True Medicaid stories

Posted in NEWS by Joel Gillespie on Friday, July 29, 2011 at 7:59 am

With all the talk about Medicaid lately, it seemed like the time was ripe to get some first-hand accounts from people who have made use of public health services. Two couples and one individual who had benefited from Medicaid coverage during pregnancy were willing to relate their experiences:

• Bill and Sarah had a child in late 2010, and they received Medicaid benefits during Sarah's pregnancy and the delivery; Bill was working part-time, but has since moved to a full-time job with benefits
• Joe and Rachel had two children, in 2004 and 2007, for which they received Medicaid assistance while Rachel was in medical school; she had begun her residency two weeks before the second child was born, and is now an OB/GYN
• Karan had two children, the first when she was 16, and received Medicaid benefits during both pregnancies; she eventually got her Master's degree and adopted two additional children

All three received basic medical benefits during pregnancy without co-pays, but the additional assistance that each received varied. Bill and Sarah received WIC assistance until Bill began working full-time; Joe and Rachel's benefits were limited to medical insurance; Karan received a variety of public assistance while she was a student. Thank you to each of them for sharing their stories.

FINANCIAL SITUATION AT THE TIME

Joe: With our first son, he was actually a surprise, we weren't planning on having a kid at the time. I was working as a substitute teacher right after college, and [Rachel] was a medical student. She got pregnant, and we basically at that point didn't know what to do to pay to have the baby, because we had to pay for our own health insurance with her in school, and as a substitute teacher I didn't have insurance.

Sarah: We did have a major medical plan, but it didn't have any maternity coverage. Because if we would have gotten maternity coverage on me, our premiums would have doubled what they were, so we went with the most basic, cheapest plan that we could get, which was major medical with a $5,000 deductible. So actually, nothing probably would have been covered.

Bill: I was part-time making $15.50 an hour with no benefits.

Sarah: And I was subbing, but our total income was pretty low, I guess. I think I made $80 a day.

Karan: I had Medicaid during two separate pregnancies. I was 16 years old during my first pregnancy and was covered by my mother's insurance as primary. I was employed part time and a full time high school student. During my second pregnancy I was employed full time working at a family owned convenient store/gas station, [and] insurance was not an option.

BECOMING AWARE OF MEDICAID BENEFITS

Joe: We found out through some other people at the school, other students that had families, about the assistance that we could get through the state of Missouri.

Sarah: We had gone to the Health Department to have a pregnancy test done. I took a home pregnancy test and it came back positive, so our next step was to go to the Health Department and have them do a pregnancy test to confirm before I went to see a doctor or anything like that. At the Health Department, after they did the pregnancy test, I think they just asked us if we wanted to apply for the medical card and some other programs that they had. So, we applied there that day."

Karan: My mother worked in the social work field and was aware of resources available. She initially assisted me with the application process, interviews, etc.

OPTIONS WERE IT NOT FOR MEDICAID

Joe: Really at that time in our life, with her being a student and me making no money, we had no other options. What [Medicaid] did was, it allowed us to continue; if not for that, I don't know how Rachel would have continued in medical school.

Bill: We would have just had to go into debt, probably.

Sarah: Before we knew we were eligible for the Medicaid, I feel like there were a few insurance companies that will take you after you're pregnant and issue maternity coverage. But that's also very expensive; your monthly premiums are really expensive. If this wasn't available, it would be tempting to not have any medical treatment during your pregnancy, because it's expensive. So, I would say that's a reason that I'm really thankful it's there

Karan: [I had] no other options available.  I would have likely used other social services (i.e. women's clinic/planned parenthood) or the ER for "prenatal care."

THOUGHTS ON CARE IN THE PROGRAM

Sarah: I guess the other thing related to this that I would say is that in general, we're really conservative when it comes to health care - conservative in what kind of treatment we do. If we can get by without taking medicine, then we don't take medicine. If we can get by without doing extra bloodwork, doing extra sonograms during a pregnancy - if we can get by without it, we don't do it. We just do the basic things, like regular doctor checkups. There we a lot of extra tests that we could have done to check the baby for Down's Syndrome, and developmental disabilities that the baby might have had, and I assume that those kinds of things would have been covered by the medical card as well, but we opted not to do it.

Bill: It was one of those questions where if I was paying for this, would I choose to do it? Probably not, so why would I just do it because someone's willing to pay for it.

Karan: Probably the most frustrating aspect of this was the difficulty in obtaining preventative and non-emergency medical care for myself and my children. Many doctors refused Medicaid, and those who would accept it were often too booked to fit in a sick appointment and would recommend going to the ER.  Not only was this frustrating in that I knew it would take several hours to be seen and that I would be exposing myself and/or children to significant illness/trauma, but I also know this is so much more costly than a dr. visit.

Joe: The cool thing is that Rachel's an OB/GYN now, and she accepts public aid patients. That's an important thing for her, because it was an important thing for us. We all benefit from people not having to go into huge debt to do these things because when you can't pay for health care, it can end up destroying your family life

THOUGHTS ON RECEIVING BENEFITS

Joe: At the time, I had some reservations, because there's a stigma attached to taking assistance, be it food stamps or whatever. Whether you want to rationalize it by saying, 'Well, I actually pay enough in that it'll work out,' or what. Regardless, I think that society as a whole benefits when everyone has better health.

Bill: I'm very thankful that we don't have to worry about this big loan or whatever we would have had to take out, and in a way, if taxes went into programs like this that people benefit from daily, if they went into medical and educational programs that benefit all of society, that would make a lot of sense. It's hard for me to understand arguments against that.

Sarah: I would say we're in favor of state health care, overall.

Karan: I relied on some form of public assistance (i.e. food stamps, tanf, medicaid, child care vouchers, subsidized housing, WIC, MAP/PELL Grant, Work study) in order to make ends meet from the time I was 16 until I graduated from college at 24. The most anxiety-provoking aspect of it was re-determination and potentially losing benefits. I was able to go to college with assistance of child care vouchers and work study. In order to be maintain eligibility for vouchers I had to maintain employment/student status. In order to maintain employment and attend classes I had to have child care. There were frequent occasions in which I was "rejected" for one thing or another and had to resubmit/reapply/request an appeal. During those times I was at risk of losing everything I was working for.

CLOSING THOUGHTS

Karan: Don't mistake my complaints for condemnation. The system is flawed, but necessary and beneficial. Without the assistance I never would have graduated high school, let alone college.

Bill: It's close to $500 a month now that comes out of my paycheck now for FICA and privatized insurance. I think I was paying FICA before we had a baby, and I'll probably pay it for the rest of my life, but if that's what universal coverage looks like, then that's pretty great. I'm a little unsure why we're paying the privatized portion if it ultimately means that we pay another party, and then with our new insurance, we have co-pays and other things, too. It seems like we're all paying a lot for health care coverage, and having the system divided out the way it is, is the only thing that doesn't make much sense to me. If you're sick or elderly or poor, then you're going to be covered by the state. If you're healthy and young and rich, then insurance companies would like to take your money and insure you.

Joe: Sometimes you'll see where someone gets cancer and they lose their insurance, and you look around, and their neighbors will band together and do fundraisers. I think as Americans, we're very prone to doing those things for our neighbors -- we love to help each other out. I think that sometimes with health care, we don't have that mentality. But we really do want to help out the people that we are close to and our neighbors, but for some reason there's a disconnect when it comes to extending that assistance to people that we might not know personally.