The perils of Florida’s refusal to expand Medicaid

http://www.orlandoweekly.com/orlando/the-perils-of-floridas-refusal-to-expand-medicaid/Content?oid=2241137

By Billy Manes
April 8, 2014

Charlene Dill didn’t have to die.

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They were the working poor, and they existed in the shadows of the economic recovery that has yet to reach many average people.

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Dill, who was estranged from her husband and raising three children aged 3, 7 and 9 by herself, had picked up yet another odd job. She was selling vacuums on a commission basis for Rainbow Vacuums. On that day, in order to make enough money to survive, she made two last-minute appointments. At one of those appointments, in Kissimmee, she collapsed and died on a stranger’s floor.

Dill’s death was not unpredictable, nor was it unpreventable. She had a documented heart condition for which she took medication. But she also happened to be one of the people who fall within the gap created by the 2012 U.S. Supreme Court ruling that allowed states to opt out of Medicaid expansion, which was a key part of the Affordable Care Act’s intention to make health care available to everyone. In the ensuing two years, 23 states have refused to expand Medicaid, including Florida, which rejected $51 billion from the federal government over the period of a decade to overhaul its Medicaid program to include people like Dill and Woolrich – people who work, but do not make enough money to qualify for the Affordable Care Act’s subsidies. They, like many, are victims of a political war – one that puts the lives and health of up to 17,000 U.S. residents and 2,000 Floridians annually in jeopardy, all in the name of rebelling against President Barack Obama’s health care plan.

Woolrich has spent the better part of 2014 canvassing for the Service Employees International Union and for Planned Parenthood in an effort to educate people about Medicaid expansion and to enroll residents of poor neighborhoods into the Affordable Care Act’s medical-care exchanges. During the course of her work, she saw women with tumors that had yet to be treated, many chronic conditions affecting people living in the gap, and sometimes she found herself having to be the bearer of bad news. March 21 was her day off. She was looking forward to getting away from the politics. “I was off. Spring break was going to start for me and her kids,” she says.

Woolrich was aware that Dill was trying to get refills on her medication but not that she had become ill. Dill had been bumped off Medicaid because she was making too much money – an estimated $9,000 a year – and had yet to be able to afford a divorce, which might have bettered her chances. A message to Woolrich from a distant relative confirmed that Dill would not be showing up that Friday because she had passed away, but even that might not have happened if Dill’s cell phone hadn’t lit up while she lay prostrate on that Kissimmee floor. The people to whom Dill was peddling vacuums noticed the phone and called her relatives, says Woolrich, telling them, “There’s a girl lying on our floor. We don’t know who she is.”

These are the people in the coverage gap – the unknowns, the single mothers, the not-quite-retired – the unnamed 750,000 Floridians who are suffering while legislators in Tallahassee refuse to address the issue in this year’s legislative session, which ends on May 2. The working poor – who used to be the middle class – are on a crash course with disaster for no logical reason. Charlene Dill, at the age of 32, didn’t have to die.

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“She worked really hard to provide for her kids,” Woolrich said from the lectern, surrounded by supporters holding up Dill’s picture. “She did baby-sitting, cleaned houses, collected cans for recycling and took them to recycling centers and got money for it, and sold vacuum cleaners. Whatever it took. But Charlene had health problems. She had pulmonary stenosis, sepsis from tooth decay, fibromyalgia and a lot of other health issues from these conditions. When she separated from her husband in 2009, that was last time she had reliable health insurance.”

Woolrich actually walked Dill through the process of the ACA online calculator and they found that she was in the gap. As recently as last October, Woolrich used online crowd-funding sources to help Dill get the medication she needed. Her heart condition had complicated all three of her pregnancies, and sometimes the hustle to survive wasn’t enough to make life bearable.

“People like Charlene are dying,” Russo says. “The thing is, the resources are there to pay for it. That’s what’s so mind-boggling about this situation. The money is there; it’s on the table.”

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According to the DCF website, parents are only eligible if their income is less than or equal to 19 percent of the Federal Poverty Level. The Federal Poverty Level for a household of four in 2014 is $23,850. Charlene Dill would have missed that mark if she made more than $4,531.50. Medicaid expansion would have raised that percentage of FPL to 138 percent, or $32,913, and would also have included non-parents in a household of just one that made less than $16,104.

Coincidentally, Kathleen Voss Woolrich found out she lost her Medicaid benefits on April 2 after driving all the way from Conway to Kissimmee to see a doctor that would accept Medicaid – again, on a day off from canvassing for the ACA. She was bumped into the “Share of Cost” program via DCF.

The program operates with a deductible of sorts – you are given a monthly share-of-cost dollar figure that’s tabulated based on your income. If your medical needs for the month meet or exceed that figure, Medicaid then kicks in and pays the bill. If not, you pay your own bills. From the website: “Your share of cost is $800. You go to the hospital on May 10 and send us the bill for $1,000. You have met the share of cost and are Medicaid eligible from May 10 through May 31. Medicaid will pay the $1,000 medical bill. This is only an example.”

D’Aiuto gives a similar example and says that there is no reimbursement should you accidentally pay your bill. And in order for Medicaid benefits to kick in, you have to spend a lot of money (or at least owe a lot of money) before you have any coverage at all. Woolrich says her doctor – who charged her for her visit and gave her the required prescriptions for the autoimmune disorder for which she is often hospitalized; prescriptions she couldn’t afford to fill until she met her $491 share of cost – asked, “Why don’t you just go to the emergency room?”

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