Alabama has seen eight hospitals close in rural areas since 2011, creating concerns about access to medical services and drawing attention to the state’s refusal to expand Medicaid for poor people.

According to the Alabama Hospital Association, the closed hospitals include one in the 2nd District, Georgiana Medical Center in Butler County. Another hospital in the district, Monroe County Hospital, stopped its labor and delivery services last year.

AL.com asked the 18 candidates – 11 Democrats and seven Republicans – in the race for the 2nd Congressional District about healthcare.

Ten of the 11 Democrats in next Tuesday’s (March 5) primary responded to our questions. We’ll have responses from Republican candidates in a separate story.

The 2nd District is much different than it was for the last election two years ago, when it covered the southeast portion of Alabama, from the Montgomery area southward.

In October, a federal court approved a map extending the district from Montgomery to Mobile, from the Georgia line to the Mississippi line. Black residents now make up 49% of the voting age population in the district, changing it from a safe Republican district to one where a Democrat could win, potentially becoming the second Democrat and second Black member in Alabama’s seven-member Congressional delegation.

AL.com asked the candidates three questions about the top issues and priorities. We will report what the candidates in both parties said on each question. This story is about the Democratic candidates’ answer to the first question about healthcare.

Some of answers have been edited for clarity and brevity. The candidates are listed in alphabetical order.

Question: Rural hospitals, as well as maternity services, have been closing across Alabama. Do you feel healthcare is a critical issue in District 2? And what could you do in Congress to help?

James Averhart

James Averhart is from Mobile and is executive director of the NAACP Alabama State Conference. He served on active duty in the Marines from 1987 to 2017. He was the Democratic nominee in the 1st Congressional District in 2020 and lost to Jerry Carl in the general election.

Healthcare is, indeed, a critical issue in District 2. Many factors prevent citizens of the district from having affordable quality healthcare, and I will work to make sure they are afforded the best care.

By advocating for funding for facilities to reopen in our rural areas, the protection of women’s reproductive rights, a decrease in the cost of medication, and a Medicare voucher program for seniors, (I) will help to alleviate the issues that are being faced in the district.

Napoleon Bracy Jr.

Napoleon Bracy Jr. has represented a Mobile County district in the Legislature since 2010. He previously served on the Prichard City Council.

As a state representative, I’ve been fighting to get the Governor to expand Medicaid across the state.

All it takes is (the governor’s) signature to address rural hospital closures and the overcrowding of urban hospitals because of it and provide more benefits to Alabamians that would directly impact our maternity services by keeping moms covered from prenatal care to postpartum.

In Congress, I plan to increase the grant funding to the Department of Health and Human Services to ensure the six Federal Qualified Health Centers in District 2 have received the funding they need to fill the gap of these closures and provide quality healthcare to our communities.

I also will add to my work of expanding telehealth services and broadband access for our doctors to see more patients and relieve our healthcare providers from the physical strain of seeing so many patients in person a year.

Merika Coleman

Merika Coleman was elected to the Alabama Senate in 2022 after representing a Jefferson County district in the Legislature for five terms. She is an attorney and an instructor at Miles College and is chair of the Legislative Black Caucus.

The largest listening session that I’ve held thus far in Congressional District 2 was in Monroe County after the announcement of the end of health services for pregnant women and babies.

We can stop these closings and provide additional health care services to the neediest Alabamians by expanding Medicaid. Although a state issue, as the Congresswoman for the District, I can sponsor and support bills to give the states the incentive to expand Medicaid.

While Doug Jones served in the Senate, he introduced the States Achieve Medicaid Expansion (SAME) Act, a bill which would allow states that choose to expand Medicaid after 2014 the same level of federal matching funds as states that expanded earlier.

As the Congresswoman, I will push for the passage of this bill and advocate for the expansion of Medicaid as I’ve done as a member of the legislature. Doing so would provide health insurance for over 300,000 Alabamians and provide a nearly $3 billion economic boost to the state.

Anthony Daniels

Anthony Daniels has represented a Huntsville-area district in the Alabama House since 2014. He has been House minority leader since 2017.

Every Alabamian deserves quality maternity services and accessible health care, regardless of their zip code.

I understand the importance of fighting for the 11 rural counties and urban Montgomery and Mobile counties in the second congressional district as hospitals face closure across the state, and will prioritize real solutions that ensure access to care for all mothers and families – not one-size-fits-all payment policies.

When I get to Washington, I will fight to expand Medicaid, increase telemedicine services, invest in community behavioral health, and support efforts to recruit and retrain doctors, nurses, and healthcare workers, so we can give voters opportunities for healthier, happier lives. They deserve it.

Shomari Figures

Shomari Figures is a Mobile native who worked in the Obama administration and as deputy chief of staff and counselor to U.S. Attorney General Merrick Garland.

Quality healthcare access, in general, is a major issue for too many of our friends and neighbors across this District. The closing of hospitals and maternity services exacerbates the already alarming disparities in health outcomes that mothers, low-income individuals, and people of color face across the entire state.

Not only does this impact the lives of those who need the services, it diminishes the prospects of growth and prosperity for rural communities in the state as businesses and people are less likely to choose areas with little or no healthcare access – especially emergency healthcare access – to make their home.

In Congress, I will work to build on the legacy of the Affordable Care Act (ACA). I am proud to have been part of the team that helped support the implementation of the ACA while working for President Obama in the White House.

I would strive to incentivize the state of Alabama to expand Medicaid like (40) other states have already done. Medicaid expansion would provide approximately 300,000 people in this state with access to quality healthcare coverage, and it would save the state money in the long run.

I’ll also work to increase funding for community health centers and advocate for more federal funding to support building out healthcare networks, especially in our rural communities, and better address disparities to make quality care more affordable, accessible and equitable.

Juandalynn Givan

Juandalynn Givan has represented a Birmingham district in the Alabama House since 2010. She is an attorney.

Closures are definitely a problem here in the state of Alabama.

One reason is there’s only a few rural, hospitals per county anyway. Many of these counties actually have a utilization of one hospital per possibly every two and a half to three counties. The distance in time from which a person or someone who may become ill being able to get the necessary care they need is very problematic, especially in life-saving or life-threatening moments or situations of trauma. Many patients are airlifted to get to hospitals, even as far as to Jefferson County and Montgomery.

There is however, a need to address why, these hospitals are closing and especially the obstetrics and maternity wards of hospitals.

As I’ve researched and because of my knowledge as an attorney and the number of malpractice cases our office has handled, malpractice and the matter of Medicaid is an issue. There are so many hospitals, in which doctors are being sued and these hospitals can no longer bear the burden of the costs associated with settlements or outright judgements upon adjudication.

Malpractice suits are now playing an even larger role in hospital closures because doctors are no longer willing to take a chance on being able to provide obstetric care and maternity care in hospitals because of this combination of both.

The State of Alabama, needs for additional federal funding that flows down from hospital to hospital county to county, I think we definitely need to look at getting more hospitals for sure, or some type of urgent care facilities in these rule counties.

This continues to be an issue, and I would definitely make it a priority to fight the good fight to advocate for more additional dollars, especially for employee pay, because if you can retain good employees, that’s also an issue in these hospitals. When I am elected to Congress, I will do just that.

I would definitely fight as an advocate for additional services, as well as to continue to work with state leaders, and to push the fact that we need Medicaid reform here in the state of Alabama for Sure.

Jeremy Gray

Jeremy Gray was elected to the Alabama House in 2018 and represents a district in Lee and Russell counties.

The closure of rural hospitals and maternity services in Alabama’s District 2 is a pressing concern, and healthcare demands immediate attention.

If elected to Congress, I will prioritize passing the Save Rural Hospitals Act (H.R. 3635) to support struggling rural hospitals. I will also work on Medicaid expansion to access federal funds for hospital support and reduce our high maternal mortality rate.

Additionally, I’ll advocate for affordable prescription drug prices and address healthcare professional shortages, particularly in maternity care deserts.

This bipartisan approach aims to ensure quality healthcare and economic opportunities for the constituents of the 2nd Congressional District.

Phyllis Harvey-Hall

Phyllis Harvey-Hall grew up in Evergreen and taught in Montgomery Public Schools from 1985 to 2010, mostly teaching sixth grade. She was the Democratic nominee in the 2nd District in 2020 and 2022.

Yes, healthcare is a critical issue for District 2, particularly because our community has a large rural population. In recent years, we’ve witnessed the closure of several hospitals and maternity wards, with Monroeville being the most recent maternity ward closure. Moreover, there are faint fears that even more healthcare facilities are on the brink of closing due to lack of resources. This ongoing crisis not only compromises access to essential healthcare, but also endangers the well-being of our residents. Health metrics impact every other quality of life measure.

Republican legislators’ refusal to expand Medicaid has been a critical misstep, denying much-needed support that could have bolstered Alabama’s healthcare infrastructure, extended coverage to thousands, and potentially saved numerous hospitals in distress throughout the state. The current federal match rate for Medicaid expansion funds stands at 90%, with the state responsible for the remaining 10% — a share our legislators claim Alabama cannot afford.

In Congress, I intend to advocate for an amendment to the Affordable Care Act (ACA) to increase the federal match rate to 95% to the 12 states that refused Medicaid expansion. This adjustment would significantly lessen the financial burden on Alabama, requiring the state to cover a mere 5% of Medicaid expansion costs.

Moreover, I am committed to collaborating with state leaders, healthcare professionals, and the Rural Healthcare Connect Fund Program to ensure that our rural communities receive the funding and support necessary for comprehensive healthcare access.

Willie J. Lenard

Willie J. Lenard, who lives in Pike Road, is a Tuskegee University graduate, Air Force veteran, and businessman. He worked for the South Carolina Department of Corrections for 10 years.

Healthcare, or lack thereof, is in a very critical state in Alabama’s Congressional District 2. With poor healthcare and a state government that is not responsive to the healthcare of its citizens, healthcare in the State of Alabama is in a State of Emergency.

Maternity services for the poor (white, black, and brown) have been in crisis for decades.

There is a huge disparity in the healthcare service delivery as it relates to poor people and particularly as it relates to black Alabamians. We believe that we can have better healthcare in District 2.

We will propose, through government channels, to reclaim the abandoned VA Hospital property at Tuskegee and convert this already functional health property into a rural regional research hospital and medical center, medical college, nursing college, dental college, and allied health sciences college for citizens of the Black Belt region and coastal plain counties of District 2.

Vimal Patel

Vimal Patel manages his family’s hotels in Troy, Montgomery, and Dothan and a laundromat in Eufaula. Patel ran for the Democratic nomination in the district in 2022, losing to Harvey-Hall.

Healthcare is a critical issue in D2 and beyond and if elected, I will be working on improving the infrastructure of all of our hospitals to be better positioned. Space is an issue, labor is an issue, and these smaller rural hospitals are closing down because they are not profitable which does not have a one size fits all.

But my day-to-day job is being a “problem sponge” and we will solve it.

Read more: Democratic candidates in Alabama’s 2nd Congressional District debate residency, voting, healthcare

Residency remains sticky political issue during Alabama Congressional District 2 forum

AL.com staff writers Roy S. Johnson and John Sharp contributed to this report.