I’m currently watching The Pitt, the hit Max series that follows life and death, hour by hour, in a crazy-busy emergency room in a large fictional Pittsburgh hospital.
This show will scare the living daylights out of you—but at least you know it’s a TV series, not an accurate depiction of how a real emergency department operates.
It might not be a perfect depiction, however in some ways it’s closer to reality than you’d think. Unfortunately, this past year I’ve had a good deal of personal experience in metro Birmingham emergency rooms with family members.
Stacked Up in the Hallway
We see throughout the series that the Pittsburgh hospital often does not have rooms available for ER patients who need to be admitted, so they keep stacking up in the hallways.
That’s not just dramatic license. It’s what’s happening, in some form, in Birmingham right now.
UAB has tried to ease the crunch by adding two modular emergency department units outside its main building—essentially trailers bolted onto the hospital to handle overflow. They expanded UAB’s ED capacity by 50%. That’s how serious the demand has become. But spending your worst day or days in a trailer in the parking lot isn’t ideal, even if it beats a hallway.
Where Are All These Patients Coming From?
A lot of them are coming from rural Alabama, where hospitals keep closing or cutting services.
Alabama has lost at least seven rural hospitals since 2010. Right now, the Alabama Hospital Association says 27 more rural hospitals are in danger of closing, with 19 of those at immediate risk. Eighty-three percent of Alabama’s rural hospitals are operating in the red. Only 15 hospitals in the entire state still have full 24/7 labor and delivery units—meaning women in much of rural Alabama now drive an hour or more just to give birth.
When a rural hospital closes or cuts its ER, the patients don’t disappear. They drive to the nearest place that’s still open—often Birmingham. Danne Howard, who runs the Alabama Hospital Association, put it plainly: “The rural issue is not just about rural Alabama, it’s about all of us. If the rural hospitals are not there stable enough, urban hospitals cannot absorb the volume.”
That’s the crushing burden landing on Birmingham.
“Not My Problem”—Except It Is
Plenty of well-off Birmingham-area folks figure Medicaid isn’t their problem. They have good insurance. They’re not the ones who’d qualify.
But sick people have to go somewhere. When rural Alabama runs out of places to send them, a lot of them show up here—in our ERs, our hallways, our trailers. Every insured and uninsured patient who can’t get care closer to home and ends up at UAB or Brookwood or St. Vincent’s adds to the wait you’ll face next time you or someone you love needs emergency care.
Uncompensated care costs get baked into everyone’s bills and insurance premiums, whether you ever set foot in a Medicaid office or not.
Alabama Is One of Only 10
Forty states plus Washington, D.C. have expanded Medicaid. Alabama is one of just ten holdouts left—along with Florida, Georgia, Kansas, Mississippi, South Carolina, Tennessee, Texas, Wisconsin, and Wyoming.
Alabama has turned down billions in federal funding that would cover 90% of the cost of expansion, year after year, while our rural hospitals collapse and our urban ERs absorb the fallout.
A2022 economic analysis by the Public Affairs Research Council of Alabama (PARCA) found that expansion would cost the state an average of $225 million a year—but generate average savings of nearly $400 million a year through reduced state spending elsewhere and a stronger economy, for a net gain of over $170 million annually.
This isn’t charity. It’s math. And it’s costing all of us—in dollars, in wait times, and in the kind of care we get when we’re the ones lying in that hallway.
Maybe it’s time Alabama stopped being one of the ten.
David Sher is the founder and publisher of ComebackTown. He’s past Chairman of the Birmingham Regional Chamber of Commerce (BBA), Operation New Birmingham (REV Birmingham), and the City Action Partnership (CAP).
12 thoughts on “Alabama Sabotaging Birmingham Healthcare”
Someone please send this to Tommy Tuberville. Let’s see how many ways he can say expanding Medicare is not the solution needed. Obama has been gone for 10 years and it’s time to get over it.
One might make the assumption this is a healthcare issue, a humanitarian issue, an economic issue, or even a political issue. All of those assumptions are wrong. Ronald Reagan expanded Medicaide…several times during his tenure. His expansion received vast support from both Republicans and Democrats. So what is it? It’s the same issue that I point out when folks suggest consolidation of Birmingham metro functions. Always go aback to the root of the problem. Ask yourself why “white flight” happened and then ask yourself why expanding Medicaid under a white Republican was acceptable but expansion under a black Democrat was not acceptable. The answer is in Black and White but everyone is affraid to talk about it or even admit it. We (Alabama) would rather lose money, or have to spend extra money, or have to travel more miles for healthcare than to address the Black and White issue.
Reagan expanded Medicaid for pregnant women, infants and young children. The ACA expanded Medicaid to non-disabled, non-elderly adults without dependent children. Quite a big difference.
David, this is very concerning. Over the past few years, friends have told me about being stuck in hospital hallways for hours—or even days—waiting for a proper room. It is a very real problem, and anyone can face a medical emergency at any time.Since you brought this issue to light, what action items do you suggest for us as readers? We would love to know how we can help fix this situation.
Thank you for this article, this state needs a governor and govering body to expand Medicaid. Because the outcome is people are going to have delayed care, or possibly even die because of travel time to get to Birmingham. It is past time EXPAND MEDICAID.
If enough of us would contact our state legislators about this issue they would act on it. It’s really that simple.
Most people don’t know who their representatives are, much less ever contact them.
Democracy works but only if citizens do their part. The squeaky wheel gets the grease.
Everyone is missing something that is fundamental in finance and economics. The power of compounding over time, and how that can work for you or against you. Healthcare inflation runs between 4% and 7% annually. Economic growth, and hence tax collections, increases between 1% and 3% annually.
I grew up in Alabama. I now live in North Carolina. North Caroline has been booming for the past ten years. Furthermore, North Carolina is substantially wealthier than Alabama. North Carolina expanded Medicaid yet is now struggling to pay for the Medicaid expansion. Why, because the cost of Medicaid is growing faster than tax collections allocated for the Medicaid expansion.
Everyone says the U.S. government is paying for 90% of the Medicaid expansion, so it is a no-brainer. However, the cost of the 10% the state is paying is compounding at 4% to 7% annually. The tax collections you have allocated to pay of it is growing at 1% to 3% annually. In a few years, there will be a meaningful gap between the cost of the Medicaid expansion and the money available to pay for it.
Someone please send this to Tommy Tuberville. Let’s see how many ways he can say expanding Medicare is not the solution needed. Obama has been gone for 10 years and it’s time to get over it.
“…top five states at risk of losing community-essential rural hospitals are all [Medicaid] expansion states.”
https://www.wsj.com/articles/medicaid-expansion-wont-save-rural-hospitals-obama-care-fraud-dependency-e9ad20c7
“Medicaid increases emergency-department use: evidence from Oregon’s Health Insurance Experiment”
https://pubmed.ncbi.nlm.nih.gov/24385603/
Hayden Dublois is a hack, he’s paid by right wing influencers…
One might make the assumption this is a healthcare issue, a humanitarian issue, an economic issue, or even a political issue. All of those assumptions are wrong. Ronald Reagan expanded Medicaide…several times during his tenure. His expansion received vast support from both Republicans and Democrats. So what is it? It’s the same issue that I point out when folks suggest consolidation of Birmingham metro functions. Always go aback to the root of the problem. Ask yourself why “white flight” happened and then ask yourself why expanding Medicaid under a white Republican was acceptable but expansion under a black Democrat was not acceptable. The answer is in Black and White but everyone is affraid to talk about it or even admit it. We (Alabama) would rather lose money, or have to spend extra money, or have to travel more miles for healthcare than to address the Black and White issue.
Reagan expanded Medicaid for pregnant women, infants and young children. The ACA expanded Medicaid to non-disabled, non-elderly adults without dependent children. Quite a big difference.
David, this is very concerning. Over the past few years, friends have told me about being stuck in hospital hallways for hours—or even days—waiting for a proper room. It is a very real problem, and anyone can face a medical emergency at any time.Since you brought this issue to light, what action items do you suggest for us as readers? We would love to know how we can help fix this situation.
Thank you for this article, this state needs a governor and govering body to expand Medicaid. Because the outcome is people are going to have delayed care, or possibly even die because of travel time to get to Birmingham. It is past time EXPAND MEDICAID.
It is crazy how I can’t leave a comment about medicaid.
Maybe we can get Tuberville on our side and fix this problem.
Call your congress rep and let them know we are for expanding Medicaid
Good luck with that. Tuberville is only interested in helping those who can help Tuberville, namely big donors.
If enough of us would contact our state legislators about this issue they would act on it. It’s really that simple.
Most people don’t know who their representatives are, much less ever contact them.
Democracy works but only if citizens do their part. The squeaky wheel gets the grease.
Everyone is missing something that is fundamental in finance and economics. The power of compounding over time, and how that can work for you or against you. Healthcare inflation runs between 4% and 7% annually. Economic growth, and hence tax collections, increases between 1% and 3% annually.
I grew up in Alabama. I now live in North Carolina. North Caroline has been booming for the past ten years. Furthermore, North Carolina is substantially wealthier than Alabama. North Carolina expanded Medicaid yet is now struggling to pay for the Medicaid expansion. Why, because the cost of Medicaid is growing faster than tax collections allocated for the Medicaid expansion.
Everyone says the U.S. government is paying for 90% of the Medicaid expansion, so it is a no-brainer. However, the cost of the 10% the state is paying is compounding at 4% to 7% annually. The tax collections you have allocated to pay of it is growing at 1% to 3% annually. In a few years, there will be a meaningful gap between the cost of the Medicaid expansion and the money available to pay for it.