Medicaid expansion: A tale of two Southern states

Print Friendly and PDF By: Charles Craig Published: Apr 6, 2014

Annie Jones says she works hard and tries to keep fit, but she has high blood pressure, a condition that doctors have told her she inherited from her father.

The Sparta resident, who turned 60 this year, is worried about health care. Jones won’t reach Medicare age for another five years. She earns $10,000 a year as a part-time home health care worker and can’t afford her blood pressure medicine as well as the regular monitoring she needs.

Jeanna Buckler of Kentucky has qualified for Medicaid under expansion.

Jeanna Buckler of Kentucky has qualified for Medicaid under expansion.

Jones is one of up to 600,000 Georgians defined as the working poor  — those adults who earn less than 100 percent of the federal poverty level (FPL). (In 2014, that’s $11,670 for an individual and $23,850 for adults in a family of four.)

For the first time ever in Georgia, these adults would be eligible for Medicaid if the state expanded the program as authorized by the federal Affordable Care Act (ACA), also known as Obamacare.

The ACA originally made Medicaid expansion virtually mandatory for states. But the U.S. Supreme Court, while upholding the ACA in general, ruled that expansion must be optional. That made things complicated, because some other provisions of the law presupposed that Medicaid would be expanded.

Now the issue of expansion is being hashed out in the individual states.

In Georgia, Gov. Nathan Deal refuses to expand Medicaid, saying the state cannot afford it. The Republican-controlled General Assembly agrees with Deal and has even gone a step further. It passed legislation during the 2014 session that requires the Legislature, not just the governor, to approve any Medicaid expansion.

“They’re telling me I don’t deserve it,” Jones said of Medicaid. “When they say Georgia is just fine without expanding Medicaid, well, it’s just fine for them. I need some type of help. I can’t get it anywhere. It’s very stressful.”

If Jones made more than $11,670, she would be eligible for federal subsidies to buy private insurance through Georgia’s health care exchange, which is operated by the federal government as part of the ACA.

“I didn’t get enough money working part time, making minimum wage,” Jones said. She assists two home health care clients for 22 hours a week and is trying to get more work. “A lot of people are just like me, trying to make it. Where do you go?”

House Minority Leader Stacey Abrams (D-Atlanta) said the decision not to expand Medicaid ‘‘places an unnecessary burden on our families, our hospitals and our communities.”

She argues that Georgia Republicans are playing politics with people’s lives.

“The arithmetic is simple,” Abrams told GHN. “Taxpayers fund the uninsured, either through higher premiums and higher taxes or through Medicaid expansion. With expansion, communities also gain new jobs, economic expansion and better health outcomes. Georgia can ill afford to reject these funds when veterans, rural hospitals and working families will instead pay the cost.”

But Deal, in an interview with GHN, said, “We simply cannot afford the $2.5 billion in new spending that the expansion would require without a severe impact on public education. The federal administration needs to start acknowledging the Supreme Court ruling and look at other alternatives that don’t force new spending by the state.”

 

‘Not on welfare’

 

Dymond Jones

Dymond Jones

Two people a generation younger than Jones — Dymond Jones (no relation) of Cherokee County, and Jeanna Buckler of Kentucky — also earn less than $11,670 a year, making them eligible for insurance under Medicaid expansion. But their situations are different because they live in different states.

Dymond Jones, 39, recently was hired to coach track at The Howard School in Atlanta for $1,500 for the spring season. He continues to apply for full-time jobs.

Jones has a degenerative eye disease called keratoconus and needs special contact lenses that cost $700 a pair. He hasn’t had health insurance for four years and his lenses are worn out.

“I’m using temporary contact lenses,” he said.

“I don’t know why we citizens of Georgia aren’t important,” he said. “I guess the issue is that people think we are deadbeats. I’m not on welfare. I’m not on any subsidies. We finally have an opportunity for health care coverage but can’t get it.”

 

 

Coverage not a panacea

 

Buckler, 44, of Paris, Ky., has worked all her life “waitressing and cleaning up.” She is divorced with a grown child and a teenager at home. She lost her health insurance two years ago when she hurt her hand and could no longer work for a company that cleaned away trash and debris from newly built homes.

Because she lives in Kentucky, a state that has expanded Medicaid, she’s now on the program, and seeing a doctor about her hand and waiting to find out if she needs surgery.

“This really took the stress off me,” she says. “I was worried about crippling my hand. I love to work. I’ve worked all my life to take care of me and my kids.”

Although she now has insurance, Buckler still faces challenges. She’s had trouble finding a doctor in the small town of Paris and travels 20 miles to Lexington, relying on friends to drive her. Doctors in Paris told her they weren’t taking new Medicaid patients.

The ACA will fund states’ Medicaid expansion up to 138 percent of the FPL – $15,586 for an individual.

Kentucky implemented aggressive statewide programs to educate people about their options and get them enrolled. Aside from Arkansas, it’s the only Southern state expanding Medicaid so far.

As of April 1, 371,000 people, nearly half of Kentucky’s uninsured, had signed up for Medicaid, most of them becoming eligible through expansion. Another 77,000 people have signed up for private insurance through Kentucky’s health care exchange, which is state-run and called kynect.

Jill Midkiff, spokeswoman for the Kentucky Cabinet for Health and Family Services, which administers Medicaid and kynect, said the Bluegrass State launched an outreach campaign in the summer of 2013, four months before enrollment began in October.

“The response has been tremendous,” Midkiff told GHN. “We never really set a goal.”

In Georgia, newly passed legislation prohibits the state from setting up its own exchange under the ACA, and also restricts state employees from advocating for expansion during their work time.

About 180,000 Georgians have signed up for health care insurance through mid-March under the ACA’s federal exchange. The state has roughly 1.8 million people who are uninsured.

 

Dissatisfaction and anger

 

Buckler, the Kentuckian newly on Medicaid, said she sympathizes with uninsured Georgians. “Everybody works for a living,” she said. “They try to do what they can, and when the economy goes bad or other things happen. Somebody could help. It doesn’t pay to get old no more. I see how these old people struggle.”

Annie Jones would agree. She worked for Rheems Manufacturing in Milledgeville for 28 years until the company shut down the plant in 2009, laid off 1,200 people and moved operations to Mexico. That was the first time she had lost her health insurance.

Jones moved to Atlanta to help care for her mother, who lives in a nursing home. She landed a full-time job at Naturally Fresh Products and again had health insurance. But she was forced to return to Sparta two years ago to protect the family home after vandals damaged it several times.

Since returning to Sparta, she has had to make trips to a hospital in Milledgeville for blood pressure medicine and physical exams. It’s her only option.

“I had to do indigent care,” she said. “It bothers me. I never had to go through that before. I worked ever since I was 17.”

Last year, Jones applied for food stamps. “I had no choice,” she said. “I had to do it.”

She has since lost that assistance. In her effort to earn enough to qualify for private health insurance, she increased her income — not enough for insurance subsidies, but too much for food stamps.

“I work every day,” she said, “and I still can’t make it. I can’t get any help. It’s sad.”

Dymond Jones has an undergraduate degree from Kennesaw State University and a master’s degree in sports and recreation education from the University of Illinois.

He is divorced and has two children. They have health insurance through their mother’s employer.

Jones was co-owner of a gym, but the business folded.

He was working part time as an instructor in health and physical education at Georgia Gwinnett College in Lawrenceville until the beginning of 2013. He wanted a full-time job with the college so he could qualify for health care benefits, but finally decided to quit when he couldn’t get one. He said it cost too much to commute 40 miles each way for a part-time job.

In addition to coaching track at The Howard School, he works intermittently as a personal trainer to make ends meet.

He and a business partner are seeking investors to open a school for families who want to home-school their learning-challenged children.

“I haven’t been politically active,” Jones said, “but I want to do my part and let people know how [not expanding Medicaid] is affecting responsible people in the state. The decisions [that Georgia officials] are making are not from the point of view of being in our shoes.”

 

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