Annals of Medicine April 6, 2020 Issue: A Preventable Cancer Is on the Rise in Alabama

[BeckyDem]

One winter day in 2016, Tonya Carter felt a sharp pain in her lower back. In the months that followed, the pain grew more frequent and more diffuse, running down the back of her legs when she was sitting, and flaring up when she lay on the sofa in her living room at night. A devout Christian, Carter prayed that God, whom she referred to as “my ultimate physician,” would make the pain go away. It didn’t go away. She would have gone to see an actual doctor, she told me recently, but it was beyond her financial means.

Carter worked for Comfort Keepers, a company that provides in-home care for seniors. She liked the job, which involved tending to elderly people who required assistance with personal care and such chores as cooking and cleaning. Carter was a dedicated caretaker, sometimes fixing homemade corn bread and turnip greens for her clients. Her salary was low: eight dollars an hour, without benefits. “That’s good for around here,” said Carter, who lives in Anniston, a small city in northeastern Alabama with a troubled racial history—in 1961, a Freedom Riders bus was firebombed by a local mob—and an uncertain future. In 1999, a nearby U.S. Army base, Fort McClellan, closed down. Since then, Anniston’s population has shrunk, and the poverty rate has risen to nearly thirty per cent. Carter sometimes considered moving elsewhere, but her options were limited. At the time she started working at Comfort Keepers, she was divorced and had four children, three of whom still lived at home. Between rent, utilities, and providing for her family’s needs, her income was stretched far too thin to pay for health insurance.

In dozens of states, Carter would have qualified for Medicaid, particularly after the passage of the 2010 Affordable Care Act, which extended Medicaid benefits to all households earning up to a hundred and thirty-eight per cent of the poverty line. But in 2014, when Medicaid expansion took hold, Alabama and twenty-four other states, almost all of which had Republican-led legislatures, opted out; that year, Robert Bentley, then the state’s governor, argued that it would burden taxpayers and foster “dependency on government.” In Alabama, as in much of the South, the Affordable Care Act was derisively called Obamacare, and was attacked as a wasteful government program that showered benefits on undeserving recipients. In 2016, Donald Trump tweeted that Hillary Clinton “wants Obamacare for illegal immigrants.” More recently, Jeff Sessions, who is running for his former Alabama Senate seat, aired a campaign ad accusing Democrats of plotting to provide “free health care for illegal immigrants.” In fact, undocumented immigrants are ineligible for Medicaid, but it’s not hard to imagine how such a claim might arouse indignation among poor voters in Alabama, where the income requirements for Medicaid are more stringent than in any state except Texas. In a family of four, a parent qualifies for benefits only if the household income is less than three hundred and ninety-three dollars a month—roughly eighteen per cent of the poverty line.

https://www.newyorker.com/magazine/2020/04/06/a-preventable-cancer-is-on-the-rise-in-alabama