Issue: Medicaid Expansion

Healthcare, food aid still may be at risk of further federal funding cuts

By Debbie Smith

Healthcare and hunger relief programs may avoid further harmful federal cuts this year. But Alabama Arise members should remain vigilant and keep speaking out against proposed cuts, both now and in the future.

Congress is moving quickly on a budget reconciliation bill, with leadership aiming to pass it by June 1. Senate Republicans on April 21 introduced a proposal that excludes spending cuts and narrowly focuses on funding for ICE and the Border Patrol. However, we worry that other lawmakers may push for cuts to health coverage or food assistance. This could put healthcare and food access at risk for millions of Americans, including here in Alabama.

Budget reconciliation bypasses the Senate filibuster and allows legislation to pass with a simple majority. This means decisions with far-reaching consequences could move quickly, with limited opportunity for debate or compromise. This is the same process used last year to make major nationwide cuts to Medicaid and the Supplemental Nutrition Assistance Program (SNAP), also known as food stamps, under HR 1, the so-called One Big Beautiful Bill Act.

Further cuts would hurt those with greatest needs

Medicaid plays an important role in providing health coverage to those who need it most in Alabama. The program primarily serves children, seniors, people with disabilities and pregnant women. Alabama already operates one of the country’s most bare-bones Medicaid programs. Our program has little to no room for cuts without directly impacting people who rely on it for life-saving care.

Because we have not yet expanded Medicaid to cover adults with low incomes, Alabama largely avoided major Medicaid cuts under HR 1. While that softened the immediate impact, it also means further cuts would fall squarely on Alabamians with the greatest needs. That includes children who rely on routine care, seniors in nursing homes, and individuals with disabilities who depend on consistent treatment and support.

Cover Alabama Advocacy Day attendees gather for a workshop session to discuss challenges and solutions for Alabama’s healthcare system. (Arise staff)

Alabama’s healthcare system is under strain

Other parts of the healthcare system are also under strain. Congress allowed enhanced Premium Tax Credits for Healthcare.gov coverage to expire in December, making Marketplace plans under the Affordable Care Act (ACA) more expensive. At least 20,000 fewer Alabamians enrolled in these plans in 2026 as a result. Many who enrolled had to select a lower-quality plan with higher out-of-pocket costs to stay insured.

This increase in the uninsured and underinsured population harms our whole healthcare system. Hospitals, especially in rural areas, face growing financial pressure as they provide care to more uninsured patients while receiving less reimbursement.

These challenges are interconnected. When people lose coverage, they often delay care until conditions worsen. That leads to more serious health issues and higher costs down the line. Hospitals absorb much of this burden. And in communities where margins are already thin, this can threaten access to care for everyone. More cuts to Medicaid or ACA coverage would only deepen these problems.

Your voice matters

This is a critical moment. Congress is acting quickly, and the outcome will have lasting consequences for Alabama families and communities. That is why your voice matters right now. Lawmakers need to hear directly from you about the importance of protecting access to food and healthcare.

Please take action today. Contact your members of Congress and tell them to oppose any cuts to food assistance, Medicaid and ACA coverage. The health and well-being of our communities depend on it.

‘Resilient communities begin with healthy people, period’

By Whit Sides
A smiling man in a black shirt and black hat.
Warren Tidwell works as a disaster rebuilding and recovery organizer in rural communities like Parrish in Walker County and Camp Hill in Tallapoosa County. (Photo courtesy of the Alabama Center for Rural Organizing and Systemic Solutions)

Warren Alan Tidwell has spent years doing work that depends on trust. He does the slow, often unseen work of bringing people together across differences after an emergency.

“There’s very few men like me who aren’t a part of marginalized communities that have the ability to work across working-class lines, between white folks and Black folks, trans folks, queer folks, whatever,” Tidwell said. “And it’s built on 25 years of experience working in places like Ghana and Haiti, but most importantly, right here in rural Alabama.”

Warren is originally from Walker County, just west of Birmingham. But in recent years, he has centered his organizing work on disaster relief and recovery in Camp Hill in Tallapoosa County.

The work became more challenging after a powerful hail storm and flooding hit the small east Alabama town in March 2023. Since then, Warren has tarped roofs, rebuilt everything you can imagine and gathered resources as the town continues to recover.

“It’s not my job to lead, but it’s my job to help draft leaders, you know, build them up and get the hell out of their way,” he said.

Chronic pain that keeps getting worse

Warren said his approach as executive director of the Alabama Center for Rural Organizing and Systemic Solutions (ACROSS) focuses on helping communities grow their own leaders and solve problems together. Step one is getting people what they need. That’s tough to do without a grocery store or doctor in town.

And lately, the work has become even harder to keep up for personal reasons. Warren’s health is getting worse, and he can’t afford healthcare. He’s facing several health issues, often on his own and with no treatment. One of those is a hernia he has had for two years.

“It’s umbilical,” he said. “If it was inguinal, I’d have had to figure something out by now.”

Without health insurance, Warren has put off surgery and is trying to manage the pain day by day. But that keeps getting harder.

“If I keep on this rotation of NSAIDs and Tylenol, man, it’s just going to ruin my stomach and my liver,” he said.

Warren also recently has been facing headaches caused by trigeminal neuralgia. The pain wears on him.

“Chronic pain is what I’ve always feared, because I know it’s something I struggle with tremendously,” he said.

For Warren, that means not being there for a town that counts on him.

“My wife’s a schoolteacher, but her employer doesn’t offer [spousal coverage],” he said.

Warren went onto healthcare.gov to find coverage in the Marketplace, but he found no affordable plans available for him. He said his monthly premiums would’ve cost him nearly $800 out of pocket.

“Then the federal cut in tax subsidies cut me out of being able to afford it,” he said. “And because our nonprofit needs better funding, I can’t even keep the folks working for me in health coverage, least of all myself.”

Lack of healthcare limits workforce development

Two men smile and embrace for a posed photo.
Warren Tidwell and Tommy “Pops” Sellers (left) worked together after a powerful 2023 hail storm in Tallapoosa County to set up a logistics network that still serves the people of Camp Hill. (Photo courtesy of Warren Tidwell)

Recent federal changes have made things even more difficult. Policies tied to the One Big Beautiful Bill Act have reduced access to affordable coverage for many people with low or middle incomes. That makes it even harder for people like Warren to get the care they need.

Warren spends every day investing in the people living in rural Alabama, and he said he wonders why the federal or state governments can’t do the same. He said lack of affordable health coverage isn’t just about being sick and skipping care for himself. It is also is limiting what organizations like his can do from a workforce development perspective.

“These are self-fulfilling prophecies,” he said. “If you can’t offer healthcare, people are going to have to sacrifice a lot just to be a part of that. Two people who work with me moved here from out of state to do this work. I don’t know if anyone would make that leap now.”

In rural places like Camp Hill, those struggles are easy to see — especially during disaster recovery. But as prices rise and wages stagnate for more Americans, Warren said rural Alabamians feel even more disenfranchised and alienated.

Lack of healthcare access affects entire communities. When people can’t get care, it weakens the systems meant to support everyone, Warren said.

“We have a number of seniors who are disabled on fixed incomes,” he said. “When prices go up, it affects every aspect of their life. They have no agency to take part in any kind of recovery.”

Investing in communities before it’s too late

Warren said he believes healthcare is the starting point for strong communities.

“Resilient communities begin with healthy people, period,” he said. “How can you help create opportunities and solve issues for other people when you’re trying to navigate the complexities of those issues yourself?”

For Warren and his organization, the stakes are rising. Without new funding to help cover costs (including health insurance for him and his staff), the work may not last much longer.

“If it gets worse with all of this health stuff, I mean, they’ll have to replace me,” he said. “If we’re not able to get the kind of funding we need by end of summer, we’re shutting down. I’ve got to take a job that I can get myself some insurance to take care of my health issues.”

What’s happening to Warren isn’t unusual. It’s the result of policy choices.

Alabama’s leaders often talk about investing in rural healthcare and economic development. But Warren’s situation shows a problem: Many of the people doing this work can’t afford to stay healthy enough to keep doing it.

Expanding Medicaid and renewing enhanced Premium Tax Credits for Marketplace coverage would be a good start. These investments in a healthier future would help Alabamians like Warren get the care they need. And they would make it easier for nonprofits like ACROSS to stay afloat.

In Camp Hill and rural communities across Alabama, the question is simple: Will policymakers invest in the people holding these communities together… before that work disappears?

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.

2026 Alabama election guide and candidate questions

By Alabama Arise

2026 election questions

Where do candidates stand?

Meeting and talking with candidates as they campaign for your vote helps shape the conversation and let them know which issues are most important to their constituents. Below are some questions you can ask and info you can share when meeting candidates. Please let us know what you hear back!

Click here to download this resource as a PDF.

Funding public services

Alabama’s tax system is upside down. People with low incomes pay a higher share of their income in state and local taxes – double the amount paid by wealthier Alabamians. Alabama gives tax breaks and incentives to wealthy individuals and large corporations that are not accessible to low-income families and small businesses.

Alabama is the only state still providing the outdated federal income tax deduction, which costs our state $1.3 billion in lost revenue every year and overwhelmingly benefits the wealthiest households. At the same time, when Arise proposes policy solutions to help folks get ahead, we often hear lawmakers claim the state doesn’t have enough money.

Congress last year passed HR 1 (aka the One Big Beautiful Bill Act), which will cut $1.5 trillion from services like healthcare and food assistance to give more tax breaks to billionaires and highly profitable corporations. Because of this cut, Alabama may need to pay up to $261 million in additional state money to fund SNAP in 2027.

Questions for legislators or statewide candidates: Would you support getting rid of the outdated federal income tax deduction, which costs Alabama more than $1 billion a year and mostly helps wealthy households, while also ending the state grocery tax to help everyone? If not, what is your plan to untax groceries sustainably and responsibly?

Alabama is one of three states with no state dollars set aside for public transportation, and one of five with no funds directed toward affordable housing. Would you support providing dedicated state funding for affordable housing through the Alabama Housing Trust Fund, and for transportation through the Public Transportation Trust Fund?

Question for congressional candidates: Will you work to repeal the harmful spending cuts in HR 1, particularly Medicaid and SNAP cuts that will hurt Alabama for decades?

Health equity

Rural hospitals across Alabama face ongoing financial strain. More than 1 in 3 Alabama counties offer no maternity care services. Around 160,000 Alabamians fall into the health coverage gap, earning too much to qualify for Medicaid but too little to afford private insurance. The income limit for a single parent with two children to qualify for Medicaid is just $410 a month. That leaves many working families without affordable health coverage.

Questions for legislators or statewide candidates: Do you support Medicaid expansion to keep rural hospitals open, reduce maternal and infant mortality, help families afford healthcare and help low-wage workers stay healthy enough to work? If not, what is your specific plan to stabilize rural hospitals and improve healthcare?

Questions for congressional candidates: Will you pledge to repeal the $1 trillion in Medicaid cuts passed in HR 1, protect Medicare and make health insurance more affordable?

What will you do to hold healthcare corporations accountable for high costs?

Hunger relief

More than 750,000 Alabama families use SNAP to help put food on the table. In 2025, Congress enacted HR 1, aka the One Big Beautiful Bill Act, which will shift more SNAP costs onto states. Alabama may have to pay an additional $175 million next year just to ensure families continue to receive SNAP benefits.

About 1 in 6 Alabamians struggle with food insecurity, including more than 1 in 5 Alabama children. One positive step Alabama has taken in recent years is expanding no-cost school breakfast to more classrooms with increased state funding. We would like to expand this program to every school.

Questions for legislators or statewide candidates: Will you pledge to find new revenue to protect SNAP funding in next year’s state budget? Will you pledge to expand funding for no-cost school breakfast and lunch programs?

Questions for congressional candidates: Will you help families put food on the table by fighting to protect SNAP funding and roll back cuts to SNAP in HR 1? If not, what is your proposed solution to reduce hunger?

2026 election information

Key dates for the 2026 elections

Primary election: Tuesday, May 19, 2026

  • May 4 is the voter registration deadline for the primary election.
  • The election manager must receive absentee ballot applications by May 12 (by mail) or May 14 (in person).
  • Completed absentee ballots must arrive at the election manager’s office by May 18 (if hand-delivered) or by noon on May 19 (if returned by mail).

Runoff election (if necessary): Tuesday, June 16, 2026

  • May 29 is the deadline to hand-deliver a voter registration form for the runoff. June 1 is the deadline to register online or postmark registration forms delivered by mail.
  • The election manager must receive absentee ballot applications by June 9 (by mail) or June 11 (in person).
  • Completed absentee ballots must arrive at the election manager’s office by June 15 (if hand-delivered) or by noon on June 16 (if returned by mail).

General election: Tuesday, Nov. 3, 2026

  • Oct. 19 is the voter registration deadline for the general election.
  • The election manager must receive absentee ballot applications by Oct. 27 (by mail) or Oct. 29 (in person).
  • Completed absentee ballots must arrive at the election manager’s office by Nov. 2 (if hand-delivered) or by noon on Nov. 3 (if returned by mail).

What to know about voter registration and absentee voting

  • Alabama’s voter registration deadline for the 2026 primary election is May 4. For the runoff election, the deadline is May 29 (hand delivery) or June 1 (online or postmarked by mail). For the general election, the deadline is Oct. 19.
  • These deadlines are both for new voters to register and for current voters to update their information if they have moved to another location within Alabama.
  • People who have faced domestic violence, or guardians of people who have faced domestic violence, may submit a form to protect their residential and mailing addresses from appearing on the public list of registered voters.
  • Alabamians are not officially registered to vote until their county board of registrars reviews and approves their application.
  • Alabamians applying for an absentee ballot must certify that they cannot vote in person on Election Day for a reason allowed under state law. Those reasons include absence from the county on Election Day or an illness that prevents a trip to the polling place.
  • Visit alabamavotes.gov to learn more about voter registration and absentee voting.

What to know for the elections

  • Polls will be open from 7 a.m. to 7 p.m. on Election Day. If you’re a registered voter in line by 7 p.m., stay in line! You’ll be allowed to vote.
  • A valid photo ID is required to vote. Visit alabamavotes.gov to learn more.
  • Alabamians can vote in either the Democratic or Republican primary, but not both. Both ballots will include proposed constitutional amendments.
  • State law forbids “crossover voting” in runoff elections. If a runoff election is necessary in June, people who vote in the Democratic primary will be able to vote only in a Democratic runoff, and people who vote in the Republican primary will be able to vote only in a Republican runoff. Voters who participate in neither party’s primary can choose to vote in either party’s runoff.
  • The crossover voting rule does not apply to the general election in November. Voters may vote for whomever they wish in the general election, regardless of which primary (if any) they participated in earlier in the year.
  • Voters’ party choice for this year’s primary election does not bind their choice for future primaries.
  • Visit alabamavotes.gov to check your voter registration and polling place, find sample ballots by county and more.

2026 Legislative Day – Close the health coverage gap: Enact policies to save lives in Alabama

By Debbie Smith

No one should have to choose between going to the doctor and putting food on the table. But for more than a decade, Alabama lawmakers have turned down the opportunity to expand Medicaid to cover adults with low incomes. This choice has cost lives, weakened our health care system and left billions of federal dollars unused.

Alabama still urgently needs Medicaid expansion to help more people get care and to keep hospitals and clinics open across the state. Unfortunately, while expansion remains essential, HR 1, the so-called One Big Beautiful Bill Act, has made financing more challenging and has increased the need for sustainable funding solutions.

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 coverage gap, earning too much to qualify for Medicaid but too little to afford Marketplace insurance subsidies.

HR 1 eliminated a two‑year increase in the federal Medicaid match rate that would have brought Alabama an estimated $619 million in exchange for expanding coverage. This incentive would have been enough to cover at least the first two years of Medicaid expansion. Without it, expansion will cost more and will require identifying new, sustainable financing sources.

Provider tax changes create more budget constraints

HR 1 also restricts how states can use provider taxes to finance Medicaid. Under the law, Alabama would be required to reduce provider tax collections if it expanded Medicaid. This could result in the loss of more than $100 million annually in health care revenue. Alabama Arise will continue making the case that lawmakers should not pit current Medicaid enrollees against people who need coverage but cannot afford it.

Healthcare.gov enrollees face higher costs after the end of enhanced tax credits

Congress allowed enhanced Premium Tax Credits (ePTCs) for Marketplace coverage under the Affordable Care Act to expire on Dec. 31. This lapse left nearly 500,000 Alabamians facing steep increases in their monthly premiums. Early 2026 enrollment data from CMS shows that 20,000 fewer people selected Marketplace plans this year. We will not know the full number of people who have lost coverage until July, but the growing affordability crisis makes Medicaid expansion even more critical.

Persistent gaps in health coverage and outcomes

Nearly 200,000 adults remain stuck in Alabama’s coverage gap, and that number is expected to grow. Alabama also continues to rank poorly on key health outcomes, including maternal health and infant mortality. These harsh realities underscore the need for comprehensive coverage solutions.

Sustainable revenue options to fund Medicaid expansion

Even with the loss of the federal incentive, Alabama has multiple viable revenue options that can fully fund Medicaid expansion and strengthen the state’s long‑term fiscal stability. Earlier revenue analysis provides several pathways. These include:

1. Remove the state deduction for federal income taxes

Removing the state deduction for federal income tax (FIT) payments would generate $1.26 billion per year. Alabama is the only state that still allows a full FIT deduction. Eliminating it would modernize the tax code and generate enough revenue to:

  • Fully fund Medicaid expansion.
  • Pay the state share of costs for SNAP food assistance benefits.
  • Remove the remaining state sales tax on groceries.

2. Remove the state deduction for FICA payroll taxes

Removing the state deduction for FICA payroll taxes would generate $387 million in revenue per year. Alabama is one of the only states offering a full FICA deduction. Ending it would broaden the tax base and provide stable, recurring revenue for Medicaid and other essential services.

3. Other revenue options

  • Increase the cigarette tax.
  • Adopt a tax on sugar‑sweetened beverages.
  • Close corporate tax loopholes, including adopting combined reporting.
  • Ensure large landowners pay a fairer share of property taxes.

These measures would diversify Alabama’s revenue streams and help the state meet long‑term health care needs.

Bottom line

Alabama can no longer afford the cost of inaction. Health coverage gaps are widening, health outcomes are worsening and federal policy changes have made delay even more expensive. The state has clear, achievable revenue options to fund Medicaid expansion sustainably and to strengthen our entire health care system. Medicaid expansion is a choice for healthier families, stronger communities and a more resilient future for Alabama.

Arise 2026: How we’re working to build a better Alabama

By Matt Okarmus

Alabama Arise believes in dignity, equity and justice for all. We believe in an Alabama where everyone’s voice is heard and everyone has the opportunity to reach their full potential. And we believe better public policies are the key to building a brighter future for our state. 

Below, we’ll share some details of that vision as the Alabama Legislature’s regular session begins January 13. This blog focuses on the crucial legislative priorities on our 2026 roadmap to change.

If you’re not already a member of Alabama Arise, join us! Members will receive an exclusive version of our weekly Legislative Updates throughout the session. These emails include a weekly video update from Arise staff members on what’s happening at the State House, as well as details about upcoming legislation and links to additional resources.

Executive Director Robyn Hyden welcomes us to the 2026 session

Arise’s Robyn Hyden welcomes everyone to the Alabama Legislature’s 2026 regular session. Watch to see what to expect this year and to learn more about our advocacy on school breakfast, protecting funding for public schools and other member-selected legislative priorities. 

Strong investments in schools, housing and transit improve life for all Alabamians

Strong funding for public services like education and public health broadens opportunity for everyone, especially for Alabamians with low incomes. Arise members for decades have urged robust and secure state funding for these services. Our top adequate state budget priorities include protecting funding for public schools and securing state support for affordable housing and public transportation.

READ OUR FACT SHEET

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

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. Our top health equity priorities are Medicaid expansion and investments in comprehensive maternal health care.

READ OUR FACT SHEET

Federal SNAP cuts underscore Alabama’s need to protect and increase food access

Alabama’s food insecurity rates are among the worst in the country. More than 1 in 6 people in our state (17%) face food insecurity, according to the Alabama Department of Public Health. And that share is even larger for children: Nearly 1 in 4 Alabama children (23%) live in households with food insecurity. Our top hunger relief priorities are increasing the availability of no-cost school meals, protecting SNAP food assistance and continuing the successful SUN Bucks summer nutrition program.

READ OUR FACT SHEET

An inclusive democracy is vital to building a better Alabama for all

Alabama was central to the struggle for democracy and voting rights in the United States during the Civil Rights Movement in the 1950s and 1960s. And the need for our state to do more to build a more inclusive democracy continues today. That is especially true after recent U.S. Supreme Court decisions affecting the rights of people nationwide to have their say in who represents them at the local, state and federal levels. Our top inclusive democracy priorities include no-excuse absentee voting, early voting and removal of barriers to voting rights restoration.

READ OUR FACT SHEET

Alabama’s justice system should focus on rehabilitation, not cruelty

Alabama’s criminal justice system too often prioritizes punishment over evidence-based interventions. This cruel orientation has fueled heavy-handed sentencing policies and a broken parole system. And it has led to a death penalty system where state officials continue to kill prisoners against the recommendation of the juries that convicted them. Our justice reform priorities include reforms to Alabama’s sentencing and parole practices and legislation to make the state’s ban on judicial override in death penalty cases retroactive. 

READ OUR FACT SHEET

Alabama’s tax system is upside down and needs real reform

Alabama’s tax structure is among the nation’s most unfair and unjust. The state is heavily reliant on regressive sales taxes on consumer goods that account for a larger share of spending for households with low incomes. Our state continues to tax groceries, though at a lower rate than other goods after grocery tax reductions in 2023 and 2025. And Alabama does not tax numerous services that people with higher incomes more often purchase. Our tax reform priorities include untaxing groceries, reining in income tax breaks for wealthy households and opposing further diversion of public school funding to private schools and homeschooling.

READ OUR FACT SHEET

Empower workers to build an economy that works for all Alabamians

Alabama has a history of anti-worker policies that prioritize the interests of wealthy corporations over those of working people. This top-down structure has led to our state falling behind in measurable standards of well-being. Our worker power priorities include increased accountability for child labor law violators, expansion of paid leave and stronger protections for temp workers.

READ OUR FACT SHEET

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

By Alabama Arise

Haga clic aquí para leer esto en español.

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.

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.

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.”