What the South Tells Us About Medicaid’s Future
In the natural experiment that is America’s patchwork health care system, states in the Deep South represent a long-suffering control — less insurance, less access to health care, higher medical debt, and some of the worst health outcomes and shortest life expectancies in the country. Seven of the 10 states that didn’t expand Medicaid in the wake of the Affordable Care Act are in the South, and not coincidentally, the region has been hard hit by successive waves of rural hospital closures over the past decade as hospitals struggle to cover the costs of larger uninsured populations. These structural barriers to care are compounded by the long history of racism and discrimination that continues to shape racial disparities in everything from rates of chronic diseases to access to insurance and hospitals. As we stand on the cusp of a major retrenchment in the Medicaid program and the country’s safety net system, what lessons can we draw from Southern states that didn’t expand Medicaid? Sweeping cuts to the safety net in the GOP’s recently passed megabill and new work requirements for Medicaid recipients are projected to increase the ranks of the uninsured by 10 million over the next decade. Hospitals and clinics in rural areas are expected to be hit especially hard. What can the Southern experience of life without expanded Medicaid teach us about the consequences of going uninsured across the nation? And what story ideas can reporters explore now as they prepare for this massive policy shift?
This webinar is free and made possible by The Commonwealth Fund and The California Endowment.
Panelists
Roy Mitchell is the executive director of the Mississippi Health Advocacy Program. He has 35 years public interest advocacy experience in non-profit management, legal services, community organizing and legislative advocacy. Mitchell has staffed and supervised legal clinics for domestic violence victims, low-income housing tenants, ACA Marketplace consumers, SSI disability appeals, Medicaid appeals, TANF recipients and seniors in both urban and rural settings. He has organized several statewide coalitions and initiatives and successfully promulgated Mississippi health and welfare legislation. He served as the consumer’s representative on numerous Mississippi Medicaid, Human Services, Insurance and Health Department committees and task forces. Mitchell is a native Mississippian and a graduate of the University of Mississippi. He is also a member of the State Bar of California.
April Simpson is an independent journalist based in Greater Houston, Texas. Until 2024, she served as a senior reporter covering racial equity for the Center for Public Integrity, where she worked from 2020. Simpson was a 2025 Pulitzer finalist in the explanatory reporting category for her contributions to the project “40 Acres and a Lie,” a historical investigation into how formerly enslaved Black Americans were given land and then unjustly stripped of it. She was previously the rural issues reporter at Stateline, an initiative of The Pew Charitable Trusts, and before that, associate editor of Current, where she covered public media. She was a U.S. Fulbright fellow in Botswana, Eastern Democratic Republic of Congo fellow with the International Women’s Media Foundation and Innovations in Food and Agriculture fellow with the National Press Foundation. Simpson is a graduate of Smith College and the London School of Economics and Political Science.
Anna Claire Vollers covers health care for Stateline and is based in Huntsville, Alabama. She’s been an Alabama reporter for a nearly two decades, covering health, education, politics and social justice. Her work has won state and national awards, including the Society of Professional Journalists' Sigma Delta Chi Award for feature reporting in 2018, and the 2017 Story of the Year from the Alabama Associated Press for an investigative piece on religious boot camps for teens. She previously reported for AL.com and The Birmingham News. Vollers was also a 2018 Data Fellow at the Center for Health Journalism. Her project looked at child deaths and injuries in Alabama that result from abuse or neglect, to gain a better understanding of how poverty contributes to the maltreatment of children.
Suggested reading
“How lack of Medicaid expansion fuels rural poverty in the Deep South,” by April Simpson, The Center for Public Integrity
“Resistance to Medicaid expansion creates different health care access along state borders,” by April Simpson, The Center for Public Integrity
“In the rural South, poor health tied to systemic racism and legacy of slavery,” by April Simpson, The Center for Public Integrity
“The South is ‘the epicenter’ of a new HIV crisis. Medicaid expansion could help.” By April Simpson, The Center for Public Integrity
“Photo gallery and voices from the Deep South,” by April Simpson, The Center for Public Integrity
“Journalist’s work in four states shows how Medicaid expansion improves access to care,” by Joseph Burns, AHCJ
“For powerful series on deep health disparities in South’s Black Belt, a reporter marries data, history and moving life stories,” by Anna Maria Barry-Jester, Center for Health Journalism
“In the Deep South, health care fights echo civil rights battles,” by Anna Claire Vollers, Stateline
“Mental health care for new moms is critical. And hard to access in Alabama.” By Anna Claire Vollers, Stateline
“10 Medicaid holdout states scramble to improve health coverage,” by Anna Claire Vollers, Stateline
“States scramble to shield hospitals from GOP Medicaid cuts,” by Anna Claire Vollers, Stateline