Q&A: Florida Health Justice Project director Alison Yager on reducing Florida’s health disparities

Alison Yager is the executive director of the Florida Health Justice Project, one of the state’s leading advocates for reducing health disparities. 

In this interview, Yager expressed her frustration with state leadership, saying the state’s health disparities were not only worsened by the COVID-19 pandemic, but stem from the legislature’s decade-long disinvestment from public health services. Yager also discusses efforts to expand Medicaid and improve access to care among Florida’s most vulnerable communities. 


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Nicole Pasia: How has the last year and a half impacted health disparities in Florida? How has the Florida Health Justice Project worked to address these disparities?

Alison Yager: “We’ve been tracking COVID outcomes through the lens of disparities. We have a COVID disparities dashboard that we update monthly. It’s looking at infection rates, hospitalization rates, death rates, and now vaccination rates by race and ethnicity at the state level and then in targeted counties. And we are absolutely seeing disparities that have been talked about at the national level, playing out locally. And, there is a lot of geographic diversity in terms of how those disparities play out on the ground in Florida. 

We were clearly seeing that COVID is not impacting all communities equally. And we are also feeling through this pandemic, the pain of what has been a decade of disinvestment in public health infrastructure in Florida. Public health services have been cut year over year for the last 10 years. The challenges in creating state level systems for testing, for treatment, for vaccination, I think have all been the lens through which we’ve seen what that looks like when you disinvest in public health. It makes access to health services challenging. 

We’ve seen that the state’s response to COVID, has really not been driven by data. If anything, there’s been efforts at the state level to suppress the data…[It’s] just gotten more challenging with the state’s recent changes to the data reports — now changing from daily to weekly. They’ve gotten rid of some county specific data points. So, the obfuscation of data is a challenge, and there’s clearly a desire to ignore data from our state leadership. And yet, that’s a counterproductive approach to pandemic.” 

NP: Florida is one of 12 states that has yet to expand Medicaid. How is this affecting health disparities in the state?

AY: “We have between 400,000-500,000 Floridians who are in the coverage gap, without the ability to access Medicaid coverage or subsidies into the marketplace exchange. And, we know that were Florida to expand Medicaid, not just those folks in the coverage gap but actually folks at the lower end of the income spectrum, who are currently receiving health coverage through the marketplace, would be eligible for Medicaid expansion. The number of Floridians who are estimated to benefit from Medicaid expansion is over a million. 

So, the Florida Legislature has remained intransigent in its refusal to expand Medicaid and yet we have over a million Floridians who would benefit if the program expanded. And again, we find ourselves in the midst of a pandemic that’s not over. Huge numbers of people lost access to their employment-sponsored insurance, or for other reasons, lost access to health coverage over this period. 

The American Rescue Plan Act, as the most recent COVID relief plan, offered a huge incentive to non-expansion states to expand Medicaid by giving a five percent bump in federal share of the cost…and it’s been estimated that doing so would result in approximately one and a half billion dollars in net revenue to the state. 

We’ve just let the money sit on the table because of the fundamentally partisan opposition to the program.” 

NP: What are some resources your organization has to help underserved communities receive equitable health care? How do you identify what types of resources are most beneficial?

AY: “We and others have tried to play that role to help people get information about where they can get [COVID] tested. There is a federal program that should be covering the costs of treatment for uninsured so that you shouldn’t fear going to the hospital. You shouldn’t fear ending up with a big hospital bill, because [the Health Resources and Services Administration] should be paying the hospital for your treatment if you’re uninsured. 

And now with vaccines, we and many others have pushed really hard against the state residency requirements, seeing that that was really getting in the way of people being able to access vaccines. People like agricultural workers, who may not have had the necessary forms of ID but are out there harvesting our food every day, literally putting food on our tables and unable to access vaccines themselves because of state level requirements — that just stood as barriers. So there’s been a lot of mobilization, and that role was changed, although there still remains a lot of confusion at the sites. 

So there’s a lot of work to be done there in terms of letting people know that they should be getting free treatments even if they’re uninsured because the hospital should be tapping into these federal funds. There’s a lot of lack of knowledge about these programs because there haven’t been great public education programs coming from the state, and there needs to be more information. So, I think those of us trying to do this work are trying to fill those gaps.”

NP: What other policies would you like to see the state and federal government enact to ensure health equity in Florida?

AY: “Right now one of the pots of money that’s being considered for inclusion in the next federal relief package is a big boost to home and community-based services. The President has recognized and talked about the need for additional funding for those programs, and we really see that in our work. We speak to folks who receive home and community-based services through Florida’s Medicaid Long-Term Care Waiver programs, and they’re routinely not getting the level of services they need, or unable to find folks to work on evening hours or weekend hours because the rate of pay for these home based workers is so low. And so we’re pushing, and others are pushing, for Congress to include significant funding over the next decade for home and community-based services to ensure that people are able to get adequate care at home. 

That serves a public health purpose by keeping people out of institutional settings like nursing homes. We saw when we were hit by a pandemic that the pandemic just raged violently through these institutional settings. And the more that we can do to keep people in the safety of their homes, away from the virus but also just home with loved ones in a setting where they’re safe and comfortable…that’s a hugely important next step. And we hope that we’ll see that at the federal level.

And frankly there’s a lot that the state legislature could do. They could increase access to high quality data for instance, and data specifically about racial and ethnic groups’ ability to access care and health outcomes. And that’s a bill that was in the legislature this year. There are so many needs, but truly the number one need that eclipses all others is the need for the state to expand Medicaid.”

NP: What gives you hope, looking forward to the next few years?

AY: “There is a tremendous community of advocates and a growing number of mobilized Floridians, who are really coming together to say, this system isn’t working for us, and we need health coverage. I think the pandemic underscored that for folks. We’re in a moment where people have identified what matters to them…So I am really heartened to see all of the folks pushing for that and we have some incredible leaders in the state legislature who really are champions for health care access. And, you know, they will continue pushing for Floridians to get the care and coverage that they need. 

As we hopefully move out of the pandemic, it is an opportunity to say, ‘Let’s not go back to business as usual.’ This last year and a half has really shaken things up, and has illuminated for us the need to reprioritize and take care of the collective… We can’t have a thriving society if we’re not ensuring that everyone is able to be healthy.”

This interview was edited for clarity and length.