‭This is a guest opinion column

Healthcare isn’t a luxury. It’s the thread that holds families and communities together. But across the American South, that thread is unravelling.

While some Southern states have expanded Medicaid, this coverage is increasingly precarious. Twelve states, including North Carolina, have enacted “trigger laws” that would automatically end or alter Medicaid expansion if the federal match rate drops below 90%. This means that even in states where expansion has occurred, access to care is not guaranteed.

The consequences are already visible: closed hospitals, overrun clinics, and hundreds of thousands of uninsured individuals left in limbo.

By shifting the focus to proposed Medicaid cuts and work requirements, millions may soon be denied timely care or trapped in red tape that delays it until it’s too late. That’s exactly what happened to Jenny and her sister Beth.

Jenny, an Alabama visual artist, watched as Beth fell seriously ill and tried to get help. But the system failed her. Her story is a warning of what’s to come if these policies move forward.

The Human Cost of Medicaid Inaction

Beth’s illness didn’t start as a death sentence.

She applied for Medicaid when her symptoms first emerged, but her application sat for months. Her appointments were cancelled. The system stalled. And the tumour growing inside her didn’t.

By the time her Medicaid application was finally approved, her condition had progressed to late-stage cancer. It was too late. Beth died not just from illness, but from abandonment.

Today, Jenny earns $11,000 a year while caring for her grandmother, disabled father, and grieving nephew—juggling jobs, teaching art, and trading services just to get by.

Poverty, pride, and policy failure

In the South, some working-class families see asking for help as failure. But even when they do, support is scarce.

In Jenny’s town, just 40 residents get Meals on Wheels. “You basically have to wait for someone to die to get a slot,” she says.

The programs exist, but they’re out of reach. This sends a cruel message: care is conditional, not guaranteed.

A Crisis Worsened by Policy Denial and Misdirection

Alabama has refused federal funds that would cover 90% of Medicaid expansion costs—at the expense of 190+ rural hospital closures and countless missed opportunities for essential care. And if those federal funds are cut, Alabama is even less likely to expand coverage.

Even in states that did expand—like Arkansas, North Carolina, and Virginia—coverage remains fragile. All three have “trigger laws” in place that would end or reduce Medicaid expansion if federal support drops, putting thousands at risk of losing care.

Even the working poor aren’t spared. Jenny’s nephews are employed but fall in the gap; they make too much for Medicaid but too little for private insurance. So, they go without care because the system refuses to meet them halfway.

Instead of expanding coverage, Republican lawmakers are pushing to restrict it further. Up to 7 million adults could lose Medicaid if federal work requirements and direct funding cuts included in the House-passed budget bill are signed into law. In Arkansas, thousands already lost coverage not for lack of work, but because the paperwork was too complex. Over 90% were already eligible but trapped in red tape.

“I have to count every dollar to meet ACA minimums just so I can get my eyes checked,” Jenny shares.

These policies reflect a harmful belief: that paid work is more valuable than unpaid caregiving. That belief—rooted in racism and sexism—forces families like Jenny’s to ration care in a system that decides who deserves help.

Reclaiming Dignity Through Story, Art, and Solidarity

When systems fail, we turn to what we have. For Jenny, that means using art to document loss, express resistance, and build awareness.

“Visual art brings a new kind of awareness,” she says. It does what policy briefs often can’t: it humanises the crisis.

As public systems retreat, the burden of care falls to communities. “If you’re not part of a religious community, you’re on your own,” Jenny says.

At MDC, we step into the gaps left by the government and help people question unjust systems—like healthcare—and imagine what’s possible instead. We support communities in building shared visions, equipping advocates to push for policy change, and reminding nonprofits of their vital role in civic life. Through State of the South convenings, we use art and storytelling to bring the human impact of inequity into full view.

Resistance is growing in the South. Across states like North Carolina, Georgia and Mississippi, communities are organizing for healthcare justice.

In North Carolina, years of coalition-building led to Medicaid expansion. In Georgia and Mississippi, campaigns like Cover Georgia and Care4Mississippi are organizing advocates, healthcare workers, and business leaders to make the moral and economic case for change.

These aren’t isolated efforts—they’re part of a broader Southern movement led by those closest to the pain and the possibilities. Groups like Alabama Arise show what’s possible when community voices are at the center.

The powerful and wealthy in our region may be scrambling to stay in power, but Southern communities are stepping forward and will continue the fight to be heard.

The Path Forward: Expand Access, Invest in Belonging

We know what needs to be done.

1. Expand Medicaid now to cover 340,000+ Alabamians.
2. Reject federal work requirements.
3. Invest in care navigation and community-based support.
4. Amplify Southern art and stories that ground and inspire the struggle for change.

Jenny says it best: “All bodies are worthy of dignity. All bodies require care.” If we truly believe in protecting and amplifying the voices of the vulnerable, we must act. This isn’t about partisanship. It’s about whether we treat people like they matter.

Do we honor life? Or do we hoard care like a commodity?

Let’s build a South where no one is left behind. Where care is a right, not a reward.

Cate Elander is Director of State of the South at MDC, where she curates storytelling experiences connecting personal narratives with policy change. As a quilter and printmaker, she believes deeply in the power of art to bring people together and spark change.

​​