Cut away the politics and health care is about real people’s lives. Below are just some of the dozens of stories Missouri Health Care for All has collected from Missourians who are affected by the health policy issues facing our state. They include stories of Missourians who are in the coverage gap, have enrolled in plans through the federal marketplace, lack access to non-emergency medical transportation, are insured but cannot find doctors in their networks, or are struggling to afford sky-rocketing health insurance premiums.
Please check back for more stories.
Eileen is 63 years old and lives in St. Louis County. She was diagnosed with colon cancer in 2009 and underwent two surgeries followed by chemotherapy and radiation treatments. She was declared cancer free in 2010. Eileen had health insurance through a private insurer prior to and throughout her cancer treatment. After her cancer diagnosis, Eileen’s insurance premiums dramatically increased and she found herself paying for a plan that was three times her mortgage payment. She quickly exhausted her retirement savings in order to pay for her cancer treatments. After she was declared to be in remission, Eileen struggled to pay off her medical bills. “I lived in constant anxiety and lost sleep worrying about making the payments. I was unable to even afford to see a doctor for follow-up care.”
In 2016, Eileen signed up for a plan through the Marketplace. She received a subsidy and has an affordable monthly premium. With her ACA plan, Eileen was able to see a doctor for the first time since her cancer diagnosis six years ago. Preventative care and monitoring is important for cancer survivors and Eileen is finally able to see a doctor to get the follow-up care she needs. Proposed repeals of the ACA leave Eileen wondering how she would pay for her health care. “While I still believe there is room for improvement of the ACA, I know that I will not be able to be financially responsible if the proposed AHCA is enacted. I will have to drop health insurance and hope for the best.”
Anne is 60 years old and lives in Clay County. For years, Anne had health insurance through her husband’s plan. Once he retired, Anne lost her health insurance and the peace of mind that came with it. She looked for insurance through private insurers, but their plans would have cost her thousands of dollars every month. For years, Anne only had access to preventative care through a community health program. “I felt like I was dodging bullets before I had health insurance and was always worried about what would happen if I got into a car wreck,” says Anne.
Her fears were well-founded. In 2015, Anne was admitted to the hospital with flu-like symptoms. Tests revealed that she was bleeding internally, had a severely damaged liver, and only had 2 pints of blood left in her body. After spending a month in the hospital, Anne stabilized and qualified for financial assistance with her overwhelming hospital bills. That health crisis bolstered her belief in the importance of having health insurance. Anne signed up for an affordable plan through the Marketplace and couldn’t be happier. “Having health insurance is such a relief. I love the ACA because it has given me options. I’m able to see my own personal doctor and go to the hospital that saved my life.”
B.B. is 63 years old and lives in St. Louis County. She is a grandmother, mother, and owns a small business. Both B.B. and her husband have preexisting conditions and struggled to find affordable coverage through private insurers. Thanks to the ACA, B.B. and her husband were no longer denied coverage because they have preexisting conditions. B.B., her husband, and her twin boys all found coverage through a Marketplace plan. Her 27-year-old daughter works a minimum wage job and was also able to find an affordable plan through the Marketplace for just under $100/month.
Though B.B. and her family now have health coverage, she grapples with the idea that they were once denied health care because of preexisting conditions. “No one asks for a preexisting condition,” says B.B. She acknowledges that the ACA could be repaired, but says that repealing the ACA is not the answer. “Any replacement of the ACA would hurt poor folks and will end up costing me more.”
K.V. is 20 years old and lives in Cass County. She recently gave birth to her 4-month-old son. While pregnant, K.V. qualified for Medicaid and had health insurance for the first time in her life. After having her son, K.V. was no longer eligible for Medicaid and lost her coverage. Without insurance, K.V. worries about what would happen if she were to get sick. “I worry I would have to go to the doctor one day and would not have insurance,” she says.
Her young son still qualifies for Medicaid. K.V.’s son was born in breech, causing problems with his neck and legs. Doctors did not know if he would have permanent defects and ran multiple tests to make sure he was healthy. Luckily, her son will not have any permanent problems, but requires physical therapy. Without Medicaid, K.V. could not afford the care her son needs. “With Medicaid, my son has the care he needs and we don’t struggle when he needs to see the doctor.”
Mary is 30 years old and lives in Jackson County. She is a hardworking single mother and has a four-year-old son. As a low income parent, both she and her son qualify for coverage through Medicaid. Shortly after being born, her son had to be hospitalized for several days. Medicaid completely covered his hospital stay, treatment for his asthma, and the care he needed for a hernia several years ago. Mary says Medicaid gives her peace of mind as a single mother. “With Medicaid, I know my son will be taken care of. I’m not wondering how I would feed him after the medical bills show up.”
Mary also qualifies for Medicaid. Last year, she was diagnosed with cervical cancer and soon after lost her job. Her diagnosis made her realize the importance of having health care. Mary now requires treatment for the cancer and has to see the doctor regularly. “Everyone needs health care. Without Medicaid, I don’t know what I would do. I’d probably have to sell our house just to pay for the medical bills.” Thanks to Medicaid, Mary is receiving the care she needs and is able to be there for her son.
Rosemary and her husband are 61 years old and live in Howell County. For years, they could only afford a catastrophic health care plan with high deductibles and premiums. All preventative care had to be paid out-of-pocket. Once the ACA passed, Rosemary and her husband signed up for comprehensive, affordable plans through the Marketplace as soon as they were able to. They received subsidies that made their plans affordable and only pay $100/month for both of their plans. For the first time in years, Rosemary and her husband had access to preventative care and were able to get screenings that gave them both peace of mind. “Having health care as you get older is so important. I’ve had friends lose all they had because they can’t afford to pay their medical bills,” says Rosemary.
Without the ACA, Rosemary and her husband would not be able to afford a plan with comprehensive coverage. They would be stuck with the same unaffordable catastrophic plan they had before, praying they would not get cancer or another chronic condition. “We are thrilled with the ACA and are finally able to go to the doctor regularly.”
John and Fran and are in their fifties and thinking about retirement. They know that without the ACA, they would likely be bankrupt. John has a master’s degree, is a musician and teaches at all the area colleges and local Boys & Girls Clubs. Fran works at a local restaurant. They both lead a healthy lifestyle, but neither of their employers offered health insurance so they had been uninsured for decades. John and Fran purchased a plan through the ACA several years ago. Subsidies made their plan affordable and they pay $300/month. For the first time in decades, Fran and John had access to health insurance. After a run one day, John had blurred vision and sharp pain in his head. It turned out to be severe case of shingles, which spread to his eyes. Thanks to the ACA, John was able to get the treatment he needed immediately, including having access to a vision specialist and undergoing necessary tear duct surgery. Without insurance through the ACA, his surgery would have been over $15,000 – he would have either been deeply in debt or gone without the treatment he needed. Losing ACA coverage would mean losing the ability to see the specialists John needs to see once a year and going without his needed prescriptions to manage his risk of glaucoma. The subsidies make health care affordable for Fran and John. “There’s no way we could afford coverage without the ACA,” says Fran. Both Fran and John say that having health insurance allows them to be productive members of society. John says it is extremely stressful watching politicians talk about taking away the ACA. John and Fran are in their late 50s. They say without affordable health care and coverage, it’s incredibly tough to figure out a retirement plan and not be in debt. “I can’t imagine we would ever be able to retire without the Affordable Care Act.”
Kellie is 43 years old and lives in St. Louis. She has four children, including her 17-month old son. Kellie suffers from hemiplegic migrains, rare variant of chronic migraine that results in paralysis, vision and speech problems, and can possibly lead to a stroke. For 15 years, Kellie was uninsurable because of her preexisting conditions and was forced to go without treatment. Without treatment, Kellie had a stroke that resulted in peripheral neuropathy. She now has permanent nerve damage in her hands that prevents her from working. The pain from these migraines are so intense Kellie becomes blind, her right side is paralyzed, she can’t speak, and loses control of her body and sometimes her bladder. Her last migraine lasted five long days. After fifteen years of being uninsured, Kellie was able to finally get health coverage and the treatment she needs through MO HealthNet. Medicaid allowed her to get a primary care physician, see a neurologist who specializes in her type of migraines, receive regular MRI scans, and have access to therapy and medications she has needed over the past 15 years. Her doctors have told her that the next stroke may kill her. “If Medicaid gets cut, all of this care gets taken away. Without access to my doctor and medication, I would surely have another stroke and my doctors don’t think I can have many more and survive. I wouldn’t be here without Medicaid. I know I wouldn’t.”
Tim is 34 years old and lives in St. Charles County. He suffered a spinal cord injury in 2004 and became completely disabled, unable to work or manage to take care of his daily needs. Luckily, since he is classified as disabled, Tim is able to have primary insurance coverage through his father’s union plan. Though Tim’s major health needs are covered, he cannot live independently and needs daily help to get up in the morning and perform day-to-day tasks.
As a disabled individual, Tim is eligible for Medicaid’s Consumer Directed Services. CDS provides an in-home worker to help Tim live independently which allows his parents to continue to work instead of shifting their lives to take care of him. “Without CDS funding, I would be in a nursing home, away from my family.” Tim is the father of a beautiful 10-month-old baby, works part-time from home, and is an active part of the local disabled advocacy community. Without Medicaid coverage, he would not be able to afford in-home care. Tim says Medicaid gives him the help he needs to give back to society, pay his taxes, and be an active member of his community. “I’m trying to be a productive member of society and cannot do that without the help Medicaid and CDS give me.”
Beth is a nurse and works with children with diabetes. When Beth began her nursing career, she witnessed the enormous financial impact on families whose children were denied insurance plans because they were born with congenital anomalies or developed chronic conditions. The ACA allowed her patients with preexisting conditions to receive coverage. “Each and every family I work with benefits from the inclusion of persons with pre-existing conditions in health insurance plans.” Beth has witnessed firsthand the devastating physical and financial harm caused by not having access to affordable health insurance. On average, diabetic medications and supplies cost up to $1200/month. Families desperately try to cut astronomical medication costs by not checking blood sugar regularly or skipping insulin. Without preventative care, complications can develop, including diabetic ketoacidosis, kidney and eye disease, and, in some cases, death. Medication is lifesaving for diabetic patients and affects their quality of life. Without access to affordable health care, Beth’s young patients are at risk of losing their lives. Her years spent as a health care provider have made Beth passionate about health care. “We as a society need to provide a system that ensures that every one of us has access to affordable, quality, humane health care,” says Beth.
Marissa is 38 years old and lives in St. Louis County. Every member of her family suffers from a preexisting condition. Marissa has an autoimmune disease, her husband has depression, her older daughter has an overactive thyroid, and her younger daughter was born premature and has asthma. Between medications and doctor’s visits, Marissa says “our family is now destroyed financially because of illness.” They have filed for bankruptcy twice due to massive medical bills.
Marissa and her family are not the only ones adversely affected by the financial costs of preexisting conditions. About 52 million Americans have preexisting conditions. Before the ACA, insurance companies denied people coverage, charged them more, or refused to renew their policies because of preexisting conditions. Obamacare protects Marissa’s family from being discriminated against because of their health conditions. Though they still struggle to pay for their deductibles, the family feels fortunate and are grateful they have health care. With the ACA, insurance companies are no longer able to discriminate against people with preexisting conditions and need health care the most.
LeAnn benefitted from Medicaid while she was pregnant with her first son, Isaac. While LeAnn had insurance coverage, her plan did not fully cover her pregnancy and prenatal care – which was especially important because she was considered a higher risk pregnancy.
When asked what she would have done if she did not have Medicaid coverage during her pregnancy, LeAnn said “we would still be paying for the medical bills.” She would have needed to call in favors and help from family without Medicaid, or work overtime while pregnant.
Medicaid covered all the care she and Isaac needed during pregnancy and his first year. LeAnn was diagnosed with gestational diabetes and Medicaid covered her blood sugar monitor, supplies and education to ensure a safe delivery. Medicaid also covered Isaac’s care when he had heart murmurs needing to see specialists, prescriptions and a nebulizer when he had pneumonia.
The veracity of a mother’s love is strong. LeAnn said she would go without insurance for herself and make many sacrifices in order to insure and care for Isaac.
After going through this process, LeAnn took advantage of the health insurance marketplace and shopped for a new plan when Open Enrollment came around. Previously coverage for just her was nearly $400 a month. Thanks to the Affordable Care Act, both LeAnn and Isaac are covered for $157 a month on a silver plan – which continues to cover their important wellness visits at no additional cost.
When asked what a repeal of the Affordable Care Act would mean for LeAnn and her family, she said “The relief I felt when learning I qualified for Medicaid during my pregnancy and later tax credits on the Marketplace would turn to a very real fear.”
P. is 54 years old and lives in St. Louis County. She recently moved to Missouri from Florida to be with her parents after going through a painful divorce. P. had insurance through her husband’s employer but lost her coverage as soon as the divorce was finalized. “If it weren’t for the ACA, I don’t know what I would have done,” she said. P. applied for a plan through the Marketplace and qualified for tax credits. Her plan also covers the cost of an antidepressant she began taking to cope with the stress of her divorce.
P. considers her Marketplace plan a “stop-gap” that got her through a difficult life transition. When she left Florida, P. gave up the small gardening business she owned for ten years. She moved in with her parents and now works part-time while looking for a full-time job that will provide her with insurance. P. said she is grateful for the ACA, and that it provides support for those going through life-changing circumstances.
Suzanne lives in Joplin and has struggled with health issues her entire life. She was born 6 months premature, was not strong enough to receive vaccinations, and suffered from measles, mumps, and chicken pox. Suzanne grew up, worked for 18 years, married, had 2 kids and then divorced. After her divorce, her health took a drastic blow. She was diagnosed with diabetes, was showing signs of schizophrenia, and had no way to get the help she needed. Luckily, she qualified for Medicaid at a time when she needed it the most. Medicaid has helped her pay for diabetic supplies, therapy for her mental health needs, and dental care.
Suzanne is grateful for the health care services she has received through Medicaid. “Without Medicaid, I would not be able to function. I do so now with help,” says Suzanne. She is employed and an active member and facilitator of Joplin NAMI (National Alliance on Mental illness). With the medical services she receives through Medicaid, Suzanne has made the road to recovery a reality.
Chelsie is 23 years old and has not had health insurance since she was 18. When Chelsie worked at a fast food restaurant she did not have access to health insurance. Chelsie was left uninsured, just hoping that she would stay in good health. Unfortunately, Chelsie’s wisdom teeth became infected and she had to visit the ER. This ended up costing her over $300 just for the visit and a round of antibiotics. She also has mental health needs but she has been unable to receive treatment and medication since she does not have insurance. Chelsie says, “If I had health insurance, I wouldn’t have to suffer because I can’t afford medication. I would be much, much happier and more stable.”
Julie is a busy, hardworking grandma with six grandchildren. Both Julie and her husband have been uninsured for three years. Julie suffers from migraines and high blood pressure, but is unable to afford the medications she needs. Her husband has been very sick and has a family history of cancer, but they cannot afford to see a doctor for a diagnosis. “It’s frustrating to not have insurance when you know you need to see a doctor,” she says.
Julie works at Hardee’s and is offered health insurance through her employer, but it would take the majority of her paycheck and she already struggles to pay rent. She tried signing up for the ACA several years ago, but could not afford the plans offered. Both Julie and her husband find themselves forgotten in Missouri’s Medicaid Coverage Gap: they do not qualify for Medicaid, but cannot afford insurance through the Marketplace or their employers. Julie and her husband find themselves without resources or help at a time when they need it most.
Pam has been a school nurse for 13 years and lives in Greene County. She works at an elementary school and sees firsthand how important Medicaid is to her young students. About 1/3 of her students qualify for free lunches and have health insurance through Medicaid. She sees students with health issues ranging from strep throat to diabetes. As a school nurse, Pam cannot prescribe medications. “It’s sad and frustrating that I can’t get these kids medical care.” All she can do is recommend that they go to the doctor. Medicaid gives her students access health care. They are able to see a doctor and get the medications they need in order to be healthy enough to attend school. “Adequate medical care for kids is essential to ensure proper learning for kids to grow up into healthy, productive adults. Decreasing Medicaid could have long term detriments to society as a whole.”
Joycelynn is 31 years young and lives in Jasper County. She has autism and was born with a brain injury. Jocelynn has health insurance through Medicaid which has allowed her receive the help she needs to be an active part of society. She loves to read, ride horses, and be with children. Joycelynn volunteers at three different schools and reads and does crafts with the students. Her mother says the volunteer work gives her a sense of purpose and belonging. Joycelynn is not able to live independently, but lives at a host home where she is thriving. This is only possible because of the personal aid that she has through Medicaid. This aid keeps Joycelynn focused and allows her to be an active member of society. Everyone loves her and she is a vital part of people’s lives. When asked about what Medicaid means to them, Joycelynn’s parents say, “Medicaid has provided quality of life for our daughter, and so many others like her.”
In 2012, Jenifer’s husband Cory was hit and killed by a police officer racing to a domestic abuse call. The officer never saw Cory or his motorcycle until he looked under the bumper of his SUV. Cory died on impact and Jenifer, his wife, was left alone to raise their three children, ages 6, 2 and 1. Luckily, her children qualified for Medicaid and were able to receive health care.
In 2014, Jenifer found a lump in her breast. She feared the worst, and didn’t want her kids to grow up without either parent. A mammogram revealed Jenifer had cancer. Once the cancer developed to stage 2, she qualified for Medicaid through a program that insures women with breast cancer. Jen says, “Without Medicaid, I am sure that I would be dead.”
Since that time, Jen has undergone dozens of chemo and radiation treatments, as well as a complete mastectomy. Although she is not done with treatment, she is now cancer free. Her children will never know their dad but they won’t lose their mom. Medicaid saved Jen’s life and helped her when she needed it most.
L.D. is 55 years old and fears she will lose her affordable health insurance. As a breast cancer survivor, she understands that having quality, affordable health coverage is lifesaving. Before Obamacare, L.D. paid $800/month for health insurance and her premiums increased every year, sometimes by $200. Through the federal marketplace, she was able to find a plan with a consistent $540 monthly premium. The plan better fits L.D.’s health and financial needs, and it allows her to successfully own and operate her own business.
If L.D.’s health insurance costs increase, she would be forced to give up the small business she worked so hard to start. She also fears that she would be denied affordable coverage due to her preexisting condition. Currently, the ACA protects L.D. and others with preexisting conditions from being denied coverage or being charged more. With the Affordable Care Act, L.D. has the freedom to pursue her dream of owning a small business and the peace of mind to know that if her cancer ever returns, she has affordable health care to help her through.
Lucinda is a single mother living with her son and daughter in Stoddard County. She is currently pursuing a degree in social work at Three Rivers College while working part-time as a secretary at a local salvage yard. She says if it wasn’t for Medicaid, her son would not be able to receive the care he needs for on-going health issues he has with his ears. Both of her children depend on Medicaid for all their health care needs. They are able to receive annual dental and vision exams along with a brand new pair of glasses that otherwise would be unaffordable. If she didn’t have Medicaid for her children, she said she would have to figure out a way to purchase insurance for them, even if that means going without basic, everyday necessities. “Should I give up paying my electric bill so I can pay for health insurance?” she wonders.
Lucinda also falls into the Medicaid Coverage Gap. Because Lucinda had to get a job to support herself and her children, she no longer qualified for Medicaid. In the state of Missouri, the financial threshold for an adult with 2 dependent children is $318 a month. So now Lucinda goes without health insurance. She worries about becoming ill and not being able to afford to go to the doctor which could result in her missing more time from work than she would have if she had insurance. If she doesn’t work, she loses income she needs to support her children. Like many Missourians, Lucinda is forced to choose between having health insurance, and working to support her family.
Rose has two young children and has been on Medicaid since she was pregnant with her twins. Rose had a high-risk pregnancy and was admitted to the hospital when she was just four and a half months pregnant. Doctors induced her labor and her twins were born two weeks later. Her daughter was born with a hole in her brain and heart and was hospitalized for 4 months. Her son also required hospitalization. Medicaid covered all of the twins’ surgeries, treatments, and medications. It gave them the care they needed to stay alive.
Now two years old, Rose’s children still require medical care. They see occupational and speech therapists, take medications, and still need to see their doctor regularly, but they are survivors. Rose says it is all worth it. “I thank God for Medicaid because it has given my babies a chance to live.”
Richard is 50 years old and lives in Christian County. He has M.S, is unable to work, and on disability. Because Richard is a low income parent, his 16-year-old son qualifies for Medicaid coverage. When his son was 10 years old, he began to complain of debilitating headaches. An MRI revealed that Richard’s son had a malignant tumor the size of a golf ball pressing on his pituitary gland. He underwent emergency surgery and the tumor was removed successfully. After 8 months of regular radiation and chemotherapy, Richard’s son was declared cancer-free.
Richard is forever grateful for Missouri’s Medicaid program. Without health coverage for his son, Richard would have had to file for bankruptcy in order to pay for his son’s cancer treatments and surgery. As a parent with a fixed income, he says having Medicaid coverage saved them financially. “Medicaid saved my son’s life and allowed me to keep a roof over his head.” Richard’s son emerged from his ordeal stronger and more grateful than ever. He is a mentor to his peers and an inspiration to those around him. Without the coverage he received through Medicaid, Richard does not think his son would have survived. “He knows he’s been given a gift and he wants use his experience to help others.”
Shanette is 43 years old and lives in St. Louis County. She has 4 children and 4 grandchildren. Her two youngest sons are 11 and 6 years old. Kayden, her six-year-old, was born prematurely. After Kayden’s birth, Shanette contracted a severe infection. Both Shanette and Kayden were in intensive care for one month. Because of the care they received, they stabilized and Shanette was able to walk out of the hospital with a healthy baby boy. Luckily, both Shanette and Kayden were covered through Medicaid and able to have the lifesaving care they needed.
Today, the family relies on Medicaid for their health needs. Both Kayden and his 11-year-old brother have severe asthma and require medications and breathing treatments. Shanette has high blood pressure and mental health conditions and needs medications to stay stable and healthy to take care of her young sons. “My children are my world and it’s a blessing they have health insurance. I’m so thankful for Medicaid.”
Sandy is 64 years old and lives in St. Louis County. Her son D.O. is 31 years old and was born with spastic quadriplegic cerebral palsy. He cannot speak or walk, has severe asthma, and is prone to seizures. As a disabled person, D.O. qualifies for Medicaid which covers all of his health needs. As he gets older, his medical issues become more serious. Over the past 8 months, D.O. has been hospitalized three times. During a seizure, he broke one of his legs. Due to his asthma, he was hospitalized for pneumonia. His hands became so contracted they affected his circulation and he required corrective surgery. Without Medicaid, D.O. would not have received care for any of these procedures.
Most importantly, Medicaid gives him social interaction with others through a local adult day program. D.O. has a feeding tube and requires consistent care throughout the day. Both Sandy and her husband work full time. Without the adult day program, one of them would have to stay home with him and he would lose the social interactions with his peers that bring him joy. He loves going to the zoo, restaurants and the mall with his friends in the program. Despite all of his health difficulties, D.O. is social, outgoing, and happy thanks to his ability to participate in the adult day program. Sandy draws strength from his optimism. “He wakes up with a smile on his face. If I’m having a bad day, I think that if he can be happy, so can I.” Medicaid has given D.O. the care he needs to be happy and healthy and Sandy is forever grateful. “Without Medicaid, I don’t know what we would do.”
Jessica is 37 years old and lives in Johnson County. Her son Nicholaus is 14 years old and was born with dwarfism and has severe scoliosis. In his short life, he has undergone 30 surgeries in an attempt to straighten his spine. Without these corrective surgeries, Nicholaus’ back will eventually bend to the point of crushing his lungs. Having health coverage for Nicholaus is a necessity.
Luckily, Jessica has health coverage for them both through her employer. She works as a full-time secretary at a local university and makes $16,000 a year. The insurance deductibles take 2/3 of Jessica’s paycheck, but their plan allows Nicholaus to see a specialist. Because of his disability, Nicholaus qualifies for Medicaid which covers the remaining balance of his medical bills. Without Medicaid, Jessica would be drowning in a sea of medical debt, unable to pay for the care her son needs.
The ACA gave Jessica peace of mind. She can keep Nicholaus on her plan so he can see his specialist. He will not be denied coverage because of his preexisting condition. Jessica will not be solely responsible for Nicholaus’ medical bills when he exceeds the lifetime cap. Both Nicholaus and Jessica rely on Medicaid to help pay for the balance not covered by the insurance companies. She is incredibly grateful to both the ACA and Medicaid for giving Nicholaus the care he needs to live a normal life. “The ACA made me feel hopeful. I didn’t feel like we were one step away from drowning in medical bills. The worry that he might lose coverage or not be able to see the doctors he needs is always in the back of my mind as a parent.”
Sarah is 61 years old and has relied on the Affordable Care Act for the past three years and hopes to see it remain. Each year she has been eligible for subsidies, making her insurance more affordable and giving her the ability to own and operate a small business while also working part-time as a substitute teacher.
If not for the ACA and premium tax credits, Sarah would not have access to affordable coverage. She would be forced to give up her business. Sarah contributes to her community and is a hardworking small business owner. She serves as just one example of the thousands of Missourians who depend on the Affordable Care Act for their quality, affordable health insurance.
Jeanie is a young freelance artist who owns and manages her own business. She recently had a high-risk pregnancy that required extensive medical treatment. Her son was born prematurely and remained in the hospital for one month after he was born. Fortunately, Jeanie had affordable health coverage through the Marketplace and her plan completely covered both her and her son’s medical exams and hospital bills.
Having health insurance through the ACA saved her son’s life and kept her family out of massive medical debt. Before the ACA, Jeanie would not have had access to affordable health coverage and would be paying off medical bills for the rest of her life. Jeanie’s son is currently doing well and living at home. She is extremely grateful for both the ACA and the Children’s Health Insurance Program for keeping her son safe and healthy. The family’s health ordeal made Jeanie realize that having health insurance is absolutely necessary. “Having health care is pro-life,” she says.
Alex is 20 years old and lives in St. Charles County. As a full-time student, Alex has her own health insurance plan through the university. Before doing so, Alex was on her parents’ insurance plan along with her younger brother. Fortunately, under the Affordable Care Act, her brother can remain on their plan and receive the care he needs. Both her brother and her mother have pre-existing conditions. Her brother suffered a head injury and requires medications to help with his symptoms. Her mother has chronic, debilitating migraines and needs both medications and therapy. Before the Affordable Care Act was passed, her mother had trouble getting coverage to help treat her chronic condition even though she had a private insurance plan. Without medication for her migraines, her mother experiences chronic pain that often leaves her bedridden. She could not work if she did not have health insurance. “Without the Affordable Care Act, my mom and brother would not be able to get the medications and treatment they need and would be miserable all the time.”
Erin is 25 years old and a full-time law student. Both Erin and her mother benefit from provisions in the ACA that have given them access to affordable, lifesaving health care. Several years ago, Erin’s heart and lungs suddenly failed and she underwent emergency open heart surgery. Erin’s mother has survived cancer four times, but lives with the knowledge that it could come back at any time. Health coverage for both mother and daughter is a matter of life and death.
At the time of her heart surgery, Erin was covered through her father’s insurance plan. After her diagnosis, the insurance company refused to renew Erin’s coverage. Thanks to provisions in the ACA, insurance companies can no longer discriminate based on her preexisting condition. Erin also benefits from the elimination of lifetime caps. A lifetime cap would make her financially responsible for her treatment once it passes a certain amount. In 2013, her procedures totaled $500,000. Erin would have been paying off medical bills for the rest of her life. Thanks to the ACA, insurance companies must pay for essential health procedures, like Erin’s open heart surgery, not just a set amount.
The ACA essential health procedures provision has also helped Erin’s mother receive preventative breast cancer screenings and allowed her to get reconstructive surgery. These ACA protections have given Erin and her mother peace of mind that they will have health coverage if faced with another serious health scare. Erin emerged from her health care ordeal with a passion for helping others. She is a law student at St. Louis University and hopes to advocate for individuals with disabilities and use her education to fight for health care expansion.
Michele is 39 years old and lives in St. Louis County. She is a full-time mom to three young boys. Michele’s pregnancies have been difficult; her first son was born 8 weeks premature. He received medical help through the special care unit and was admitted to the NICU for one month. Thankfully, Michele and her son were covered through Medicaid during her pregnancy. Without Medicaid coverage, the family would have been hundreds of thousands of dollars in debt paying for the care her son needed to stay alive. “I’d still be paying those bills. Medicaid coverage saved us.”
The entire family was through her husband’s employer for 10 years, but his income suddenly changed and they could no longer afford to keep the children on her husband’s plan. They applied for Medicaid coverage for the boys and are waiting to be approved. Right now, the boys are uninsured and Michele lives in constant fear that if one of her children were to get sick or injured she would not have a place to take them. “Even if I were on my deathbed, it’s more important that my children have health insurance than me. They are my priority.”
Julie is 29 years old and a full-time grad student at Webster University studying English as a second language. In addition to being a full-time student, Julie also works part-time at a call center. She has been covered by a Marketplace plan for the last two and a half years. This year, she purchased a Cigna Silver plan. Julie’s plan normally costs $260, but thanks to tax credits, she only has to pay $63 a month. Julie has cerebral palsy, and while she has not needed any surgeries recently, she takes comfort knowing that if she needed any treatment, she would be covered by her insurance. Without affordable marketplace plans, Julie said she would be without health insurance for the foreseeable future. She says her Marketplace plan is a lifeline. Three months ago, Julie had bronchitis and was sick for approximately two weeks. “If I hadn’t had insurance, I would have had to pay for my medicine and doctor’s visit out of pocket,” she said. “I only make $10 an hour, so those costs would have likely taken my whole paycheck.”
Charlene is 55 years old and has been on Medicaid her entire life. As a baby, she was diagnosed with dwarfism as well as a disability that affects her brain, breathing, and speech. “The doctor told my mom I was a fighter,” she said, “I’ve always been that way.” Last Christmas, Charlene was sent to the hospital when she was found unconscious in her apartment. She had overheated and her diaphragm had collapsed. At the hospital, she was diagnosed with pneumonia, hypoxia, vitamin deficiency, and lactic acid build up in her muscles. The doctors told her having one of those was enough to kill her, but as a fighter, she survived.
Medicaid covered all of her treatment, rehabilitation, and trachea equipment. Without Medicaid, Charlene would not be able to afford lifesaving prescription medications and her oxygen tank and mask. Charlene’s speech has improved, which she says has helped her to advocate for herself and others. She hopes to go back to school and become a community advocate working to improve accessibility to care for disabled individuals.
Susan S. knows firsthand why health coverage for young adults is important. “Without young adult coverage, we’d be in financial ruin.” Last year, Susan’s 20-year-old son suffered from a major mental health crisis and was hospitalized for over a week. He was diagnosed with bipolar disorder but, thanks to treatment, Susan’s son is healthy and doing very well in his college classes. If he was not covered on his father’s employer-provided health insurance, Susan and her family would be in financial crisis. They would have to pay all of the costs of her son’s hospitalization out of pocket. Susan thinks all parents should fight to keep coverage for adult children because mental health issues are so likely to become apparent during young adulthood.
Suzy is 67 years old and lives in St. Louis County. In 1999, she was diagnosed with Muir-Torre syndrome, a chronic condition that predisposes Suzy to breast, skin, and uterine cancer. She will require regular chemotherapy and radiation for the rest of her life. Suzy was married for 30 years and had insurance through her husband’s employer. In 2000, they divorced and Suzy lost her insurance while undergoing treatment for breast cancer. She looked for insurance through private insurers, but was repeatedly denied due to her preexisting condition.
Eventually Suzy found an insurance company that would give her coverage for $1000/month and a high deductible. She went without groceries and heat in order to afford her premium. After the ACA was signed into law, Suzy signed up for a plan as soon as she could. Her premium payments were cut in half and her plan covered her radiation treatments. “The ACA gave me peace of mind and I felt safe. I was no longer at the whim of my disease or the insurance companies.”
Barbara is 56 years old and lives in St. Louis County. She is a self-employed sales rep and has high blood pressure. Because of her preexisting condition, she was only approved for a catastrophic plan. In 2008, Barbara was diagnosed with breast cancer and was quickly dropped from her insurance policy. She applied for insurance through Missouri’s high risk pool, but her coverage did not kick in for 12 months. Barbara was in need of surgery and found herself without insurance. She completely depleted her savings to pay for her cancer treatment. Not knowing how she “Insurance caused me more pain than the cancer. I could beat the cancer.”
In 2013, she signed up for a plan through the ACA that covered her cancer treatments. Barbara is now in remission and is able to begin building up her savings again. “Having coverage through the ACA was lifesaving. It brought me to a place where I could look forward to the future.”
Erin is an English professor and lives in Greene County. Previously, Erin lived in Massachusetts and worked as a part time, adjunct professor. As a part time employee, Erin was not eligible for insurance through her employer and could not afford insurance through private insurers. Though she does not have any chronic conditions, Erin did not have access to preventative care and worried about getting sick or injured. Several years ago, she signed up for a plan through the Marketplace. Erin paid $43 a month for her plan and was finally able to get the preventative care she needs. “Having health insurance means being able to proactively take care of myself. I don’t have to worry about losing all of my savings if I get injured or sick.” Erin found a plan that took care of her needs for an amount she could afford.
C.R. had health insurance through his parents’ plan until recently when he turned 26 and could no longer be on their plan. C.R. did not qualify for insurance through his employer because of his part-time status, so he turned to the Marketplace to get his own health insurance. He said, “Having health insurance is important because you never know when you could be in a car accident and get injured or something like that, it’s just as important as having car insurance.” In the beginning of December, C.R. went to his local community center to receive help with enrollment and choosing the right plan. Because C.R. qualified for a premium tax credit, he pays about $22 a month for his Silver plan, saving him $200 a month. C.R. said he was grateful this type of help was available to him and that health insurance is made easy on the Marketplace.
Valeria was a healthy, athletic, and energetic 27-year-old. One morning she woke up to find she could not feel her left leg. After four weeks of the numbness spreading and being turned away by the emergency room and local physicians, Valeria was diagnosed with multiple sclerosis. She began treatment with heavy doses of steroids and other maintenance drugs, which averaged about $67,000 a year (more than her annual salary).
Fortunately, Valeria was living in Massachusetts at the time Governor Mitt Romney’s “Romneycare” was enacted. Due to Romneycare, the predecessor of the Affordable Care Act, Valeria’s graduate school was required to offer quality, affordable health insurance to its students, regardless of preexisting conditions. This meant that Valeria could continue to go to school and work while getting access to the lifesaving treatment she needed. Since her diagnosis ten years ago, Valeria has worked full time and paid her taxes and medical bills. “I wouldn’t be able to be a productive member of society without Romneycare and Obamacare.”
Kimberly is 44 years old and lives in Jefferson County. She has been a hair stylist for 25 years and owns her own business. In her 20s, she was diagnosed with connective tissue disease. Her immune system attacks the tissue surrounding her joints, causing her pain that can be debilitating. Kimberly had insurance through her husband’s employer, but lost her coverage when he became disabled and had to retire.
Kimberly was uninsured for two years and did not have access to medications for her chronic condition. She anxiously hoped nothing would happen to her. In 2012, she applied for a silver plan through the ACA and was finally able to get the care she needs for her connective tissue disease. The cost is worth the peace of mind. “Having health insurance means having security. Without it, a broken arm could bankrupt us.”
Susan is 48 years old and lives in St. Louis County. She has five young grandchildren and is a lifelong St. Louis resident. Susan spent most of her teenage years in foster care. Years later, she developed sleep apnea, asthma, and major depression, all chronic conditions that require consistent care and medications. She has severe respiratory problems and avoids going places in fear of getting sick. Susan applied for disability and has coverage through Missouri’s Medicaid program. Having health care is lifesaving for Susan. Without her coverage, Susan would have to ration the medications that allow her to breathe. She is grateful for Missouri’s Medicaid program, but fears that coverage might be cut. “I’m so afraid for the youth and the elderly. They’re the ones that depend on Medicaid.”
Miles is 28 years old and lives in Greene County. He works as a graduate assistant at a local college and is an avid cyclist. In 2013, he was hit by a car while cycling, required three surgeries, and had a titanium rod put in his leg. At the time of the accident Miles was uninsured. As a graduate assistant he did not make enough to qualify for discounts through the Marketplace and made too much to be eligible for Medicaid. Luckily, the driver’s insurance company covered a portion of his astronomical hospital bills.
In 2015 Miles’ income changed and he became eligible for discounts through the ACA. He purchased a silver plan for $23/month and was finally able to see a physical therapist to rehabilitate his leg, but more importantly he has peace of mind. For Miles, the car accident demonstrated the importance of having health insurance. “Without health insurance, I could lose my savings. Even driving gives me anxiety. It’s constantly in my mind.”
Sarah is 48 years old and lives in St. Louis County. In 1993, Sarah was diagnosed with endometriosis. Luckily she had coverage through her employer. In 2000, Sarah left her job to become an independent grant writer and looked for insurance through the private marketplace, but was turned down multiple time because she had a preexisting condition. She eventually found an expensive catastrophic plan, but it did not cover her preexisting condition. While covered under the catastrophic plan, Sarah had to have a hysterectomy which cost her several thousand dollars.
In 2014, Sarah purchased a silver plan through the Marketplace that covered her preexisting conditions. She was able to get the care she needs for her endometriosis. However, Sarah fears a repeal of the ACA would put her life back in the hands of insurance companies. “If insurance companies won’t let me purchase insurance because of a preexisting condition, it would bankrupt my family. It would be the end of everything I’ve worked for.”
Robin is a sales representative and lives in St. Louis County. Several years ago, she was diagnosed with a chronic neuromuscular autoimmune disorder and required regular testing and medication. Her disorder affects her speech, muscle coordination, and breathing. Last year, Robin was admitted to the hospital 9 times. Though she had insurance through her employer, they required preapproval for every treatment Robin received which prevented her from seeing her doctor. Eventually, Robin became too sick to work and was hospitalized. She was let go from her job and found herself without insurance.
In 2016, Robin purchased a plan through the ACA. The plan preapproved Robin’s treatment for 5 years. She does not have to wait to see her doctor, has access to all the medications she needs, and is finally stabilized. “Without coverage through the ACA, I would be completely debilitated. I’m back in a place where I could work again.”
Sally 35 years old and lives in St. Louis County. She is a single parent to her 13-year-old son Colin. As a low income parent, she and Colin both qualified for Medicaid in Missouri. Luckily, both of them were in good health. Last Halloween, Colin abruptly fell into ketoacidosis and was rushed to the hospital. He spent several days in the ICU and was diagnosed with Type 1 diabetes. With treatment and medication, Colin stabilized and is living a healthy, normal life.
Sally is incredibly grateful for Missouri’s Medicaid program and says it has given them both peace of mind. “I would like him to have the same opportunities as any other kid and that starts with good health. Medicaid has given him the care he needs to stay alive.”
Toni is 57 years old and lives in Cooper County. She works part time. Prior to having coverage through the ACA, Toni has been without health insurance for 10 years. Toni began to experience severe pain in her side and knew she needed to see a doctor. In 2016, she signed up for a plan through the Marketplace and was finally able to get a physical. A CT scan revealed the pain in her side was actually a dead liver and she required immediate surgery.
Toni’s silver Marketplace plan cost her $1/month and paid for most of her treatment costs. She had surgery in December and is quickly healing and ready to return to work. Toni is incredibly grateful that she had access to health insurance at a critical time. “Obamacare saved my life. Without it, I don’t know what I would have done.”
Michele is 66 years old and lives in Greene County. She is a retired attorney with two grown daughters. Throughout the course of her thirty year career, Michele always had a good job with benefits. In 2010, she developed health problems and her doctor advised her to apply for disability. Though Michele was approved for disability, she was ineligible for Medicare for 24 months and found herself without health insurance.
She applied for a Gold plan through the Marketplace and was able to receive subsidies. In 2013, Michele had to be hospitalized, required in home care, and faced a mountain of hospital bills. Her plan paid for her treatment and care, something Michele is incredibly grateful for. Her daughters did not have to interrupt their lives and rush home to take care of her and her hospital bills were completely covered. “There’s no way I could have paid those hospital bills. Without the ACA, I would have had to file for bankruptcy. It would have been a disaster.”
K.M. is 50 years old and lives in Clay County. He has chronic back and knee pain and cannot stand for more than fifteen minutes at a time. Five years ago, he was diagnosed with polycythemia, a condition that makes his blood clot too quickly. K.M. worked in a warehouse and for a lawn company, but could not stand for long periods of time without his legs swelling. In order to be gainfully employed, K.M. needs to receive care for his chronic, debilitating conditions.
K.M. tried to apply for health insurance through the Marketplace, but did not qualify for discounts and could not afford the plans. He then applied for Medicaid, but was told he must apply for disability in order to be eligible for Medicaid. K.M. has applied for disability twice and been denied each time. He has applied for Medicaid three times, but was told he is ineligible each time. K.M. is one of hundreds of thousands of Missourians who can’t afford insurance through the Marketplace, but does not qualify for Medicaid. He is stuck in the Medicaid Gap, unable to work until he has access to health care. “Everyone wants to be healthy and take care of themselves. Without insurance, I can’t be productive and self-sufficient.”
Mary is 74 years old and lives in Lawrence County. She has insurance through Medicare and both of her children have insurance through their employers. Though Mary and her family are not insured through the Marketplace, they still benefit from the ACA. Dean, her son, is able to keep his children on his plan until they are 26. Recently, one of his children had kidney stones and had to go to a local Urgent Care. He has peace of mind knowing his children have coverage if something unexpected happens to them.
Mary’s daughter also has insurance through her employer, but she benefits from the protections the ACA has enacted. Mary’s granddaughter was born premature and had to spend two months in intensive care. Without insurance, their bill would have been nearly $1 million. The ACA caps out of pocket expenses, so Mary and her family were able to bring her granddaughter home and spend time with one another and not be burdened with huge medical debts.
“Even though I don’t have coverage through the ACA, it’s helped me and my family. It’s a godsend that my grandchildren get to stay on my son’s plan.”
Reba and her husband are in their 50’s and live in Jefferson County. They have been raising their two grandchildren for fourteen years. Since Reba works part time, she does not qualify for insurance through her employer. Her husband works full time and makes $10/hour. They signed up for insurance through her husband’s employer, but soon found it unaffordable. With a $377 monthly premium, Reba and her husband had to choose between making their house payment and having health insurance. They make too much to qualify for Medicaid, but do not make enough to qualify for subsidies on the Marketplace. They are both stuck in the Medicaid Gap.
Since they’ve been uninsured, Reba’s husband has been hospitalized twice, including once for Bell’s palsy, which led to an eighteen-hour visit and a $13,000 bill. Although Reba has high blood pressure, she refuses to go to the doctor in fear that she will not be able to afford the visits and medication. Both Reba and her husband have worked and taken care of themselves for years. “We are not asking for a handout. We’re just trying to make ends meet.”
Dee is 50 years old and lives in Jefferson County. She works part time and is a full time caregiver to her 17-year-old daughter who has Down syndrome. Dee had health insurance through her husband’s employer. After he lost his job, the entire family qualified for Medicaid. Dee’s husband passed away several years ago and she began receiving survivor benefits. With the income from the survivor benefits, Dee was no longer eligible for Medicaid. Two years ago, Dee applied for insurance through the Marketplace and purchased a plan. After having her plan for over a year, she was told she no longer met the minimum income requirements and lost her health coverage. Dee is not eligible for Medicaid and she doesn’t make enough to qualify for discounts through the Marketplace. She is stuck in the Medicaid Gap.
In April, Dee went to the ER for her high blood pressure. Doctors diagnosed her with diabetes. In addition, Dee noticed blood in her urine, has an undiagnosed kidney condition, and chronic asthma. Luckily, she was able to apply for financial assistance through Mercy Hospital for her treatment, however she still struggles to pay off the mounting medical debt. Her survivor benefits and the little she makes working part time go to daily living expenses for her and her daughter. “I spend too much time worrying about my health and insurance. I should be spending time taking care of my daughter.”
Steve is 62 and from Neosho, MO and has lived there his entire life. He is on disability and suffers from chronic back pain after years of strenuous factory work. Steve worked at the local high school and had insurance through the school. After he retired, he applied for health insurance through the ACA and qualified for a Silver Humana plan. His insurance through the ACA gives him more coverage and is more affordable than his insurance through the school.
Recently, Steve was hospitalized for a small bowel obstruction, which he has a history of having. After his hospital stay, Steve knows the importance of having health insurance. Without the ACA Steve fears that he would have lost everything, even his life. “Even though I’m a conservative, I know how important it is to have health insurance and I know that there are a lot more people like me that desperately need it.”
Laura is 43 years old and lives in Franklin County. She works part time at a nursing home and is a full time caregiver to her son who has severe ADHD and Asperger’s. Laura received Medicaid when she was pregnant, but lost coverage because she was no longer eligible after her son was born. She does not qualify for subsidies through the Marketplace, is not eligible for Medicaid, and cannot afford insurance through her employer. Laura fell in her kitchen two years ago and fractured her leg and ankle. Doctors recommended surgery to put plates and screws in her leg and ankle, but Laura could not afford it. Instead, she opted for the cheaper option and put her leg in a cast. Her leg was not able to properly heal and she still experiences pain two years after her fall. She works part time and spends the rest of her time caring for her son. Laura cannot afford to pay off her medical bills, has significant debt, and her credit has been dramatically affected. “It’s frustrating. I fall in the gap and can’t get any help. There’s nothing I can do about it.
Paula is 54 years old. She and her husband live in Joplin, MO. Paula works for the Joplin school district and has access to insurance through her employer. Luckily, Paula is in good health, but her husband had a heart attack five years ago and needs to see a cardiologist regularly. Because Paula’s employer provides insurance and her husband is able to join her plan, he is no longer eligible for Marketplace subsidies.
Paula pays $120 for her monthly premium and $867 for her husband’s monthly premium. Her husband worked at a small mechanic shop they owned, but had to close as business slowed and they began to lose money. Paula works two jobs and has considered getting a third. “It’s hard to make ends meet when you’re paying $900 in insurance every month.”
Joe and Joy are newlyweds in their 30s and live in Greene County. They met when Joe was working overseas, fell in love, got married, and moved back to Missouri. Joy had a back ache which seemed to be getting worse, so she went for an MRI. The MRI showed Joy had stage IV lung cancer which had spread to her bones and brain, causing her to become nearly blind. Joe and Joy were insured through Joe’s employer, but lost coverage when he was laid off in early 2015.
Knowing they were now in desperate need of health coverage, Joe and Joy applied for Medicaid, but were ineligible because they have no children. They applied for health insurance through the Marketplace and each purchased a Coventry plan. Because of her immigration status and income, Joy was eligible for premium tax credits and her plan covered most of her treatment costs. US citizens have higher income requirements so Joe was not eligible for the same premium tax credits as Joy. He had to pay a $200 monthly premium and meet a $7000 deductible. Joe is Joy’s full time caregiver and they are living off of credit and savings. He doesn’t qualify for Medicaid and can’t afford insurance through the Marketplace. He has fallen into the Medicaid coverage gap.
Starting in 2017, Coventry will not participate in Missouri’s health insurance marketplace. Joy now has to find another insurance provider, but neither of the two remaining insurers are accepted by her oncologist’s hospital. Soon, Joy will not be able to see her doctor. After living overseas for ten years, Joe had no idea what he was coming back to. “I had no idea the system was like this. We even considered moving, but it would be awful to move.”
Tim is 41 years old and lives in St. Louis County. In 2012 he was diagnosed with cancer and needed immediate surgery, but he didn’t have insurance. He looked at plans through many private insurance companies, but none of their plans were affordable. He would have to pay $1000 in monthly premiums because he had a preexisting condition. “I was shopping for insurance in all the wrong places”, says Tim. He paid for his treatment out of pocket, from surgery to follow up CAT scans and bloodwork. It cost him a total of $40,000 to pay for his cancer treatment.
Tim’s friend told him he might be eligible for a discounted plan on the Marketplace. With the help of a navigator, he found out his income made him eligible for premium tax credits. Tim bought an Anthem silver plan, received $260 in tax credits, and only pays $50 a month for his insurance. “I have peace of mind that I don’t have to spend $5000 on a CAT scan.” He is able to see a specialist and receive the follow up treatment he needs to make sure his cancer is in remission.
Thomas is a 51-year-old veteran from St. Louis. He is fortunate to have had good health throughout his life. Right now, he does not have private insurance. He does not qualify for subsidies on the federal marketplace and cannot afford to pay full-price for a plan. Fortunately, Thomas does have VA health care benefits, and he is very thankful the care that he receives.
Not too long ago, Thomas was working outside when he accidentally split open his thumb with a hammer. He used his first aid skills to care for the injury quickly. He did not go to the emergency room. At one point, he thought he might lose his thumb. If Medicaid were expanded in Missouri, Thomas would be eligible. With Medicaid supplementing his VA benefits, he would not have to worry about calling an ambulance in an emergency and receiving care from a non-VA hospital. In addition to Thomas, there are approximately 30,000 Missouri veterans in the coverage gap in our state. Let’s close the coverage gap for those Missourians who have served our country in the military!
Sara is a 23 year-old part time student, a full time caregiver for her disabled father, and works part time. She is working toward a degree in social work, has goals of entering the medical field, and works with at-risk youth. Sara experiences chronic pain and has undergone multiple diagnostic surgeries. Half of her paycheck goes to paying off her medical bills, which she pays out of pocket. Though she still doesn’t have a diagnosis for her chronic pain, she hesitates to get further care because she can’t afford to accumulate more medical bills.
Though she was previously covered by her mother’s insurance plan, she lost coverage when her mother changed jobs. Sara makes too much to qualify for Medicaid, but does not make enough to qualify for subsidies through the health insurance federal marketplace. She is an intelligent, hard-working student, a compassionate daughter, and an advocate for underserved youth. Yet she has fallen through the cracks, living with constant anxiety that her chronic pain doesn’t get worse. “I don’t think it’s fair. I don’t make enough [to qualify for Medicaid] for valid reasons… Things add up until you’re pushed into this place.”
K.M. is a 20-year-old from Greene County. She is both a full-time student at Drury University and a full-time employee. She cares deeply about getting a quality education and is a strong, independent young woman who pays all of her bills by herself.
Unfortunately, K.M. does not have health insurance. She has had both Medicaid and a federal marketplace plan in the past, but she cannot afford private insurance on top of her other bills right now. K.M. says, “It is a real struggle to be in the Medicaid gap and unable to find a health insurance option that is best for me. You have to make so much money to even qualify for subsidies.” In her low-wage work, she does not meet that mark. Because she is an adult without dependents, she also is ineligible for Medicaid. K.M. is resilient. She is hard-working. Missouri has left her venerable because she has no option for affordable health insurance.
Mary is a 32-year-old from Greene County who is currently in school part-time at Ozarks Technical Community College and is also working part-time. Because she has no dependents and is an adult, she is ineligible for Medicaid in Missouri. She does not make enough money to get discounts through the federal marketplace. Mary, like 300,000 other people in our state, has fallen through the cracks of Missouri’s broken health care coverage system.
Mary says, “I wish we had a system that was affordable for everyone. I want to be able to pay for health insurance. There has to be a better way.” Mary lives with the fear of getting ovarian cancer. All of the women on her mother’s side have been diagnosed with it in their early 30’s. If Missouri were to expand Medicaid, Mary would have access to coverage and could receive regular care, including preventative care. Mary said that, if she were to suddenly come across some money, the first thing she would do after paying off student loan debt is get a complete medical workup. Missouri is leaving behind too many people, including hard-working, education-pursuing young people.
E.P. is a 36-year-old wife, mother and small-farm owner from Polk County. Her husband is insured through his work and her children through Medicaid, but her husband’s workplace does not offer coverage for spouses. She cannot afford a private plan, and is therefore left uninsured. For E.P. to be eligible for Medicaid, her family’s household income would have to be at or less than $6,190 per year. For her to receive subsidies on the Federal marketplace, her family’s household income would need to be at or greater than $32,580 per year. Their income is $20,000 per year.
While she has been very fortunate to remain “extraordinarily healthy” and not need much medical care, E.P. would like to have regular checkups and preventative care. She is also aware of the impact that a health emergency she might encounter while uninsured could have on her family. The family owns their cars, house and land, and they subsistence farm. All of these things enable them to stay secure financially. But, E.P. says, “Emergency room charges would devastate my household.” If our state were to expand Medicaid, E.P. would have access to affordable insurance and would no longer have to worry that one accident or health crisis could leave her family destitute.
Maricela is a full-time mother. Her husband is not offered insurance through his employer, so she and her two children are covered by Medicaid. However, all of the doctors in her network are in Neosho, which is 25 miles from the family’s home. Maricela and her husband have a single car that they share. The distance makes it really hard for Maricela to get her children to their doctor’s appointments. If health care provider networks were more adequate in Missouri, Maricela might not have to travel as far to receive care.
John is 55 years old and lives in Jasper County. He suffers from a bulging disk, which has led to hip trouble. He still experiences periods of immense pain despite having had two back surgeries in the past. One of these surgeries caused permanent nerve damage, resulting in drop foot. John’s back trouble is a result of the labor-intensive work he did for many years. Now his injured back leaves him unable to work. He has no dependents, so he is ineligible for Medicaid. Because he cannot work, he also does not qualify for federal subsidies on the marketplace.
When John is in too much pain to bear, he goes to the emergency room. This is the least cost effective and least efficient option for him, but he has no choice. He cannot pay for a doctor’s visit, and he cannot afford the pain prescriptions that the emergency room doctors prescribe him. John wants to get well and be able to work again, but he will not be able to recover until he has coverage.
When Laura began her job with a local charity as a social worker, she was able to purchase coverage for herself for only $1/month. Before taking her current position, she and her husband had coverage through the marketplace. Unfortunately, with her employer-sponsored care, her husband Bull would have to pay $354/month to be on her plan. They simply cannot afford that price, so he goes without insurance. Bull no longer qualifies for subsidies on the marketplace, and their income is too much for him to qualify for Medicaid.
Laura worries for Bull. He is a diabetic and suffers from neuropathy and Charcot foot. His conditions require a specialist, and there is not one in their area. He has not been able to work due to the numbness in his hands and feet, so he is applying for disability at 44 years old. He would much rather get the medical help he needs and get healthy enough to work again.
Laura works with the homeless. She sees first hand how devastating it can be to let health concerns go untreated. She is a compassionate, understanding and loving community servant. She wants what is best for Bull, but he cannot receive the healing care he needs until he has affordable health care coverage.
Ron is a 63-year-old retiree from St. Louis County. Ron had private health insurance before he retired and is currently able to get insurance through his wife’s employer. However, his premiums are $650 per month, and he worries that if his pension were to get taken away he would not be able to afford it.
Fortunately, the ACA helps give Ron another option. If his income goes down, he may be eligible for an income-based discount for a plan on the federal Marketplace. And if he wants to switch plans, he can’t be discriminated against for any past health conditions. Without the ACA, Ron wouldn’t have these choices. Missouri also just passed a bill with language that will create rate review for our state. The Department of Insurance will be able to review and publicly publish increases in premiums. The aim of this legislation is to increase transparency with health insurance companies and keep down costs of insurance plans for consumers.
N.S. is 46 years old and lives in St. Louis. She has high blood pressure but cannot afford her medication because she is uninsured. Without her medication, she gets ill frequently. If she could get insurance, N.S. could access medication and would get sick less often. N.S. believes that if Missouri would expand Medicaid it would help her to be healthier and happier and enable her to do more with her family.
Robert is a 53-year-old husband and father of one. He is self-employed. The marketplace plan he purchased with the help of ACA subsidies saved his life. He was a healthy man when he first bought his policy, but just six months later he suffered a heart attack. Robert’s coverage allowed him to get the treatment he needed to recover his health and also saved his family from bankruptcy. He speaks from personal experience to the importance of expanding Medicaid for Missouri families. He says, “Without the ACA, I would surely have died that day. I think everyone should have access to healthcare.”
Ashley is a 30-year-old mother of four who lives in St. Louis County. She works part-time as a cashier and dedicates that rest of her time to caring for her children. Because Ashley is not offered health insurance through her work, is ineligible for Medicaid and does not qualify for subsidies that would help her afford a private plan, she goes without coverage. She often worries about being able to afford simple, routine check-ups. Ashley believes that if she had health insurance she would feel much better about going to get care. She says, “[Health insurance] would help me out a whole lot.”
Chalea is a fighter. She works a full time job, takes care of her children, and takes college courses. She does all of this while struggling with debilitating autoimmune diseases. Chalea was on Medicaid in another state and was under the care of an immunologist. However, once she moved to Missouri, she lost her Medicaid coverage and can no longer afford to see a specialist. She worries about the possibility of getting cancer in the future because her family has a history of it, and she also worries about missing days of work due to illness. If Missouri were to expand Medicaid, then Chalea could get the medical attention that she needs, and she could do more to make the future secure for her family.
Steve is a 26-year old full-time college student at St. Louis Community College (STLCC) working towards his associate’s degree in Business Administration. He is employed by STLCC as a student worker in the Student Lounge; however, he makes very little money and relies heavily on student loans to live and go to school. Since Steve does not have children or a disability, he cannot qualify for Medicaid in Missouri. He also makes too little as a student worker and cannot receive subsidies to help with costs on the Health Insurance Marketplace.
Although Steve is currently in good health, he has not seen a doctor in a few years and is worried that he could get sick or into an accident and be faced with serious medical bills that are unaffordable. It is Steve’s belief that having health insurance is fundamentally important for every individual and that health care is an investment in America’s future similar to that of education.
Geraldine is a 56 year old woman who lost her job and her health insurance almost a year ago. She had to stop physical therapy for her arm before it was complete. She was fortunate that few health problems arose over the course of the year, but she did find herself paying for some medical care out of pocket. The reduced-cost clinic she tried turned her away because she was uninsured.
Because Geraldine was employed for part of the year, she qualified for a discount on the healthcare.gov marketplace. She was able to get a health insurance plan for herself. Now she has less anxiety. She says, “I am comfortable now knowing I can go to the doctor – my own personal doctor.”
Geraldine isn’t sure what will happen to her next year, but she is hopeful that she can stay healthy and find another job and a better future.
Brad lives in Washington County. Several years ago, before the Affordable Care Act was enacted, Brad’s comfortable lifestyle dissolved with the onset of the Great Recession. He lost his job and his health insurance with it. He did not qualify for Medicaid and could not afford a private health care plan. Fortunately, Brad was able to enroll in Medicaid when his young nephew became his dependent. He had noticed that the birthmark on his leg was changing color. With his sudden access to health care, Brad decided to get the spot checked. The doctor determined that it was pre-melanoma. Within a week, Brad had surgery to remove the mark. He attributes his life to the Medicaid program and is a strong advocate for expansion. Brad says, “People who vote ‘no’ on Medicaid expansion have the blood of the people who have died on their hands.”
When Brad’s nephew turned 18 and was no longer considered a dependent, he lost his Medicaid coverage. He went without any kind of coverage for two and a half years. Recently he enrolled in a subsidized insurance plan through the federal marketplace. He is thankful to have coverage again.
Geneva is 44 years old and lives in St. Clair County. She has several chronic illnesses for which she needs regular care and medication. She also has a knee that needs to be replaced and a bone spur that is pinching her sciatic nerve. She is uninsured. These health concerns prevent Geneva from working full-time, so she works part-time as a librarian.
Geneva is fortunate enough to be able to receive care from hospitals and clinics that help with medical costs, but she still pays for some of her care out of pocket. These costs have added up over time, so she bears the extra burden of medical debt. She says, “I’m lucky to have what I have, but compared to when I had Medicaid, my current situation is very difficult.” Geneva now finds herself in the Medicaid gap, making too little to receive subsidies on the marketplace but too much to qualify for Medicaid. She will not be able to get the surgeries she needs on her knee and back and live her best possible life until the coverage gap is closed.
Carl is a 55-year-old nurse from Platte County who suffers from diabetes. When the Affordable Care Act was enacted, he was relieved to finally be able to get a private health insurance plan. That relief was short-lived. He lost that coverage when he suddenly found himself looking for new work. With his new job, Carl falls into the coverage gap. He notes, “Now I am without health insurance and lack any way to pay for my ridiculously priced insulin.”
Carl is frustrated that representatives in the Missouri legislature are trying to repeal the Affordable Care Act. He knows that repealing the act would mean that even more people would wind up in positions similar to his.
Lynn is a 53-year-old wife and grandmother of 8 from Stoddard County. She has lived without any insurance for years. She currently falls into the coverage gap.
Lynn’s family is very dear to her, and she wants to be able to spend time with them and especially wishes she could play with her grandchildren. Without coverage, however, Lynn cannot obtain the care she needs for her arthritis and debilitating migraines. Chronic pain prevents her from living her fullest life and enjoying fun activities with her loved ones. She says, “if I had Medicaid then I would be able to go to the doctor and get the medical care I need so I won’t have to be in so much pain anymore.”
Ms. Williams lives in St. Louis City. After paying her bills and caring for her son and grandson, she has no discretionary money and is unable to purchase health insurance. She currently relies on a clinic that charges patients on a sliding scale and treats patients regardless of their insurance status. She saw a navigator with the hope of getting insurance, but she did not qualify for subsidies, and her plan would have cost almost $400/month. For now her better option is to remain uninsured and continue using the clinic. She notes, “[The Missouri legislature] should work on programs that help the people in the middle.”
Tim is an engineer who is on the job market after resigning from his previous job due to health and ethical concerns. He would be happy to take a part-time job while he continues the search for full-time employment. The problem he faces, however, is that income from a part-time job would place him in the Medicaid Gap, meaning that he, his wife and his daughter would lose their health insurance.
By not expanding Medicaid, Missouri legislators are effectively incentivising Tim and people in similar positions to stay unemployed until they can find full-time work, which can mean they’re staying unemployed for a longer periods of time. Tim notes, “Given how Missouri values work and hates work dis-incentives, I don’t understand why Missouri allows the coverage gap to stand. Approving Medicaid Expansion makes sense for workers and aligns with Missouri’s values.”
When Gordon moved to Missouri and discovered that Missouri had not expanded Medicaid like his previous home state of New Mexico, he had to purchase a Marketplace Bronze plan. “I had the Bronze plan with the $6,500 deductible for the year 2015. When I got the new plan from Coventry this year, the rate tripled for the same coverage.”
Anyone making less than $50,000 per year automatically had full coverage under New Mexico’s state plan. There was only a $20 copay for office visits and no deductible. Gordon is a minister in Joplin. He took a large pay cut to come to Missouri. Now he finds himself without any way to access quality, affordable health care. Gordon says, “All I can afford to pay is the penalty.”
Donna is a 58-year-old mother and part-time professional from St. Louis County. For many years, Donna and her son enjoyed great health care coverage through her husband’s railroading work. When her husband became eligible for Medicare, however, Donna had to find new coverage for both her son and herself. She was able to find a private plan, but over the course of a few years her premium has increased drastically from $202 per month to $398 per month. She has also been told by her insurer that their plan may be discontinued at any point. Her family’s income is right on the line for federal subsidy eligibility. She would have received only $1 of discounts had she switched to a more expensive Marketplace plan. Currently, she is staying on her private plan with the hopes that premium prices will stabilize.
Amanda is 22 and has a 6-month-old daughter. She is a full-time college student and works 3 part-time jobs in addition to a degree-related internship. Amanda lost her Medicaid 60 days after her daughter was born. While Amanda makes too much to qualify for Medicaid, she does not make enough to get a subsidy for a Marketplace plan.
Amanda does have insurance through her mother but cannot afford the co-pays and deductibles to get the treatment she needs for her depression and tendinitis. She is fearful of her knee “going out” due to her tendinitis, causing her to fall while she is carrying the baby. She also knows that access to depression medication is essential in preventing major depressive episodes. Amanda notes, “Keeping Medicaid would allow me to get the treatment I need so that I could overcome my depression episodes and focus on what is most important, my baby.”
J.H. is a 58 year old mother from Jackson County. She is a freelance worker who has done well enough to afford private health care for herself and her daughter. Because she has had her plan for many years, she was grandfathered into the plan six years ago when her insurance company stopped offering it to new customers.
J.H.’s daughter was diagnosed with a brain tumor at the age of 12, and thanks to their very comprehensive coverage, the tumor was removed within 10 days of the diagnosis. Her daughter is healthy and well taken care of. Needless to say, J.H. has truly seen the importance of having quality health insurance.
Recently, J.H. was informed that her current plan will be entirely dissolved within the next few years. In the past six years, it has nearly quadrupled in price. J.H. visited a helpful navigator in Kansas City and discovered that plans with the same kind of coverage that she receives presently are selling for over $1,000/month. That is twice what she pays now.
J.H. works hard and can afford private care. Insurance companies should not be allowed to overcharge her.
Jody is a 56 year old St. Francois County resident who lost her house and livelihood when she sustained a serious back injury at work. Worker’s comp provided her with enough money to live off of for a short period of time after the injury, but she was only able to receive part of the medical care she needed to heal her back. Because of this, she still lives with a lot of pain. Although she has computer skills, she cannot get a job in which she utilizes them because she is unable to sit in front of a computer for extended periods of time.
After three years of struggling to get back on her feet, Jody finally began receiving Medicaid. However, when she received a couple of months worth of SSI money that was being withheld until she completed the SSI application process, she exceeded Missouri’s Asset limits. In other words, because she had more than $999 in her possession due to the SSI back pay, she was removed from Medicaid. Now Jody is without health care while she continues to suffer from back trouble and chronic pain. Jody and many other Missourians would greatly benefit from raised asset limits.
J.K. is a mother who immigrated to the United States ten years ago from Sierra Leone. Although she lives in Missouri now, she previously lived in Tennessee and was receiving health care through Medicaid there, as were her young children. When her family moved to Missouri a year ago, she was unable to get health insurance because she fell in the gap – she made too much money to qualify for Medicaid in Missouri yet did not make enough be qualify for a Marketplace plan. She is unable to see doctors about her painful teeth and mouth problems, and she says, “Medicaid would be nice to have just in case I get sick and need it.”
Karen is in her 50’s and lives in Jefferson County. A few years ago she found out that she has liver cancer. She was treated at Barnes Jewish Hospital in St. Louis and was able to receive a liver transplant. However, the extensive medicine she must take post-surgery is very expensive and has drained her income. Karen is still under the care of the transplant team at Barnes until this February, at which time Karen says she will be “cut loose.”
“I serve God every day and so far he’s taken care of me, but now I need the medicine or I’ll die,” Karen says. “It’s something I’ll have to take the rest of my life.”
Karen does not qualify for Medicaid and cannot afford all of the costs of her medication. Since her transplant, Karen constantly worries what her health will look like in the future and if she will continue to get care.
John has lived in Carthage, Missouri for his entire life. He has worked since he was 15 years old. At a young age he was employed by one of Carthage’s main manufacturers. Thanks to the skills he learned while at the factory and his own hard work, John was able to start his own business thirty years ago. John has always had a good work ethic and says, “That’s what it takes to be able to provide for your family.” He is a proud home-owner and father of three.
Despite owning a successful business, John never had enough money left to pay for Health Insurance. He has been fortunate enough to stay healthy despite this fact. A few years back, John’s truck was totaled, and he was thankful that he had physical damage insurance and was able to replace his much-needed work truck. John learned the importance of insurance through that accident, and he is so relieved because he is now able to afford health care coverage through the Marketplace. In his words, “I now have peace of mind. I won’t have to lose my home to pay for medical bills if I was to get sick.” John says, “I’m still strong, just not as young as I once was.”
Jennifer is a 45-year-old mother of two. She has had rheumatoid arthritis since she was ten years old, so she has needed surgeries on a pretty regular basis. At the beginning of the year, Jennifer had a major surgery that was necessary to keep her body functioning well for the long term. This very important surgery required extensive rehabilitation, but she got permission to take a couple of months for recovery from her boss so that she could jump back into her career when she was healed. Unfortunately, her employer grew impatient and let her go in the middle of her rehabilitation, leaving Jennifer without health insurance.
Jennifer was desperate for a health insurance plan because she knew that she would need routine care for her condition on top of the care she needed as she completed her recovery. She has taken on three part-time jobs as she waits to find work in her field. Fortunately, Jennifer was able to find an affordable plan through the Marketplace. She says she is now “breathing easy”. She also notes, “I believe strongly that part of being human is also acknowledging that at some point we may all need a chance or a break. Not one of us is productive and strong every moment of our lives. If that opportunity is not allowed we have certainly lost more than just health insurance.”
Julie is a Stoddard County resident who currently lives with her son-in-law and two grandchildren because she cannot work due to her health issues. She has a dropped bladder that she needs surgery on, an overactive thyroid for which she should be taking medication, and is borderline diabetic. She is also supposed to have a check-up every 4 to 6 months because of a previous blockage in her pulmonary valve. Julie is unable to get the care she needs because she does not have health insurance. Although she used to have Medicaid, she no longer qualifies. Her children are grown, so she has no dependents. Missouri does not offer Medicaid to childless adults. If Medicaid is expanded in Missouri, Julie would be able to receive the care she so desperately needs. She hopes that by receiving care, she will one day be able to work again.
‘Sarah’ is a single mom. She helps with the family business in exchange for rent and utilities. When she applied for Medicaid she discovered she does not qualify. She applied to the Marketplace only to find out that she also does not qualify for subsidized premiums because of her meager income. ‘Sarah’ notes, “I should qualify for Medicaid, but I don’t. I’m without affordable coverage options.” ‘Sarah’ suffers from asthma and has to use an inhaler, which costs more than she can afford. If Missouri closed the coverage gap, ‘Sarah’ would be able to get the medical treatments she needs to breathe easier.
Casandra, a 26- year-old working mother, lives in Callaway County. She has been without health insurance since March. Despite the fact that she is employed, she does not make enough money to qualify for health insurance subsidies through the Marketplace. She makes about $8,000 a year- about 50% of the Federal Poverty Level for a family of two- and yet she makes too much to qualify for Medicaid in Missouri. Although she currently does not have any pressing health concerns, she would like to be able to see a doctor when she gets minor sicknesses. She notes, “As a mom, I have to go- always- and keep my child going too.” She cannot get sick because she has to pay the bills, and missing work at all would jeopardize that.
Karen is sixty-four years old and lives in Jasper, MO. She recently had to retire in order to become the full-time care-giver of her young granddaughter. She has high blood pressure that she believes is controlled, but she has not been able to go to a doctor to confirm that everything is okay. If she had Medicaid coverage, she would know that she was in the best health possible to care for her granddaughter. Her current and only option is to hope that she’ll be okay until she’s eligible for Medicare.
For fourteen years, Jerry and his family were without health insurance, and he was constantly worried about what would happen if someone were to get sick. When the Affordable Care Act passed, Jerry thought he might finally be able to get insurance through the Marketplace. Unfortunately, he did not make enough money to qualify for subsidies. He also found that he made too much money to qualify for Medicaid. Despite this frustrating reality, he continued to own and operate his small business, hoping that one day he would make enough money to be able to afford health insurance.
Recently, Jerry’s wife who had been ill became healthy enough to get a job. With her additional income, they were able to afford a Marketplace plan for the whole family. Jerry is happy and relieved to have coverage for his family, but he says, “I feel guilty that there are so many that are not fortunate enough to make the minimum threshold- and they’re left behind.”
Peggy is a 53-year-old mother of two. Layla, her 25-year-old daughter, works at Wal-Mart while attending college. She also has a child. Although her child receives Medicaid, Layla makes too much to qualify for Medicaid herself and not enough to get a discount on the Marketplace. She has a cyst on the back of her knee that swells up and makes it difficult for her to stay on her feet all day at work. However, she cannot afford to go to the doctor without insurance. Layla would benefit immensely from Medicaid expansion because it would allow her to get the care she needs in order to be the best mother possible. Without access to health care, her condition will likely continue to make working difficult. Peggy wants her daughter to be healthy and able to receive the care she needs. “Medicaid expansion would be a lifesaver for my family,” Peggy says.
Christopher is a 36-year-old husband and father of two. He works part time at Schnucks, and his wife works for a before-and-after school program. Christopher shopped on the Health Insurance Marketplace, but his income is too low to receive Marketplace discounts, and he earns too much to qualify for Medicaid.
Christopher says, “My concern is that my father passed away around the age of 40 from a hereditary heart condition…I am now 36 and worried that I could possibly have this condition.” Without insurance, a heart check-up would cost at least $1,000 out of pocket, which does not include the cost of any follow-up tests or medications. He has three young children and is using most of his income to pay for rent, utilities, and food. He does not have money to pay for expensive medical care, even if it means his health and life are on the line.
A.D. had not needed to see a doctor in over 30 years except for her regular checkups. However, in late October she found herself in and out of the hospital for three weeks with a very serious and life-threatening condition. She was without insurance at the time. Fortunately, she received the care she needed to get her health under control, and she happened to know the doctor who was treating her in the ICU. He wrote off his part of her hospital bill, but the rest of her screenings and surgeries were paid for out of pocket.
A.D. realized that, with her new complications, health insurance was imperative. With the help of a very thorough navigator, A.D. found a “wonderful” Marketplace plan. She did not think that she was going to qualify for subsidies, but she did! Her medications are very affordable with her plan. She notes, “I am relieved. I am thankful. I couldn’t complain about it at all.”
Melinda is in her 50’s and lives in Fenton, Missouri. She was diagnosed with diabetes four years ago. During that time she made too much money to qualify for Medicaid, but she did not make enough to be eligible for Marketplace subsidies. Melinda was in the coverage gap and was unable to consistently access insulin. She was forced to spread her insulin out as thin as possible, and she even tried to go without it to save money. Melinda notes, “If Medicaid expanded three years ago, I wouldn’t have to live with the daily stress of whether or not I will have enough insulin to control my Type I diabetes.”
Eventually, Melinda’s diabetes resulted in weakened bones, which led to a broken hip. Going partially untreated for so long has really set Melinda back. She says, “I went to college and had a career. I could still have work.” Had Melinda been insured, she would have been able to receive proper treatment and her quality of life would be greatly improved.
Stand On My Own Two Feet – Health Coverage Gap“If people are sitting at home sick, they’re not making money. They’re not contributing to the economics of the state.” After an injury, skilled worker Matt H. finds himself with a personal understanding of how the expansion of Medicaid in Missouri would help more citizens stand on their own two feet.Credits:Directed by Nathan Lucy Edited by Bradley Fann Cinematography by Joshua Dobkins Production Sound Mixing by Shawn Jones
Posted by The Ferguson Commission on Wednesday, November 4, 2015
Vicky is 64, and she lives and works in St. Charles County. She was diagnosed with cancer 8 years ago and also suffers from several other health conditions. Before the enactment of ACA, she was unable to get private insurance because it was either unavailable to her due to her pre-existing health conditions, or it was way too expensive. Now she is able to get affordable health care for herself thanks to Marketplace subsidies. Vicky appreciates the flexibility her plan gives her. She now only pays $70 per month for her insurance, and most of her prescriptions are $5 each. Vicky says, “Without Obamacare I wouldn’t be able to get the care I need.”
Amy, a 40 year old mother living in St. Louis City, falls into the Medicaid coverage gap. Amy previously served in the military, and now she works in retail. She has a back injury stemming from being hit by a car several years ago. She can only work part-time because she spends much of her time caring for her 5-year-old daughter who is mentally handicapped. Because Amy continues to work part-time, she has an income that makes her ineligible for Medicaid in Missouri. This income is not enough to qualify her for a tax subsidy on the health exchange. She is left without an opportunity to obtain health insurance that she can afford. Amy said, “It is a frustrating system. I don’t mind paying for insurance, I just can’t pay several hundred dollars a month when I make less than $17,000 a year to support my family.”
Carrie is 37 years old and lives in Barton County. She is a full-time care giver to her husband, a retired Marine veteran who is severely disabled. Her husband suffers from a traumatic brain injury, post-traumatic stress disorder, bi-polar disorder and social anxiety. He also has physical disabilities. Although his health care is covered by the VA, transportation costs are high and make it difficult for him to see his specialists. He misses most of his appointments simply because he cannot afford to get to the doctor.
Unfortunately, Carrie sustained an injury that has caused her to have health complications of her own. Despite the fact that she had insurance at the time of her injury, out of pocket costs for corrective surgeries were enormous. After paying for some of the care she needed, her and her husband lost almost everything, including their home. They have not recovered financially or physically. Carrie needs further tests and surgery, but she is going without them because she is now without insurance. Carrie and her husband do not qualify for Medicaid, nor do they qualify for subsidies on private insurance plans. Carrie says, “It is terrible that I have to put off getting the medical care I need because everything we have is going towards our basic needs, housing, utilities and food. It takes a toll on the family and puts a lot of pressure on me.” If Medicaid was expanded in Missouri, Carrie could finally receive the medical care she needs.
Bob is a retired veteran who lives with his wife in rural Texas County. He receives routine health care thanks to his wife’s insurance plan and his own VA benefits. In addition to having cardiovascular disease and glaucoma in his right eye, Bob recently had to have an invasive corrective surgery on his left eye. This has prevented him from driving for the past several months.
Bob’s wife works in Jefferson City through the week, so he needed to find a way of getting to his nearly weekly doctors’ appointments after his surgery. For several weeks, he had to rely on church friends to drive him over 50 miles per trip to various doctors’ offices. Bob did not want to demand so much from his friends and eventually began looking for different modes of transportation to appointments.
When he is going to a VA doctor, Bob is able to get transportation with the Disabled American Veterans van. However, his cardiologist and ophthalmologist are not VA doctors. Fortunately, Bob discovered HealthTran, a southern Missouri project sponsored by Missouri Foundation for Health, which is designed specifically to provide non-emergency medical transportation to rural Missourians. Bob feels that he has been incredibly fortunate in having these transportation options, noting that “HealthTran has been a life-saver.”
Unfortunately, many Missourians are out of reach of HealthTran and other non-emergency medical transportation programs. Missouri Health Care for All recognizes the importance of all Missourians having access to quality health care, which includes patient-friendly, affordable transportation to and from medical appointments.
Regina is 47 years old. She is a nurse and presently works part time for a home health care service. She has been battling stage IV inflammatory breast cancer for several years. It has now spread to her liver. While fighting the breast cancer she was eligible for Medicaid. Now that it’s moved to her liver, she has been told that she is no longer eligible. Regina is hesitant to inquire further because she is afraid to lose the health care she now receives. Regina says, “Having coverage really is life and death for me. Without Medicaid I would have gone home and made my peace a long time ago.”
Regina has raised three kids and still provides for the two that are in college. She could potentially leave her job and go on disability; however, she fears the money she would receive would not be enough to pay her bills. She goes to chemo and radiation treatments regularly, so working full time is impossible for her. If Missouri would expand Medicaid, Regina would be eligible and not have to worry about whether or not she can afford her cancer therapy.
A.L. is a 53 year old mother of three who lives in St. Louis County. Although she has coverage now, there have been times in her life when she has been without insurance. Seventeen years ago she found herself in a high risk pregnancy and without insurance. Fortunately, she was temporarily eligible for Medicaid because of her status as a pregnant woman. When reflecting on this pregnancy, A.L. commented, “If it wasn’t for Medicaid, I’m not sure my daughter would be alive today.” Later in her life, one of her children needed medical treatment for a serious chronic illness, which included medication that would cost $800 a month. Again, she was fortunate enough to get her son the treatment he needed through Medicaid. Her family would not have been able to afford his medication otherwise. A.L. supports medicaid expansion whole-heatedly because she has personally seen ways in which Medicaid can be the difference between life and death.
Chris, Leilani and their three children live in Jasper County. Chris works several part time jobs. Leilani takes care of their children, one of whom needs special care because of a liver transplant. Frequent medical visits out of town are necessary so that this child can remain stable and healthy. Leilani’s caregiving is full-time work.
In 2011, Joplin’s F5 tornado destroyed Chris and Leilani’s belongings and rendered their rental house uninhabitable. Fortunately, they were able to purchase a Habitat for Humanity home the following year. They worked hard alongside none other than Governor Jay Nixon to build their Habitat home.
Chris is seeking full time work. Although he appreciates the flexibility of his current jobs, which enable him to help Leilani on days when their child has medical appointments, a full time job would likely come with health insurance. He and Leilani currently do without health insurance because they make too much to qualify for Medicaid and too little to qualify for Marketplace subsidies. They try to stay healthy and go to the doctor when they need to, but Chris says,“The costs of urgent care are high, and I can’t afford them.” Stress is high with a special needs child, and Chris worries for Leilani’s health because most of the daily care falls on her. Having health insurance would give them comfort in knowing that they can receive medical care when they need it.
Robin is 58 years old and lives in Arnold, Missouri. She dedicates her time to caring for her elderly parents who require full-time assistance. Although Robin has tried multiple times to get health insurance, she does not qualify for Medicaid. She has been in the coverage gap without insurance since 2006.
Robin hasn’t been to a doctor in years and worries about her health. Even though she is relatively healthy and doesn’t have any current health issues, she has not been able to get any preventive services or screenings in over ten years. “I could have cancer right now and I wouldn’t know,” says Robin.
Dan is 44 and is a member of Dancing Rabbit, a sustainable living community in northeastern Missouri. Many of the members of Dancing Rabbit struggle to get health insurance. It is difficult for them to make enough money to qualify for federal subsidies on Marketplace plans in such a rural area, but they also make too much to qualify for Medicaid. Dan has been fortunate enough to remain in good health for most of his life. In the past, he either received coverage through his employer or was part of a mutual health insurance pool with members of the ecovillage. When the Affordable Care Act was enacted, however, the insurance pool for ecovillage workers dissolved. Recently, Dan has just met the income requirements needed to qualify for subsidies on the Marketplace. Although he is relieved to have better coverage, he worries about whether he will continue to make enough money this year to keep his subsidies.
Kathryn is a 48 year old single mother. She has a son with disabilities whose health care is covered by Medicaid. Until recently, Kathryn also received Medicaid benefits; however, she lost them a year ago when her son turned 19 and was no longer recognized by the state as a dependent minor. Kathryn spends most of her time caring for her son, and her health problems limit her ability to work. She does not have a large enough income to qualify for discounts on the federal insurance marketplace.
Kathryn suffers from high blood pressure and gall stones and is also overweight. She simply cannot afford to pay out of pocket for visits to her doctor for these chronic health problems. Although she needs to be taking her medications on a regular basis, she takes them sporadically because she has no insurance to help with cost. The one doctor’s visit she has made since she was removed from Medicaid cost her $100. She really needed that money to pay for other necessities. Without Medicaid expansion, Kathryn is forced to live with too little medication and inconsistent care.
Terry is a former office manager for a health insurance wellness coaching company, where she worked for 15 years before going on disability. Prior to that she owned and ran a cleaning service. She is an avid gardener who, along with members of her church, distributes her home-canned fruits and vegetables to homeless living in St. Louis’s “tent city.” She also volunteers 20 hours per week at the Affton Food Bank.
Three years ago, Terry was disabled from herniated disk in her back and crippling IBS. She also suffers from PTSD and migraines. While acquiring disability benefits was a straightforward process, she has had trouble getting much-needed healthcare coverage. Terry applied for Medicaid but was denied coverage due to income, though her income is still too low to qualify for the Health Insurance Marketplace.
Terry’s only income is her disability check, but she has a retirement account containing $11,000 dollars -which is all the savings she has left from her career. This is the only earned income available to sponsor her retirement. Unfortunately, this modest savings makes Terry ineligible for Medicaid.
Terry’s herniated disk creates numbness in her legs, forcing her to sit frequently. The pain in her back and stomach makes it difficult for her to sleep. “If Medicaid expanded”, Terry expressed, “I would at least be able to take care of myself.” Terry wishes that she had treatment to help her with her chronic pain so that she could sleep more than a few hours per night, and be more able-bodied so that she can maintain independence as she ages.
Emily is a single mother in graduate school full-time at St. Louis University’s School of Public Health. She also works two part-time jobs, which do not cover all of her expenses. At the end of January 2014, she signed up for health insurance on the Marketplace. Emily is healthy and just needed to find an inexpensive plan that would allow her to go to see a doctor when necessary or to a hospital for an emergency. She was able to find a Silver plan, and pays less than $25 a month for coverage.
Diana, 50, lives in Greene County with her two children. She works part-time as an in-home aide, and is uninsured. Although Diana works, she makes just enough to support her and her family, “We live very minimal…You do what you got to.”
Diana lives with diverticulitis (a disease that attacks the digestive tract) and arthritis. She also has other serious symptoms she is unable to have treated or diagnosed, since she does not have insurance.
With Medicaid Expansion, Diana would not have to worry about balancing work and her health. “Someone in my situation, who works and works, and does not get insurance…it’s scary, especially to someone at my age. I need that security – just to know that it is there…I think it needs to be heard that some of us have fallen through the cracks.”
Beverly lives in St. Louis and cares for two grandchildren. She is uninsured and unable to work due to her medical conditions, including lupus, fibromyalgia, arthritis, osteoarthritis, and COPD.
If she were able to attain health insurance, she would be able to pay for her treatment, including four surgeries. Beverly is in the process of trying to apply for Medicaid, but may have to file bankruptcy due to a “mountain of medical bills.”
Katie is in her late 20’s and has had asthma for most of her life, which has counted her as having a preexisting condition. Once she graduated from college and was off her parents’ insurance, she could only get catastrophic insurance because of her preexisting condition. As a result, Katie delayed or avoided the doctor and preventive care. Through the Marketplace, she was able to find a much better, affordable insurance plan that covers the treatment she needs for her asthma.
Terri is a widow living in rural Missouri. When her husband became sick a few years ago, she left her job to take care of him. Since then she’s had a difficult time finding employment. Luckily she’s been able to make ends meet with a small pension of $435 a month. Unfortunately, however, Terri does not qualify for Medicaid in Missouri, and her pension is too small to qualify her for affordable health insurance in the Marketplace.
Without health insurance, Terri can’t afford quality health care and is not able to afford insulin for her diabetes, which already has begun to cause kidney failure. In addition, she also can’t afford treatment for a detached retina, which could cause blindness.
Terri has already racked up hundreds of dollars in medical debt due to a lack of health insurance, and she is very concerned about taking on even more debt.
Jessica was signed up for the state’s Women’s Health program, which meant she received an annual well woman exam, but nothing more. She was making too much money to qualify for Medicaid, even though she only works part-time.
As a result, she went without insurance, and had to prioritize immediate financial needs for herself and her son over health needs. She knew she needed health care check-ups, but couldn’t afford to get them. She also had preexisting conditions, but knew she would be unable to afford treatment.
Now that she’s enrolled in a plan through the Health Insurance Marketplace and her payments are reduced by a large subsidy, Jessica can afford to go to a neurologist for her migraine headaches, schedule primary care appointments and have an OB/GYN as well. Knowing that both she and her son are covered by her Marketplace plan gives her great comfort. She says, “now I can go to the neurologist for my migraine headaches, go to a primary care clinic, and I even have an OB/GYN.”
Kyle is in his early 20’s works part-time at a fast food restaurant, where he averages 30 hours a week making minimum wage. When Kyle was 10, he had a malignant brain tumor. Luckily, he was able to have surgery, which resulted in years of many medications and visits with doctors and other specialists. When Kyle turned 18, he lost his Medicaid coverage. He was uninsured for three years and went without medications or check-ups during that time. Kyle is now enrolled in a Silver plan through the Marketplace with monthly premiums less than $40 a month, and a low deductible of $150.
Lizzy is an artist and a part-time adjunct professor at several local community colleges. Her salary and work hours are always fluctuating depending on the demand for classes. She does not receive health insurance from her part-time employment.
In the summer of 2012, Lizzy got sick with colitis, and her trip to the urgent care center cost her $1,300. Lizzy was thankful for being able to get medical help that day, but, in her words, “that was most of the teaching money I made that summer and it was all gone.” She had been saving that money to buy a new laptop in order to do freelance work and grow her career. Her plans for career growth were side stepped by the emergency health care situation.
Lizzy worries when the next health crisis will strike. Besides in the case of emergencies, Lizzy worries about getting her annual check-up because she has a family history of diabetes and breast cancer. However, without health insurance, Lizzy cannot afford to see a doctor, and in her words, “preventive care has not happened for me for the past few years.”
Lizzy is in the coverage gap, making too little to qualify for a Marketplace discount, but too much to quality under current Medicaid eligibility levels. If Missouri expanded Medicaid, health care costs will not prevent young entrepreneurs, like Lizzy, from starting their careers and pursuing their dreams.
Deb lives in St. Louis County, and was in a serious automobile accident several years ago. Only then did she find out that she didn’t have a quality health care plan.
Following her accident, she was not able to get all of the treatments she needed and still suffers the consequences. Deb has a shattered bone, and needs IV treatments to get iron. Without this, Deb says, “I don’t have the energy to get up a flight of stairs.”
Deb works as much as she can, but because of her medical condition, she cannot work full-time. Medicaid expansion would allow her to become healthy again and continue contributing to her community. Deb says, “I want to work, and I could work more if I could get the right medical treatment.”
Isabel is recently divorced and has two college-aged daughters. She was covered through her ex-husband’s employer plan, but when he left to start his own business, she learned she was not insurable because of her high blood pressure, fatty liver disease and depression. She purchased COBRA coverage, and when it ended she went to the Marketplace to find health insurance. The premium is $100 less than her prior plan and her co-pays are also lower.
Despite serving almost ten years in the military, including two tours in Iraq, Frank and his family still can’t get the basic health care services they need to keep their family healthy. Frank works full-time and has served in Missouri’s National Guard, but the family makes too much money to qualify for Medicaid and not enough to get subsidies. Without this financial help, Frank and his wife continue to forgo needed medical attention, including his wife’s serious liver disease.
More affordable medical care would allow Frank and his wife to spend more money on their young son. Additionally, they wouldn’t need to rely as much on social service organizations for help with basic needs, like heat in the winter, to make ends meet.
Larry, who currently has Medicare because of a disability, insured his wife Rachel through a COBRA plan until that coverage ran out. Rachel has significant health issues, including fibromyalgia and significant pain in her shoulders that is likely due to nerve damage. She also has a spinal disease that causes vertebrae in her back to fuse together, resulting in intense pain.
Due to Rachel’s preexisting conditions, she couldn’t get health care coverage after COBRA. As a result, she was uninsured for over five years. During this time, she also put off needed medical care, even skipping preventative care such as mammograms because of the expense.
This past year, Rachel was able to enroll in a Gold plan through the Marketplace because she qualified for subsidies that made the plan affordable. Now that she has insurance, Rachel has been able to finally get important services, including an MRI and blood tests.
Andy is currently running an AmeriCorps VISTA donation center in Joplin, Missouri. The VISTA volunteer program provided him with a health plan that had a limited choice of doctors, required referrals for ‘specialists’ such as a chiropractor, and didn’t cover anything related to a pre-existing condition. Andy was able to enroll in a Marketplace Bronze plan that was the best fit for him, and he didn’t have to pay a monthly premium due to tax subsidies.
Robert is in his mid-50’s and holds a Master’s degree, a health information technology degree, and has a work background in education in the medical field. Robert has worked consistently since he was 15, but was laid off almost two years ago. After losing his employer health insurance, Robert had to dip into his savings to pay for a COBRA plan that had a monthly fee of $700 – and did not cover his preexisting condition. When his COBRA plan ran out in December 2013, Robert went to the Marketplace and found a Silver plan. He can now get his preexisting condition treated and no longer experiences the stress, depression, and anxiety of not being insured. With his health coverage plan, Robert says, “I’ll be able to get out of the vicious cycle of not being able to get treated for preexisting conditions.”
While in law school, Nathaniel needed to find coverage for both himself and his spouse. They were both students and Nathaniel worked part time. Initially, they had insurance coverage through the school, but it was extremely expensive.
Based on the income of just over $25,000 per year, Nathaniel chose a Marketplace Silver plan that included an HSA option. They qualified for $387 in assistance, which Nathaniel chose to apply to the monthly premium. As a result, the premium for two adults was only $43 per month. Their yearly deductible was also reduced to $1000 per year ($500 for each family member).
Nathaniel’s Marketplace insurance plan was critical when he tore his ACL. After meeting his share of the deductible, his surgery and ongoing physical therapy were completely covered and he was able to rehabilitate his knee without sacrificing extra income.
Nathaniel graduated in 2014 and now has employer-sponsored coverage; therefore, he no longer needs his Marketplace plan.
Lisa is a 40-year-old St. Louis County resident who recently completed her Master’s in Fine Arts in Creative Writing at the University of Alabama and received Master’s in Social Work before that. However, she couldn’t find a job and has been working part-time in her family’s business, as well as focusing on writing.
Unfortunately, Lisa’s individual insurance plan didn’t cover her many of her health care needs since they were pre-existing conditions. For example, she has sleep apnea and needed a new hose for the machine that helps her breathe at night. However, her insurance didn’t cover the doctor’s appointment that was needed to get the prescription to buy the equipment. As a result of her financial situation and her insurance problems, Lisa put off essential tests and treatments.
Lisa was finally able to get a new individual plan from the Marketplace, which does cover her pre-existing conditions. This enabled her to get the breathing machine fixed for her sleep apnea. The plan also costs about half as much as her old plan. As a result, Lisa feels less worried about being able to take care of herself. If something is wrong, she can go to the doctor and get it taken care of instead of putting it off.
Josh was employed and insured up until Fall 2013, when he left his job and moved in with his family to complete his Bachelor’s degree in human services from Columbia College. After he finishes his undergraduate degree, he plans to pursue a Master’s degree in mental health counseling at Webster University.
He now has no income aside from his student loans and a very small 401k; thus, his income does not currently qualify him for discounts on the Marketplace. As a single adult with no dependent children, he also does not qualify for Medicaid.
Without any kind of assistance, Josh cannot afford to be insured. He’s been insured in the past and knows the importance of insurance; it’s helped him with pre-existing conditions and other surgeries he’s had. Unfortunately, now he finds himself in the scary situation of being uninsured. He has up to $400/month to live on, or $4800/year. Josh could afford to pay a small amount toward health insurance, but he can’t afford the full price of $200-400 per month for a private plan.
Closing the coverage gap would help Josh stay healthy as he completes his education and launches his career.
Abby has been an independent contractor for the past 22 years. Even though her employer offered a health insurance plan, the monthly premium was extremely expensive and unaffordable. As a result, Abby was uninsured for over 10 years. With the passage of the ACA Health Insurance Marketplace, she was able to purchase an affordable health insurance plan. With tax subsidies of $562 per month, her monthly premium is only $83.66 for a Silver plan. Finally, Abby has peace of mind thanks to health care coverage she can afford.
Brandon is a 26-year-old writer and a recent college graduate with a Master’s degree in Fine Arts. Although he is healthy and in shape, Brandon decided to enroll in a 2014 Marketplace plan before the open enrollment deadline passed.
A few short weeks after enrolling and paying his first premium, Brandon was hit by a drunk driver in a head-on collision and suffered serious injuries. He had to spend one week in the hospital, followed by another week in an inpatient rehabilitation facility, and then several weeks of outpatient physical therapy. The costs of Brandon’s inpatient physical therapy alone would have been more than $15,000. However, thanks to his Marketplace plan coverage, Brandon had financial protection and only ended up paying about $1,000.
Instead of worrying about the financial devastation he could potentially face for treatment after his traumatic car accident, Brandon knew that his Marketplace plan would cover his hospital care, his prescriptions, and his physical therapy, which gave him one less thing to worry about on his road to recovery. Brandon‘s Marketplace plan has given him the knowledge that if he ever has to go to the hospital again, he’s protected and covered.
Lacey lives in West Plains with her husband and two school-aged children. She is currently working part-time while she goes to school to get her teaching certification. While her husband gets insurance through his employer and her children are on CHIP, Lacey is uninsured. Lacey tried shopping the Marketplace and found that even the discounted premiums were not affordable for her. With an income under 138% of the poverty level, Lacey would qualify for Medicaid if Missouri expanded it.
Lacey lives with two pr- existing conditions, depression and polycystic ovarian syndrome. While she is able to purchase discounted generic medicine for her depression through the pharmacy where her husband works, her polycystic ovarian syndrome is going untreated. She should be taking medicine for it and getting regular doctor exams, as she is at an elevated risk of heart disease, cholesterol and diabetes, but can’t afford to go to the doctor.
Lacey describes being uninsured as “scary,” and notes that even relatively minor problems become more significant when you can’t see a doctor. She has had an untreated sinus infection and cough for two months, which has impacted her ability to take care of her children and complete her school work. Once Lacey finishes school and goes back to working full-time, she will likely have access to insurance through her employer, but she needs help now while she works to finish school.
Having insurance through Medicaid would allow Lacey, in her words, to be “the best mother, wife and student I can be.”
As a single mother in her 30’s, Toni works two jobs to provide for herself and her young son. Despite this reality, Toni struggles to make ends meet.
Due to the high cost of health insurance, Toni remains uninsured, despite suffering from PTSD, bi-polar and epilepsy. All medication she takes is all paid for out of pocket. Concerns over cost have resulted in her taking half the medication she’s supposed to.
Unfortunately, Toni falls into the coverage gap and is ineligible for health insurance discounts. If Missouri expanded Medicaid, this working mom would be able to afford the much-needed health care. With better medical coverage Toni would be able to begin building a better future not only for herself, but also for her son.
Courtney and her family have struggled with rising medical costs for the past several years. After her father lost his job and his health insurance, Courtney was uninsured for four years. During this time, she avoided going to the doctor and went days without prescription medication until she could afford refills. Courtney purchased quality, affordable insurance through the Marketplace, and now has a Silver plan for $185 a month. The costs of Courtney’s prescription refills have dropped from $75 to $5. Within the first month after getting health insurance, Courtney went to the doctor for a well woman exam and a physical. Without the affordable plan through the Marketplace, Courtney would not be able to receive the preventive care that keeps her healthy.
Brandy is a 35-year-old mother who lives with her boyfriend in West Plains and takes care of her three children and his two children. She is recently unemployed, and has lost her health insurance. The children are covered through Medicaid, but she and her boyfriend have no access to insurance.
Both Brandy and her boyfriend have dental problems and are afraid of what might happen without insurance. They previously had to go to the hospital because her boyfriend was having chest pains. Since they have no insurance to cover the costs, the hospital has begun garnishing his income check. This check is the sole source of income right now for the family of five and only amounts to about $1520 per month. Even going to the low-income doctor’s office is costly for their family. Brandy hopes that she will find a job soon, but is nervous about having no insurance for the time being.
Eailene lives in Adair County and works full-time in private homecare. Nine years ago Eailene was diagnosed with cancer, and received treatment through insurance provided by the hospital where she worked at the time. However, Eailene’s health forced her to leave her job and, although her cancer was in remission, she no longer had insurance. Three years later, she suffered with severe pain for several months before finally going to the emergency room and finding out she had a ruptured appendix. Today, Eailene is insured through a Marketplace plan, and is happy to be able to get prompt medical care.
Husband and wife, Daryl and Marcia, live in St. Louis County. They are currently unemployed and living off the money they carefully saved for years. Marcia had to stop working because the mental stress was negatively impacting her health. Marcia also suffers from an autoimmune disorder.
Daryl continued working as long as he could but after suffering from pneumonia twice in the same year, he couldn’t continue anymore. Daryl has been wearing a pacemaker for the last 15 years and also suffers from diabetes.
Since they don’t have any income, they cannot afford to buy health insurance on their own. Also, they are not eligible for Medicaid because they do not have dependent children. They fall in the coverage gap.
Marcia and Daryl are worried how they’ll be able to pay for health insurance after their COBRA plan ends next year. Marcia wants to return to work but she needs to take care of her health and feel well enough to start working again. Also, she fears for Daryl’s health and their finances. She said, “Daryl’s medical conditions are ongoing and the expenses associated with them will never stop.”
Charlene was worked several part-time jobs for the years, but has never been offered health insurance by her employers. She could not afford to purchase health insurance on her own because of the high premiums and her tenuous financial situation. As a result, Charlene was uninsured for 12 years.
Prior to enrolling in the Marketplace, the last time she had health insurance was when she had her children. Her husband also didn’t have insurance through his job, so Charlene had Medicaid coverage during her pregnancies. However, she lost this coverage after her children were born.
When the Marketplace opened, Charlene was able to sign up for insurance. Eligible for over $400 in tax credits, Charlene found an affordable plan that allows to her to go to the doctor and take care of her health. Now that she has insurance, she can afford to get the colonoscopies that she requires after having colon surgery 12 years ago.
Jeri lives with her husband, daughter and grandson. She works 30 hours per week and will receive her Bachelor’s degree this May. She is a proud volunteer with the Special Olympics.
Jeri and her husband adopted and raised four children. After decades of employment, her husband has become disabled with rheumatoid arthritis. One of her adult daughters is also disabled and lives with Jerri and her husband, as does their 17-year old grandson, who they adopted after his parents died. As a result, Jerri is the only wage earner in the home.
Jeri is anxious about her health every day. She is a cancer survivor, but cannot afford the check-ups she is supposed to get to make sure the cancer has not returned. The last time she saw her doctor, he told her she should take medication for high cholesterol. However, it costs $38 a month and she can’t afford that.
In addition, Jeri is also concerned about her grandson’s future. Having lost both of his parents, he has experienced severe trauma. As a minor, Medicaid has allowed him to see a psychiatrist and get medication that has stabilized him. One of Jerri’s greatest fears, however, is what will happen to him after his 19th birthday. Like his father, he struggles with major depression and suicidal thoughts. Jeri is concerned about what will happen to him without health care coverage.
Closing the coverage gap is pivotal for the health and well-being of Jeri’s family. Medicaid Expansion would allow people like Jeri to continue working and caring for their loved ones.
Jasmin has been largely uninsured since she graduated college in 2008. After college, she took a job for two years primarily because it offered health insurance. However, only catastrophic and emergency coverage was offered. Under that insurance plan, Jasmin learned to navigate urgent care and free/reduced fee medical clinics. She now works full time at a St. Louis non-profit, where she’s the only employee. Now that she is insured through the Marketplace, she can get preventive care and see a doctor when needed. She qualified for subsidies, which allowed her to purchase a Silver plan for $123 a month.
Rebecca is 60-year-old woman from Henley, MO. She and her husband moved to Henley from Kansas City, after her husband’s company shut down due to financial problems. He was able to find a job in their new town, but unfortunately he had to start from scratch and is only paid a quarter of what he made at his previous job.
Rebecca is currently unemployed. She received a serious health diagnosis shortly before she moved. She used to work in childcare, but has been unable to work since her diagnosis. Rebecca used to have health insurance through her husband’s previous employer, but insurance for her is too expensive under his new employer’s plan. As a result, she is unable to get the treatment she needs for her condition and has been forced to go to the emergency room for medical emergencies.
Rebecca and her husband do not have enough money to qualify for premium discounts in the Health Insurance Marketplace, but she is ineligible for Medicaid coverage. Having health insurance would allow Rebecca to get the proper treatment and give her peace of mind.
Joanna recently completed her graduate degree and is seeking a job, and she has had limited financial resources since she started graduate school.
Due to her past health and financial experiences, Joanna values insurance and understands the benefits it can provide in the event of an emergency. Currently, she experiences constant back pain due a back injury in October 2012.
For Joanna, insurance is a necessity, and the Marketplace allowed her to access affordable plans. Having insurance allows her to continue with her therapy and provider visits in hopes of fully recovering from her back injury.
Crystal, a 28-year old mother from St. Louis City, had leukemia as a young teenager. She has been in remission since 2000, but lives with the never-ending fear that her leukemia could come back and she will not live to see her children grow up. Recently, she has been having symptoms that make her worry that it may have returned.
Crystal works full time as a cook at Burger King while she cares for her two children, ages seven and six. Because Crystal receives hourly wages, she is not eligible for health insurance benefits from her employer, even though she has been a loyal, hardworking employee for seven years.
The last time Crystal went to the doctor was over six years ago when her son was born. However, because the treatment she received for leukemia can impact her heart rate, doctors have advised her to return at least once a year for a heart rate test. She has never received that test.
This has made it impossible for Crystal to receive the crucial testing she so desperately needs. She says, “When I was first diagnosed with leukemia, my symptoms started with bruising. What scares me is that I have constant bruising. I actually have new bruises every single day.”
Having insurance through Medicaid would allow Crystal, “To not wake up every day worried that I have cancer again.”
Zhanara and her husband are both self-employed. As a result, they were responsible for all the expenses for their health insurance. Before the ACA Marketplace was established, Zhanara and her husband were paying over $1,000 a month for bare bones coverage, even though they did not have any pre-existing conditions. In order to save money, they switched to catastrophic coverage at a cost of $600 per month that only covered life threatening issues. The plan had a $10,000 deductible for each person and did not cover doctor’s visits, dental or vision expenses.
Just before Christmas in 2013, Zhanara caught the flu, and her least expensive option was to visit a Walgreen’s Take Care clinic. She received a prescription for Tamiflu, with a total cost of over $300 out-of-pocket for the visit and medication. Her husband then caught the flu, doubling their expenses.
Zhanara and her husband now have a Marketplace plan. They have more comprehensive coverage to meet their health needs – at a cost of only $47 a month.
Shelley lives by herself in Greene County. She has no form of health insurance and only receives care through the services available at local community health center. Almost four years ago,, doctors found a cyst growing on Shelley’s ovaries and multiple tumors on her uterus. However, due to Shelley’s high blood pressure, she was unable to get the immediate surgery she needed, which required a complete hysterectomy. Doctors placed Shelley on medication to lower her blood pressure until they could safely perform the surgery.
Shortly after her diagnosis, Shelley lost her job and no longer had insurance to cover the important surgery. Since losing her job, Shelley has been homeless and unable to find work without risking a stroke because of her high blood pressure.
Without an income, Shelley cannot afford a plan on the Health Insurance Marketplace and, without a dependent child, she cannot qualify for Medicaid without being declared disabled. “I’m not ready to give up on myself and be on disability. I want to work. If I could have gotten the surgery that I needed, I would have been employed these past four years,” Shelley reflects.
Through Medicaid Expansion, Shelley could finally get the proper medical treatment that she needs. “This is America, we have to shake things up and wake people up in order to make that change.”
Before retirement, Ron worked in the automobile industry for 35 years. His wife, Sue, was a teacher and they received insurance through their employers. But when they retired, Sue’s pre-existing condition, which required regular medication, made it difficult for Ron to obtain health insurance.
On the Marketplace, Ron was able to find insurance for him and his wife for $565 per month- which was then reduced by a $900 yearly tax credit. The ACA has given Ron and Sue the peace of mind they deserve in their retirement years.
Angela is in her 30’s and lives with her four children in Washington County. Almost nine years, Angela was involved in a serious car accident that crushed three vertebrae in her spine. Since then, Angela has required medical care forarthritis and is also being treated for asthma. The amount of pain Angela experiences due to her arthritis is treatable only by prescription medication.
In the past, Angela received coverage through Medicaid, but she lost her coverage when she got a part-time job. Even after she no longer worked at her part-time job, she was still unable to qualify for Medicaid because she receives disability for two of her children as well as child support. Angela’s 13-year-old son suffers from bipolar disorder, ADHD, asthma, and autism, while her 15-year-old daughter is severely asthmatic.
Without proper prescribed medication for her arthritis it is a struggle for Angela to engage in day-to-day activity without being confined with pain. Not having [medication] for your arthritis is a daily battle… I tried to exercise so it is not so horrid, [however] not being able to go to the doctor when you are sick or in pain is hard.”
Battling everyday with arthritis not only takes a toll on her body but on her ability to keep up with her children. If Missouri closes the coverage gap, Angela could finally get the medication she requires. Although getting the proper medicine won’t completely cure her crippling pain, it would significantly alleviate it and provide her with an opportunity to be able to work again.
Nicole was insured off and on when she was employed or able to work full-time, but now she is unable to get or keep employment due to her medical conditions. Being uninsured has led to Nicole delaying medical care until she had two week-long hospital stays. This has left her family in tremendous debt, $100,000, and has her family considering bankruptcy.
If Nicole had insurance, she could see a specialist – endocrinologist – to get her diabetes and health under control so she can go back to work and feel productive again. Instead, her family lives frugally and Nicole worries what will happen to her family if she’s unable to access the care she needs to get her health back on track.
Getting health insurance would allow Nicole to access preventive care, which would reduce the chances of a serious incident that might result in another long hospital stay. She wants to get healthy enough to go back to work and contribute. She also wants to regain her health so she can be a better, more involved mother to her children.”
Ashley, 27, is a baking and pastry student currently studying to pursue her dream of becoming a pastry chef. Although she has been looking for a part-time job that fits with her class schedule, she knows she likely will not qualify for health insurance benefits as a part-time worker. Without a job and with no children of her own, Ashley makes too little to qualify for subsidies to buy insurance through the Marketplace and too much money to qualify for Medicaid.
Ashley worries a lot about her health and is very concerned about her uninsured status because cancer runs in her family. Her mother was diagnosed with cancer at age 27 and her father was diagnosed with lymphoma at 44. This places greater importance on preventive screenings to maintain Ashley’s health and ease her anxiety. Without coverage, she worries that she will not be able to access or afford potentially life-saving preventive services and screenings in time.
Sara, 25, grew up in a single parent household without ever having health insurance. As a student-athlete in college, she was able to receive the basic minimal coverage through the school. However, Sara knew that she still wouldn’t be able to see an outside doctor or afford any extensive care unless it got to be an emergency situation.
Shortly after graduating college, Sara was diagnosed with Crohn’s disease and decided she needed to look for health insurance options. During the first year the Marketplace became available in Missouri, Sara was able to successfully enroll in a great Silver plan. She currently works part-time at Rockwood School District and is very pleased with her coverage plan and overall health.
Muriel is a hardworking waitress and mother of two. Throughout the entirety of her life, she has never had access to health insurance. Muriel tried to rely on other resources for health care, but was never fully able to get the care she needed. When sick, she had to live without professional care and medications. This past year, she became eligible to purchase health insurance through the Marketplace and received premium discounts saving her approximately $3000 per year.
Muriel admits that because she is getting older, she was worried about receiving the proper preventative care. She is happy to have insurance so she can have access to services such as mammograms and colonoscopies. Unfortunately, Muriel sits on the cusp of being eligible for Marketplace discounts and being in the Medicaid coverage gap. She is fearful that if her income decreases next year, she will again be in the Medicaid gap and will have to forgo purchasing insurance, as it would be too expensive without the subsidy.
Jamie is a 30-year old mother of five children, living in Potosi. She is a survivor of domestic violence who stayed in a homeless shelter in order to escape her ex-husband, but is now back in our own home. Her ex-husband is in prison, where he can access free health care, but Jamie is uninsured.
Jamie works full-time in home health care and as well as two part-time jobs. She also volunteers with local civic organizations and is an active member of her church. She has an Associate’s degree in business management, an accounting certificate and is working toward her Bachelor’s degree.
She is in the Medicaid gap and uninsured.
Jamie has back damage resulting from the domestic violence. They only way to fix it is with surgery that she can’t afford. Recently, the pain is getting worse and spreading; Jamie’s left leg is numb every morning when she wakes up. Jamie has been told that she could legally apply for disability, but she doesn’t want to do that. Medicaid Expansion would help Jamie get healthier so she can finish her education, get a better job, and be the best mom possible for her kids.
Jennie owned and operated her own small business, a retail store, for a year and a half. During that time and prior, she was uninsured. She now works part-time at The Container Store, but is still uninsured. Though the Marketplace was a hassle for the first two months, she was able to enroll in a Silver plan in December 2013 with significant financial assistance and cost-savings, including no monthly premium. When her coverage began in January 2014, she was grateful to be able to go to the doctor for free well woman exams, birth control, and treatment for her migraines. Jennie also has peace of mind knowing that she is finally has the possibility to go to the doctor when she’s sick.”
Lola is a 60-year-old, self-employed woman from Ozark County. She has suffered from sleep apnea, migraine headaches, and restless leg syndrome. Luckily, thanks to the Marketplace, she was able to find an affordable health insurance plan for her and her husband. With $1,300 a month in tax subsidies, Lola and her husband only pay $87.77 a month for their plan.
After Lola got health insurance, she was able to go to the doctor and was relieved to find out that she no longer needed to be on the CPAP machine. Since being released from the machine, her migraine headaches have subsided. In addition, she can finally get the preventative care she needs. Lola has a family history of both breast and colon cancer and now she is able to get regular exams and screenings to detect for any possible problems before they become life threatening. She is thankful she was able to buy a health insurance plan that has allowed her to get both preventative and curative care, and above all, attain a healthy life.
Pam is a St. Joseph resident who had a full-time position with health care benefits until her health began to deteriorate about 10 years ago. She was diagnosed with Thrombotic Thrombocytopenic Purpura (TTP), a rare blood disorder. Pam spent time in ICU and had seven months of plasma pheresis. After this care, she was finally able to go back to work.
Pam later left that position for a better paying job. Unfortunately, soon after she started having health problems again. Her TTP returned and she developed blood clots in her legs, which prevented her from sitting for extended periods or walking long distances. Pam’s health issues led to her losing her employment 18 months ago due to an inability to work.
Pam has been without access to health care for the last year and a half. She has since been diagnosed with Fabry Disease. Pam is also diabetic and getting her insulin and medication she needs for TTP has been a struggle, if not impossible.
Pam has found herself in the coverage gap and unable to afford health coverage at a time she needs it most. She has used all her savings to pay for medical bills. If not for family to stay with and a free clinic in St. Joseph, Pam would be in an even worse situation. She says, “I worked all my life. I never expected to be unable to work because of illness. To be denied health care when I need it most is like getting kicked down when I was most vulnerable.”
Ryan is 25 years old and works two jobs while planning to marry his fiancé, Kelsey. He was uninsured for two years and in that time developed chronic pain but didn’t know why. He had to save up, delay treatment, really plan out medical appointments, forgo lots of things, and still be really stressed.
“It really wears on you and takes over your life. When a condition pops up that you know could be fixed, but you have to meticulously plan out ‘I have to work this many more hours and not do this if I want to take care of myself. And then still ask whether I’ll be able to afford this. The stress certainly made my pain worse.”
In 2014, right before the close of the first Open Enrollment, Ryan enrolled in a Marketplace insurance plan with discounted premiums and costs. After years of paying out of pocket, rationing and delaying health care, Ryan couldn’t believe he was able to get a great, Silver, plan for less than $50/month.
Kristine is 39 years old and married with four children. She and her husband own their own business and were uninsured for a time. They were quoted monthly fees of over $600 when they tried to get health care, even though both were healthy. They went during the first day of open enrollment in the Marketplace in 2013 and found that they were also eligible for subsidies. Now both of them have insurance for only $105 per month.
Jennifer works part-time at a community college as an educational assistant. She struggles with diabetes but her employer will not give her enough hours to qualify for benefits. Although she looked on the Marketplace for coverage during the open Enrollment period, all the plans were too expensive. Jennifer’s diabetes would be under much better control with insulin, but because she is uninsured she has few options to obtain it.
Jennifer has two kids who are covered through the state. Still, she has considered moving the family elsewhere just to get access to health care so she can continue to provide and take care for her kids. Jennifer says, “I’ve actually looked into moving to another state just to get better access to care, because it’s terrible not having health care when you have a medical condition.”
Marilyn is a 64-year-old woman in Kansas City. Marilyn works part time for a small business and also part time as an actress. Prior to the Affordable Care Act, Marilyn purchased her own insurance while she could afford it. However, she had to go without health insurance for a year because the premiums were too expensive. As a result of subsidies through the Marketplace, Marilyn can now afford quality health insurance. Without the newly purchased insurance plan, Marilyn would not be able to afford her medications, and would thus see a drastic reduction in her quality of life.
Michelle has not had any health insurance prior to marrying her husband in 1996. After that time, her husband’s employer offered reasonable health insurance. Michelle learned later on that she had adult Attention Deficit/Hyperactivity Disorder (ADHD) and received care through their insurance.
Recently, Michelle and her husband both lost their jobs. She has started to search the Marketplace, but has not been able to find anything. “I started to get a little frantic. We tried to do the right thing paying off the house so we wouldn’t be homeless. They just keep cutting back support programs for people who need it most.”
In addition, she got into an accident recently and fears that if the injuries progress she will need to go to the ER, which she cannot afford the cost.
Jennifer is a 36-year-old St. Louis resident and a church volunteer for the city. She suffers from many physical and mental ailments, and she is currently on an antibiotic treatment for bronchitis and gum disease. She has had part-time jobs, but none of them provided her with health insurance. Therefore, she bought a plan on the Marketplace even though it was too expensive for her. The insurance plan was not accepted by many doctors in her area and put a costly strain on her. After many failed attempts at getting medical care, Jennifer cancelled her plan.
“In the past, I tested positive for cancer cells and they came back in my cervix. If they come back again, I wouldn’t know what to do,” Jennifer says. If Missouri expanded Medicaid, Jennifer wouldn’t need to worry about the “what if” and instead focus on her professional and personal growth.
Crystal is 50 years old and lives in Marian County with her son. She has a rare health condition called Complex Regional Pain Syndrome, which causes lots of pain throughout her body. Her condition has left her unable to find a good job or get health insurance. Without health insurance, she is not able to access the care she desperately needs.
Without a steady income, Crystal cannot buy insurance through the Marketplace, and she has been denied Medicaid three times due to the rareness of her illness. Crystal would qualify if Missouri expanded Medicaid.
Arielle is a mother of two young sons, one who has severe disabilities and autism, and is a survivor of the Joplin tornado. Before the tornado, Arielle worked at a company that provided health insurance benefits, but she lost everything in the tornado, including her job and benefits. Arielle moved to Oklahoma for a job, where she also had insurance, but moved back to Missouri to be closer to home.
Because her son has severe disabilities and requires a significant amount of care, Arielle was unable to work full time or receive benefits. After finally getting her son covered through Medicaid, Arielle was able to hire a worker to care for him, which allows her to work part-time and go to school full-time. However, Arielle’s employer does not provide health insurance. She now makes too much to qualify for Medicaid in Missouri, but not enough to receive Marketplace discounts, so she remains uninsured.
Arielle suffers from PTSD related to the tornado, migraines and arthritis, but she goes without the medication she was prescribed after a recent E.R. visit because without health coverage, the medication would cost her $1,000 per unit. Arielle says that Medicaid Expansion would help give her security and peace of mind as she works hard to get a good education, remain as healthy as possible, and provide for her family.
Arielle says in her own words, “There are so many stereotypes about single mothers. But there are many like me who are working hard, trying to take care of themselves and their families. We’re in a constant battle to keep our heads above water. And it’s really scary to think of what could happen to us if something awful were to happen to me and I don’t have any coverage.”
Last year, Natalie had a full-time job as a teacher with health insurance benefits. However, when her one-year contract expired, no additional positions were available and Natalie had to take a position as a substitute teacher. As a substitute teacher, with unstable income, she’s unable to afford COBRA or the Health Insurance Marketplace plans. As a result, Natalie made the difficult choice to be uninsured.
Natalie says being uninsured is scary, because you never know what’s going to happen. She has to be tighter with her finances and forgo important services. When deciding whether or not to see a doctor, she must always think if it’s worth a day or two of work. Natalie never imagined her life would be like this. She’s works hard and tries to be healthy. She knows that living without health insurance is a gamble, but has learned that this is a difficult one too many people have to make.
Jamie is a college senior who was uninsured for a few months after her college canceled their insurance plan. The college told Jamie and other students that they had to find their own insurance. Jamie enrolled in a Marketplace plan on Healthcare.gov. Although Jamie experienced a few bumps at first, she found a helpful navigator who got her enrolled in a plan that covers care both at school and in her hometown.
Beverly is a home care worker who had health coverage until she was laid off. She’s been diagnosed with rheumatoid arthritis but can’t get the medicine or doctor’s visits that she needs now that she is uninsured.
Beverly is a mom to three children, two of whom have special needs. She works and is doing what she needs to do to keep her family going. She has known uninsured people who had to choose between food and medicine and died too soon because they were forced to have to make this choice. In Beverly’s words, it’s a choice where “you’re damned if you do and damned if you don’t.”
Rene had affordable health insurance through her employer until three years ago. This insurance helped her see the doctor regularly and afford medication for her severe arthritis. Unfortunately, when she lost the job she held for fifteen years due to downsizing, she was no longer able to afford health insurance. With the slow economic recovery, Rene has had trouble finding new employment and affordable health coverage. As a full-time student, Rene makes only $6,000 a year. Without Medicaid expansion, Rene would need to pay over 2/3 of her income for health insurance. Rene worries that a serious health problem will bankrupt her. She’s already paying off a visit to the emergency room when she didn’t have insurance. She’s concerned that without adequate health insurance another similar trip will end in the loss of her house.
G.M. is a retired artist and teacher living in St. Louis. She was diabetic for 31 years, and after going through a divorce she lost her health insurance. Following this event, G.M. received a kidney and pancreas transplant and was required to continue on many expensive medications to keep her transplanted organs. Right as her Medicare was about to run up last year, she was able to get covered through the Marketplace. She qualified for assistance and was able to purchase a Coventry silver plan for about $162 a month. Before the assistance, her premium would be somewhere around $600 per month. G.M. says she is extremely happy with her plan, which allows her to visit her doctors without issue and pay for the medications she needs.
Bradley is a 47-year-old veteran from Crawford County. He served in the military for five years, and as a result, suffers from a back injury, post-traumatic stress disorder (PTSD), and insomnia. He has health benefits through the Veterans’ Administration, but the closest VA provider is more than two hours away. Although there is a small clinic closer to his house, it does not provide all of the services he needs. His various conditions require him to get monthly medications and see his specialists every few months, making the long travel necessary.
Bradley is currently in school studying to become a mechanic. While working on cars, he has suffered some minor injuries and accidents. He sought treatment for these injuries at a local hospital and had to pay out-of-pocket since they were not VA providers. As a result, Bradley now has $7,000 in medical debt. If Bradley had access to Medicaid to supplement the gaps in his insurance, he would be able to get convenient and accessible health care without the need to travel afar for each visit.
Theresa is a Johnson County mom of four who has tried and struggled many times to get health insurance. She first attempted to contact an insurance office, but was referred to the Medicaid program. However, when Theresa tried to apply for Medicaid, she was told that she made too much money to qualify. In Missouri, an adult with three children who makes more than $300 per month cannot qualify for Medicaid but does not earn enough to obtain subsidies through the private market place.
Without insurance, Theresa is forced to go directly to the emergency room when she experiences an injury or infection. Hospital bills have continued to add up and place a heavy burden on Theresa. As a single mother of four boys and a full-time job, she already struggles with the day-to-day activities of caring for her family. Theresa has said that she tries to keep the debt from getting her down. “I’ve learned to live with it,” she said.
In Theresa’s own words, “I am one of over 6,000 Missourians in Johnson County alone that lack health insurance and would benefit if Senator Pearce would stand up for working families like mine and advocate for Medicaid expansion.”
G.A. is a 61-year-old, self-employed man from Jackson County. Despite a shoulder surgery and knee replacement, he continued working to support his family. However, he could not afford to buy insurance on his minimal salary and, therefore, could not tend to the continuing problems with his knees. He feared that unexpected medical bills could jeopardize his family’s finances and force them to sleep on the streets.
Thanks to the Affordable Care Act, G.A. was able to find an affordable insurance plan for the first time in thirteen years. The tax subsidies enabled him to find a plan for both he and his wife for only $40 per month. Now that G.A. has health insurance, he feels very relieved and said, “If something terrible happens, at least I will have health insurance.”
Anthony and his wife, Kristy, live in West Plains with their four children. Anthony has two Associate’s degrees and works as much as he can, but must also take care of his wife who is living with significant mental illness related to Schizophrenia. Anthony was recently working at a furniture store until his wife ended up in the hospital for a few days. As a result, he had to be home to help her recover which led him to lose his job. It’s hard for Anthony to keep full-time work and maintain his duties to protect and keep his family safe. Without a reliable job and source of income, Anthony is unable to get affordable health insurance.
Anthony’s family depends on him, and if he could get coverage through Medicaid, their family would be more secure. “I can’t just go to the doctor when I need to,” Anthony says. “If I have a health issue, my wife worries even more.”
When Tom, a self-employed attorney, and his wife LaDonna got pregnant, their insurance company raised their rates by $1,000 a month. The company defined pregnancy as a pre-existing condition. The price increase made the insurance unaffordable and the couple canceled their coverage.
As a result, Tom and LaDonna went without insurance for four years, luckily without serious medical issues. When the Marketplace opened, they signed up for a Silver plan.
Tom had been insured for only a few months when he had to have surgery after an accident that detached the tendon in his right hand completely from the bone. The surgery required extensive physical therapy after to help Tom regain full function of his hand.
In August, LaDonna was diagnosed with Stage IIIA breast cancer, and underwent a double mastectomy followed by radiation and chemotherapy treatments. Thanks to their Marketplace plan, they were both able to get the care they needed and escape financial disaster.
Megan is a hardworking 29-year-old single mother from Salem. She suffers from a series of mental health issues that require her to take certain medication, but she has no access to health insurance. The cost to merely manage her symptoms is more than half of her monthly income. The side effects of taking her medicine inconsistently are extremely severe. She currently gets discounted care through a local clinic, but the out-of-pocket costs are too expensive. “I tried to go through the division of family services,” Megan said. “I can’t afford to see an actual doctor.”
Megan fears that if she is unable to access the care and medicine she needs, she will be unable to work or support her daughter Alexa. She says that if she could get coverage through Medicaid, she could create a more stable lifestyle and be a better mother.
“One of the hardest things I have to do is try to tell my daughter what is wrong with me when I don’t even know,” Megan says.“I just think if I have the medicine I need and insurance to cover it I would be a lot more stable.”
Mary is a single mother and self-employed. Beginning in 2012, Mary began having serious stomach pains. Because she was uninsured, she sought help at a local clinic. Over the course of the next 18 months, Mary had 18 different clinic visits and spent $5000 trying to solve her health problem. She was diagnosed with GERDS multiple times and was told the problems may be from her heart. Although Mary told the clinics about previous gall bladder attacks she experienced several years ago, this information was never connected to her current problem until she got health insurance through the Marketplace in 2013. Soon after, she saw a physician who immediately identified the problem with her gall bladder and referred her to a surgeon. In June 2014, Mary finally had her gall bladder removed after suffering with the problem for nearly 18 months.
Mary says she is very happy with her Marketplace plan. She has a silver Coventry plan, which she pays about $70 per month for in premiums as a result of the subsidies that make it affordable. Without assistance, her premium would be about $300 per month. Because Mary is a self-employed artist, her income varies. She says that it’s wonderful knowing she can see her doctor for issues now. As she puts it, “I don’t know where I would be right now if I had not gotten health insurance.”
Eddie is 62 years old and lives in Jasper County in Southwest Missouri. He was diagnosed with cancer two years ago and his health condition made it difficult for him to continue working. Although he had COBRA insurance for some time after he stopped work, it was very expensive and put a strain on his family’s finances. Thanks to the Marketplace, Eddie found a Silver plan with a monthly premium of only $111 thanks to $470 in tax credits. Eddie can finally afford a good health insurance plan that meets his medical needs and is affordable for him and his wife.
Abby* is a 64-year old woman from St. Louis County. She has been an independent contractor for the past 22 years. Even though her employer offered a health insurance plan, the monthly premium was extremely expensive and unaffordable and she has been uninsured for over 10 years. With the passage of the Affordable Care Act, she was able to purchase affordable health insurance. With tax subsidies in the amount of $562 per month, her monthly premium is only $83.66 for a silver plan. Finally, Abby has the “peace of mind” and in her words, “I don’t have to worry about whether I will be able to eat or afford health insurance.”
*Name changed at the request of the individual
Jackie was born with neurological damage. She graduated from college and found fulfilling work as a caregiver for people with disabilities. Her conditions make full-time work nearly impossible, but she is able to work part time for minimum wage. She earned $7,000 last year, but one trip to the hospital cost over $1,000, even after charitable write-offs. As a single woman without children, Jackie is uninsured because she is not eligible for Medicaid. Jackie struggles to get the medications and health care she needs.
Jackie has decided to move in with family in Minnesota, where Medicaid has already been expanded. She will be able to get the health coverage and care she needs. When Jackie is able to better manage her health, she will be able to work more and support herself more independently.
Virgil and his wife Mireya live in Pineville, MO, near Joplin. Virgil worked 45 years as a heavy machinery mechanic. Unfortunately, he was infected with cellulitis, which caused his legs to swell severely. Virgil had to be treated in the hospital for weeks. Eventually, he and his wife were unable to pay their COBRA insurance premiums of $980 per month. They went to healthcare.gov and found a navigator who met with them in person and helped them in the process. Virgil says, “Once we found the right person (navigator), it was a piece of cake.”
As a result, they were able to get an affordable Silver plan from Coventry through the Health Insurance Marketplace.
Crystal, Marian County
Crystal in in her 50’s and lives in Marian County with her son. She has a rare health condition called Complex Regional Pain Syndrome, which causes lots of pain throughout her body. Her condition has left her unable to find a good job and without any health insurance.
She is not able to access the care she needs due to being uninsured.Without a steady income, Crystal cannot buy insurance through the Marketplace, and she has been denied Medicaid three times due to the rareness of her illness. Crystal would qualify if Missouri expanded Medicaid. With proper treatment, Crystal could possibly even return to the workforce as well.
Diane is in her late 40’s and has 3 young children she stays home to care for. Now that her youngest is in kindergarten, she hopes to find work outside the home. Diane has a chronic health condition that affects her inner ear, and she is uninsured.
Without access to medical care, Diane can’t be the mom she wants to be. It also makes it hard for her to seek employment. She needs to be healthy in order to take care of her kids properly.
Diane would gain health insurance if Missouri were to expand Medicaid. Until then, she is forced to go without care. She says, “It’s very frustrating. I don’t think they clearly understand how important it is for a mother to be healthy. Even when you fly on an airline they tell you to put your mask on before your child’s. If something happens to me, what is going to happen to my kid?
K.M. recently left her job in order to provide care for her mother, whose health was deteriorating after a recent heart attack. K.M. does not have health insurance anymore and cannot afford to purchase it on the Marketplace with the minimal pension she receives from her previous job. “I’m poor. I do not know. I have never been in a situation where I have not had health insurance. I’m not lazy. I have worked all my life. I am pissed off.”
K.M. has accrued $10,000 in medical debt, partially from an incident she had with her right wrist last year after she lost health insurance. To make matters worse, the Urgent Care where she sought treatment performed an incorrect procedure that has left her with constant pain in her right wrist. She is right-handed but has to use her left to do daily tasks. There is treatment available to relieve her of the pain but she cannot afford it, and she doesn’t want to take on more debt.
Her income does not qualify her for any help in affording health affording health insurance and her only hope is Medicaid Expansion. K.M. would not have to live a life of constant pain if she could afford medical treatment.
Will is a 61-year-old from Webster Groves who has his “dream job,” combining librarianship, Yiddish music performance, writing, and teaching. He recently spent two years cataloging rare books from the 16th-19th centuries. He loves what he does, despite the lack of a high paying salary. Will has always viewed healthcare as, in his own words, “essential.” With three pre-existing conditions, Will’s monthly premium in 2012 was $615.00.
In December 2013, Will purchased a silver plan through the Marketplace for $25.36 per month, and has better insurance coverage now then he did before. The Marketplace made it possible for Will to receive great coverage, and as he said, “approach health insurance planning without a sense of panic. I am able to evaluate and map out my future and choose exactly how I want to work.”
Will always wanted health insurance coverage even though he is a very healthy man because “no one is immune from catastrophe.” Now, the price of his insurance plan does not dictate his life choices. As he says, “I am able to approach health insurance planning without a sense of panic. I am able to evaluate and map out my future and choose exactly how I want it to work.”
Jennifer is a 46-year self-employed entrepreneur from St. Louis County. Even with an annual income of $6,454, which is below the poverty line, she is ineligible for Medicaid. She is in the Medicaid gap. Using her minimal earnings and savings to build her business, has left her unable to afford health insurance. The fear of huge medical bills that could result from an on-the-job accident has prevented her from taking riskier jobs that are necessary to grow her business. If Jennifer had health insurance, she wouldn’t have to worry, in her words, “every moment of every day that a little accident could wipe me out and put me under a bridge.” If Missouri expanded Medicaid, health care costs will not be a source of fear, and instead hard-working, tax-paying entrepreneurs like Jennifer could build their business and contribute to the State’s growth and prosperity.
John is self-employed and owns and publishes a magazine in Kansas City. He has been unable to find and keep affordable health insurance due to preexisting conditions such as high blood pressure and gout, despite being in generally good health.
John purchased a Silver plan through the Marketplace for $291 a month, thanks to a premium discount. This insurance will help John manage regular health needs, but more than anything, it gives him peace of mind that he will be covered in case of injury or illness.
After 38 years, Debbie, 58, lost the only job she ever had as a surgical technician at a hospital operating room. Leaving her central Illinois home to Wells Fargo, Debbie was forced to move back home to central Missouri. She cannot get a surgical tech job in Missouri—it requires both money for training and an employer willing to invest in an aging worker. She has few employment options. Currently Debbie works as a server at a private school cafeteria. The job is part-time, physically draining and pays minimum wage. For the first time in her life, she is faced with learning how to navigate social service and charity programs to survive.
When she lost her health care career and her first time home ownership, she also lost her health insurance coverage and health providers. Debbie struggles with COPD, intestinal disease, Carpal Tunnel Syndrome in her wrists and more. She has to seek out doctors willing to see an uninsured patient and must figure out which medications she can purchase and which ones she must go without. Facing bankruptcy now and living in a family member’s spare bedroom, some days it is difficult to keep going. She lives in fear of just one more health emergency or financial crisis.
Janet and Stacy moved to West Plains 15 years ago, where they create artwork that they sell at art fairs across the country in addition to raising animals. The recession hurt their income so badly they were forced to drop their $1,400/month health care insurance.
They went without insurance for five years. Thanks to the Marketplace, they were able to find health insurance for $100/month each, with a prescription benefit as well.
With insurance, Janet was able to make a doctor’s appointment for the first time in years this past January. As a result, she had a recommended colonoscopy that cost almost $5,600, an amount she never could have afforded before. They both feel their Marketplace plans give them the ability to make regular health care affordable.
Up until recently, Pamela had always bought her insurance on the private market. Currently, she’s working three part time jobs, but in the past has had to take on more to make ends meet. While in the private market, her insurance premiums were continually going up each year while the plans seemed to cover less and less. When Pamela looked into the new health insurance marketplace, she was able to find a plan with better coverage and lower monthly premiums. This will make things easier and less stressful at home. It will also give Pam the peace of mind that when she visits the doctor and they recommend a test or preventive care such as a mammogram, she doesn’t have to crunch the numbers in her head and worry about whether or not it’ll be covered.
Jasmin has been largely uninsured since she graduated college in 2008. She took a job for two years after college largely for the health insurance, but it was only catastrophic/emergency coverage. She now works full time at a St. Louis non-profit, where she’s the only employee. While being insured, she’s learned to navigate urgent care and many free/reduced fee medical clinics who use sliding fee scales. Now that she’ll be insured, she’s looking forward to preventive care and an upcoming doctor’s visit being covered. She qualified for subsidies, which allowed her to purchase a silver plan that will cost her $123/month in premiums. Jasmin says, “It’s a relief knowing I can just go in and say, ‘I have insurance’.”
John is a veteran who served our country in Iraq. Now that he is back home, he is studying
aviation mechanics. Although John can get medical treatment from the VA hospitals at a reasonable cost, his wife Shannon needs health insurance coverage.
Shannon works at a restaurant and volunteers with the Boy Scouts. Shannon needs medications for a lung condition that makes her susceptible to infections and pneumonia. But their family cannot afford all of the inhalers, medications, and treatment that she needs.
John also needs better coverage. He hurt his back while helping a neighbor. Since he could not make it to a VA hospital, he now has hundreds of dollars in medical bills from the ER. John, Shannon, and their two children need Medicaid expansion. If they had better coverage, their family would be better able to take care of each other.
K.C. is 56 and lives with her husband in Howell County, in South Central Missouri. They purchased insurance through the Marketplace both last year and this year. In the private market, their health insurance premiums would have cost over $1,300 a month. Now their premium totals $60 a month through the Marketplace. Because they have lower cost health insurance through the Marketplace, K.C. and her husband are now able to contribute to their savings, in order to help their two children with college tuition in a few years.
Russell is a 63-year-old gentleman living in Wayland, Missouri. Russell has worked his entire in life in labor-intensive jobs — for construction companies, in saw mills, and for the railroad. Russell is not currently employed and lives with intense back pain. Aside from the back pain, Russell has high blood pressure and reoccurring growths, although benign, on his arms. He has had four growths removed, and said, “I wasn’t in pain, but they grew so big that I couldn’t move my arm.” He was able to have those four removed because he was employed with insurance. Russell currently has a growth on his arm that will continue to grow, but will be unable to remove it because he can’t financially afford the outpatient surgery.
In 2013, Russell attempted to get insurance through the Marketplace, but was quoted a bronze plan for $425.00 per month. Russell stated, “I need insurance but there is no way I could have afforded that plan. Instead, I will have to tough it out without insurance.”
Christine, 62, lives in St. Louis City. She assumed the role of full-time caregiver in 2008 when her mother’s physical health and diagnosis of Alzheimer’s demanded round-the-clock attention. Her mother is not wealthy and would be dependent on Medicaid for nursing home care without the in-home care her daughter provides.
For decades, as a successful entrepreneur, Christine could afford insurance, but only an expensive and unreliable hospital/surgical policy was available to her. And now, without an income, she has exhausted her savings and no longer has the resources for proper treatment of her hypertension, diabetes, and hypothyroidism. The cost of medical consultation, high-quality medications, and testing is prohibitive.
If Missouri expands Medicaid, Christine will be able to take care of her health and stop worrying that an unexpected event will cause her to lose her home and incur large medical bills.
Cathy, who works in Macon county, enrolled for health insurance through the Marketplace. Her ability to enroll for health insurance has allowed her husband to retire. Previously, they were both concerned about her ability to get coverage because of her pre-existing conditions. However, now that she’s insured, her husband has put in for retirement. Now Cathy says, “I am actually paying less than I was for my insurance prior to enrolling through the Marketplace”.
Tammy is a 42-year-old mother of four who works full-time as a nail technician. Before the Affordable Care Act, she never had health insurance because it was cost-prohibitive for her. Now, thanks to the Marketplace, Tammy was able to get in-person help from a navigator and buy a Coventry plan that covers herself and two of her dependents for about $70 a month. Although neither Tammy nor her kids have any health problems, she is glad to be covered for the first time. Thus, Tammy says she is very happy and pleased with her plan.
Nicole is a Springfield resident who has had health insurance on and off when she was employed and able to work full-time. However, her medical conditions have left her currently unable to get or keep employment. Due to the fact she was uninsured, Nicole delayed medical care until she had to be admitted for two week long hospital stays. This has left her family in tremendous debt ($100,000) and has her family considering bankruptcy.
If Nicole had insurance, she could see a specialist, particularly an endocrinologist, to get her diabetes and health under control so she can go back to work to pay her debts and feel productive again. Instead, her family lives frugally and Nicole worries what will happen if she’s unable to access the care she needs to get her health back on track. If Nicole could get insurance, she would be able to get back into the workforce.
Up until she was 26, Shatema was lucky enough to have insurance through her mother’s employer. However, now that she’s over 26, she no longer has health insurance. Shatema has diabetes, needs medication and often visits the doctor. She feels bad about going to the doctor because she’s not able to pay for everything with the money she makes from her part time job. Shatema says, “I’d be much happier if I could pay for the doctor visits myself. However, this is not a reality without insurance.”
Brian, 47, is a writer from St. Charles County. Last year was the first time in many years that he was able to afford health insurance. With $125 in tax subsidies, he was paying an affordable amount of $155 in monthly premiums.
Unfortunately, his telemarketing company downsized and he was laid off. Without an income, he is about to lose his discount, and he cannot afford to buy an insurance plan on his own. Without insurance, he will not be able to get proper treatment for the two bulging discs in his back, the arthritis in his hips and back, and the worsening abscess in his mouth. With recurring pain in his mouth and back, some days are difficult for him and he cannot get out of bed.
Despite the unexpected end of his telemarketing career, he is ready to start his life back up, pursue a career in writing, and is actively pursuing new avenues to get published. Brian fears that an unexpected event could be a major setback for him and his new career. If Missouri expands Medicaid, Brian will be able to take care of his health and stop worrying that an unexpected event will push him back instead of moving forward.
Mike is in his 60s and lives in Clay County. Mike had been a teacher for years, earning his master’s degree early on in his career, and had good health insurance. However, Mike encountered a series of health issues that prevented him from continuing to work full-time, and he lost his insurance. Mike continued to work as a substitute teacher, but he couldn’t qualify for health insurance through his work.
Mike suffers from diabetes and high blood pressure, and eventually had two heart attacks. He also had to undergo several operations, including double hip surgery. Thankfully, his wife was able to obtain health insurance by working low-paying jobs that did offer health insurance.
Once Mike’s wife was laid off, both she and Mike were totally without health care coverage. Mike was facing another round of surgeries necessary to keep him alive – but without the means to pay for the operations and hospital care.
Getting insurance through the Affordable Care Act Marketplace has allowed Mike to get lifesaving operations, medication and doctor care.
Peggy* is a 35-year old woman from St. Louis County. She is uninsured and has serious, debilitating anxiety. She is in the Medicaid gap. After she lost her health insurance in 2012, she was no longer able to see a psychiatrist to learn necessary “coping skills” or obtain prescription anxiety medication. As a result, her anxiety worsened to the point where, in her words, “it is hard for me to function.”
Her anxiety has prevented her from holding a job. Her temporary, bare bones insurance plan will end in a year and she worries whether she will be able to afford health insurance that will cover her mental health disability. If Missouri expanded Medicaid, deterioration in mental health access can be prevented, and people, like Peggy, will be able to get proper, timely care for their behavioral health problems.
*Name changed at the request of the individual
Bert recently found himself unemployed when he was laid off from his labor-intensive job. Bert takes care of both his parents who have financial and medical problems of their own. Bert is currently insured through COBRA but his unemployment recently ran out and he’ll soon find himself struggling to make the monthly premium payments. Due to his long career in labor intensive jobs, he has back, knee and hip issues that require medication along with high cholesterol. He’s currently spending upwards of $500 on maintaining his health.
Bert says that without Medicaid Expansion, “Soon I’ll have to start selling things I’ve built up over my life just to live and survive. I can’t give up, just gotta keep going. Giving up is not an option”
Jared, has type 1 diabetes and recently lost his job. While employed, he was lucky enough to have insurance and keep his diabetes under control. Now that he’s unemployed, he knows he’ll run out of medications to keep him healthy and potentially risk serious health complications or possibly his life. If he were able to qualify for Medicaid or affordable insurance coverage, his life would be tons better. He wouldn’t be looking six weeks down the road and wondering if his body would shut down or go into a diabetic seizure. He’d be healthy and able to pull himself and his family back up and find gainful employment.
Joseph is 27, married with two kids. He is a full-time student and supports his family with two part-time jobs. Joseph regularly takes anxiety medication and has periodic follow up visits with a mental health specialist. Currently, his full-time student status allows him to get mental health treatment through his school. However, after he graduates, it “scares” him that he will not be able to afford the treatment. Joseph says that, “If I have to go to a psychiatrist after graduation, I don’t even know what that would cost if I didn’t have health insurance. I can’t just stop taking my medication. That would have some serious negative side -effects. I have kids that are depending on me to succeed. If I am not in good health, then I will not be able to take care of them.”
If Medicaid is expanded in Missouri then Joseph—who is a hard-working individual working 2 part time jobs to support his family while being a full-time student—would not have to worry about whether he will “be able to afford a doctor to refill his prescription” which he needs to function and take care of his 2 kids and his wife.
John* lives in Howell County with his wife. His wife is over 65 and has Medicare, but John is in his early 60s and uninsured. He can’t remember ever having insurance. He works every night delivering newspapers in an adjacent county. John has diabetes that he manages pretty well by paying cash to see the doctor and getting his medicines through a discount program. Still, he describes his financial situation as “just scraping by,” and he has no coverage if he were to get seriously ill or injured. John tried to buy insurance through the Marketplace but found it would cost 92% of his annual income because Missouri hasn’t expanded Medicaid. If we were to expand, he would get coverage for his diabetes and any future health needs.
*Name changed at the request of the individual
Alexis is working part-time while she studies for her master’s degree. She has always had health insurance, but lost it when she moved to part-time work. And she can’t get on her school’s plan as a part-time student. When she tried to apply for insurance in 2013, she was denied due to a pre-existing condition. As a result, she went without care and medications she should have been receiving. When the Health Insurance Marketplace opened, Alexis couldn’t wait to enroll in a new plan, since the law now prohibits insurers from denying coverage based on pre-existing conditions. As a result, Alexis was able to enroll in a Silver plan for just $45 a month after discounts.
Working as a self-employed hair and nail stylist since June of 2013, Cat is 36 years old and makes less than $7,000 a year. Unfortunately, this is not enough for Cat to afford health insurance without assistance. When she went to a navigator to try signing up for health insurance through the Marketplace, she found she didn’t qualify for subsidies, but would have qualified for Medicaid had it been expanded.
Cat is very concerned about being uninsured and says she “can’t afford to be sick.” Without medical coverage, Cat can’t afford regular, preventive trips to the doctor or prescriptions when she is sick. Without access to this basic level of care, Cat says she has to rely on emergency medical care and limit trips to the doctor. Having quality, affordable health insurance would give Cat “less stress in her life” and allow her to remain healthy.
Steve lost his job of 17 years in September of 2013. When that happened, he also lost his health insurance. This was a large problem for Steve because of several health conditions, including gout, high blood pressure, high cholesterol, type 2 diabetes, prostate cancer and depression.
At his age, Steve is afraid he will have difficulties finding a new job. This was compounded by his concern over where he would get health insurance to cover his medical needs.
Last year, Steve was able to successfully sign up for health insurance through the Marketplace. With a $550 monthly subsidy, he is able to afford a Silver plan for $110 a month. His coverage under the new plan is equivalent to the coverage Steve had through his previous employer, allowing Steve to continue getting the care he needs. Without the Marketplace, Steve wouldn’t have been able to afford insurance while he continues to look for another job.
Lonnie is a 51-year-old man from Pettis County. The injuries from an accident in 2012 have prevented him from working, and as a result he lost his employer-sponsored insurance. His wife’s income, the only source of household income, makes Lonnie ineligible for Medicaid in Missouri and premium assistance in the Marketplace. He is in the coverage gap.
Lonnie cannot afford to see a doctor for his accident-related injuries, or for potentially cancerous skin lesions on his leg and back.In addition, he also has high blood pressure and high cholesterol. If Missouri expanded Medicaid, in Lonnie’s words, “I could get the skin lesions taken care of. Finally, that wouldn’t be in the back of my mind.” Closing Missouri’s coverage gap would prevent further deterioration of Lonnie’s health by helping him find out what doctors can do to treat him.
Chelsea is 27 years old and a recent law school graduate. While she was in law school, she lost the insurance coverage she had through her parents when she turned 26. Chelsea’s previous insurance coverage did not cover medical treatment outside of Indiana, so she had to travel 200 miles to get health care.She says, “The fact that my coverage did not extend past Indiana while I have been in law school has been extremely complicated.”
Even when she could take time off from school and work to travel back to Indiana, the treatment for her preexisting conditions wasn’t always covered. Chelsea was able to find affordable coverage in the Marketplace that allows her to get treatment in Missouri, Indiana, and anywhere else in Anthem Blue Cross/Blue Shield’s network. Her preexisting conditions are covered and the deductible is low enough that she can meet it on her own.
Bertha is an unemployed home health care aide who takes care of her grandson. Despite her limited income, she makes too much to qualify for Medicaid. Although she suffers from diabetes and heart problems, she often chooses to forgo seeing a doctor in order to put food on the table for her grandson. Bertha is one of the thousands of Missourians who would benefit from Medicaid expansion. You can watch her story, which aired on CBS, here.
Kimmy is a 38-year-old medical assistant who recently lost her job, and thus her insurance. She has been working as a temp doing office work since, but her temp work does not come with insurance. A few years ago, Kimmy hurt her back and had to have surgery to correct the bulging disk. She had the first surgery with private insurance prior to losing her job but had to have a subsequent minor surgery to accompany it.
Kimmy has applied for Medicaid, but was denied because she has no children and no permanent disability which would qualify her for coverage- she falls in the gap. Kimmy has been told that she needs another surgery, but she fears to go ahead with the procedure without permanent and reliable insurance.
Sheryl is a 50-year-old woman who was working full-time until she recently injured her back. Due to the severe pain and muscle spasms from the injury, her doctors advised her to stop working. She recently signed up for a plan through the Marketplace but does not know whether she will be able to afford the premiums with her minimal disability payments. She might have to cancel that plan next year if she does not start working and earning money.
She is not eligible for Medicaid in Missouri and her income is not enough to allow her to make her monthly payments for the Marketplace plan. If Missouri expands Medicaid, Sheryl would be able to get the care she needs without having to worry about the medical bills and get back on her feet. Sheryl says, “If people could get the health care they need, there would be a lot less sick people.”
Ronei is a 35-year-old mother of five. She and her husband both work part-time jobs to provide for their kids. Unfortunately, both Ronei and her husband are uninsured. Although their children are covered through Medicaid, they were told they make too much to qualify. When Ronei tried to get coverage through the Marketplace, she was informed she did not qualify for assistance either.
This last year, Ronei hurt her knee and had to go to the emergency room for surgery. Although the hospital worked with her so she could get the care she needed, Ronei wishes she had coverage for future instances such as those. As Ronei says, “If you don’t have health insurance and you don’t qualify for Medicaid, you just lose. It’s awful to feel like you can’t go to the doctor when you need it.”
Jessica is a 32-year-old single mother from St. Louis. She has experienced mental and physical health problems because of the injuries she has sustained after being hit by a drunk driver. As a result of this event, Jessica had trouble finding employment. She has never had access to health care until recently when she became eligible for Medicaid, which “has made all the difference.”
Jessica recently got a job where she works approximately 30 hours per week making minimum wage. Although she is excited to able to get back to work and help better her family, she will lose her Medicaid eligibility as soon as she starts receiving paychecks from her new job. Her job does not offer affordable health insurance; therefore, she will lose all access to the health care she needs. Jessica is a perfect example of how the Medicaid gap negatively impacts so many working class Missourians.