Another guest blog this week by Randy Moore, an Appleseed intern, who shares his personal experience with having insurance because of the Affordable Care Act, after many years without.
The Senate Finance Committee will debate the “Healthy SC” amendment this week to provide a private option plan for affordable healthcare. Healthy SC would close that healthcare coverage gap through a public/private partnership that would allow these uninsured individuals to purchase much needed healthcare. Contact them to express your support so we can finally close the coverage gap for 194,000 people in South Carolina.
As a Master’s of Social Work student at the University of South Carolina, I’ve spent the last eight months completing my practicum with SC Appleseed Legal Justice Center cultivating an understanding of the issues that low-income people face in our state. But it’s my own experiences of growing up in rural Lee County, here in South Carolina that has led to my desire for fighting injustice.
When I first came to Columbia, my dream was simple: to get a degree in a fulfilling helping profession, while also providing means to better my life and give back to those who helped me get here. But I quickly realized that in doing so, I would have to work for — and I did. Between a full class load and two jobs, I worked seven days a week for four years, all the while with no health insurance. Every day I worried about what it would mean to get sick, knowing fully that an illness could potentially sabotage this once in a lifetime chance I was taking –but that was yesterday.
Thanks to the Affordable Care Act, today I am covered, yet many in our state remain uninsured. My hope is that the following piece sheds some light on the difference health insurance made for me and my family and our ability to not just get ahead, but to simply stay afloat; we serve as just one example.
THE WAITING ROOM
“This surely must be what it feels like to die,” I thought. Pleading with myself, I offered an impossible deal that couldn’t be made — it was too late, it was all over. Yet, sitting in what felt like the arctic tundra, I repeated over and over, “Please call my name, please call my name, please call my name — if you call my name I promise I’ll” — “Mr. Moore,” a voice interrupted, “you can come on back now.” My spirit sprang, as I dragged the dumb weight of my poor, achy, no-good body through her door.
Perhaps I should offer a little more information here. When it comes to getting sick, I’m the absolute worst. I’m not too humble to whine, or too proud to plead — I’m a big baby. And like 24 year-old babies so often do when sick, I picked up the phone and called quite possibly the only soul who could stand the infantile groans of a man reduced by a microorganism- my mom: Who would ever want to deprive their mother the opportunity to say, “I told you so.” I only had to listen to roughly twenty minutes of should’ve, could’ve, would’ve before I received some seemingly helpful advice as of what to do. She sent me the address for an urgent care center.
“What brings you in today, Mr. Moore?” a nurse not too much older than myself asks. “Everything hurts,” I said — “everything.” I cringed as the blood pressure cuff tightened – nauseated by the sound of my own sick little heartbeat. I almost forgot what this felt like. I always hated it – I still hate it. “Have you been running a fever?” the nurse asked. With uncertainty, I replied: “Well, I think so. One minute I am really hot, then really cold. I don’t own a thermometer so I can’t be sure… but I am really sweaty, but only sometimes, and sometimes at the same time but not all the time… Does that mean anything? … Sorry, it’s been awhile.” I continued, “Also, I haven’t had a flu shot.” She gasped. Shaking her head she said, “You should always get a flu shot.” “I know”, I replied “I know.” Then she swabbed my brain… Alright, maybe not my brain, but for the sake of the story and the clever hashtags that accompanied its telling on Facebook, my brain was swabbed, okay?
Nevertheless the brain swab confirmed suspicion: I had the flu. Following a fifty-dollar copay, I had my doctor’s note and a prescription for Tamiflu. I gathered up all of my self-pity, I was on my way. Just so you know, I have nothing against the flu shot. I just haven’t had one as an adult. It’s seems that I have learned to avoid the doctor. It’s not that I haven’t been sick, but when you’re uninsured you tend to avoid any additional cost incurred beyond the illness itself. In fact, I was uninsured for almost the entirety of my undergraduate program; during which time, more than once, I have walked away from a pharmacy counter level by sticker shock and appalled in knowing I’d have to make a choice between a return to wellness or this month’s bills. Even still, prior to January of 2014 the four jobs held between my mother and I did not pave a path to affordable coverage, even as we each worked to complete a college degree. Could it be said that we did not work hard enough? Well, that depends on whom you ask.
The Coverage Gap
Unfortunately, here in South Carolina we are not the exception. Prior to the implementation of the ACA, 1 out of every 4 South Carolinians was uninsured. While many, such were able to gain coverage through the marketplace, like my mother and I who are only eligible due to our combined income, over 194,000 South Carolinas are still deemed ineligible for health insurance coverage following the decision of state leaders not to expand Medicaid. Expanding Medicaid would have opened eligibility to all who did not qualify for a subsidy in the federal health insurance marketplace. Of this number, an astounding 171,000 (88%) are working. This includes 26,700 military veterans and their spouses and 63,000 low-income seniors between the ages of 50 to 64. Yet, while these South Carolinians work every day to contribute to our economy, some state leaders disavow their honest efforts, reciting misguided platitudes of fiscal and personal responsibility. They drown out the heartbeats of the living, breathing, dying, constituents they’ve left behind in their districts. Yet, I would invite any elected official to forgo their own families’ insurance plan for, lets say a month, and try shouldering the weight of South Carolina’s uninsured.
To further clarify, the coverage gap as it has come to be known, refers to any persons whose income is between 62% and 100% of the federal poverty level, which in South Carolina is $20,090 for a family of three or $11,770 for an individual. These citizens make too much to qualify for traditional Medicaid and make too little money in order to receive insurance premium assistance in the form of tax credits to be used to purchase insurance in the federal marketplace. Prior to a Supreme Court ruling (NFIB v. Sebelius) back in 2012, states under the ACA were to expand their Medicaid programs with assistance from the federal government to provide coverage for these lower-income individuals. The ruling ultimately put the decision of expanding Medicaid eligibility in the hands of state governments. As it stands now, South Carolina’s governor Nikki Haley has reiterated her opposition to the expansion of Medicaid, vowing to veto any measure that would act to do so. Yet South Carolinians each day are missing out on an estimated 4.7 million dollars of their own tax dollars to fund expanded eligibility: funds which would reduce the burden of uncompensated care on hospitals, ultimately affecting us all.
Close the Gap SC — Another Way
The current political climate has made it difficult for state leaders to act on the Medicaid question in its current form — to expand or not to expand. However, other states including Arkansas, Kentucky, and New Jersey have found another way. Under section 1115 of the Social Security Act, states may apply for a demonstration waiver allowing them the ability to take federal dollars and develop a Medicaid program that best suits their needs. This approach generally includes applying funds to keep individuals in the private health insurance market as opposed to adding them to the rolls of Medicaid. In spite of the inborn flaws of relying solely on the private market for health coverage, many advocates see this as a reasonable compromise in the short-term until a better solution can be met. Yes, while it is preferable to many that access to healthcare be universal, myself included, making sure South Carolinians have access — period, preempts any and all things. This has led to the formation of the Close the Gap SC Coalition, which supports this compromise approach. As stated in the coalition’s mission, Close The Gap SC is “comprised of non-profits, statewide associations, business leaders, a chamber of commerce, and individuals who are concerned about the future of healthcare in South Carolina (Close Gap SC, 2015).” These leaders believe now is the right time to act, the squabbling of yesterday is behind, now is time to do right by those whose sacrifices we all are guilty of taking for granted.
Access to Care & the Difference It Makes
Following the whole “flu ordeal of 2015,” now only a few weeks ago, I can’t help but sit back and wonder about how things are different now that I am insured. For the first time in five years, I am able to get the care I need without fear of financial ruin. I no longer have to go to work or school sick, as I have done so many times in the past when I could not “afford” a doctor’s note or prescription. No longer do I have to selfishly put the health of others in jeopardy as a result of my income. Now it is possible to receive a check-up and have my doctor remind me of the importance of getting a flu shot, even though “I know.” She can even laugh when I secretly lie and say, “Sure, I don’t mind getting the shot” only to pass out in the office ten minutes after anybody expects me to (oh, its happened). But most of all, I no longer have to worry about my mother who so often has forgone her own needed treatment in order to pay an electric bill or buy groceries for that week, or to simply have enough to make sure her children are okay.
But my mother and I have been lucky. Our combined incomes were just enough to qualify us for coverage through the health insurance marketplace. Still, had we depended solely on our individual incomes, we too would fall in the coverage gap along with so many other hard-working South Carolinians in our state. This is unacceptable. Time and time again, these individuals show us what it means to work hard. They show us that true hard work is not measured by the balance of your checkbook or by the size of your boat or your car. “Hard work” is measured by sacrifice, by dedication and the ability to compromise; and now we must embody this spirit and work hard to ensure everyone in South Carolina is provided a pathway to affordable health coverage. It is time to close the gap South Carolina for every working parent, every low-income senior, every United States Veteran, and every promising student.
Close the Gap SC. (2015). Retrieved March 1, 2015, from http://www.closethegapsc.org
Ruoff, J.C., Smith, J.L. (2015) Why health care gap matters to older South Carolinians. Retrieved March 1, 2014, from http://www.closethegapsc.org
Staff, W. P. (2010). Landmark: The inside story of America’s new health-care law and what it means for us all. New York, NY: Public Affairs.