming up with a solution even though I’ve talked to both Medicaid and Medicare.”

An adult woman sits at a table.
Angel Garrett said she began finding her voice to advocate for Alabamians with disabilities at age 22. “I haven’t shut up since,” she said. (Photo by Whit Sides)

The unmet health care needs don’t stop there. Angel said she hears stories from the community about procedures being denied and about coverage losses for children with autism. She said she also believes dental care should be included with Medicaid and all other health coverage.

“I’m lucky enough to have dental coverage,” she said. “I feel like oral health is one of the most important factors in overall wellness, and Medicaid should cover that.”

While Medicaid always has had room for improvement, Angel said, any new cuts would be life-altering for Alabamians like her. She said she will continue to speak out about how vital Medicaid is for her life and her future.

“I feel that I would be wasting my life — and my mind, my thoughts, my voice — if I didn’t fight for what I have,” Angel said. “It’s disheartening that instead of fighting for expanding the programs that help people like me, I am having to speak up to protect and just keep the programs that allow myself and so many others to live. Not even live independently, but simply just live.”

‘Progression, not regression’

Medicaid provides essential protections for people whose voices often go unheard in policy debates, Angel said. She said she feels the program should aim for abundance and not austerity.

“Oftentimes, people with disabilities are infantilized. Not every person with a disability has a voice to say what they need,” she said. “It has always been a goal of mine to help progress the quality of life for people like me. Progression, not regression.”

An adult woman stands in front of a wall.
Angel Garrett is a writer who lives in DeKalb County and is an advocate for the Governor’s Office on Disability. Angel has schizencephaly, which has affected her development and speech. But the condition has not deterred her from speaking out about Medicaid’s vital importance for the lives and futures of her fellow Alabamians with disabilities. (Photo by Whit Sides)

As she alludes to with her “lucky to be disabled” mantra, Angel said she believes she often “turns lemons into lemonade” to help ensure she is not the only one to benefit from her advocacy.

“Because of my disability, people don’t take me as seriously as I need them to until I’m raising hell, cussing or flipping metaphorical tables,” she said. “However, I’ll continue to flip as many tables as I need to just to make a difference when things like Medicaid are on the line. I will leave this world better than I found it.”

About Alabama Arise and Cover Alabama

Whit Sides is the 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 unveils 2026 roadmap for change in Alabama

By Chris Sanders

Expanding health care access and improving maternal and infant health will remain top goals on Alabama Arise’s 2026 legislative agenda. The organization also will continue advocating for state funds to help public schools provide free school meals to every student.

Nearly 600 members voted in the last week to affirm Arise’s legislative priorities. The seven priorities chosen were:

  • Health equity, including policies to close Alabama’s health coverage gap for adults with low incomes and to protect access to maternity care.
  • Hunger relief, including legislation to allow more public schools to provide no-cost breakfast and lunch for all of their students.
  • Adequate state budgets, including equitable public education funding for every student and state funding for affordable housing and public transportation.
  • Inclusive democracy, including no-excuse early voting and removal of barriers to voting rights restoration for disenfranchised Alabamians.
  • Justice reform, including legislation to apply Alabama’s ban on judicial override of jury sentencing decisions in death penalty cases retroactively, as well as improvements to the state’s sentencing and parole systems.
  • Tax reform to build a more just and sustainable revenue system, including eliminating the rest of Alabama’s state sales tax on groceries and replacing the revenue equitably.
  • Worker power to advance the health and safety of Alabama families, including legislation to remove tax incentives from companies that violate child labor laws, as well as efforts to extend paid parental leave protections to more workers.

“Alabama Arise believes in dignity, equity and justice for everyone,” Alabama Arise executive director Robyn Hyden said. “Our legislative priorities seek to empower Alabamians of every race, income and background to reach their full potential. And they reflect our members’ commitment to building a healthier, more just and more inclusive Alabama for all.”

Alabama Arise graphic text reads "2026 legislative priorities: Arise's roadmap to a better Alabama." Issues named are health equity, hunger relief, adequate state budgets, inclusive democracy, justice reform, tax reform and worker power.

The urgent need to close Alabama’s coverage gap and protect affordable Marketplace plans

Arise members believe Medicaid expansion is a path toward a healthier future where all Alabamians can afford the health care they need. Expanding Medicaid would reduce racial health disparities and remove financial barriers to health care for adults with low incomes. Expansion also would support thousands of new jobs across the state. And most importantly, it would save hundreds of lives every year.

Alabama is one of only 10 states yet to expand Medicaid. Medicaid expansion would ensure health coverage for nearly 200,000 Alabamians caught in a coverage gap. Most of these residents earn too much to qualify for the state’s bare-bones Medicaid program but too little to afford private plans.

The number of Alabamians in the coverage gap could soar in 2026 if Congress fails to renew enhanced Premium Tax Credits for Marketplace plans under the Affordable Care Act. If lawmakers allow the credits to expire, about 130,000 Alabamians would lose their health coverage, and premiums for many others would nearly double.

Those setbacks would add further strain to the health care infrastructure that serves all Alabamians. About two dozen rural hospitals in Alabama are at immediate risk of closure, and four labor and delivery units have shut down since 2023. These closures have reduced care options in a state that already has one of the nation’s worst maternal mortality rates.

“Everyone should be able to get the health care they need when they need it,” Hyden said. “Congress must act quickly to protect affordable Marketplace coverage for hundreds of thousands of Alabamians. And our state policymakers need to step up to close Alabama’s health coverage gap once and for all. This investment would pay off in the form of healthier families and stronger economic growth in communities across our state.”

No-cost school meals help Alabama children learn and thrive

Another key step toward a healthier Alabama is to ensure every public school can offer no-cost meals to every student. Hundreds of Alabama schools provide no-cost meals through the Community Eligibility Provision, but some schools cannot participate in the program.

Arise will advocate for additional state funding that local districts can use to match federal funds to offer no-cost meals. Legislators this year approved $17.3 million to expand school breakfast and continue Alabama’s participation in SUN Bucks, which provides $40 in food benefits per summer month for hundreds of thousands of Alabama children.

Stronger investment in school meals is more urgent amid threats to federal funding for the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) and cuts to the Supplemental Nutrition Assistance Program (SNAP). Alabama and other states could run out of money for WIC in a few weeks if Congress does not renew its funding. And the federal budget law enacted in July will make fewer people eligible for SNAP while shifting more costs to states.

Children and communities across Alabama would enjoy immediate and long-term benefits from no-cost meals in public schools. No-cost meals would reduce child hunger in a state where nearly 1 in 4 children face food insecurity. Extending the reach of school meal programs would help reduce behavioral problems and improve attendance and test scores. Reducing food insecurity for children also can help improve their mental health and overall health as teenagers and adults.

“It’s hard for children to focus in school when they’re hungry,” Hyden said. “Lawmakers should ensure that WIC and SNAP continue to provide food assistance for families across our state. And our legislators should invest in no-cost school meals to reduce hunger and help every Alabama child succeed both in the classroom and throughout their lives.”

What the new federal budget law means for SNAP, health care in Alabama

By Alabama Arise

By Carol Gundlach, senior policy analyst, and Debbie Smith, Cover Alabama campaign director

While many Alabamians were celebrating July 4, Congress passed a sweeping budget reconciliation law that will hurt families across the country. To extend more than $1 trillion of tax cuts for the richest Americans, Congress slashed health care, food assistance and other vital services for ordinary people.

“It’s wrong to hurt people who are struggling to help people who are already far ahead,” Alabama Arise executive director Robyn Hyden said after the bill’s passage. “But Congress just passed legislation that will do exactly that. This budget bill is not only a moral failure. It’s bad policy, and it is a really bad deal for Alabama and our entire country.”

The biggest cuts nationally will be to Medicaid and to food assistance under the Supplemental Nutrition Assistance Program (SNAP). Alabama has not yet expanded Medicaid to cover adults with low incomes, but the harmful new budget law will make it harder for our state to improve and expand health care access. And the law’s SNAP cuts and barriers will increase hunger and hardship across Alabama.

SNAP cuts will make it harder to make ends meet

The SNAP cuts will threaten Alabama’s ability to fund essential state services. They also will impose red-tape barriers for SNAP participants and reduce the future buying power of SNAP.

Threats to state budgets: Beginning in 2026, the Alabama Legislature will have to appropriate an estimated $35 million a year in new funding for SNAP administration. Beginning in 2027, the Legislature also may have to appropriate an estimated $172 million annually in new funding to help cover SNAP benefits, which have been fully federally funded for decades. If Alabama lawmakers cannot or will not provide the required state share of funding, the state would have to reduce the number of SNAP participants or opt out of the program entirely. Eliminating SNAP would end food assistance for more than 750,000 Alabamians and send hunger rates soaring in a state where 1 in 4 children already struggle with food insecurity.

Changes that place time limits on more people who receive SNAP: Many older adults, families with teen children, veterans, people who are experiencing homelessness and young adults who were in foster care may face burdensome new work reporting requirements to receive food assistance. And beginning immediately, many people who are legally in the United States as refugees, asylum seekers or victims of domestic violence or sexual assault may no longer be eligible for SNAP.

Changes that likely will reduce the amount of SNAP assistance over time: The new law prohibits the federal government from making substantive changes to the USDA’s Thrifty Food Plan, on which the amount of SNAP benefits is based. This change will reduce the value of SNAP assistance over time.

Health care cuts will increase human suffering

Reconciliation cuts to Medicaid primarily targeted states that had expanded Medicaid, but the bill also will make it harder for Alabama to improve our Medicaid program. The law also failed to renew subsidies that make health coverage more affordable for hundreds of thousands of Alabamians.

The law eliminates key financial incentives that encouraged Alabama and other states to expand Medicaid. We no longer will be eligible for $619 million in additional federal funding on top of the 90% federal match, which would have helped pay for the startup costs of Medicaid expansion.

The law also includes restrictions on provider taxes — a key tool Alabama uses to help fund its share of Medicaid. This will make it more difficult for Alabama to expand coverage going forward and could put a long-term limit on how our state finances Medicaid as health care costs rise.

Congress also failed to renew enhanced tax credits that have made Marketplace plans under the Affordable Care Act (ACA) more affordable since 2021. These subsidies have helped hundreds of thousands of Alabamians lower their monthly premiums. Now, those enhanced subsidies are going away at the end of 2025.

The cuts to healthcare.gov tax credits mean that Alabamians’ monthly premiums will increase and fewer people will qualify for financial help. About 130,000 Alabamians are expected to lose coverage because of these changes.

Where we go from here

Arise is taking numerous steps in response to this law’s passage. These actions include:

  • Analyzing the law’s long-term impact on SNAP, Medicaid and ACA financing.
  • Creating resources for partners, community organizations and the public to explain the changes and what they mean. 
  • Meeting with state and local leaders to discuss options and ensure they understand the financial and human stakes of these changes. 

Even in the face of harmful federal policies, Arise’s commitment to the people of Alabama remains strong. We are working every day to protect access to food and health care and make sure families have the information and support they need.