Policy Watch: Top Public Health Issues in the 2022 Alabama Legislative Session

February 7, 2022, by Kimberly Tsoukalas | LHC Program Coordinator


Photo Courtesy of Getty Images

Legislatures have spoken about various agendas, and points of interest as the Alabama House of Representatives and Senate reconvene for the official 2022 session. The Alabama House Republican Caucus has dubbed its plan “Standing Tall for Alabama” and includes legislation banning Critical Race Theory, allowing concealed weapons to be carried without a permit, and increasing technology access to rural areas of the state. Meanwhile, state democratic lawmakers have declared that social issues such as ​​reducing or eliminating grocery sales tax, expanding Medicaid, and prison reform to be their top priorities. Here is a look at the leading public health issues expected to come up for debate over the next few months and the corresponding bills filed in the Alabama legislative directory. 


Infrastructure packages have been proposed at nearly every level of government over the last year. H.R.3684 – the Infrastructure Investment and Jobs Act passed through the US Congress in November, authorizing $65 billion to improve passenger railways, rebuild or repair roads and bridges, upgrade airports and improve public transportation in various metro areas across the country. Alabama seems to be following in the trend, as HB1 advocates the use of $225,000,000 to “improve access to clean water to the citizens of Alabama through investments in water and sewer infrastructure projects.”  

The bill allocates: 

  • Up to $120,000,000 in water and sewer systems grants for emergency or high need projects previously identified for participation in the Clean Water State Revolving Fund or the Drinking Water State Revolving Fund. 
  • Up to $100,000,000 in matching grants to public water and sewer systems for water or sewer infrastructure projects. 
  • Up to $5,000,000 provided as grants to install clustered decentralized wastewater system demonstrations utilizations utilizing a collection system known as Septic Tank Effluent Pump (STEP) or other demonstration systems in the Alabama Black Belt areas of low population density, rural poverty, and/or soils with poor perc characteristics, where there is a finding of discharge of raw sewage onto the ground due to the utilization of straight pipes, failing septic systems, or similar circumstances. 

In addition to the improvements to water and sewer systems, the bill also allocates $85 million for statewide improvements to broadband internet access, particularly in rural communities. The Federal Communications Commission found that while broadband service is accessible to roughly 75% of the state’s population, some rural areas, such as Greene County, had fewer than 2% of residents subscribed to the service. According to SpeedMatters.org, high-speed internet access in rural communities is vital to economic growth and development in these areas. Additionally, as more services such as telehealth and online pharmacies become more prevalent, broadband internet can impact the healthcare of rural citizens.

Gender-Affirming Medical Treatment 

In 2021, the Alabama Senate passed SB10, also called the Vulnerable Child Compassion and Protection Act, which made the administration of gender-affirming medical treatment a felony in Alabama. At the time, the Southern Poverty Law Center released a statement in opposition to the bill: 

“We are disappointed that, despite reservations expressed by committee members, House Bill 1 is moving forward, particularly after the heart-wrenching testimony during last week’s public hearing by Sgt. David Fuller. This legislation disregards the medical needs of transgender children and the hard choices that their families make in their best interest. It would criminalize the very doctors that so many families turn to in their times of need. The last place for governmental overreach is at the bridge of personal medical decisions and the advice of trained professionals.”

While SB10-2021 ultimately never went to a vote in the house, failing, similar legislation has been proposed this year as HB150 was filed by Representative Wes Allen and SB5 was filed by Senator Shelnutt. 

Did you know: The Lister Hill Center published a testimonial from a UAB student on SB10. Read it here

The bill works to “prohibit the performance of a medical procedure or the prescription or issuance of medication, upon or to a minor child, that is intended to alter the appearance of the minor child’s gender or delay puberty … [and] establish criminal penalties for violations.” 

Prison Reform

Following a special session in October 2021, critical pieces of legislation were passed to address prison reform. Overcrowding, a significant contributor to the spread of COVID-19 in prison systems, inspired a bill that funded the construction of new prison facilities. Additionally, legislation was passed that retroactively applied a mandated probationary period to individuals sentenced before 2015. However, in the 2022 general session, SB87 has been filed in the general session, which looks to roll back some of the granted probation initiatives. 

The legislation reads: “Under existing law, certain prisoners in the physical custody of the Department of Corrections are eligible for correctional incentive time. This bill would provide that any person who enters into a plea agreement would not be eligible for correctional incentive time.” 

The United States legal system has come underfire in recent years for a trend referred to as “coercive plea bargaining,” where prosecutors can use a wide variety of techniques to convince defendants to accept a guilty plea rather than going to trial. According to a report by the Pew Research Center, over 90% of convictions at the state level come from a plea rather than a jury, even though trial by jury is a constitutionally protected right. While it has not been passed, SB87 could remove the protections granted in the special session last year related to the mandated probationary period to those who plead guilty, a large percentage of current inmates in the Alabama Department of Corrections. 

HB28 looks to approach prison reform from a different angle. Pre-filed by Representatives Hollis and Hall, the bill offers protections for women who are pregnant or up to six weeks postpartum who are incarcerated. The legislation reads: 

“This bill would provide for prohibited practices relating to a pregnant female inmate or a female inmate who is in the immediate postpartum period. This bill would also specifically prohibit certain actions relating to strip searches, restraints, examinations, labor and delivery, solitary confinement, and transfer.” 

Specifically, the bill details specific instances in which pregnant or postpartum women would or would not be restrained through the use of wrist cuffs or placed in solitary confinement. The ACLU has declared that ending the shackling of pregnant inmates is a priority in the coming year. The United States is the only remaining industrialized nation to partake in this practice due to the abundance of evidence pointing to the mental and physical health implications to both the mother and child. 

Health Insurance Reform

Healthcare and insurance reform have been a growing state and national politics trend. The Department of Health and Human Services enacted new federal guidelines on “surprise” hospital bills effective January 1, 2022. The new rules work to shield Americans from unexpected bills from an out-of-network provider, out-of-network facility, or out-of-network air ambulance provider. However, legislation has been proposed at the state level to help patients receive the proper medical treatment approvals from their insurance providers. SB27, proposed by Senator Butler, enacts a timeline for insurance providers to approve or deny a request for prescription drug coverage. The legislation reads:

“This bill would require a health insurer to communicate to a physician or other health care professional with authority to prescribe drugs, within three business days of receiving a request for insurance coverage of a prescription drug benefit, that the request is approved, denied, or requires supplemental documentation. This bill would also require a health insurer to communicate to a physician or other health care professional with authority to prescribe drugs, regarding the approval or denial of the request, within three business days of receiving sufficient supplemental documentation.” 

This legislation will work to streamline the authorization process in Alabama, hopefully increasing the speed at which patients receive their medications. According to a report by HPI, 66% of first-time prescriptions are rejected at pharmacies due to required authorizations, causing a bureaucratic battle for patients who may be waiting for weeks. Only 29% of patients end up with their initially prescribed medication when authorizations are required.