This is a guest opinion column
It was 2015. I had just started my medical residency at UAB when I met a patient I will never forget. Carrie was a 20-year-old woman with Crohn’s disease, an autoimmune condition that causes inflammation in the intestines. Her inflammation was so bad that she needed part of her large intestine removed. She was working at a fast-food restaurant, saving up to attend nursing school. While hospitalized, she lost her job.
“How did her Crohn’s get so bad?” I wondered. Many people thrive with Crohn’s disease thanks to treatment advances. That’s when I realized that she had lost her pediatric Medicaid coverage at age 19 and therefore, had lost access to health care. Carrie would not be the last young adult with a chronic healthcare condition I’d meet whose life would be greatly altered by insurance loss.
I attended medical school in North Carolina and chose UAB for my residency because of its world-class facilities, excellent faculty and collegial environment. I figured the challenges of practicing medicine in Alabama would be like those in North Carolina. At the time, neither state had expanded Medicaid and both had large numbers of under- and uninsured patients. In 2023, though, I watched as North Carolina moved forward, choosing to expand Medicaid and provide health care to thousands.
Alabama, however, still denies care to its young people who so desperately need it. And now, potential federal policy changes threatening Medicaid funding cuts could make things worse. In states like Alabama, where coverage is already limited, these cuts could be catastrophic.
Over the last decade, I have watched, helplessly, as patients succumbed to preventable illnesses because they could not afford medical care. Alabama Medicaid covers health care for children, but once they reach age 19, their care is cut off, denying many sick kids access to care that would allow them to live the lives they wanted. I am not the only doctor who has had patients die because of insurance loss.
Blake’s story is another that’s seared into my memory. Diagnosed with Type 1 diabetes at 12, his condition was well-managed with insulin he could get thanks to his father’s insurance. But everything changed when his father died. Despite the heartbreak and hardship of losing his dad, Blake persevered. At 17, Blake qualified for Medicaid. He worked part-time at a gas station to help his mom make ends meet while he finished high school. He even adjusted his work schedule so he could help care for his younger siblings.
But when he turned 19, Blake aged out of Medicaid. Suddenly, he could no longer afford insulin. Forced to pay out of pocket, he resorted to using inferior insulin and rationing it. Hospitalizations became more frequent, and he lost his job as a result.
On one occasion, Blake’s blood sugar soared to dangerous levels. By the time he was admitted to the hospital, it was too late. Blake died of complications from diabetes — a condition that was manageable when he had access to proper care. He left behind a mother and two siblings who adored and depended on him.
Blake’s death wasn’t inevitable. It was the result of a healthcare system that abandoned him. And he’s not alone.
In Alabama, Medicaid covers children and some pregnant women but offers no help to low-income adults. Alabama remains one of 10 states that has not expanded Medicaid, leaving over 200,000 Alabamians in the “coverage gap.” These folks earn too much money to qualify for traditional Medicaid but too little to afford private insurance or marketplace plans. People like my patients, young people who just want to work, go to school and become independent adults.
Medicaid expansion states have seen increased access to preventative care, fewer uncompensated hospital visits and reduced rural hospital closures. In Alabama, expansion would create jobs and provide health insurance to working families who struggle to survive. Studies show that Medicaid expansion reduces mortality rates for conditions like diabetes, heart disease and kidney failure — conditions I see every day in patients who are dying because they can’t afford care.
I went into medicine to save lives, not to watch as preventable deaths become inevitable. Alabama’s doctors are treating symptoms of a broken system — one that forces hardworking families to choose between food on the table or life-saving medications.
Protecting Medicaid will save lives. Funding cuts would be devastating — not just for patients, but for our entire health care system. People like Carrie and Blake deserve a chance to thrive. And physicians like me deserve a fighting chance to do what we trained to do: heal.
Please write to our Alabama legislators and tell them to protect Medicaid. For the sake of our patients, their families and the future of our state, it’s time for Alabama to do the right thing. Lives depend on it.
Dr. Madeline Eckenrode is a med-peds physician serving patients in Birmingham, AL. These views are her own and do not reflect those of her employer. Names and circumstances have been changed to protect patient privacy and comply with HIPAA.