In 2013, the New England Journal of Medicine estimated that Medicaid expansion could save up to 550 lives annually in Alabama. That was before the COVID-19 strain of Coronavirus. If that virus sweeps through the state, how many of our citizens will go to work sick because they don’t have paid sick leave, delay medical care because they don’t have insurance, and/or send their kids to school sick and infect others because they have no paid time off and can’t miss work? This is a public policy failure.
With the country now on high alert for Coronavirus infections and nervously pondering the health, economic, and political consequences of a pandemic, let’s think about Alabama’s situation. Since the Republicans gained control of all statewide offices and supermajority status in the legislature after the 2010 midterms, they have proudly pushed through legislation and public policies that will make our citizens and the state’s economy more vulnerable to a pandemic.
Nice work, y’all.
Let’s take a walk down memory lane….
Alabama local governments can’t mandate paid sick leave
According to the Alabama Department of Labor, only about 50% of the state’s employers offer paid sick leave. That’s just fine with our GOP supermajority, who – with Democratic support! – passed the “Give Your Boss the Flu Act” in 2014.
“It prohibits Alabama local governments from requiring employers within their jurisdiction to offer any sort of paid sick leave, vacation time, or leave that’s not already mandated by the federal government.”
Just a year later, in 2015, the legislature revisited the issue to make something they had already made illegal even more illegal…. or something. They passed an updated version of the “Give Your Boss the Flu Act” and added prohibitions against raising the minimum wage.
This was quite the double whammy for low-wage workers. The Bureau of Labor Statistics reports:
- Among private employers nationwide, only about 50% of the workers at the bottom 25% of the pay scale have paid sick leave.
- At the bottom 10% of the pay scale, only 30% of workers have paid sick leave.
Working people without paid sick leave are are 3 times more likely than workers with paid sick leave to go without medical care. The lower the income, the more likely workers are to forgo medical care for themselves or their families. They’re also more likely to go to work sick because they need the money and/or are afraid of losing their jobs.
The Alabama legislature refused to expand medicaid
Medicaid expansion in this state would give 134,000 low income people greater access to medical care, but Republican legislators dug in their heels and refused to do it. They even spent part of their precious 30 days of legislative time in 2015 debating a non-binding resolution that described their opposition to Medicaid expansion.
“WHEREAS, the Legislature has no intention of allocating funds to support Medicaid expansion; now therefore, BE IT RESOLVED BY THE LEGISLATURE OF ALABAMA, BOTH HOUSES THEREOF CONCURRING, That we express our intention that the State of Alabama not expand Medicaid above its current eligibility levels.”
Alabama’s rural hospitals are in crisis
Seven of the state’s rural hospitals have closed since 2010, and a 2019 report found that many others are on the brink.
The report identified more than 450 rural hospitals nationwide as vulnerable to closure, with 216 of those designated as “most vulnerable.” They found the highest numbers of vulnerable hospitals in the South and Midwest. They designated 17 rural hospitals in Alabama, or nearly 40 percent of those in operation, as vulnerable.
In 2019, 88% of rural Alabama hospitals were operating in the red. Officials cite the lack of Medicaid expansion as a leading cause:
The U.S. Government Accountability Office estimates about half the rural hospitals are located in states which chose not to expand Medicaid. Of the rural hospital closures between 2013-2017, 83 percent are located in non-expanding states, according to the GAO.
When local hospitals close, doctors relocate as well, worsening the health care shortage in small towns and rural areas. We are ill-prepared in Alabama to deal with a large-scale public health crisis. And that’s something our legislators should have been worried about in the past 10 years.
Blame public policy, not sick people
It’s really easy to urge people to “just stay home” when sick, but we all know there’s a “tough-it-out” culture in many workplaces. 90% of workers admit to going to work sick at some point. Even employees with sick leave are worried about getting the side-eye from the boss if they call in sick. For heaven’s sake over-the-counter cold medicine commercials even encourage people to do it!
For lower-paid workers, the stakes are even higher: missing a week’s pay – or even a couple of days worth – is the difference between paying the utility bill, having food at the end of the month, and making the car payment. What will happen to these families if the state institutes mandatory quarantines or schools close?
It’s awful when people go to work sick and send their kids to school sick, but nobody want to work when they’re sick. All parents would rather be home comforting their sick children, instead dropping them off at school because they can’t lose pay. Let’s quit blaming the individuals and address at the public policies that put families in such untenable situations.
Coronavirus should be a wake-up call for Alabama citizens and government officials. Will it be? That’s up to voters.