At Medicaid expansion rally, speakers describe struggles without insurance

Alabama is one of 11 states that has not opted into federal program

By: - March 21, 2023 7:00 pm
Man speaks to his wife outside

Jesse Odland (right) speaks to his wife at the Mar. 21, 2023 rally for Medicaid expansion at the Alabama State House. (Alander Rocha/Alabama Reflector)

One day last year, Jesse Odland, a 41-year-old from Huntsville, couldn’t walk out of work. He soon learned he had 45 to 50 pounds of fluid in his system. He could not put his shoes on. He was bedridden for about three months.

He had no insurance.

Odland said that when he or his family needed to see a doctor, he’d go into the emergency room. Each visit cost $1,200. But he knew he would be seen.


“I know that if I can pay it, I can pay it, but if not, then I just don’t,” he said. “But I know they’ll at least get help.”

Odland now has insurance, but the bills from that time remain unpaid.

Odland’s story was one of many heard on Tuesday morning as advocates held a rally urging lawmakers to expand Medicaid and extend health insurance to hundreds of thousands of uninsured Alabamians.

Woman speaks at rally
Campaign Director Debbie Smith speaks at the Mar. 21, 2023 rally for Medicaid expansion at the Alabama State House.

Alabama is one of 11 states that have not approved Medicaid expansion, which extends Medicaid benefits to people and households making up to 138% of the poverty line ($20,120 for an individual; $34,307 for a household of three.) The federal government would pay at least 90% of the cost of expansion.

Federal incentives to encourage expansion have also emerged. The American Rescue Plan Act, signed by President Joe Biden in 2021, included a 5% bump for states that have not expanded to cover the first two years of Medicaid expansion for previous enrollees. That would bring the federal matching rate to about 77% to help with the initial costs of expansion. Additionally, the state would receive a 90% federal matching rate indefinitely for new enrollees under expansion.

Republican officials in Alabama have resisted Medicaid expansion, citing ideological opposition or concerns about finding the money for a 10% state match for the program.

Three people spoke about their personal experiences with no health insurance because of living in the coverage gap. They live in the Medicaid coverage gap because they make between 18% ($4,475) and 100% ($24,860) of the federal poverty rate for a family of three. Subsidies for insurance plans under the Affordable Care Act are available to people making between 100% and 400% of the poverty line. People making less than that are ineligible.

Woman talk to man about social justice issues
Kenneth King (right) and Rev. Carolyn Foster discuss social justice at the Mar. 21, 2023 rally for Medicaid expansion at the Alabama State House.

Kenneth King, a 58-year-old construction worker from Birmingham, said that he discovered he had a potentially fatal condition after being stabbed. 

He was rushed to the emergency room, where doctors saw something strange in the first MRI, meant to look at his stab wounds. They asked him if they could complete another one.

“And I said, ‘will it be on the same bill – you won’t double bill me, right?’” he said jokingly.

On the second MRI, they discovered a separate condition — a tear in his aorta unrelated to the stabbing.

Since then, he is on several medications, which he is able to get through a number of non-profit services.

Trent Thomas, a 42-year-old hairstylist from Birmingham, did not have dental insurance and couldn’t keep up with the care he needed. He said that three of his molars broke and had to be pulled at the UAB School of Dentistry. He paid for that out of pocket.

Man speaks at rally for healthcare
Trent Thomas tells his personal story at the Mar. 21, 2023 rally for Medicaid expansion at the Alabama State House.

Alabamians in the service industry, Thomas said, have no health insurance because they make too much to qualify for health insurance, and make too little to qualify for subsidized plans on the federal health insurance marketplace.

“As a hairstylist, I’ve got to be able to deliver when people need me the most,” Thomas said. “That includes at the end of the day when I’ve done 10 haircuts and everything is hurting. And I think it’s time for our leaders to step up and do the same.” 

Robyn Hyden, executive director of Alabama Arise, said that each of the three speakers had to take off work today to come share their experiences, and that if they don’t work, they don’t get paid.

“It is really tough for average, everyday workers to come down here and speak to lawmakers about the need for healthcare, but that’s why it’s critical that we can share those stories,” she said.

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Alander Rocha
Alander Rocha

Alander Rocha is a journalist based in Montgomery, and he reports on government, policy and healthcare. He previously worked for KFF Health News and the Red & Black, Georgia's student newspaper. He is a Tulane and Georgia alumnus with a two-year stint in the U.S. Peace Corps.