The Cost of “Poor” Health
When I hear opponents of Medicaid expansion talk about all the reasons we shouldn’t do it, and how it will benefit so-called able bodied adults who could work, but simply won’t, I’m immediately reminded of why I decided to serve in the Kansas Legislature. Among all the various groups represented in Topeka, there is one whose voice is consistency ignored or overpowered: The working poor.
I was, for a very long time, in that group. It’s where my childhood was formed, with two parents who had dropped out of high school yet fought to make enough money to keep us in a home, and adequately fed. We had our share of difficulty, but still, my life was better than many – my parents didn’t struggle with addiction issues, or run afoul of the law. We didn’t move around a lot, and had a relatively stable environment, compared to many of my likewise not-so-wealthy peers.
When I left home, it didn’t take long before I had a child of my own. By the age of 19, I was preparing to become a father. The day my daughter was born, I grossed $250 per week. We relied on the state’s health care to cover the cost of delivery, and later on food stamps and WIC (Women, Infants, and Children) to make sure we had enough food.
Over time, things got a little better. I landed a job in a machine shop, where I learned to operate a computerized lathe. When overtime was available, I’d take it. But after about 5 years, the overtime stopped, hours were cut, and layoffs began. I took a second job at Home Depot, and crammed those hours between work, night classes at the local college, and my family. When the layoff ax finally came my way, I was earning slightly over $13 per hour.
So, when opponents of Medicaid expansion talk about the working poor with such disdain, I get a little hot. They are talking about me and my family. They are talking about many of my friends. They are talking about the people I came of age with, and they’re talking about the people I worked alongside for for so many years. And none of us ever made enough money that one unexpected disaster – like an illness or accident – wouldn’t send us into poverty.
When you are working and poor, healthcare doesn’t work the same way it works for people with ample means. Every illness is viewed through the lens of cost. And that cost is weighed against who is sick, and to what degree. For children, the threshold for heading to the doctor is much lower, but I suspect even that threshold is higher than it is for affluent families. Because while we’re in the doctor’s office, and there’s talk about what tests to run, or whether an overnight observation might be needed, we’re quietly calculating how many years it’s going to take to pay off this medical bill. We’re wondering what the hospital or clinic will accept for a monthly payment. We’re running our budgets through our minds, trying to figure out where we can find room for this new debt – because we’ve already managed our grocery budget to the penny, and there doesn’t seem to be anywhere else to cut.
Even for those families with insurance – who likely spend somewhere between $300-$700 per month on a family policy – the deductible, co-pay, and co-insurance for even a minor medical event will likely result in a bill that’s upwards of $1,000. While many families might be able to settle that debt in a few weeks or months, for a working family that’s barely getting by, that one doctor visit is going to be a year’s worth of payments they will struggle to make.
For the parents, it works a bit differently. In my early experience, we’d try to wait it out. If the illness grew worse, so did the concern. Eventually, there’s a trip to the doctor – at which time the physician is likely to say it’s a virus or some hidden illness that can’t be easily found. So there are tests, blood work, and follow up appointments. Suggestions of a CAT scan or MRI will likely be rejected, because that’s an automatic $800-$1,000 we don’t have. Within a few days, you start feeling better, and suspect you would’ve without medical intervention. By the time the bill comes in, avoiding the doctor is cemented as the best decision for the family. This one medical visit – along with any missed days of work (which doesn’t offer sick leave) – ends up compromising the family’s finances for months, or years.
So the next time that adult is ill, he or she remembers the past. And the delay is longer, or it’s avoided altogether. But this time, it is something more sinister, and the delay has only complicated the condition. By the time the illness becomes unbearable, or has affected the ability to work, it’s a trip to the Emergency Room, and quite likely a longer stay in the hospital. And, of course, a bigger out-of-pocket medical bill.
When I hear people like Sen. Susan Wagle say “My personal opinion is that is an entitlement program because it is for people who qualify who are able bodied who are not working,” I know that her life experience is quite different from mine. I know that she’s not ever built her grocery list around which coupons were in the paper. I know she’s not ever had a hot water heater go out, and struggle to figure out how to replace it. I know she hasn’t hunted deer, not for sport, but because it’s cheaper than buying beef at the grocery store. And I know that she’s not ever negotiated with a medical provider about whether they’d be willing to accept a payment of $25 a month for the next 18 months.
I am weary of people who have never faced such challenges – who were effectively born on 3rd base – telling the rest of us that if we’d work harder, or manage our lives better, we’d elevate ourselves to the highest levels of earning available to everyone in the United States. It’s true that extraordinary work and determination can move the working poor to the middle class – but not if elected officials piously and actively work to withhold the available tools that can help them achieve it.
Henry David Thoreau’s statement, “The mass of men lead lives of quiet desperation. What is called resignation is confirmed desperation,” might be more true today than it was in the mid 1800s. Certainly, there are inspiring examples of people with unusual will, mixed with a measure of luck, who have defied the odds. But let’s not pretend it’s the norm, because it’s not.
One tool that’s available to Kansas that could aid in the solvency and upward mobility of the working poor is Medicaid Expansion. Yet, people like Sens. Wagle and Jim Denning, along with others, have stood resolute against this provision for nearly six years. They never sat at the table in an effort to find a workable path to provide healthcare to our working poor; instead they stood in defiant opposition, while chastising those who were not born into the same privileged stations these leaders have enjoyed in life. While they presume to know how we might live our best lives, they have no real understanding of the chronic fatigue, desperation, and hopelessness families face every single day. It’s one thing to face a setback every now and then, but something completely different when a routine fever or illness becomes a financial or physical setback for months, or years.
Now that the tide has turned, and upwards of 80 percent of Kansans recognize the need and value of expanding Medicaid, these same people claim they want to study the matter another year, so we might produce the best policy possible next year. I might believe them, had I not witnessed their refusal to negotiate and compromise in good faith, and their righteous indignation that we’d even consider giving an “entitlement” to “able-bodied adults.”
Now is the time for Medicaid expansion. Not next year. Not the year after. Now.
Because families who are struggling to keep their heads above water can’t afford to wait another year for elected officials to over-study the matter, or to figure out how they might best leverage it for political gain in the next election.
Contact your Senator today, and tell he or she to do whatever can be done to bring Medicaid Expansion to Kansas.