When Marshelle Grimes-Billings started work as a smock room attendant at a poultry processing plant in Decatur, Ala., in 2021, health care was a luxury she couldn’t afford. At the time, Grimes-Billings weighed 330 pounds, and she carried with her a baggie full of pills including three medications for high blood pressure, three medications for diabetes, and various medications to manage gout flare-ups. Each trip to her physician — a 45-minute drive from her home in Courtland, Ala.