Karen: There has to first be an acknowledgement of the past wrongs, and that's been a hard conversation for this country.

Cliff: We come out of a history where as enslaved people, we were only needed to be as healthy as necessary to work the plantation.

Karen: Even when we think about what happened to black soldiers during the Civil War who were fighting and how their medical care was very different and segregated.

Cliff: Selma was, like, the diabetes capital of the country.

Karen: The syphilis study was actually from the United States government.

So you had a drug, you could treat it, but they said, well, we don't know what the natural history of syphilis is, so let's not treat these black men for 40 years and see what happens.

Cliff: We know about Lowndes County, which deals with sanitation issues.

Karen: And we think about how segregated even some of our hospital systems were until the 1970s.

It's not that long ago.

So when you have entire communities that have been disenfranchised on purpose, that's poverty by design, and that's what enables entire populations of individuals to have some of the worst healthcare outcomes in the nation.

(somber music) Neidre: LJ, come get your stuffed prepped.

Neidre VO: I've been told that my great-grandfather came here when the government was giving 40 acres and a mule.

Neidre: All right, go on, do what you gotta do.

Neidre VO: So we've been here for well over a hundred years and we've kind of just stayed here, left, came back, had children, left, came back, had children.

So it's about four generations here now.

Tupelo is a small city.

You pretty much know everybody.

So if my kids go anywhere, like my oldest son, when he would go to the mall, people knew who he was.

Neidre: That's good, I'll finish it.

Neidre VO: I have three sons.

Joseph is very charismatic, he's a people's person.

Neidre: Ah, I don't know why he put no seasoning on it.

He didn't put a drop of season on it.

So y'all gotta put your own seasoning.

LJ you not gonna season the eggs?

Neidre VO: LJ is very wise very responsible, very adultish.

Bobby Cole is very loving, he's concerned about people.

Neidre: Here, LJ, you eat yours in the car.

Don't.

It's hot, I know it's hot.

Neidre VO: I've pretty much been in that house all my life.

It's extremely important that the land stays in the family.

If my mom and dad had lost that land, I don't know where I would be.

But my goal is to get out of Mississippi.

There are a lot of things that were offered and Mississippi was just like, no, no, no, no, and no.

I don't really feel like this would be the ideal place to raise black children.

The income is pretty low and it's not high enough to take care of basic needs.

I was a case manager for a community mental health service.

Between car payment, car insurance, rent, two daycare-- I just, I mean, I didn't have enough for food, so I chose self-employment, which means that there's not much income.

Even with the healthcare system, if you don't make a certain amount, you pretty much just stuck.

You in poverty and then you work to stay in poverty.

Those who are making these laws, I don't really feel like they have the people's best interest at heart, I just don't.

Karen: I would kind of describe myself as a health disparities abolitionist, but it's really about dismantling a system that's been put in place by individuals who are not directly impacted.

We know that socioeconomic status-- that's the greatest driver of health outcomes, which means that wealth matters.

And wealth, in fact, is what dictates health.

If you go down the line, HIV AIDS, cardiovascular disease, diabetes, mental health, obesity, you name it, blacks have the worst outcomes, worse than any other race or ethnic group.

So that's about access, that's about safety, that's about something happening in our healthcare system that's not right.

Medicaid is a federal program that's been established to allow individuals who are at or below the poverty line to access basic medical care.

It allows them to establish a relationship and a rapport with a provider and allows them to actually go and be proactive.

During the Obama administration, the Affordable Care Act put in Medicaid expansion, which means that individuals who were slightly above the poverty level could also gain access to Medicaid services.

While it's federal dollars, those federal dollars go to each state and the state then has to decide.

There are 10 states that have not expanded Medicaid, eight of which are actually in the South, and 60% of those eligible for that expansion would be people of color.

There's a whole cadre of individuals from rural backgrounds, people of color, who are not gonna have access because this has been so hyper politicized.

-Hello.

-Woman: Hey, how are you?

We are actually taking these meals downtown in Sylvester, Georgia.

Getting out into the community gives me the opportunity to share what I feel inside.

-(Woman talking indistinctly) -Thank you, Johnny.

Pamela: It just gimme a great feeling that I can bring something to someone else.

I wouldn't go nowhere else.

All right, thank you all.

To compare to other parts of the state, I would say that we're rural.

In terms of resources, investments, what we're being left out of, everything basically down to the health and medical provisions, you know, everything really stops in Macon and from Macon down, we're lost.

We don't have the investment that we should here.

We are missing out on the opportunity to have talented children, instead of them growing here, they leave to find a better place and position.

-That's me at graduation.

-It's you.

Yeah, you were at graduation.

- Can you believe that?

- Look at, look at Kiana.

Pamela VO: My family is from Sylvester.

We've been here all our life.

Pamela: Isn't it?

You just ain't changed.

Pamela VO: My mom and dad are from here.

Woman: That was in '81.

Pamela VO: We went through some up and downs with my father just in February.

-You ain't seen this book.

-No I haven't seen this one.

Pamela: My every day is to take care of my family.

Who is that?

Me and Dia, look at my hair.

Interviewer: I took my shower and laid down to rest.

At 2:30 I believe, I looked at the clock, I couldn't move.

My body was stiff and my bones was popping like I broke a chair.

Pamela: Now you remember this picture?

Pamela VO: All this was happening and nobody heard me and I thought I was dying.

When he finally woke up, my husband took me to the clinic.

I was diagnosed at that moment with rheumatoid polyarthritis from the top of my head to my toe.

So bad that I stopped walking.

I couldn't work, I had gave up, I didn't wanna live.

My daughter was four at this time, and all I could see is that she was gonna be without her mother.

After 2018, they start saying I could still work, and I made myself get up and I made myself work.

As time start progressing, it got worse.

I was on a walker and at this time I had a stroke.

They didn't think I was gonna survive that day.

At the very end, it's my right hand, you know, on the front of my phone.

Pamela VO: There was one time when I just wanted to just give it all up and she called, she said, I need you to Psalms 91, little girl.

I walked and I talked that scripture.

Part of my incentive to work was to keep my insurance.

2021 I was at my job and I became real ill.

When I went to the doctor, he told me that I had to stop working again.

As time progressed, I was able to receive social security.

Last year, I received some letters stating that I no longer would be receiving my benefits.

They stated that my income was too high.

I fought with them about it.

For a couple months, I had no income, period.

They still, at this day, have not gave me a decision.

I, right now, don't have any insurance.

I need my medicine.

And that's what helped me get around, helped me move, relax these muscles in my body.

Cliff: You know, the state of Georgia is really interesting.

It's the deep South, got some very traditional Southern ways for better and worse, but it's the state that's obviously in transition.

There's a whole narrative that's being thought of differently of of like who is Georgia and what are black folks in Georgia, from black folks in metro Atlanta to the recognition that black folks are rural as well, and that ultimately, those two worlds have to be merged.

How I would describe myself, there's a lot.

(laughs) So organizer, teacher, writer, strategist, husband, dad.

Yes, we've always been fighting for voting rights and ending segregation and all these other things, but healthcare has always been right in the middle of that.

In the state of Georgia alone, almost half a million people are living in the Medicaid gap.

Think about this gap.

You've basically got people that make too much to be on Medicaid, right?

Which is a ridiculously low threshold to begin with, but you're not making enough to be able to afford private insurance.

Karen: The median income for families who are not eligible or cannot qualify for Medicaid is only $9,500 a year, 9,500 for a family of three.

The minute they start making money, they lose all their benefits, including healthcare, which then puts them in a deeper state of poverty.

So people will turn down promotions, they'll turn down positions that would give them a slight elevation in terms of a raise or allow them to be promoted to a new role because they fall into that gap.

Healthcare unfortunately is tied to work.

It's tied to a benefit from a job, and so families are struggling to make ends meet, number one but then also don't have the benefit of having healthcare.

Cliff: In a society calls itself the greatest democracy on the face of the earth, the strongest economy, that shouldn't exist.

What we're saying is that we wanna care for certain populations and not others.

We wanna give basic healthcare to certain populations, but not others.

Because it was tied to the Affordable Care Act, people politicized healthcare.

Why would we do that?

Cliff: Well, you know, somewhere, some folks wrote a document talking about life, liberty and the pursuit of happiness.

You can't pursue happiness if you don't have good health.

Before we can advocate for some of the other things that we fight for, education and fight for increasing the minimum wage and fighting for reparations, we got to have the health that we need to be able to do any of that.

Brian: How I'd describe Tallahassee?

Diverse.

We have Florida State University and FAMU.

So you definitely get a lot of different people here just from all over the place.

Leader would be how I would describe myself.

I am a life coach for Dreams and Success Homes.

And this top corner right here it just shows the availability of your coach.

Cliff VO: DASH, we provides transitional housing for young adults that just aged out of foster care, typically, starting at 18 years old up to 23 years old.

Brian: Just applying it to your everyday daily life.

Brian VO: So I grew up in Tallahassee, Florida, but I was born in Quincy, Florida.

Brian: This is one of the examples of the room set up.

When I turned 11 years old, I went into foster care and I was placed in Tallahassee until I turned 18.

Brian: ...and all that stuff like that.

Brian VO: What led to me being in foster care, my mother was just never home, my other two siblings couldn't do a lot of things on their own, so I had to step up and little brother had to be big brother.

Eventually, it kind of caught up to my mother, that's when DCF stepped in and said, we feel this is a better situation for you.

(jazz music) So today I'm going to be whipping up some roasted vegetables and shrimp.

Just kind of give y'all a little taste of what I eat on a daily basis.

I try to keep it healthy as possible.

Brian VO: I come from a country family, so country cooking, a lot of fried foods.

So health wasn't one of those top priorities.

But in 2017, health became probably the most important thing to me.

So that morning, just caught the bus to work and I have to use the restroom, but it was like the urgency was like just intense.

As time went on that day, I started to feel fatigued.

It just became a struggle to just go throughout the day to the point where I almost passed out.

Brian: Asparagus, one of the best vegetables.

Brian VO: And my coworkers was just looking at me like, "Hey, are you okay?"

So I just went to the emergency room and they ran their tests on me and they say, "Hey, you have type 2 diabetes."

I don't quite remember that moment, but like I just didn't know the severity of it at the time because I just wasn't educated.

I'm gonna go with a little color for my shrimp.

Brian VO: The first couple years, I did struggle with maintaining it.

Brian: Let's see, to make sure there anything else that I need in here.

Brian VO: But also just having access to that health insurance.

Brian: Sea salt right here.

Brian VO: Living now without insurance definitely just means I have to tidy down on my nutrition, my exercise.

Getting insurance, that right there is a priority so that I can still get those prescriptions that I need.

Brian: We gotta make do what we got, we gonna go with it.

Brian VO: The cost of insulin can go up to $500 a bottle for a bottle that doesn't last even a month.

The doctor usually cover the first prescription and then your insurance covers the rest.

So I would basically just kind of go to different doctor and get this insulin for free.

It kind of worked for a while.

Two years ago, I did apply for health insurance through Healthcare Gov and the cost of insurance for me was $400 a month.

If you making $19,000 a year and just so happen to have your own apartment, maybe a car or something, you have no money left after that.

Those two years without insulin were tough.

I started to gain weight, I didn't feel up to do things.

I didn't feel like going to work.

I didn't feel like being that joyful person that I normally am.

Brian: All right, thank you.

We got them groceries, now we outta here.

(somber music) (indistinct chatter) -Neidre: Who took this shot of us?

-You.

Neidre: Yeah, I had my phone trying to hide it.

This photo is my granddaddy, and there go our only two aunts-- Neidre VO: My grandmother had diabetes real bad.

My mom, I don't know if she went to the doctor very often because she was very private.

We found out she had cancer, like a week and a half later, she was gone.

Everybody on this side has passed.

Everybody on this side is still alive.

Growing up, you just didn't go to the doctor.

My mama took me very few times and it was like, dire.

When you was sick, you just go lay down, go drink you some water.

This is LJ?

He's my middle, and this is Bobby Cole.

This is Joseph's first portrait-- professional portrait.

Neidre VO: With my first pregnancy.

Neidre: First baby.

Neidre VO: I also had my first Pap.

They had found some cells that wasn't looking good, I didn't have a good Pap.

Pretty much in Mississippi, if you're pregnant, you can get on Medicaid.

So after I had him with the childbirth trauma, my gynecologist pretty much said that he wasn't gonna see me again because he didn't know what to do.

So he sent me to Jackson.

Medicaid, shut off a month after you have the child.

So I took that four-hour drive, but when I got to Jackson, I didn't have Medicaid anymore.

This is the last picture we've taken.

We took this Mother's Day.

So they pretty much told me that for them to even look at me or evaluate me, it would be $10,000.

Of course I didn't have $10,000, I had just had a baby.

I wasn't working at the time because I just had a baby, and I just drove home, I just prayed and drove home.

Cliff: At every level, Black folks are impacted disproportionately.

And yet when you look at the policies, that doesn't reflect that.

It really just started with a routine checkup.

You know, I was having some pains and said, it's been a while, but the doctor said, you know what your, your white blood count is a little elevated.

I'm gonna refer you to an oncologist.

Long story short, did an extra screening, discovered I have chronic lymphocytic leukemia.

They noticed, well the CLL is very early, that's the good news.

But we think we may see something on the pancreas, some more scans and biopsy and discovered that I had a growth on my pancreas, what's called a neuroendocrine tumor.

And so I often say that my CLL was a blessing because if not for the discovery of the CLL and then the extra scans that had to be done because of it, I could have wound up some years later at stage four with them saying, "Oh by the way."

I benefited from having insurance, being able to go into a regular checkup, being able to get some basic screenings done.

When you're in the Medicaid gap, it's those basic screenings that can lead to like some life saving care that you simply don't have access to and you could be doing the responsible stuff, you could be eating right and exercising, but still you can have something that you simply can't see.

There's some very clear policy, health equity, racial equity discussions and policies that need to be taking place.

We need to start thinking about prevention.

We need to start thinking about the things that people, individuals, families, and physicians, and healthcare systems can do to help prevent cancers.

And that's on the primary care side and that's really where Medicaid comes into play.

We already know of the states that expanded Medicaid.

We've seen a decline in terms of the cancer incidents, the number of deaths from cancer.

There is real benefit to actually having the ability to improve access to healthcare.

This is my granddaddy, Reverend E.B.

Munford Senior Pastor.

He carried this church till he was 90 years old.

It was founded in 1971 on these grounds of what we are now.

My grandparents, Reverend Eddie B. Munford and Lula Mae Johnson, they made sure we knew God.

My faith started when I was six years old.

I asked God to save me and I knew what it meant, and I ride on that, and I believe that whatever you ask for, you will receive it.

Father God, right now in the name of Jesus, my family came here through my grandfather.

He led us right there.

My grandmother always sat on that side, I do see a connection in all of it because when I'm in the community, I bring what I learned.

Love, loyalty, understanding.

You can't do the work in the community, under those volumes, if you come to church and you leave it here.

Right now, Lord, what we need in this community, this world, we need to be healed from the inside out.

The world is hurting.

They're hurting because a lot of us are not being heard.

I am affected, I am one of those people.

(gospel music) Cliff: If you're dealing with the cost of your medicines or various sicknesses, you not really trying to hear about going to the city council meeting or coming out to this rally for voting rights.

In so many ways, it impacts the organizing that we need to do in order to improve that issue and every other issue that we deal with.

We use these for going door to door, for being at events.

Wherever they are, they are basically moving, mobilizing offices.

We tell everybody we touch that you are an organizer.

Karen: Education around the benefits of Medicaid is really critical-- not just in the communities that are most impacted, but also at institutional levels and also with our legislators.

There is plenty of data that shows that the Affordable Care Act, the expansion of Medicaid has improved healthcare status in the states where expansion occurred, that's huge.

There's only this handful of states that are being real strategic about the fact that they don't wanna support people that don't look like them.

Neidre: My sister, I guess she got tired of driving out here, so she decided to build a house behind us.

Sister: I did, I thought she needed help.

Neidre: Like with three children when they were younger, you know, trying to up with daycare and all the bills and I just, you know, I don't know where we'd be at.

My oldest son has ADHD.

Neidre: Somebody pass me my zinc.

Neidre VO: Between him and then my middle baby, he was having stomach problems.

So if it wasn't picking one up, it was picking the other one up.

It had got to the point where I had used all my sick days, I had used all my vacation days.

I decided to stop working, go back to school, get my masters and just be a mom.

I love moments, I love experiences.

So I've always had a camera.

Okay, come this way.

Okay listen, I need your eyes on my camera, and three.

Neidre VO: And so I took their pictures and I put 'em on Facebook and people asking who took their pictures, who took their pictures?

I'm like, I took their pictures.

I didn't think nothing about it.

So the next, we gonna do, let's do a kind of a headshot.

So I said, well maybe I would just start taking pictures for $25.

Okay, gimme a spin.

And put 'em on a disc.

And that's what I started doing, so it grew from there.

Neidre: That's fine, you ready?

One, two, and... Neidre VO: I work and I have several different things that I do.

Like I do digital art, I do photography.

Okay, gimme a little emotion in your face.

I do like the little realistic dolls.

Whatever I can get my hands on to do, that's how I make my income.

Neidre: Perfect, let's do one more.

Neidre VO: I had that affordable health care for about four months last year and I did go to the doctor.

That evaluation wasn't great.

They were concerned about my blood pressure.

By the time I went back, I didn't have any insurance.

So it's been over a year since I've been back to the doctor.

I had a little scare where my blood sugar level was like dangerously high.

So I just kind of called around to see who had medicine.

"Listen, do y'all have some metformin?"

Well I end up, I think I did take one.

By that next day, my blood sugar level had dropped all the way down.

If I have a health concern, I google my symptoms and then I just try to find the closest things and then I google natural ways to treat.

If I qualify for Medicaid tomorrow, I mean I'm getting older, female checks, all of those things, I would definitely, you know, get all those things checked so I can kind of know where I am physically.

The peace of mind to know what's going on with your body.

Right now I'm not getting any assistance.

I'm applying, but I'm not getting, so you have to decide am I gonna put gas my car or am I gonna buy groceries?

Then there's no medical at all.

Man: What you cooking, man?

Brian: Roasted vegetables with shrimp.

-Man: Oh man.

-Brian: Yes, sir.

Man: I love asparagus too.

Brian VO: In my case, in type two, it's when it gets too high, my body does tell me when, but I don't always rely on that.

I was gonna take Levemir, which was prescribed to me, but I knew that I didn't have health insurance and so I knew that's gonna be expensive to get all those things.

I found some way to push through until someone told me that I can get insulin across the counter.

Spread them across.

That was affordable, it was about $25 a bottle.

So I just relied on that.

This particular insulin is not prescribed and maybe it's just 'cause the way that this one works, why it is available to everyone.

Man: I'm just eating kind of like, I don't care right now.

Brian: Cooking, man, you gotta do with passion, you gotta do cooking with passion, man.

Brian VO: The way I would prefer would be checking in still with a doctor.

Brian: You gotta be careful with potatoes though, 'cause they do have carbs, man.

Brian VO: Okay, let's see if we need to change something around with your prescriptions or with your diet or with your exercise to make sure that we're reaching the goal that you're trying to reach.

I mean look at all the people who could benefit from this Medicaid being extended.

I would definitely take full advantage of it where you can go see that doctor whenever you need 'em.

I'm going to use it to make sure that I can live long as possible so that whenever I can, you know, have my children and grandchildren, I can pass down the... Man: Oh man, thank you.

Oh, it looks good, it smells amazing too.

Pamela: Okay, just gimme a minute.

After this week, I'll be kinda like slowing down.

You better slow down.

Pamela: In Worth County, Sylvester area, the cancer rate is really high and it's not noticeable from people talking about it because they don't have the resources.

I feel it's my greatest event that I did was teaming up with the senior citizen building here in Sylvester.

Did you learn anything about your insurance?

Seeing other people without insurance, it does something to me.

Thank you all, I thank Ms. Marlin.

(applause) Pamela VO: Because I know how it feel when you can't go to that doctor, when you can't even go to the hospital.

Pamela: To give this information that will allow you all to grow.

And we're here for you.

There's so much that we can do together, but there's not enough that we can do apart.

Pamela VO: A lot of people are not aware that Medicaid has not been expanded in this area.

Pamela: But we thank y'all for allowing us, Ms. Milton has something she would like to say.

I thank you all being here.

We have learned a lot of things.

Pamela VO: Well even when out, doing little small things like giving away food, I learn that they don't know.

So I give 'em my information and they pass it on to someone else.

Today you may have that coverage, tomorrow they may be doing a review on you and they cut it out.

And then what are these people gonna do?

(applause) Thank you all.

And that concludes everything that I'm doing here today.

It makes me feel as though they have never experienced what we are experiencing here.

If it happened to their families, immediate family, quite sure they'll change their mind.

I will say it again and again, if you need me and you know how to find me and I'll be here for you at any time, okay?

(applause) Did I let you meet-- Karen: Access to healthcare goes beyond just having insurance.

It's not enough that people have Medicaid, they have to know that the system is for them.

Lifting up a community doesn't mean that another community has to go down.

Tons of data exists to show that when we actually focus on the most disenfranchised group in terms of elevating their status and community, elevating their ability to access care, we do it for everybody.

This is the bench that I had built as a memorial to my husband.

It says Jeffrey D. Walker.

In memory of "The Biggin."

(laughs) It's actually a really important reason why I stay here.

I live here, this is my home because you know, Jeff is always here with us in a physical way because of this memorial bench.

His experience was very jarring for me.

It's very different being on the other side when you have somebody who's sick and constantly needing care and having to see multiple specialists.

It really helped shape the work that I do, both in the caregiving, the clinic work that I do, but certainly from a policy perspective.

Is there hope?

There absolutely is.

I have been in and out of North Carolina for almost two decades and have been fighting almost that entire time around Medicaid expansion.

And it finally happened.

It wasn't overnight, but advocacy matters, and it works.

Cliff: You know, we believe in the words of Dr. Martin Luther King when he talked about love and power, right?

How power without love is reckless and abusive.

But love without power is sentimental and anemic.

And we believe our communities need both and we fight to create both.

It's gotta be based on investing in local resources, local infrastructure, local organizations.

'Cause if all you gonna do is trust and believe and not invest, then you still got folks out there just trying to make it on their own.

Part of having this conversation is to acknowledge these wrongs, to acknowledge these realities that have taken place in the past, and again, even right now.

But it is not an option for us to not engage in our health anymore than it's not an option for us to not engage in our political destiny.

We've got to find ways to overcome those realities.

Well, it takes the longer time in some places than others, but the tide is turning and we're seeing that happening.

And all we gotta do is just keep on doing the work that we know works.

We can't get discouraged and grow weary in good doing "'cause in due season, we shall reap."

(somber music)