Affordable Care Act enrollment in Alabama dropped by 95,000 enrollees — nearly 23% — after enhanced premium tax credits expired at the end of 2025.

Nationwide, ACA enrollment similarly declined in 49 states after enrollees saw significant increases in their premium costs after enhanced premium tax credits, which were passed by Congress in 2021, expired at the end of 2025. Extending these tax credits was a focus for Democrats during last fall’s government shutdown, but lawmakers ultimately failed to extend the benefit.

According to health nonprofit KFF, ACA premium costs increased by 58% on average from 2025 to 2026.

Now, there is growing concern that Alabamians being priced out of their ACA healthcare plans also fall in the Medicaid coverage gap — meaning they can not afford ACA or other private healthcare plans, while simultaneously not qualifying for Medicaid under the state’s requirements, leaving them uninsured.

According to KFF data, 8.2% of Alabamians were uninsured in 2024. 

When the ACA was passed in 2010, the law required states to expand Medicaid coverage to cover all adults with incomes up to 138% of the Federal Poverty Level — currently $22,025 a year for an individual or $45,540 a year for a family of four. However, a 2012 Supreme Court ruling made expansion optional. 

Advocacy groups, like Alabama Arise, have been pushing the state to expand Medicaid coverage to address this healthcare coverage gap. Democratic gubernatorial candidate Doug Jones has also campaigned on expanding Medicaid coverage in the state. 

Currently, Medicaid in Alabama almost exclusively covers children, disabled people and the elderly. Adults with qualifying children qualify for Medicaid in the state if they make 18% of the poverty level — $5,940 a year for a family of four.

“What that means is more people are going to the ER without health insurance coverage,” Debbie Smith, director of Alabama Arise’s initiative Cover Alabama, told Alabama Reflector. “The hospital has to pick up that cost, and that makes it more likely for that hospital to not be able to absorb it, and possibly have to get rid of services at that hospital, or even shut down.”

These additional costs especially place a strain on Alabama’s rural hospitals — 17, or more than a third, of which are considered to be at immediate risk of closing due to financial strain. 

Alabama’s Republican lawmakers have previously suggested a public-private partnership to address gaps in healthcare coverage. However, the idea has failed to gain momentum with lawmakers removing a provision from a 2024 gambling bill that would have provided funds for the program. 

Alabama top stories in brief

Health departments says cyclospora slowing in state

• The Alabama Department of Public Health said last week cyclospora, the parasite causing intestinal illness in a nationwide outbreak, is slowing down in the state.
• Alabama has seen a total of 117 confirmed cyclosporiasis cases this year, according to ADPH data, with most of those cases concentrated in the northern part of the state and most of the cases linked to contaminated lettuce. 
• According to the Centers for Disease Control and Prevention, there have been 9,481 confirmed cases in 17 states, with the outbreak concentrated in the midwest.

Jacksonville State University board votes to dissolve faculty, staff senates

• Jacksonville State University’s Board of Trustees voted last week to dissolve the school’s faculty and staff senates.
• The move fulfills requirements from a state law, HB 580, passed earlier this year that curtails the power of faculty senates at public universities in the state by relegating them to largely advisory bodies. 
• “Today’s action fulfills that responsibility while beginning the important work of developing board-approved policies that reflect the requirements of the law and support the University’s long-term success,” a statement from Randall Jones, the chair of the board, said.
• JSU President Don C. Killingsworth, Jr. said the university plans to work with faculty to develop a mechanism to incorporate faculty voices into board of trustees decision-making.
• JSU follows Auburn University in dissolving their faculty senates. Auburn’s Board of Trustees voted to dissolve the university’s faculty senate in June, despite the fact that HB 580 included exceptions for both Auburn and the University of Alabama. 

Amtrak Gulf Coast Mardi Gras line exceeds first-year expectations

• Amtrak’s Mardi Gras train service, which runs two daily trips between Mobile and New Orleans, has exceeded its first-year ridership expectations, according to Amtrak officials.
• Since its inaugural trip in August 2025, there have been 150,000 riders — shattering initial estimates that placed first-year ridership at 38,000 riders. 
• The train service has also generated about $5.2 million in revenue.
• The Mardi Gras line restored train service between Mobile and New Orleans, after Hurricane Katrina destroyed much of the rail infrastructure between the two cities in 2005.
• In light of the train’s popularity, rail and Mobile city officials have said they are discussing building a permanent train station in Mobile, though no timetable or official plan has been released. Currently, the Mobile stop lacks any covering or awning over the train platform.
• Mobile also launched a public safety campaign earlier this year to encourage train crossing safety after multiple deadly collisions.

Jackson Hospital reaches deal to stay open

• Montgomery’s troubled Jackson Hospital and Blue Cross and Blue Shield of Alabama reached a deal last week to keep the hospital open.
• Neither Jackson Hospital leadership nor BCBSA shared the details of the four-year agreement, but Jackson Hospital’s President and CEO John Quinlivan said the deal is contingent on the hospital emerging out of bankruptcy.
• Jackson Hospital declared bankruptcy in 2025, and has been fighting to stay open since.
• Hospital officials also said the deal would allow the hospital to add new services, but did not specify what services. 
• Initially, Jackson Hospital officials demanded that BCBSA pay the hospital a similar amount for patient services as it does Montgomery’s Baptist Medical Center South. However, BCBSA rejected this demand saying the two hospitals offer differing care.

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