The government we want: Health care

Healthcare: SC people who would be left out of healthcare act

jholleman@thestate.comFebruary 5, 2013 

Luis Guess works two part-time jobs in the food service business. He's not eligible for company health insurance at either. The 31-year-old Columbia resident faces a hospital bill he can't pay after an emergency apendectomy, and he struggles to deal with diabetes. He would be covered by the Medicaid expansion if South Carolina's leaders accepted it. Local health care advocates recently guided Guess to a potential medical home at Eau Claire Cooperative Health Center, but his route to that point is typical of the expensive plight of the working poor with chronic illnesses.

TIM DOMINICK — tdominick@thestate.com Buy Photo

  • ABOUT THIS SERIES What do we want government to do? And how will we pay for those services? This story is the first of a year-long look at the decisions politicians and the public must make on the scope of government.
  • Medicaid expansion talk House and Senate committees will be discussing Medicaid expansion this week. Tuesday: House Ways and Means Healthcare subcommittee, an hour and a half after House adjourns, Blatt Building, Room 101 Wednesday: House Ways and Means Healthcare subcommittee, 10 a.m., Blatt Building, Room 108 Thursday: Senate Medical Affairs Affordable Care Act subcommittee, 9 a.m., Gressette Building, Room 308

Luis Guess works two part-time jobs in the food service business, and he’s not eligible for company health insurance at either.

The 31-year-old Columbia resident faces a hospital bill he can’t pay after an emergency appendectomy, and he also has spent time in hospital emergency rooms dealing with his diabetes.

Under the Affordable Care Act, people in Guess’ situation would be covered by an expanded Medicaid program, which would cover an individual earning less than about $15,000 annually. But South Carolina Gov. Nikki Haley wants the state to opt out of the expansion, and many Republican legislative leaders have said they plan to go along with the governor.

The politicians and government bureaucrats stress that the Medicaid program is rife with waste, doesn’t allow states freedom to tailor programs for their populations and is unsustainable financially. Tony Keck, director of the state Department of Health and Human Services, also notes the number of programs already in place to provide health care for the poor, including federally backed community health centers and state public health clinics.

Many of the people who will be personally impacted by the Medicaid expansion decision, however, just want a sense of health care security that has eluded them in the past. Here are quick profiles of three of people who could end up in that expansion gap.

Luis Guess

By taking on a second job a few months ago, Guess likely will be able to make more than $15,000 and earn his way out of the expansion gap in 2013. Those making more than about $15,000 will be eligible for subsidized health insurance in 2014, and Guess would be wise to buy in.

His experience in 2012, however, helps paint a picture of those who could be in the gap.

Like many working poor, Guess, 31, faced tough decisions about how to allocate his limited income. He had just enough to pay for housing, food and transportation. The restaurant where he works about 30 hours per week doesn’t provide employer-backed health insurance. The fast-food chain where he recently began working about 10 hours a week doesn’t cover its part-time workers. And he can’t afford private insurance.

His family has a history of diabetes on both sides, and his mother died of complications of the disease in 2009. He was diagnosed with diabetes six years ago. He has struggled to pay for his diabetes medication, and he ended up in a hospital emergency room at least once when his blood sugar spiked.

Then last July, he had a true emergency.

“I went to the doctor with what I thought was a bad stomach ache, and I ended up getting my appendix pulled out that night,” said Guess, who also was hit with a $1,500 bill he can’t pay. “What can you do? If you don’t have a job with health insurance, you’re stuck.”

Guess knows there is waste in the Medicaid system. He resents those who are capable of working but decide not to and still accept handouts from the government. But he thinks the state’s leaders are using those examples to penalize the working poor.

“Benefits should be given to the working class, the people who get up every day and go to work,” Guess said. “The Republican Party is this state seems to have a vested interest in seeing President Obama fail, and that’s not fair to the people.”

Local public health officials recently hooked up Guess with the Eau Claire Cooperative Health Center, a federally qualified health center that allows patients to pay based on their income. His most recent visit to Eau Claire cost him only a $20 co-pay, and the folks there are helping him through the paperwork that should allow him to get his diabetes medication for free.

Having a medical home should make it easier to control his diabetes, and in the end it should save the government money, too.

Keck says cases like Guess’ show the free and low-cost clinics can be a safety net. But Dr. Stuart Hamilton, CEO of the Eau Claire centers, says they won’t be able to handle a rush of new patients if the state turns down Medicaid expansion. If the state accepted expansion, those patients with new Medicaid coverage could go to other physicians (though that leads to another problem because many physicians aren’t accepting new Medicaid patients).

Audrey Groom

While she is thankful her 6-year-old daughter is covered by Medicaid, Audrey Groom wishes she also could get some health care help herself while she tries to start a new career.

Groom, 27, recently cut back on her hours working for a company that staffs cafeterias in large businesses in the Columbia area. Even when she worked 38 hours a week at slightly above minimum wage, she couldn’t afford the health insurance offered by the company. She had to make car payments so she could get to her job.

She trimmed her work hours to 24 hours so she could have time to attend Midlands Tech (working toward a social work degree) and still care for her child. She would be covered by Medicaid if the state accepted expansion.

“It’s crazy,” she said of Medicaid eligibility. “They don’t look at the bigger picture.”

Groom has been to the emergency room twice in the past few years – once with scary chest pains that ended up being related to acid reflux and recently with a case of flu. The hospital has sent her bills that she has no hope of paying. After talking with health advocates, she realizes now that she should have gone to a free or low-cost clinic instead.

She and Guess both said many young people who have had few health problems before need a road map to help them through the system. Otherwise, they take the well-known route to the emergency room.

It would be simpler for low-income workers, they said, if the state accepted Medicaid expansion.

“They should accept it,” Groom said. “I’m one of the ones willing to go out and work. I just need a little help to get my feet on the ground.”

Laveda Jenkins

A 40-hour-a-week worker in a group home in Orangeburg County, Laveda Jenkins used to have health insurance. But when the large church-backed organization that owned the home sold it to a smaller company a few years back, the new owners stopped offering a health insurance program for workers, she said.

Jenkins’ disabled husband has health coverage, but she has none. With her salary of around $18,000, her two-person family would be eligible for an expanded Medicaid. If the expansion is turned down, she’s out of luck.

Jenkins, 51, of Branchville, is overweight and borderline diabetic. “That’s on me, I know that,” she said.

She also has a nerve disorder that causes chronic pain in her head and shoulder, a condition diagnosed and treated when she had health insurance. “Now I can’t go to a specialist to get services because I don’t have insurance,” she said. “It just costs so much, and I can’t afford it.”

She likely will be eligible for subsidized health insurance through the ACA in 2014, and she hopes the subsidy will be enough that she can afford it.

If Jenkins could talk with Gov. Haley about health care, “I would tell her to lay aside her personal feelings and look at the whole picture, not just the bottom line. Look at the health of the people. Not all of us can afford insurance because of different circumstances in our lives.”

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