By Swaroop Vitta and Davis Bradford
In medical school, our professors often show us maps of the U.S. illustrating where diseases strike hardest and where patient outcomes are the worst. Most of the time, Alabama is red, really red. Red is bad. So bad that over 600,000 Alabamians are uninsured and have limited to no access to health care.
Alabama is our home and this state’s spirit of compassion made us who we are. Every Sunday a small group of us with other medical students and volunteer physicians heads to a homeless shelter across from Regions Field that houses our free clinic. As we open our doors to many men and women that could not otherwise see a physician, we see first-hand what life without health insurance in Alabama is like.
A story:
Ms. C, a hardworking Alabamian, came into clinic with a terrible headache. It turned out that it was due to emergently high blood pressure. Ordinarily, this is easily treatable, but because Ms. C had gone without care for so long, she was now in danger of a stroke. Only the emergency room could provide relief. But for Ms. C, like so many others in Alabama, that relief was accompanied by a bill she could never pay with the risk of unsurmountable debt. Ms. C has since become our regular patient. While her health has improved, there is only so much a group of well-intentioned medical students can do.
Had Ms. C received medical care during the years before we saw her, her high blood pressure could have been controlled before it left her with permanent injuries. Despite treatment, the chronic issues from those years without care now leave her unable to work. And at 58 years of age, her options are running low.
Even when work was an option, Ms. C’s income was just $750 per month ($9,000 yearly)—well below the federal poverty line. At that time, Ms. C tried applying for Medicaid in Alabama. However, Alabama numbers among 23 states whose Medicaid programs deny medical assistance to poor adults without children or a federally-recognized medical disability.
Everyday Ms. C worries about her future, regularly asking the haunting question: How will I pay for my health care? Most of us working at the clinic and many of you reading this story have health insurance. As much as we wish our neighbors could have the same access, we are often left with more questions than answers. However, for Ms. C and over 191,000 other Alabamians like her, the answer is clear: Medicaid expansion.
Our state leaders decided not to expand Medicaid to individuals making less than $16,105 per year (27 states did). Although individuals earning over $11,670 per year may now have subsidized insurance plans available to them under the Affordable Care Act, the state’s decision leaves all other single adults out of luck, or—as more commonly heard, but also more easily dismissed—in the “coverage gap”. This gap means 191,000 Alabama adults that make less than $11,670 per year will have no options, through Medicaid or through a subsidized insurance plan.
Bridging this gap will not be easy. Some may wonder if it is too great of a financial burden for the state to bear, though some reports have shown that Medicaid expansion will actually boost Alabama’s economy. If this also results in hardworking people like Ms. C becoming productive members of society again, isn’t it worth it? We know implementing a large-scale program may be difficult and costly, but will investing in our neighbors’ health not create a better future for us all?
Our clinic is a tiny fiber in the safety net that tries to close a gap we alone can never fill. We are mostly students, not a hospital with specialists, x-rays, labs, or critical medications.
As Alabama continues to refuse Medicaid expansion, we witness the fallout every Sunday. For all of us, it is frustrating to think about how a preventable illness such as Ms. C’s high blood pressure, can cost so much for our healthcare system and for an individual’s well-being because it went untreated.
As care providers at the free clinic, we must swallow the hard realities of the current healthcare environment and watch our patients do the same. As future physicians, we worry about practicing in a state where the most downtrodden among us are overlooked. And as your fellow Alabamians, we hope that this state will prove to be one that looks past ideology and supports our neighbors in their toughest times.
Rethink coverage. Expand Medicaid.
(Swaroop Vitta and Davis Bradford are students at the University of Alabama at Birmingham School of Medicine.)
http://www.al.com/opinion/index.ssf/2014/05/alabama_medical_students_argue.html
Warm Southern Breeze 
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