Living in the health care ‘gap’ in Summit County
July 14, 2015
Dawn S. is a 56-year-old who lives on the East Side of Summit County. She lives with her youngest son who will enter his senior year of high school this fall. She’s one of approximately 62,000 Utahns in the health care coverage "gap" that exists while Utah decides whether to accept federal funds to expand its existing Medicaid program.
Foregoing health care
The last time Dawn had health care insurance was in 2012, when she was married to an active-duty member of the Air Force. Then, they got divorced.
"My ex-husband was supposed to keep me on Tricare through COBRA for six months and he didn’t. He let it lapse and I had cancer and I had to have surgery and I thought I had the insurance to cover it. We found out afterwards that no, he hadn’t paid the premium for the coverage to last.
"I have skin cancer on my left eye," she said. "They did surgery and removed it, but that was a major hospital bill that I’m still trying to get paid off. I think I probably still owe around $3,000."
Dawn said she’s been disabled since 2006 (she has a history of pulmonary embolisms, back problems, balance problems and esophageal gastritis, among other things), but has not yet been successful in obtaining Medicaid disability coverage.
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"I’ve got about 21 different health conditions going on," Dawn said, and she hasn’t been getting treatment.
"Somebody finally told me to go to Maliheh Free Clinic in Salt Lake (around 70 miles from her home). So I’ve been over to them twice now. That one is based on income so I qualify. But it doesn’t cover prescriptions," she said.
Among the prescriptions she can’t afford are an ointment for her skin cancer and medication for migraines, which Dawn said costs $10 per pill.
"There’s a big list," she said of the medications she should be taking. "The doctor last month wrote me four prescriptions and I can’t afford them. I’m going to have to wait to figure out if I can budget those."
Dawn is hoping to have a job that will bring in some income soon, but that’s another area with health care issues.
"I was hired in October by Utah Advocacy Network to help start an intermediate care facility for intellectually disabled adults," she said. "A long time ago I had started a nonprofit organization and I worked for a couple other group homes when I was younger."
But, she said, the new job has been slow getting off the ground because "we’re having a couple changes with the management."
"I’m not sure with that how much we’ll be making, but it’s not going to be very much," she said. "It depends on what the Medicaid and Medicare will pay for our residents to be there."
Dawn is "not really thrilled" with the Affordable Care Act, because ‘it’s geared for people in the middle class" and hasn’t addressed the poor.
She said that the poor in rural areas like the East Side of Summit County have obstacles others don’t.
"One of my biggest complaints is that not everybody lives on the Wasatch Front," she said. "A lot of times when they’re calculating your cost-of-living expenses, they don’t consider this little law that requires you to have car insurance."
"You don’t have public transportation, you can’t walk to town, you can’t walk to a job, you can’t always find someone to carpool with, there isn’t always bus service available," she said. "And not everyone can just up and move to the city."
Food stamps aren’t everything
As with Medicaid, there are often negative stereotypes associated with the use of food stamps — a federal program Dawn uses to feed herself and her son.
"I remember the first time I had to go on food stamps. I had my older kids home and they were little, it was after a different marriage, and I remember first off being really embarrassed about having to use food stamps," Dawn said. "But on the other hand, I was thankful for them. It certainly beats starving to death."
Dawn said there are criticisms she hears that are off-base.
"I didn’t have a car and so my mother would let me use her car to go grocery shopping. And so when I hear somebody say ‘Oh you see someone paying for their food with food stamps but then they’re going and getting in this car.’ Well is that their car or is that a family member’s car or is that a friend’s car? Or did somebody give them a ride?
"There’s a lot of misperceptions, I think," she said. "People aren’t on drugs, can’t afford them."
The foods that can be purchased with food stamps are another point of public and political controversy. It’s another case, Dawn said, where people jump to conclusions.
"I know they’ve been talking about banning certain meats, banning the purchase of a steak with food stamps. So what do you do if you have somebody who’s on food stamps and they’re really anemic and their doctors tell them ‘You need to get a steak and eat it, because you need to get your [red blood cell] count up?"
Dawn said she and her son receive about $139 a month, combined, in stamps. The cheapest meals she’s found are $1 TV dinners.
"I buy between 60 and 62 TV dinners when we get our food stamps — those are our meals for the month. That’s breakfast lunch and dinner, and then sometimes we’ll buy some cereal or something," she said.
"Let’s put our elected officials on a $6 a day budget for their food for the day. I think they’d be changing their mind about ‘Is this really enough to live on?’"
Utah taking its time
Utah is one of 21 states that has yet to accept the Affordable Care Act funds that are intended for it to expand its Medicaid program to provide health care to low-income Utahns. The Utah Legislature is ideologically opposed to Medicaid, a federal program, so Gov. Gary Herbert last year proposed an alternative plan, called Healthy Utah, that would use the earmarked Medicaid funds for a private-insurance program. That proposal died in the legislature and a committee of six lawmakers was formed to come up with some sort of alternative plan by later this summer, when a special session of the legislature would be called to vote on the plan.
There has been no indication that the "Gang of Six" has made significant progress on such a plan, and the next attempt to deal with the problem may not be until 2016.
"The people who would qualify are single mothers, they are low-income adults, they are families with children. Two out of every three of them are employed, many working more than one job to make ends meet. Of the other third, many are the medically frail, who have conditions that make it impossible for them to work. They are our neighbors, our friends and our family members," Herbert said when he pitched his Healthy Utah plan last year.
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