Reflections on our Work

After a relaxing day of walking on the beach and taking a run though the Gulf Breeze nature pathway, I decided to take a few minutes and reflect on the experience of helping people enroll in health care in Escambia County, AL. On the whole, I am very satisfied with our trip. We talked with scores of people, small business owners, and locals attending a rogue carnival about the upcoming Open Enrollment deadline. We spoke with about 20 people or families and helped at least 10 of them select a plan that they could afford. The five of us (with me and Lauren) worked with Bama Covered and joined the group of over 27,000 trained assistors who have helped people navigate the Marketplace.gov website.

Me setting the table for dinner at the beach

Our efforts this week seem to have paid dividends. The White House just announced that over 6 million people have enrolled in a plan, which isn't quite equal to the goal of 7 million people that was set this past summer. Still, there are a lot of people in the United States who will live measurably better lives because they don't have to worry about getting stuck with unreasonable hospital costs if something happens to them. And what's better, almost 2 million of the people who have enrolled did so within the last two weeks, and experts predict that the recently-announced extension will allow at least a half million more people to find a plan that works for them. In Alabama, one of the states that did not choose to extend Medicaid and does not have a state-based exchange, 41 percent of the people who were found to be eligible for plans enrolled in one (as of March 1). I am curious to see what effect the final push in March has on this number.

The work that students from Montevallo did this week is important and should be commended. However, seeing them talk with people has also given me a new perspective on health care legislation in the United States. My major takeaway from this week is that the Affordable Care Act does make the lives of some people better, but it does only a little to alleviate the acute need for justice and fair access to health care in our country. And the problem on the surface is the Medicaid Gap. As I and several other students have talked about before on this blog, we had multiple conversations with people who are completely helpless. They are unable to find jobs or unable to work, yet they receive just enough federal assistance to not qualify for Medicaid, and thus they cannot realistically afford health care. It was awful to walk people through the application process (people who have jobs even) and hope with them that there would be something they could afford. There's no worse feeling than having to share all of your information with a stranger and hope but later realize that the only plans you qualify for cost more than 50 percent of your income. All we could tell these people was that we were sorry and we hoped our legislators would change their mind.

It's important to phrase this dilemma in terms of real numbers, and it's worth comparing Alabama to Kentucky, a state that did choose to expand Medicaid and does have a state-based exchange, which makes it easier for citizens to purchase plans. In Kentucky, about 33 percent of people who were eligible for a marketplace plan purchased one (as of March 1). This is a lower rate than Alabama, but far more people in Kentucky are being insured. 222,448 people were deemed to be eligible for Medicaid, whereas in Alabama, only 17,980 were. Kentucky's is the highest percentage of the overall state population in the United Sates that receives some form of health care because of the Affordable Care Act, I believe. Alabama is not the worst, but it has one of the more substantial gaps in coverage.

The second thing I take away from this trip is that the Affordable Care Act is a misalignment of priorities. Many people who desperately need health care cannot afford it, while those individuals, especially those who work for large corporations and profitable small businesses and make a semi-good living, can now receive good health care coverage. I don't begrudge such people health care coverage, but I think it's important that we not lose sight of what's actually happening in the United States: the Affordable Care Act is letting many corporations and businesses off the hook for fairly compensating their employees and providing them quality health care. Instead, these businesses are allowing the government to subsidize their operations by stepping back and requiring their employees to purchase independent plans from Marketplace.gov. American taxpayers effectively foot the bill for the operating costs of Wal-Mart, Target, Trader Joe's, and other retailers while these corporations get to pocket massive profits. Of course, the ACA has anticipated this and has levied fines for businesses that can but won't offer health care, but it's unclear as to how or to what extent this will be monitored.

We experienced this first-hand on our trip when one of the students talked with a woman who works at a large chain drug store retail chain. She is not full time, but often works over 30 hours per week. That store offers her a private health plan, but it is completely unrealistic, considering how little money she makes each month. But this chain drug store company refuses to offer something reasonable, especially now that they know more and more people will be able to afford a plan with the Marketplace. The problem is, however, that even in the Marketplace, the only people who can afford plans are those who make much more than minimum wage.

Ultimately, I think that every state will expand Medicaid and accept the provisions of the Affordable Care Act, and this will lead to more people getting to have access to health care, which is good. However, it won't solve the other fundamental problem here: private health care providers will continue to get rich as they funnel billions of dollars from the government, and access to health care will still be uneven and inconsistent. To answer the question that we posed on this blog, I will continue to monitor health care legislation, and I will continue to maintain that our only option in the United States is to adopt a single payer system.

I don't think that our work with Bama Covered was for naught. Don't get me wrong. In fact, it has opened my eyes to the way that the Affordable Care Act is effecting all of us. But it's also affirmed my conviction that we need to have a single payer system. I've often casually advocated for causes like Single Payer Action, and now I will do so even more.

Health Care Advocacy and the Medicaid Gap in Alabama

We're in the middle of our second day of facilitating an enrollment fair. The public library in Brewton, AL has been kind enough to let us use their space to help people through the Marketplace.gov website, and so far, several people have come in to get help with their application.

The experience of working with people has been eye opening, and it has been a tangible example of how profoundly broken our health care system is in Alabama, and throughout the United States. We've had to explain to several people in our time in Alabama that they fall into the "Medicaid Gap," that space where one makes almost no money but just enough to avoid qualifying for Medicaid services, and certainly not enough to realistically afford a plan from the health insurance marketplace.

. @GovernorBentley please decide to expand Medicaid and give Alabamians access to affordable health care. It's the right thing to do!
— Andrew Battista (@rawdeal85) March 26, 2014

Alabama is one of 24 states whose governor (Robert Bentley) chose not to expand our state's Medicaid program. Bentley has been defiant in his decision to turn down federal funding for health care. According to Bentley in his state of the state address, "Our great nation is 17.2 trillion dollars in debt and it increases by two billion dollars every single day. That is why I cannot expand Medicaid in Alabama." But this is faulty logic. Alabama is already one of the worst states in terms of exploiting its poor citizens. We are only one of six states that taxes groceries to the fullest extent, and we have some of the lowest property taxes in the United States. Our increasing national debt has every but as much to do with the 683 billion dollars we spend each year on direct military spending than it does with whatever money one of our states would accept for health care coverage. In the United States, we fund what we want to fund.

What does this mean for actual people? Many of us think that you have to work to deserve health care coverage, but what we are finding out is that many people do work minimum wage or near-minimum wage jobs in retail outlets, yet these people still cannot afford the plans that are being offered to them. There are so many individuals in Alabama who are frustrated by cycles of poverty. Even with the provisions of the Affordable Care Act, health care coverage will not realistically be in their grasp.

One of the things we've pledged to do on this trip is to demand change in Alabama. I encourage everyone to do what I did this morning: send a tweet or make a phone call to Gov. Bentley's office and demand that he vote to expand Medicaid in our state.

Sunday Afternoon Training

Three members of the team joined Tullia Rushton on Sunday afternoon to get the introductory training for working with BamaCovered. We're trying to wrap our minds around the Medicaid Gap and what we can do about it.

Stay posted for more updates!

The Need for Healthcare Advocacy in Escambia County, AL

We're almost one month away from Spring Break. If you don't have any plans yet and are interested in serving other people, consider joining the 2014 Office of Service Learning and Sustainability Alternative Spring Break experience. This year we'll be traveling to Escambia County, AL to team up with BamaCovered, a grassroots healthcare advocacy group. The trip will take place during the week of March 24-28. We currently have about 5 spots left. If you're interested, please sign up here.

About the Trip 


Escambia County, AL is the second-most highly uninsured county in the state. According to the most recent American Community Survey 5-year estimate, 21.9 percent of its population does not have access to health care. The work we will do in partnership with Bama Covered will help hundreds of people find access to coverage under the provisions of the 2010 Affordable Care Act.

Trip Details

• Availability: The trip is open to ten students on a first come, first served basis. To apply for the trip, please fill out this form.
• Cost: $250 per student. A deposit of $50 is due by March 3 and the full payment is due by March 14. Dates: We will leave Montevallo early on the morning of Monday, March 24 and return in the late afternoon of Friday, March 28. 
• Agenda: During the first three days, we will be facilitating access to health care in Escambia County, AL. Then, we will retreat to a beachfront property in Pensacola, FL for a time of reflection upon our service. 
• What’s included: Your trip fee includes transportation, lodging in Escambia County and Pensacola, and meals on the trip. You will need a small amount of money for miscellaneous meals and personal expenses. 
• Expectations: Our Alternative Spring Break trip will be a time of service, fun, learning, and reflection. You will be asked to complete a training session in preparation for the trip, and there will be several reflective exercises on our journey. The first training session is February 25, and anyone is welcome to attend.
• Leaders: Andrew Battista and Lauren Wallis of the Carmichael Library will lead our trip.