Too Sick to Work but Too Healthy for Help - How Disability and Poverty Go Hand-in-Hand
An Urgent Call for Action
Recently, one of my poems was accepted for inclusion in an anthology “Anger is a Gift: Poetry Anthology of Resistance and Response Poems to the 2024 Election.” They accepted my poem “Blessed Be the Froot Loops.”
The gist of this poem is that people voted for certain candidates because the price of breakfast cereal is too damn high. I concur that the price of all groceries is too high, but their vote will do nothing to bring those prices down. It will only serve to strip away safety nets such as health care from those who need them the most.
If you’ve been reading my work for a while, you know that I grew up poor and I grew up sick. Poverty and illness are terrible bedfellows, but they are frequently found together.
When I was a kid, I had no choice. It wasn’t my fault I was born with a heart defect, and it wasn’t my fault that I was raised by my mother who relied on a welfare check to get by. If it wasn’t for Medicaid, I would not have received the medical care I needed for my congenital heart defect.
Back then, I qualified for Medicaid as a minor, but once I hit eighteen, I aged out of the system. There are hospitals that exist to help care for children with life-threatening chronic illnesses and you’ve probably seen their advertisements all over the television. But what happens when the clock strikes midnight on your eighteenth birthday?
Fortunately, laws have changed since I was a child, and young adults can remain on Medicaid, under certain circumstances, until the age of twenty-six, a change that only went into effect last year. This mirrors the ability of young adults who are on their parents’ employer-provided health insurance to maintain coverage.
Those laws didn’t exist when I was young. Once I turned eighteen in 1985, I had no coverage. Insurers could discriminate against pre-existing conditions and refuse to sell coverage to you. The only way I could get health insurance was through an employer, but health insurance only came with full time work, usually forty hours or more per week.
Right out of high school, I wasn’t qualified to do much other than unskilled labor, even as a college student. Unskilled labor is usually manual labor, and my sick heart couldn’t handle forty hours of labor week after week.
In Michigan, many people are employed by automotive suppliers, working grueling hours on an assembly line. Those factory jobs usually provided health insurance, but I couldn’t keep up the pace and make production. I became easily exhausted. Even when I found an easier sit-down job doing hand assembly, the boiling summer heat on the factory floor overburdened my heart and caused me to pass out.
I hopscotched around part-time jobs to survive and could not afford regular visits with my cardiologist. He wasn’t comfortable continuing to prescribe my medication when I didn’t keep my appointments, so I often went without the drugs that allowed me to handle working at all. It was a vicious cycle.
As I said before, laws have changed. Medicaid has expanded to cover young adults and many other people who are disabled. However, there are those in political power who wish to do away with Medicaid expansion and leave many disabled people without access to healthcare.
In the reconciliation bill that is currently proposed by Congress, Medicaid is on the chopping block. House Republicans are trying to push through a cut of $2.3 trillion in Medicaid spending. That’s nearly one-third of the current Medicaid budget slashed to provide greater tax cuts for the wealthy.
According to this article by KFF - The independent source for health policy research, polling, and news - House GOP Eyeing Cuts of Nearly One-Third in Projected Medicaid Spending | KFF
“House Republicans are considering deficit reductions of $5.5 trillion, which includes $2.3 trillion cuts in Medicaid, $2.7 trillion cuts in other spending, and $0.5 trillion in new tax revenues. Reductions could help offset the costs of extending expiring tax cuts. The document includes several Medicaid policy changes that could reach the $2.3 trillion total with the vast majority of savings (86%) coming from imposing a per capita cap, reducing the Affordable Care Act (ACA) expansion match rate, and lowering the match rate (FMAP) floor from the current 50% level. Policies to limit the use of provider taxes, impose work requirements, change the match rate for DC, and repeal the incentive for states to newly adopt the Medicaid expansion that was passed in the American Rescue Plan Act account for the remaining savings. These policy changes would fundamentally change how Medicaid financing works. Cuts of this magnitude would put states at financial risk, forcing them to raise new revenues or reduce Medicaid spending by eliminating coverage for some people, covering fewer services, and (or) cutting rates paid to physicians, hospitals, and nursing homes.”
What this boils down to is cutting access to healthcare by the most vulnerable among our population. This affects people with disabilities, children, minimum wage workers and their families, and anyone living below the poverty level. It also affects those who acquire their healthcare through the marketplace via the ACA.
Even if you don’t have Medicaid or purchase your insurance on the marketplace, this could affect you. Your employer might offer the top of the line in healthcare coverage, but if hospitals and doctors are earning less money through these cuts, they will cut services and close locations to reduce their budgets. You may have to travel to receive care or not be able to find care at all in your area. We will all be impacted in one way or another.
Update: This is a follow up post about the letter I sent to my Congressional Representative.
What can you do about this? How can you protect yourself, your family, and the less fortunate? Contact your congressperson. Voice your opposition to any possible cuts in Medicaid or Medicare. Find your congressional representative at this link: Find Your Representative | house.gov
Take five minutes to call or email your congressional representative. Let them know that you are opposed to any cuts to Medicaid or Medicare in the current reconciliation bill before Congress.
Help to protect the most vulnerable among us.
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Before I retired I worked in nonprofit health care in the western U.S. We did a ton of work to support Medicaid expansion and told story after story of patients who benefited from this coverage. It is not an exaggeration to say that lives were saved and many others received care that prevented disability or further disability. At its height, the Medicaid expansion covered 40 million people. Another implication of reduced coverage is that the cost of health care goes up for everyone as providers—I’m thinking of nonprofits here—try to keep some kind of margin above zero. That margin is reinvested in the community by, for example, maintaining and updating infrastructure and equipment, paying employees a living wage and giving them decent benefits, and supporting countless smaller nonprofits in their neighborhoods. Whatever the House passes has to also pass the Senate, which tends to be more thoughtful about impacts of legislation. Just a few thoughts to add to your excellent post.
Thank you for sharing Dawn. As a Canadian I don't fully understand your medical system, and I can't imagine how awful it would be to age out of such critical care like post transplant cardiology.
I'm grateful you have the care you need now and I hope Americans will hear your plea and contact their representatives.