Listen to the people who need Medicaid expansion
The Kansas City Star
In the state capitols of Missouri and Kansas, elected officials dither over expanding Medicaid. For them, the debate is about numbers, future budgets, free market arguments and the merits and flaws of the federal Affordable Care Act.
For Kierra Hawkins, it is about the fist-sized cyst on her right ovary.
Hawkins, a 23-year-old community college student in Kansas City, was at her job as an aide in a day-care center when acute stomach pains sent her to the hospital in late September. Tests detected the cyst, and found it was not cancerous. Still, doctors said it would need to be removed.
Hawkins skipped her follow-up doctor’s visit. She is uninsured and couldn’t afford the $350 initial copay, much less the entire bill.
Fortunately, Truman Medical Center has approved her application for a charity discount. Hawkins is to see a doctor this month.
Her cyst would have been detected in a routine gynecological exam, but she hasn’t had one since age 18. Her job pays about $1,200 a month, and offers no health benefits. She has looked into insurance policies but finds them too expensive.
“It is very important to me, but I can’t afford it at this time,” she said.
Hawkins is about 20 credits away from earning an associate’s degree in early childhood education. She hopes that will propel her into a better-paying job with health benefits.
For now, an expansion of Medicaid limits to the threshold called for in the Affordable Care Act, 133 percent of the federal poverty level, would get her the care she needs.
In Missouri, Democratic Gov. Jay Nixon wants to expand Medicaid eligibility, while some in the Republican-controlled legislature are trying to insure more people with a market-based approach.
In Kansas, Republican Gov. Sam Brownback is mum on the topic, while key GOP lawmakers seem inclined to reject an expansion out of hand.
If the states don’t raise eligibility, they will pass on billions of dollars of federal funding. Worse, they will create new medical “doughnut holes,” whereby people in a certain low-income range will continue to find health care unaffordable, while those with very low incomes qualify for Medicaid, and people with slightly higher incomes qualify for subsidies under the Affordable Care Act.
These are people like 43-year-old Sandra Williams of Kansas City, who had a front-desk job in a medical office and a health insurance policy until lupus forced her out of work and onto disability.
Williams, who also has diabetes, now struggles to pay about $500 a month for multiple medications. Missouri Medicaid has been paying for monthly chemotherapy treatments she needs to keep her immune system functioning, but Williams fears getting cut off because she isn’t paying the $615 a month the state is billing her to “spend down” to its very low income eligibility limits.
She also dreads being evicted from her apartment. Williams’ monthly disability check is $1,082 and there is simply no way she can pay her bills.
She wistfully recalls her old job at a cancer center, where she tried to help patients with financial problems. “I’d be sitting there trying to figure out something for my patients,” Williams said. “Now I’m in that same boat.”
As president and CEO of Health Partnership Clinics of Johnson County, Jason Wesco sees the people in the crux of the Medicaid debate every day. About 88 percent of the caseload at his three clinics is uninsured, and Wesco figures about two-thirds would qualify for Medicaid under an expansion.
“We have people who have gone so long without preventive care, they don’t even know how sick they are,” Wesco said.
The clinics, which receive federal and other funding, served 5,200 persons last year and could easily have doubled that number if it had the resources. It’s not uncommon to receive more than 100 calls for appointments in a day.
“It’s a big, big problem in our community,” Wesco said.
One of his patients is April Giddens, of Prairie Village. Giddens, 60, hasn’t had a job in years that paid enough for her to afford insurance. She visits the clinic for treatment for high blood pressure.
Giddens has been told she should have both knees replaced, but she needs insurance for that. Unless Kansas raises its Medicaid limits, she expects to limp around on her bad knees until she is eligible for Medicare in five years. Meanwhile, she struggles to pay $85 every three months for the heavy-duty pain medication she needs to function.
Giddens used to think her predicament was somewhat unusual. Now, she says, she runs into people everywhere who are postponing care.
“There’s all kinds of people,” she said. “They have jobs, they work and they don’t have insurance.”
Around the nation, governors and legislators are putting aside political ideologies and realizing that, from fiscal and humane standpoints, expanding Medicaid limits is the right thing to do. For Missouri and Kansas to do otherwise would be cruel and irresponsible.