How Expanded Medicaid Could Improve Food Security NPR's Michel Martin speaks with Jim Carnes, policy director at Alabama Arise, about how the expansion of Medicaid could help lift Americans out of the poverty that causes food insecurity.

How Expanded Medicaid Could Improve Food Security

  • Download
  • <iframe src="" width="100%" height="290" frameborder="0" scrolling="no" title="NPR embedded audio player">
  • Transcript


It seems fairly obvious that one of the root causes of food insecurity is poverty. If you don't have enough money, then it stands to reason that it's likely to be hard to get enough food, or at least enough good nutritious food, on a regular basis. But what might not be so obvious is why so many people in the United States are still in poverty. According to recent data from the U.S. Census Bureau, the No. 1 factor driving Americans into poverty is medical expenses.

That's right - medical expenses. In 2019 alone, nearly 8 million Americans fell below the poverty line because of medical bills. Anti-poverty advocates say one solution to that problem is to expand Medicaid across the country.

Jim Carnes is one of those people. He is the policy director of Alabama Arise, a nonprofit that's advocating for policies to end poverty in Alabama, including by expanding Medicaid. And he is with us now from Montgomery.

Jim Carnes, thank you so much for joining us.

JIM CARNES: Thank you, Michel.

MARTIN: So walk me through this. I mean, how do medical expenses end up forcing Americans into poverty? And I ask because I think a lot of people would assume that Medicaid, which is a program to provide medical care to people of low income, would keep that from happening. So how does this work?

CARNES: Well, the Census Bureau measures poverty in two different ways. The older way that we've been doing for 50-plus years is strictly cash income-based. And it looks at how many households have cash income less than three times the cost of what the Health and Human Services Department calls a minimum food diet for their family size.

So the second way is called the supplemental poverty measure, and it takes into account things beyond just cash income. It takes into account additional resources in a family, such as public benefits that are designed to help lift people out of poverty - things like food stamps and rental assistance and things like that. It also takes into account expenses that are not a part of the traditional basic expense spectrum, like rent and transportation and food and clothing and that sort of thing.

So it takes into account things that reduce the available resources in a family. And the factor that reduces household income - or spending money, you might say - the most is medical debt.

MARTIN: Break it down for me. Like, how does that work? What tends to be the case? Is it people with chronic health conditions and the cost of treating those conditions is high? Or is it a catastrophic incident? Why is it that medical expenses force people - that many people into poverty every year?

CARNES: Yeah. There are a number of factors moving at the same time. A huge one is the number of people without health insurance. But particularly in states like Alabama, which is one of 12 states that have not accepted Medicaid expansion, we have hundreds of thousands of people who don't have that safety net.

So, No. 1, they don't have somebody helping them pay their medical bills. When that's the case, a number of other factors kick into play. So you have people who are delaying getting medical care because they don't have a way to pay for it. And when their problem gets unavoidable, and they do have to seek care, that care is more expensive because it's late, and their condition is worse, so the bills are higher.

MARTIN: Is the connection between health care costs, poverty and food insecurity one that is starting to make sense to people? Are people starting to connect the dots? Because it's not - I mean, if you lived it, you can see why people would understand it. But if you - if they've never lived through it, then maybe it doesn't - it's not as real. And I just wondered if people are seeing that connection at all.

CARNES: I think they are. Our state government has chosen three factors to target to try to improve. And those are obesity, infant mortality and substance use disorders. So the fact that the state and our state leaders are recognizing that we really have to do something about these terrible health outcomes that are related to nutrition tells me that they are opening up to solutions that they may not have considered before.

MARTIN: Before we let you go, as you surely know, a Supreme Court justice associate, Justice Ruth Bader Ginsburg, died recently. There is now a vacancy on the high court. And we know that the Supreme Court is scheduled to hear a case that could possibly overturn the Affordable Care Act this fall, which could greatly affect Medicaid expansion. If that happens - I mean, I recognize that's a hypothetical - where do you go from there?

CARNES: Rest assured that the advocates around the country are going to be staying in the fight to continue to address the gaping holes in our health care system. And there are other ways to go about that work. So we'll just pick up. I'm hoping and praying that it doesn't come to that, that the path forward will be moving up the same path we've had and reaching the goal. But if we don't, and if we get thrown off that path, we'll make another one.

MARTIN: That's Jim Carnes, policy director at Alabama Arise.

Jim Carnes, thanks so much for talking to us.

CARNES: Thank you, Michel. I enjoyed it.

Copyright © 2020 NPR. All rights reserved. Visit our website terms of use and permissions pages at for further information.

NPR transcripts are created on a rush deadline by an NPR contractor. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of NPR’s programming is the audio record.