Health Shouldn’t Depend on Wealth
Congress needs to catch up to close the Medicaid coverage gap
Having a chronic condition shouldn’t prevent you from living a full life. That’s a pretty non-controversial statement, right? But it’s what happened to Della Young.
When she was diagnosed with lupus in 2004, Della lived in Rhode Island, where she could access the critical health services she needed to get better through Medicare and Medicaid. Later, when she lived in New York, those same programs covered the kidney transplant she needed.
But by 2015, Della had moved to Georgia where — unlike in RI and NY — her governor and state legislature had refused to extend Medicaid. Consequently, she made just a few dollars too many to qualify. That doesn’t mean she’s rich — Della lives on under $20,000 a year, and she struggles to keep her head above water because of her serious health issues. Della was grateful to have a job at an Amazon warehouse — even if it meant walking four miles, taking a train, and two buses back and forth every day — because it helped pay some of her medical bills. But she still didn’t make nearly enough to cover the close to $1,500 monthly cost for the lifesaving immunosuppressants she needs daily, after her transplant.
Because Georgia hasn’t extended Medicaid to low-income adults like Della, she couldn’t afford to pay for her kidney medication, her body attacked her new kidney and it failed, forcing her to return to a life of costly and exhausting dialysis treatments. For Della and other patients like her in the coverage gap, their only option is to fundraise on sites like GoFundMe, hoping that donations from strangers will cover the cost of her vital treatment. Is this really how we should care for our people in America? Millions of other people like Della are falling through the cracks in the American health care system. And those cracks are quickly becoming canyons.
Most people across America know if you are poor enough, there is a health care program available to you. That incredibly important program is Medicaid. It currently supports almost half the births in our nation, makes sure more than one-third of our kids get their vaccinations and can see their doctors, helps provide long-term care for our low-income grandparents, and provides life-saving services to our friends and family members living with disabilities. But that doesn’t include everyone, namely the 2.2 million people in the 12 states that refused to expand the program after the Affordable Care Act made it possible. In these states, governors and state legislatures have made the unbelievable choice to deny health care for many of their most vulnerable people, even when the federal government is paying 90 percent of the cost.
The pandemic has only exacerbated the tenuous situation our most vulnerable low-income adults were already living in. These are people whose very life-limiting struggles, like Della’s lupus, prevent them from accessing health care services. These can include unmet mental and physical health needs, substance use disorder, or problems arising from the social determinants of health. And that was before the biggest public health crisis in a century.
The leaders who wrote the Affordable Care Act never intended for Medicaid expansion being voluntary — and I can vouch for that, as a former Senate staffer who spent many sleepless nights negotiating the bill. But the Supreme Court ruled that states did not have to expand Medicaid, leaving a void where the very poorest people didn’t make enough money to afford coverage on the health insurance marketplace and Medicaid is closed to them.
The benefits from expanding access to health coverage for our most vulnerable friends and neighbors can’t be overstated. For example, states that have expanded Medicaid have seen decreases in cancer deaths, poverty rates, and evictions (the latter two because people with Medicaid coverage are less likely to face financially ruinous medical bills).
Importantly, expanding Medicaid also is a racial justice and equity issue. According to numerous studies, people of color disproportionately fall into the coverage gap. While they make up 41 percent of the adult population under 65 in the 12 states without expanded Medicaid coverage, they are 60 percent of those who fall into the gap. This only worsens existing coverage disparities, which leave people of color far more likely than their white counterparts to lack access to health care while facing a higher risk of sickness and death.
Remember, too, that all of those figures are pre-COVID. While we are still dealing with its fallout, it’s clear that thanks to low vaccination rates, people will have to negotiate the virus for some time to come. Making it harder for people to afford health care will only prolong the pandemic.
Here’s the most important thing… Congress has a real chance to fix the Medicaid gap by passing the Build Back Better Act.
So, what would a solution look like? Congress could extend Affordable Care Act marketplace subsidies to cover the people who fall into the coverage gap. Because it’s federally operated, states wouldn’t need to opt into it, and coverage would be available to all 2.2 million people currently denied care. The Kaiser Family Foundation also estimates that it would make coverage accessible for another 1.8 million uninsured adults who are living right around the federal poverty level (e.g., a person making less than $18,000 per year or less than 138 percent of the federal poverty level).
In 21st century America, it’s hardly radical to say that our main concern when we get sick ought to be getting better, not how we’re going to pay for it. We live in a country that spends almost 20 percent of its economy — a whopping $4 TRILLION — on health care, but our health outcomes are far worse than other comparable countries. This is a national disgrace.
“I just want to be free and live again,” Della says on her Go Fund Me page to raise money for a second transplant. Politicians are far behind the people of this nation. Most people believe that everyone in America should have access to basic health coverage — that our health should not depend on our wealth. Congress has the chance to level the playing field for us all before the canyons swallow more and more of our people. They need to step up and finally close the gap. In the next days, weeks, and months the decision likely will be made. The time is now.
