Stacey Abrams: “We have the chance to enact policies that will help us build the multiracial democracy a majority of us desire, yet so many of us have died while waiting to see realized.” (Photo: Facebook)

by Stacey Abrams —

When we vote, it may seem like we are voting for a candidate, but that is not entirely accurate.

We are voting for the positions that the candidate supports and the types of policies they will enact based on those positions. This is true no matter where we live, and looking at this year’s election through this lens will help us all get clear on our voting priorities.

In the South, one needs to look no further than healthcare to see the importance of advancing policies that support people – and what happens when we do not.

Of the 12 states yet to extend Medicaid to include more people with low incomes, eight are in the South. If these states expanded Medicaid right now, roughly seven-and-a-half million people would gain access to critical, life-saving healthcare. Many of these uninsured Southerners are Black and Latinx people who are more likely to be workers on the pandemic’s frontlines and are also, tragically, overrepresented in COVID-19 infections and deaths.

Think about that number for a minute. Seven-and-a-half million is a lot of people – almost the entire population of New York City. Expanding Medicaid would be the single quickest way to address the South’s devastating, longstanding racial health disparities exacerbated by COVID-19.

And so, we organize.

Recently, I moderated an online vigil organized by Southerners for Medicaid Expansion that honored the lives of people who have suffered, mostly because Medicaid has not been expanded in the region. If the term “Medicaid expansion” seems abstract, imagine this scenario: you are a single mom working full-time at a minimum wage job in North Carolina for an employer that does not provide health insurance. To be covered, you’d have to pay about a quarter of your $15,000 a year income for the least expensive, high deductible plan. Several of your coworkers who also earn low wages and have no kids are in the same boat because there’s no healthcare assistance for them either.

Though everyone’s circumstances are unique, millions of Southerners find themselves in a similar, impossible situation: they make too much to qualify for Medicaid but not enough to be eligible for financial assistance through the Healthcare Marketplace. To be covered, they would have to pay full price for private health insurance. There are four other states outside the South yet to pass expansion: Wisconsin, Kansas, Wyoming, and South Dakota. For people in these states with low incomes, the situation is also familiar. How did we get here?

Medicaid, the essential program for people with low incomes to access healthcare, was started in 1965 alongside Medicare as part of the Social Security Act. It is administered at the state level, according to federal requirements, and is funded jointly by states and our federal government. When the Affordable Care Act became law in 2010, it originally stipulated that states would expand their Medicaid programs to cover people who earn up to the threshold of what would qualify for financial help through the online Healthcare Marketplace. While the 2012 Supreme Court ruling upheld the Affordable Care Act as constitutional, the ruling essentially made Medicaid expansion optional for states. Although the federal government almost entirely funds the program, some state lawmakers have refused to do anything, leaving millions of people in a coverage gap.

So far, 38 states and the District of Columbia have passed some form of Medicaid expansion. For states with a legislative path to expansion, which is most Southern states, current lawmakers have made it clear they never intend to pass Medicaid expansion legislation, regardless of their constituents’ wants or needs. Almost all states yet to expand could see it happen during the 2021 legislative session with decision-makers in place who will prioritize healthcare. And while the Supreme Court is scheduled to hear a new round of arguments on the Affordable Care Act just a week after Election Day, support for the law remains high, and healthcare is most definitely on peoples’ minds.

And so, we vote.

When we understand that poverty in America is an outcome based on overlapping, harmful policy choices, we also see that better policy decisions can lead to better results. If we look at policy positions as we cast our ballot, it becomes clear what we must do.

As difficult as this year has been, we have the chance to enact policies that will help us build the multiracial democracy a majority of us desire, yet so many of us have died while waiting to see realized.

Expanding Medicaid is one tangible way to show we are serious about supporting policies that would address the history of racial health disparities in the South. It is one small but powerful choice, with real and material consequences.

Please join me in the fight for healthcare access by signing the petition to expand Medicaid in the South. (

(Stacey Abrams is the founder of the Southern Economic Advancement Project. She served for eleven years in the Georgia House of Representatives, seven as Democratic Leader. In 2018, she became the first black woman to become the gubernatorial nominee for a major party in the United States.)