Former Speaker joins Sewell on healthcare panel

BIRMINGHAM — James Phillips had health insurance when doctors amputated his left leg due to a life-threatening infection in 2022. But two days later, he lost his job.

Phillips and his wife, Andrea Phillips, were able to continue their insurance coverage temporarily through COBRA, but the couple ended up shifting to a plan through the Affordable Care Act marketplace.

What followed was a yearslong health crisis for both Andrea and James Phillips involving a triple-negative breast cancer diagnosis for Andrea and a major heart attack and congestive heart failure for James.

Even though their health struggles are far from over, the Phillips family decided to end their ACA coverage in January after their enhanced tax credits ended and made their coverage prohibitively expensive.

James Phillips said the couple's premium was going to increase from $200 per month to $1,800. They are now uninsured.

"Luckily we were on the Affordable Care Act and we had coverage, and that saved her life and my life," James Phillips said. "But then January of this year, that was gone, and that's been such a struggle for this entire year to figure out what do you do… It's been such a struggle just knowing that you never know when something could happen, especially with the way my body is currently."

Stories like the Phillips' about life after ACA tax credits expired were the focus of a panel discussion hosted by U.S. Rep. Terri Sewell, D-Birmingham, at Cooper Green Mercy Health Services in Birmingham Wednesday.

Joined by former House Speaker Nancy Pelosi, D-Calif., doctors, advocates and patients, Sewell talked about the role the Affordable Care Act has played in keeping health insurance affordable in Alabama and how the end of certain enhanced tax credits put thousands of Alabamians in a precarious situation.

Around 95,000 Alabamians have discontinued or lost their ACA marketplace coverage since the tax credits expired at the end of 2025, Sewell said, calling the consequences "devastating." She said that restoring ACA tax subsidies will be a priority for House Democrats after the general election.

"Delaying treatment, skipping medication, or turning to the emergency room when their conditions become so dire, and it is not just individuals," Sewell said. "At a time when 27 rural hospitals in our state are at the risk of closure, these cuts are placing even more pressure on our rural healthcare providers. We should be working to make healthcare more affordable and more accessible."

Robyn Hyden, the executive director of advocacy group Alabama Arise, said that the impacts of the Affordable Care Act "cannot be overstated." In the decade after the legislation's passage in 2010, Alabama went from 800,000 Alabamians without health insurance to around 400,000, Hyden said.

But the expiration of enhanced tax credits has undone progress, Hyden said.

"We've expanded postpartum coverage to one full year, we've streamlined presumptive eligibility for Medicaid for pregnant women, but we have so much to do, and we're going backwards because of the Big Ugly Bill," Hyden said. "So I'm so grateful we're talking about this today. We have seen 95,000 people lose coverage, where the coverage gap is only increasing. We have a lot to do to stand up for our families."

Alabama is also one of 10 states nationwide that has not expanded Medicaid coverage, creating additional hurdles for healthcare providers and patients alike, panelists said.

Dr. Bart Rose, an associate professor of surgery at University of Alabama at Birmingham and the director of UAB's Pancreatobiliary Disease Center, said that having access to care and catching diseases early "drastically" improves outcomes. Because it is more difficult for uninsured patients to access or afford care, ailments like cancer are caught later and are harder to treat, Rose said.

"That has effects down the line for the patient because their outcome is going to be worse," Rose said. "It has an impact on the system because now when they are coming into the system, it's much more advanced or requires a lot more care. When something that may have been addressed, a very simple operation, and they need an operation, they need chemo, and they may not survive it."

Rose and other panelists also discussed how having more uninsured people in the state puts strain on providers and healthcare institutions.

Pelosi, who was a significant architect of the landmark ACA legislation, said that healthcare access boils down to an issue about the "goodness of the American people."

Though she is not seeking reelection, the former speaker of the House said that she expects Democrats to take up a larger "care" agenda including paid family leave and assistance for home caregivers if the party regains control of Congress.

"We're all susceptible. You never know from one diagnosis, one accident, or whatever, what your situation might be, but hoping for the best," Pelosi said. "If your neighbor needs help, as the Gospel of Matthew tells us, you're there for them. So this is about the goodness of the American people in addition to a very pragmatic decision that if you invest in healthcare earlier, your costs are lower."

Sewell said that she wants to be a partner to state lawmakers in tackling affordability in healthcare at every level of government. She said that beyond helping people, healthcare helps bolster economic development and quality of life.

"Health care is an essential economic development issue as well," Sewell said. "We cannot have thriving cities like Birmingham without really good healthcare, really good schools. Healthcare is right up there, hospitals and health centers and clinics. What we're really talking about is the quality of life of Alabamians and Americans, and that quality of life has to include healthcare in this great country. Nobody should go without it."

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