Right now, almost a million people in Florida don’t qualify for Medicaid because they make too much money or don’t have any dependents. But they also make too little money to get help buying health insurance through the Affordable Care Act. The resulting space between the two programs is often called the Medicaid coverage gap.
Last year, we brought you the story of one woman in this gap and her struggle to get a diagnosis for debilitating joint pain. And this month she finally got an answer, though the fight over Medicaid expansion continues.
For Cynthia Louis, the sterile off-white of waiting rooms has become increasingly familiar. Over the past two and a half years she’s been to dozens of doctors appointments: check-ups, x-rays, tests. Most times she manages to scrape together the deductible, which can be anywhere from free to $40.
“I had to borrow money to come here today,” Louis says as she hands over two crisp $20 bills to the receptionist.
Because she’s in the Medicaid coverage gap, she gets her healthcare through what’s called charity care. She has had no income since she quit her job two and a half years ago.
But all those doctors appointments and borrowing money has led up to this one appointment at Jackson Memorial Hospital where a rheumatologist, Dr. Mark Jaffe, is supposed to give Cynthia her diagnosis.
“You ever wanted something so bad and then you get it and you be excited about it?” Louis asks, almost giddy before the appointment. “This is my last straw to know what’s going on.”
A few minutes later, after a nurse asks basic medical questions, Dr. Jaffe pulls up an x-ray of her knees and pronounces she has osteoarthritis, a wearing down of the cartilage in the joints.
There is no cure.
“If you get a quick, terrible problem, like a stuck shoulder, you can use injection therapy: get a cortisone shot like a baseball pitcher,” Jaffe explains to Louis. “If you need a pain pill, the easiest one is Tylenol.”
Cynthia Louis waited two and a half years to find out there’s no fix.
“[It’s] not what I was expecting to hear,” says Louis. “Hopefully that’s what’s going on, I pray to God. But, [I’m] not satisfied.”
And a lot of her frustration is that it took so long to find this out.
“If you’re insured, it opens up more options for you,” says Annie Neasman, president and CEO of the Jessie Trice Community Center, where Cynthia Louis goes for primary care. “There can be a delay in care for those who do not have insurance.”
For people like Cynthia, if you need to see certain specialists, like a rheumatologist, Jackson Memorial Hospital is often the only choice. And with the large numbers of uninsured in Miami-Dade County, that can mean long wait times.
And now Florida is facing a significant cut to the money it gets to provide these kind of charity care services.
In the 2014 fiscal year the federal government capped the amount for charity care at $2 billion. This year it’s about $1 billion, and now the state is looking at $600 million for the next fiscal year.
The Affordable Care Act was designed so that many of the uninsured would get their health insurance under expanded Medicaid programs and fewer people would need charity care.
Neasman says the center hasn’t felt a crunch yet, but “we always look at what will happen if certain dollars are cut."
The news of less federal money and calls for Medicaid expansion prompted fierce debate during last year’s legislative session in Tallahassee. That debate caused an abrupt end to the session, and an unprecedented number of special sessions were added on.
But in the end nothing changed and many political experts say they don’t see much changing this year either.
“The Medicaid expansion situation is reflecting… when Medicaid was first passed in 1965,” says Steven Ullman, chair of the Department of Health Sector Management and Policy at the University of Miami. “Initially about the same number of states that we currently are seeing not expanding Medicaid program are about the same number of states that did not adopt Medicaid in the first place back in 1966.
He says eventually all states did adopt Medicaid, or a similar program, but it took more than a decade for that to happen.
But waiting that long won’t help people like Cynthia Louis, who are dealing with their medical issues now.
She is in the process of figuring out what her diagnosis means for her life and how she might have to change her long-term goals; she really wanted to go back to work eventually.
She does want a second opinion, though. And she probably won’t get one, at least not any time soon.
“Without insurance, I just have to deal with what’s going on now and see how it work out in six months,” says Louis. “[I’ll] see how I’m feeling in six months or if it gets [worse].”
She says that since the diagnosis she has tried to work a bit at a concession stand, but she was in pain for days afterwards.
