James Phillips was back in the emergency room last Friday, facing another health scare without health insurance.
For a man who has survived multiple cardiac emergencies, lost a leg and now lives with a pacemaker and defibrillator, going without a doctor is more than an inconvenience. It means trying to manage serious health problems without knowing how he will pay for the care he needs.
His wife, Andrea, has her own struggles. She underwent chemotherapy, surgery and radiation for an aggressive form of breast cancer. Although she was declared cancer-free, she still needs follow-up appointments, lab work and screenings to monitor her health.
The couple, who live in Jasper, lost their health insurance in January after the cost of their Affordable Care Act marketplace plan climbed beyond what they could afford.
“We were paying about $200 a month for mine and Andrea’s health care coverage. When this year came about, it was going to be $1,800 a month,” he said.
For a family with five children ages nine to 24, that price was out of reach.
“Not being able to just go to a doctor when you feel like you need to — that’s an incredible stress on somebody,” James said.
The couple shared their experience Wednesday during a Birmingham roundtable with U.S. Rep. Terri Sewell, former House Speaker Nancy Pelosi and health care advocates and providers. The discussion at Cooper Green Mercy Health Services focused on the rising cost of coverage, federal health policy changes and the consequences for Alabamians who are uninsured or at risk of losing insurance.
For the Phillipses, the debate is not abstract. It is unfolding in emergency rooms, in the follow-up care Andrea cannot get and in the family’s struggle to hold on to the things they have left.
“We basically lost almost everything other than each other,” James said. “That’s the only thing we haven’t lost.”
A safety net that disappeared
The Affordable Care Act gave the family a way to obtain insurance after James lost his job shortly before his left leg was amputated in February 2022 following an infection and sepsis.
He initially relied on COBRA coverage before turning to the federal health insurance marketplace. That coverage became especially important in January 2024, when he suffered a massive heart attack.
James said he coded 17 times over 10 days during that episode. After another period of cardiac complications, he said he coded about 20 times in a week. His doctors have warned he may eventually need open-heart surgery.
He also lives with post-traumatic stress, depression, anxiety and panic attacks. He has applied for disability benefits but said he was still waiting for a decision years later.
Andrea’s health problems have brought their own challenges. Diagnosed with triple-negative breast cancer in September 2024, she underwent 16 rounds of chemotherapy, lymph node surgery and 24 radiation treatments.
The treatment left her with lasting effects, including thyroid damage, fatigue, mental fog and early menopause. Being declared cancer-free was a milestone, but it did not eliminate the need for continued medical care.
Without insurance, she said, she cannot reliably access the doctors, specialists, prescriptions and screenings needed to monitor her health.
“Some days we think, do they even care if people die?” Andrea said. “That’s very much a concern in our case.”
She said she has contacted U.S. Sen. Katie Britt seeking help but has felt unheard as the family tries to navigate its circumstances.
The couple’s financial strain extends beyond medical bills. They are in the process of losing their home and must move by the end of November. They have struggled to afford gas and food while trying to care for their children, all of whom have witnessed their father’s medical emergencies.
James said he recently had to seek emergency care without coverage.
The experience has left him thinking about how quickly a health crisis can upend a family’s life and how little control someone may have over the circumstances that follow.
The cost of coverage reaches many families
Sewell, a Birmingham Democrat, said the Phillipses’ experience illustrates what is at stake as federal health care policies change.
Enhanced federal subsidies that helped lower premiums for people buying insurance through the Affordable Care Act marketplace expired at the end of 2025. That means many enrollees faced higher out-of-pocket premiums for 2026 coverage, depending on their income and plan.
The Centers for Medicare & Medicaid Services reported that 455,776 people in Alabama selected marketplace plans during the 2026 open enrollment period, down from 477,838 the year before. Those figures measure plan selections, not how many people ultimately maintained active coverage.
Sewell said tens of thousands of Alabamians have lost coverage or are struggling to afford it. During the panel, she cited estimates of roughly 93,000 to 95,000 people who have lost coverage. That figure was not independently verified during the event.
She also criticized federal legislation that she said would make substantial cuts to Medicaid funding and place additional pressure on the health care system.
“President Trump and congressional Republicans have enacted the largest cut to health care in American history,” Sewell said, arguing that the changes would hurt low-income families and people who depend on public assistance to access care.
She urged Alabama lawmakers to expand Medicaid, a move she said could help more people obtain coverage while strengthening hospitals and clinics that care for patients who cannot pay.
Sewell said health care access is an economic issue. When people cannot afford treatment, they may delay care until a problem becomes an emergency. That can mean more financial pressure on hospitals and fewer options for families already struggling to make ends meet.
Pelosi, who served as House speaker from 2007 to 2011 and again from 2019 to 2023, joined Sewell in arguing that the Affordable Care Act remains essential to protecting people with preexisting conditions and making coverage more affordable.
Pelosi said the enhanced subsidies helped people afford marketplace plans and warned that rising premiums could push more families out of the insurance market.
“It should be a given that everyone would have access to quality, affordable health,” Pelosi said. “It is a right. It is not a privilege for the few who can afford it.”
She called for public pressure and personal stories to play a role in the political debate over health care, saying lawmakers need to hear from people whose lives are affected by changes to federal programs.
Cooper Green sees the pressure firsthand
The discussion took place at Cooper Green, a Jefferson County-supported health care facility that serves patients regardless of their ability to pay.
Dr. Raegan Durant, Cooper Green’s medical director, said the facility has about 10,175 enrolled patients. Visits have increased by more than 4,000 over the past year, he said, and about 60% of its patients do not have insurance.
Many live at or below 200% of the federal poverty level.
Cooper Green works with uninsured patients to determine whether they qualify for Medicaid or other coverage, but Durant said the facility cannot absorb every additional cost indefinitely.
“The fewer patients that are covered by some of those other sources, namely Medicaid and ACA plans on the marketplace, it just increases our burden here,” Durant said.
That burden can show up in the amount of care a safety-net provider must deliver with limited resources. County support helps Cooper Green serve people who might otherwise go without treatment, but Durant said that funding is not limitless.
Robyn Hyden, executive director of Alabama Arise, a group that advocates for policies that improve life for those in poverty, said the Affordable Care Act helped reduce the number of uninsured people in Alabama. But she argued the state’s decision to not expand Medicaid has left many low-income adults without an affordable path to coverage.
Mark Linn, assistant project director of Enroll Alabama, works with people trying to understand their insurance options. The program’s navigators help consumers compare plans and enroll in coverage without steering them toward a particular insurer.
Linn said federal funding cuts have reduced the number of full-time navigators in Alabama from 26 to four, making it harder to help people across all 67 counties.
He said some consumers who previously paid nothing for monthly premiums are now facing bills of $100 to $150. For someone living on Social Security with an annual income of $16,000 to $18,000, he said, the added expense can mean choosing between insurance and groceries.
“For every story we hear, there’s 10 stories that we don’t,” Linn said. “It’s hard to wonder how many other Alabamians are facing these decisions without anyone to tell about it.”
Rural clinics and cancer care face their own challenges
The strain is particularly acute in rural parts of the state, where clinics may serve wide geographic areas with limited staff and funding.
Keshee Dozier-Smith, CEO of Rural Health Medical Program, said her organization operates 11 community health centers serving six rural Black Belt counties.
She said the organization has seen its payer mix shift toward more uninsured patients, leaving it to stretch limited resources across a growing need for care.
Dozier-Smith said caring for an uninsured patient can cost about $800 to $1,000 a year, with patients often needing at least four visits annually. She also warned that changes to Medicaid eligibility and enrollment could force staff to spend more time helping patients maintain coverage, without necessarily receiving additional reimbursement for that work.
“With these changes to policies and forms that are occurring, that’s making health care more of a privilege, not a requirement,” Dozier-Smith said.
Dr. Bart Rose, a UAB oncologist, described how a lack of insurance can delay potentially lifesaving tests.
Rose told of one patient who needed a colonoscopy to investigate the possibility of a second cancer. With insurance, he could have arranged the test within days. Without it, the patient might have to wait while seeking financial assistance through safety-net programs.
“If he had insurance, I could get it this week,” Rose said. “Unfortunately, I’ll be lucky if I get it within a month.”
For cancer patients, he said, delays can add uncertainty to an already frightening diagnosis.
“It’s not right to lose your home just because you got sick,” Rose said.
The discussion also included the needs of people with disabilities who rely on Medicaid services outside traditional health insurance.
LaToya Mims, founder of the Wildflower Alliance, a support organization for children with disabilities and their families, spoke about her daughter, Harper, who relies on Medicaid home and community-based waiver services. Those supports help her access speech and communication technology, a wheelchair, therapy and specialists.
Mims said losing those services could cause Harper to lose progress and put greater pressure on her family to provide care without the resources they need.
Her experience underscored how health care policy can affect not only doctor visits and hospital bills but also the equipment, therapies and daily support that allow people with disabilities to live and participate in their communities.
Pelosi said Medicaid is often discussed as a program for low-income Americans, but it also helps pay for long-term care for older adults and supports people with disabilities, including veterans.
She argued that public investment in health care can help families remain stable rather than forcing them to shoulder costs they cannot manage alone.
What happens next?
The panelists offered different perspectives on how to respond, from expanding Medicaid and restoring financial assistance to strengthening local clinics and helping people navigate coverage options.
For the Phillipses, the immediate questions are personal: how to get Andrea the follow-up care she needs, how James can see a doctor when another health problem arises, and how to keep their family afloat while they try to rebuild.
James said he hopes people who hear his story will think beyond political divisions and consider how quickly circumstances can change.
“When you need help and you’re desperate, you need help,” he said. “You throw politics out the window. You don’t care if somebody’s Democrat or if they’re Republican when you need help.”
