Alabama is running out of time to tackle Medicaid expansion this legislative session.

More than 230 people gathered earlier this month with the group Alabama Arise, urging state lawmakers to prioritize the issue. Their message: Access to health care isn't just a matter of policy, it can be a matter of life and death.

Debbie Smith, Cover Alabama campaign director for Alabama Arise, said as the session winds down, the group will continue to echo the call for increased access to health coverage. She thinks it would not only save lives but revitalize communities across the state.

"Over 80% of our rural hospitals are operating in the red," Smith pointed out. "Not a great stat. About 19 rural hospitals are at immediate risk of closure, and those are the lifeblood of those communities. They're on life support."

Smith emphasized hospitals at financial risk also put their workforce at risk. Those who are against Medicaid expansion believe it is ultimately unaffordable for the state. However, Smith argued it could save the state nearly $400 million over the next six years. According to the Public Affairs Research Council of Alabama, those savings would be enough to cover the cost.

The council's study also showed Medicaid expansion would generate nearly $2 billion of economic growth. Beyond economic benefits, Smith pointed to the stark disparities in maternal and infant mortality rates in Alabama.

She stressed Medicaid expansion would do more than provide health care coverage during pregnancy or postpartum, it is about ensuring comprehensive coverage.

"We've been lucky enough to expand Medicaid coverage up to 12 months postpartum but we still need to figure out how to cover people before they even get pregnant," Smith asserted. "It's really important for people to have health coverage so they can address any kind of issues they might have, like if they have diabetes or high blood pressure that might affect their pregnancy in the future."

With limited time left in the legislative session, she noted one option could be Gov. Kay Ivey's executive authority to enact Medicaid expansion. Smith added using the power could be the simplest path forward, backed by the promise of additional funding from the American Rescue Plan.

By Nina B. Elkadi for Sentient.
Broadcast version by Nadia Ramlagan for Kentucky News Connection reporting for the Sentient-Public News Service Collaboration

The day that Robert F. Kennedy Jr. was confirmed secretary of Health and Human Services (HHS), President Donald Trump established a commission in service of the Make America Healthy Again tagline. The purpose of the commission, according to the executive order, is to "address the growing health crisis in America," by redirecting our national focus to "drastically lowering chronic disease rates and ending childhood chronic disease." The MAHA Commission also appears poised to extend RFK's reach beyond HHS to the department tasked with "nourishing Americans," but some food system reformers are skeptical that change is ahead.

After endorsing Trump in 2024, former presidential candidate Robert F. Kennedy Jr. claimed that Trump promised him "control" of several agencies, including the United States Department of Agriculture and Health and Human Services. In a video of Kennedy outside the USDA building in Washington D.C., he criticized large-scale industrialized agriculture and its negative effect on soil and water health. The description of the video reads: "When ‪@DonaldJTrumpforPresident‬ gets me inside the USDA, we're going to give farmers an off-ramp from the current system that destroys soil, makes people sick, and harms family farms."

Some advocates are calling into question his ability to follow through on the promises he made.

"He's going to do nothing to farming because he has no authority," says Ken Cook, president of the non-profit Environmental Working Group. "I don't think it's going to be the revolutionary era at USDA in the way Kennedy suggests."

The future of food and agriculture policy is largely left in the hands of the Department of Agriculture and the Environmental Protection Agency, the heads of which are also on the MAHA commission. Secretary of Agriculture Brooke Rollins is not expected to tighten regulations on corporate interests, and thus far has been taking the advice of the Department of Government Efficiency to cut - not add - programs.

EPA Administrator Lee Zeldin, dubbed the "great deregulator" is unlikely to increase pollution enforcement and other environmental protections. As of late, the USDA secretary has not been a position of great reform; former USDA secretary Secretary Tom Vilsack spent his career revolving from industry to government and back again. As head of the Department of Health and Human Services, it is unclear what sort of oversight Kennedy will have over the agricultural changes he was prioritizing months ago.

DOGE Takes on USDA

On February 16, the Department of Government Efficiency, spearheaded by Elon Musk, put out a call on X asking for "insights on finding and fixing waste, fraud and abuse relating to the US Department of Agriculture."

"It's essentially a wildfire that's burning through the federal government right now," says Sarah Sorscher, director of regulatory affairs at Center for Science in the Public Interest. "[They're] intent on dismantling the federal government, which will undermine the agenda of RFK Jr. and his MAHA cohort, because without a functioning federal government, you can't have smarter regulation. You can't have a smarter approach to food safety and chemical safety and healthcare product safety."

On January 31, the Trump White House announced a de-regulatory blitz, requiring that "whenever an agency promulgates a new rule, regulation, or guidance, it must identify at least 10 existing rules, regulations, or guidance documents to be repealed."

"It's been made very clear that those departments, USDA, EPA, interior, energy, they're going about their own deregulatory agenda, and most of that's not consistent with what I thought was Kennedy's worldview for years, which was that we needed to protect the environment from greedy, corporate interests," Cook says.

Left or Right, Big Ag Is Around

Farm Action Fund, the legislative arm of the non-profit advocacy group Farm Action, came out in support of Kennedy in late January.

"His food and agriculture policy has been very much in line with Farm Action's mission around addressing corporate abuse in the food system [and] corporate influence over government policy," says president and co-founder of Farm Action Angela Huffman.

Farm Action is largely focused on reducing corporate influence within the food system, and in a blog post they outlined how Kennedy could change the food system while at HHS. They write that Kennedy could "shape the Trump administration's agriculture and food policy." For Farm Action, the issues Kennedy has brought to the forefront have not been at the forefront of agricultural policy in decades.

"Folks have been fighting for so long on these issues, and [Kennedy] has brought them to the level that the President of the United States tweeted about taking on the industrial food complex," Huffman says.

While Kennedy has made agricultural reform a key talking point, as HHS Secretary it is unclear how much he could actually get done. Brooke Rollins, Secretary of Agriculture, is so far less vocal about flipping the system on its head than Kennedy was on the campaign trail.

Both Huffman and Cook say that "Big Ag" has dominated agricultural policy on both sides of the aisle.

"We don't defend Democrats if they don't do things well and drop the ball," Cook says. "We don't work for the DNC. I've had pretty harsh things to say about [Secretary Tom] Vilsack when he was nominated by Biden."

After his first stint as Secretary of Agriculture, Tom Vilsack immediately took a position at a dairy lobbying trade group, confirming criticisms of his "friendliness" to industry.

Misaligned 'Alignment'

For many advocates in the food and agriculture space, some of Kennedy's claims have been far from controversial, such as promoting healthy food and reducing consolidation in the industry. Some of his other takes, like vaccine skepticism (as HHS Secretary he is already breaking promises to not alter childhood vaccine schedules), are more than enough for some, like Cook, to pump the brakes.

Huffman, of Farm Action, tells Sentient that her organization is very strictly focused on agriculture issues.

"We understand that he has broader interests than that, and we really don't weigh in on issues outside of our lane," Huffman says.

In his role, Kennedy wants to target certain food additives that are given special exemptions and can be added to food without approval from the Food and Drug Administration. The administration he is working for, though, recently cut numerous FDA staff members, and the deputy commissioner for human foods (who led the ban on Red Dye No. 3) resigned on February 17.

"If your goal is to get a better functioning federal government, it's not the right approach to go in there with a hatchet and start tearing things down," Sorscher says. "What you want to be doing is going in in a surgical way, and operating with a scalpel and not a hacksaw. I think this administration still has not learned how to do that, and it's actually moving us in the wrong direction."


Nina B. Elkadi wrote this article for Sentient.


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Florida lawmakers are taking steps to address the state's growing number of people with diabetes, by improving early detection and access to care.

Legislation would link diabetes patients to community health centers through the Florida Department of Health website. More than 2 million Floridians are diabetic, and another 5.8 million are at risk, according to the American Diabetes Association. Community health centers serve patients no matter their income or insurance status.

Dr. Wilhelmina Lewis, CEO of Florida Community Health Centers, said the clinics will be key to curbing the state's diabetes crisis.

"Because they really are whole person care," Lewis explained. "They're addressing not just one problem and not just acute needs but they're really looking at those social determinants or social drivers of health that can influence a person's health outcomes."

She acknowledged challenges remain in rural areas, where access to specialists and costly medications can be barriers. If passed, House Bill 1463 and Senate Bill 1676 would establish a Task Force on Diabetes Management, allow pharmacists to dispense diabetes supplies at capped costs and require insurance coverage for diabetes testing and screenings.

Diabetes care is gaining attention in Florida, with Rep. Allison Tant, D-Tallahassee, proposing House Bill 723 to focus on early detection of childhood diabetes. The bill would require the Department of Health to collaborate with school districts to create informational materials for identifying Type 1 diabetes.

"For me this is an urgent, critical issue, as most parents (are) just not aware of the signs and symptoms of Type 1 diabetes until it happens to them, or until the disease has progressed to a stage that requires significant emergency medical care," Tant emphasized.

Early detection and intervention are critical, as diabetes can lead to severe complications, from heart disease and kidney failure to vision loss. Lewis noted their health center programs have made a difference, with patients seeing their hemoglobin A1C levels drop from dangerous highs to healthier ranges.

"When you have that team working on their care and they come in talking about how much better they feel, the weight they've lost and how much better their blood sugars are, and now they're not going to the emergency room, those are the success stories that we're hearing about and that we're really proud to be a part of," Lewis added.

However, funding and capacity challenges could limit the effect of services, with proposed budget cuts and Medicaid redetermination. Lewis stressed it is their mission to care for those in need but to do so will require more state and federal financial support.


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Almost two-thirds of Texans have skipped or postponed some form of health care in the past year because of cost.

That's according to a survey by Episcopal Health Foundation. Missed visits include everything from checkups to treatments and dentist appointments.

The foundation's Chief Communications Officer Brian Sasser said those polled see obesity and diabetes as two of the state's most pressing health concerns.

"When it comes to obesity and diabetes, what can we do, not just to treat the symptoms and just deal with it?" said Sasser. "What can we do to prevent it? And I think it starts with knowing that you're at risk. So that routine screening is key."

Research shows that diabetes-related health-care costs contribute between $6 billion and $8 billion annually to Medicaid in Texas.

This is the seventh year for the study and the results have largely stayed the same. The poll also shows that when patients received care, many struggled to pay the bill.

Younger adults, Black and Hispanic adults, and those with lower incomes say they have trouble affording medical bills compared with their counterparts.

Sasser said talk of potential cuts to health care is concerning.

"The changes that we potentially could see in Washington - Medicaid cuts and cuts to subsidies, and other things that help more Texans afford the Affordable Care Act's Health Insurance Plan," said Sasser, "how will these numbers look differently if large numbers of Texans lose health insurance?"

Other health-related issues Texans are concerned about include increasing housing costs, mental-health issues, and the opioid epidemic.