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00000173-d94c-dc06-a17f-ddddb4b10000By Wilson Sayre and Daniel ChangThousands of South Floridians too poor to afford health insurance on their own end up in what is called the "coverage gap." They earn too little to get help buying health insurance under Obamacare, but they don’t qualify for Medicaid.WLRN and the Miami Herald look at what life is like in the coverage gap through the experience of Miami resident Cynthia Louis. Reporters explore how being uninsured affects your life, your health, and your wallet.Need to find low-cost care? The Miami Herald developed a low-cost health care finder. Find help at hrld.us/findcare.

Selling Eggs For Medicine: Tradeoffs People In The Gap Make For Health Care

Wilson Sayre

 This is the third part in our series, Falling Into The Gap, in collaboration with the Miami Herald. Read more about the coverage gap and find affordable care on WLRN.org/healthgap.

Every Tuesday, a giant blue bus parks in front of the Pentecostal Tabernacle Church in Miami Gardens. Inside looks like a doctor’s office with a reclining exam chair and anatomical charts. You only know that it’s not a traditional office when it shakes as people get on and off.

Cynthia Louis comes to this free mobile health clinic about twice a month to work with Doctor Fred Anderson and various medical students on mitigating the constant aching in her joints.

Louis is one of the 850,000 Floridians in the health care “coverage gap”—she earns too little to get help buying health insurance under the Affordable Care Act but doesn’t qualify for Medicaid.

Without Medicaid

Over the past two years, Dr. Anderson has seen Louis try to piece together health care for herself without insurance.

Credit Peter Andrew Bosch / Miami Herald Staff
Miami Herald Staff
Dr. Fred Anderson has worked for Florida International University’s Mobile Health Clinic for about two years. Most of the patients he sees are uninsured.

“Her case is a very telling case study of how so many of our individuals who are taxpaying, contributing members of our society [are] continuing to fall through the cracks,” says Anderson, “and despite our best efforts they are not getting the best care that they really deserve.”

Anderson runs Florida International University’s three mobile health clinics, which pairs FIU medical students with a low-income family for the duration of their time at the school.

When Louis can’t afford the $25 dollar co-pay to see her primary care doctor at Jessie Trice Community Health Center, she comes here to the Neighborhood HELP program. Through this program, she also gets mental health counseling, legal advice and social services.

While the program is free, Louis has to open her life to all kinds of case managers, counselors and doctors.

And at first, she says that bothered her, “but then I saw them trying to help me. [Because] I don't know a lot of people, I don’t know a lot of things [and] they helped me.”

Credit Wilson Sayre / WLRN
Florida International University runs three mobile health clinics through its Neighborhood HELP Program.

For someone who’s uninsured, Louis has put together what you could consider Cadillac care.

She is in the charity care program though the county’s public hospital, Jackson Health System, which gives her deeply discounted services. When she can’t scrape together the co-payments, she has the free clinic through FIU. Also she uses coupons for medications and she’s a persistent advocate for her care.

Even all that, though, does not afford her the same level of care Medicaid would.

“I do not feel satisfied with how we've been able to really get her on her feet,” says Anderson, “because ultimately even if we do ask her to get additional x-rays she certainly can't afford them, she certainly just tells us that, 'look I can't do it this month, maybe next month.'”

When the pain started, Louis had to quit her job at Burger King and now she doesn’t work.

With no income, she has to pay $40 for X-rays, $33 for the dentist and a few dollars for each medication, of which she’s on at least nine. That puts a big strain on her finances.

Care Or No Care?

Louis now spends a lot of her time with her 78-year-old mother, Cassie Stuckey, who has a heart condition.

“She can’t do what she want to do, she can’t work, she can’t clean the house, she ain't able to do nothing for herself no more,” says Stuckey. “That’s a knock to your knees.”

This particular Monday afternoon, Louis and Stuckey sit at the kitchen table and peel eggs, about two dozen in a giant pot. Later, they’ll sell these to kids coming back from school for 25-cents apiece. Money will be used to pay for medications.

For her and so many other Floridians, it’s not just about the quality of health care. It’s about whether or not to get health care at all.  Deciding whether to spend the money they do have to get X-rays, medications, or see a doctor.

“I don’t like asking nobody for no money,” she says, “because I know they got their own problem. And I just do without.”

Louis has still not gotten the X-rays her doctor asked her to get over a month ago, but she’s saving up for an appointment with a rheumatologist in July.

WLRN is a part of Health News Florida, which receives support from the Corporation for Public Broadcasting.

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