EVA Issues in the News
Phil McCausland of NBC News covers the issues and politics surrounding Medicaid expansion in an article originally published on November 4, 2019. While state governments debate over Medicaid expansion, citizens and their communities are paying the price. From expensive, preventable procedures, to rising healthcare costs and the closing of rural hospitals that struggle to afford to stay open, the case for Medicaid expansion continues to build. Many end up forgoing medical care and risk serious complications or even death, but without insurance to help offset the high price tag of seeking care, many feel they are left with no choice. Read on for personal testimonies of Mississippi residents and the political back-and-forth surrounding Medicaid expansion, and click through to NBC News to read the full story.
“I’ve gone years without medication, and it’s gotten to a point where you hit rock bottom. And it’s just like, ‘OK, if I go, I go,’” one uninsured woman said.
HOLLY SPRINGS, Miss. — Darlene Velasco can’t afford to treat her Type 2 diabetes. She doesn’t make enough money at her job selling college sports memorabilia to pay for medication or private health insurance and, at $13.50 an hour, earns too much to qualify for Medicaid.
That’s been the case for years and without treatment, Velasco, 45, was declared legally blind in May. The disease built up cataracts in her eyes and when her vision began to blur and disappear, she found herself driving to her job that carries no health benefits steered only by the memory of the backcountry roads that surround her home.
“I reached out to everybody I could, asking about programs for people who can’t afford medical insurance — hardworking people,” she said late one October night, deep in this Mississippi hill country. “Not everyone has that financial stability with benefits. Some of us get our paycheck biweekly, struggle to make ends meet, pay rent and raise kids. It’s not easy.”
Mississippi is one of 14 states that chose not to expand Medicaid, forgoing about $1 billion from the federal government each year since 2012 when the Affordable Care Act offered states the opportunity to expand care.
The states that choose to go along with the program, first rolled out under the ACA, will eventually have to provide a 10 percent match of the funds by 2020. That would cost Mississippi about $100 million a year, and Republican lawmakers insisted it would be detrimental to the state economy.
In Mississippi, a state that has one of the highest uninsured rates in the country — currently ranked at 45 out of 50 — about 100,000 people fall in the same coverage gap as Velasco, according to the Kaiser Family Foundation. In total, 2.5 million poor adults fall into that same gap in the 14 states that did not expand Medicaid.
Meanwhile, health care costs continue to grow, creating a core campaign issue in Mississippi’s gubernatorial election that will be decided Tuesday. State Attorney General Jim Hood, a Democrat, supports expansion to address costs, while Republican Lt. Gov. Tate Reeves opposes it.
A review by NBC News of the Medicaid budgets for all 14 states that refused expansion showed their expenses increased drastically after 2012 — despite state lawmakers’ objections that accepting expansion would cost too much. Mississippi’s budget grew by about $173 million — a 20 percent increase — since 2012, while enrollment grew by only 10,000 over the same period.
Jesse Cross-Call, a senior policy analyst at the Center on Budget and Policy Priorities, studied Medicaid expansion and state budgets and testified before the Mississippi Legislature near the end of October.
He said there was a growth in Medicaid spending in nonexpansion states initially because enrollment grew briefly after the passage of the ACA, but Mississippi and the other states’ budgets remain inflated because of rising health care costs.
“State Medicaid spending is increasing and the primary driver is prescription drugs, an aging population, disabilities and other health care costs, but it’s not Medicaid expansion,” Cross-Call said. “There are greater health care forces acting on states right now, but many states have made it so Medicaid expansion has been a net saver.”
Louisiana, which passed expansion in 2016, reported savings of $199 million in 2017 and $350 million in 2018. Virginia, where expansion went into effect in January, predicted $152 million in savings in 2019 and $270 million in 2020. Numerous other states have also experienced savings through the program, as well.
A 2017 Health Affairs study found “expansion states did not experience any significant increase in state-funded expenditures, and there is no evidence that expansion crowded out funding for other state priorities.”
Mississippi has yet to see any savings, and though Velasco didn’t get health insurance through the state to treat her diabetes and avoid becoming legally blind, Mississippi taxpayers still paid through the state’s department of rehabilitation services to treat her vision at a cost of more than $20,000.
It also meant Velasco had to undergo cataract surgery in October, a procedure that terrified her and could have been prevented if she had been able receive coverage through Medicaid or somehow pay about $500 a month for her medication or the several hundred dollars needed monthly to afford private insurance.
“They knocked me out because I was that scared,” she said. “I had tears coming out of my eyes. I was crying.”
The lack of health insurance has left millions of Americans in those states that chose to go without Medicaid expansion to carry the burden of medical debt when they need to receive health care.
Velasco said she socks away a few dollars out of each biweekly paycheck to save up to go to the doctor. She’s losing hearing in one ear and doctors told her she had a cyst on an ovary when she visited the emergency room for stomach pain two years ago.
Eventually, Velasco hopes to be able to afford to have them examine it.
“I’m hoping it melted away… But I can’t just go to the doctor. I have to pay out of pocket.”
“It hasn’t caused cramps or anything. I’m hoping it melted away,” she said. “But I can’t just go to the doctor. I have to pay out of pocket. Every time I go when I’m sick, I have to pay $160 when I get seen.”
In the state that has the highest percentage of its residents with past-due medical debt in the country, it appears that many people choose to go without, according to a study done by the Financial Industry Regulatory Authority Investor Education Foundation.
More than half in Mississippi said the cost of health care led them to not fill a prescription, avoid the doctor or skip a medical test, according to the study.
“In a sense, the people of Mississippi are saying the cost of health care is driving them away from medical services, and we see that nationally in the data as well,” Gary Mottola, the research director for the FINRA Foundation, said.
When the foundation began the study in 2012, 41 percent of Mississippians said they held past-due medical debt. That number dipped to 31 percent in 2015 with the passage of the Affordable Care Act, but has since grown again to lead the nation at 41 percent in 2018 after funding and advertising for the ACA was cut.
For many, the dollar numbers attached to accidents or unexpected illnesses are so large that they become abstract and unapproachable.
Samantha Mechell, 59, broke her hip three months ago when she tripped over her cat. A visit to the hospital and the ensuing surgery needed so that the longtime waitress could walk again cost her $140,000. Without insurance, she said her bill was sent to collections before she completed physical therapy.
“I wanted to go back to work early but my doctor said I couldn’t without my walker,” she said, still limping heavily minutes after her midweek lunch shift ended. “I have bills. Nobody pays those but me. There’s only me.”
“They want all this money, but I don’t have much… It’s just rough. I know there’s a lot of people out there like me.”
She earns $900 monthly, which goes to rent and utilities, while the $20 or $30 she makes in tips each day help pay for food and gas.
When she couldn’t work, she said she used loose change she collected and some of the tax returns that she saved for a rainy day to pay for meals of ramen noodles or hot dogs.
“They want all this money, but I don’t have much,” she said. “It’s just rough. I know there’s a lot of people out there like me.”
Issues in the News highlights news items focusing on key issues for poor and low-income families, from fair work and access to health care to family economic security, criminal justice reform, voting rights, and more.