For uninsured, Medicaid expansion is ‘life or death’
Barbara Marzelli is soft-spoken, and at 50 years old, her gentle blue eyes are rimmed with fine lines.
But one day not too long ago, eating lunch with friends, her soft voice turned steely.
Someone had brought up public assistance: you know, money that goes to people abusing the system, not pulling their weight.
“I got very upset. Everybody had this misconception of people that need help. I said, it’s not people that are sitting on the couch not doing anything. It’s people that take care of their children, that take care of other people.
. . . You can’t just pigeonhole people who need help that they’re lazy,” she said.
“I’m one of them.”
Marzelli, who lives in Newbury, has received public health coverage for both her children since they were born. She relied on the Women, Infants and Children nutrition program when they were young.
If the state expands Medicaid to low-income adults, as it’s allowed to do under the federal Affordable Care Act, she and her husband would be able to afford health insurance for the first time in 16 years.
Medicaid is currently available in New Hampshire for children and parents in very low-income families, senior citizens and people with disabilities. The expansion would add anyone under age 65 who earns up to 138 percent of federal poverty guidelines – about $15,000 for a single adult, or about $31,000 for Marzelli’s family.
Under the health care reform law, the federal government would pay 100 percent of the cost to the states for the first three years and then gradually reduce its share to 90 percent by 2020. About 58,000 additional people would be eligible for coverage in New Hampshire, but the proposal is tied up in budget negotiations between the Republican-led Senate and the House, where Democrats are in the majority.
The Senate has called for studying the issue, and Sen. Chuck Morse of Salem, chairman of the Senate Finance Committee, said last week he doesn’t foresee a resolution before this legislative year ends June 30.
“The Senate will not support expanding Medicaid as part of the budget. This issue is far too complex to be lumped in with a hundred or so other provisions of (House Bill) 2,” he said. “We should study the issue further, as the Senate has proposed, and legislation seeking to expand the program should go through the normal legislative process as a standalone bill.”
Other Republican senators and conservative activists have said they oppose opening the state up to the liability of funding the coverage if the federal government doesn’t fulfill its promise.
Ned Helms, director of the New Hampshire Institute for Health Policy and Practice at UNH, isn’t sure what the Senate could gain from further study.
With $2.5 billion in federal funding due over seven years at an estimated $85 million state cost, “what we know is that the costs to the state of general fund dollars are nothing for all intents and purposes,” he said.
“Hopefully (legislators) will come to a point to put aside political posturing and say, ‘We’re not here to benefit ourselves, we’re here to benefit the people of our state.’ You’re talking about a lot of money that will be pouring into this economy, and if we keep the doors closed, that money will go to other states and we’ll be out of luck.”
Last week, the state also received a letter from the Centers for Medicare and Medicaid Services affirming that New Hampshire can rescind expansion at any time.
“It’s wonderful assurance to have, but the reality is . . . all the elected officials most places I know understood for some time the moment the state feels the money could dry up, they can end the program,” Helms said.
Out of reach
Marzelli grew up in Maine, in a family that encouraged her to finish high school and enroll at Colby-Sawyer College. She studied the arts and at graduation, saw a path ahead of her filled with creative endeavors.
Life took her in other directions. She worked in professional fields for years, until she was laid off, pregnant with her second child. Her husband works in construction, and life has been hard during and since the recession. One of their sons has a medical condition that requires her to have a flexible schedule, so she’s been working part time in landscape design.
The last health insurance policy she and her husband looked at came with a $1,500 monthly premium.
Sherri Harden of Goffstown can empathize. When she was looking for individual coverage after being laid off in 2007, she found one option, at more than $200 each month. That was more than she could pay, so she went without.
She took over full-time care for her dad, who suffered from dementia, and his wife, who was diagnosed with cancer, and couldn’t make time to search for a new job.
She has since remarried, and is covered under her husband’s health plan.
But “I will never forget what it feels like . . . the feeling of powerlessness, to have no determination on my own life and my own future,” she said.
“I was very, very fortunate that I didn’t have any chronic episode of illness, that I didn’t have an accident. . . . But that feeling of, what will happen to me – what will happen to my life – if I am diagnosed with a serious condition? That will never leave me. . . . I say now, I hope it was the worst time in my life.”
Marzelli lives with those same fears, she said.
“I wake up a few times a night now worrying. . . . What if something happens? What would happen if I got sick, terribly sick, or if something happened to my husband?” she said. “It’s now creeping into my sleep. It’s been like that for years, actually.”
Even in her precarious position, she bristles when she hears Medicaid described as “health insurance for the poor.”
“I don’t consider myself poor whatsoever. We don’t have everything we want; we have just the things that we need, and that’s where I find myself being very rich,” she said. “I have the roof over my head – but we could lose it. We do have food on the table. I’m happy doing without some things, but it’s the health care that’s the problem.”
She and her husband put off their health care needs until the last possible moment. Then, a cold left untreated becomes a sinus infection, and a $350 trip to the doctor for an exam and an antibiotic prescription.
The last time they went to the emergency room, the price tag was $7,500.
They’ve been deemed ineligible for charity care or debt forgiveness programs at hospitals because they have assets: They’ve built equity in their home, and own their 11-year-old cars outright.
“We’ve done all the right things, we’ve worked really hard, and now we’re expected to take loans out against that equity,” she said. “That’s where it’s scary as hell.”
Bad to worse
Travis Harker, president of the New Hampshire Medical Society, sees patients like Marzelli frequently as a physician with the Concord Family Health Center.
One is a woman with diabetes who can’t afford regular visits for monitoring. She’s also missing out on nutritional counseling and can’t afford all of the medications that could prevent her condition from getting worse.
Another is a mason with pain and numbness in one of his legs. It’s likely he has a pinched nerve, Harker said, but the patient can’t afford an MRI to find out for sure. He couldn’t afford the surgery to fix it anyway.
“He can still use his leg to do much of the work he’s doing, but my biggest fear for him is it’s going to get worse and he’ll be unable to work and end up on disability,” Harker said.
“Disability is an important program and it serves a key purpose in our society. But the problem is, people stop working. Often, you add isolation and depression to their situation. Many people, not all, who get on disability, it’s kind of a last stop and there’s really no road off that.”
That’s exactly the life Amanda Montplaisir of Manchester is trying to avoid.
At 26, she’s no longer covered by her parents’ health insurance. And with a history of addiction, she’s scared that when she leaves her rehabilitation facility soon, she won’t have the support to manage her recovery alone.
With health coverage, she’d have access to a therapist and outpatient addiction services. She’d have support to help her stick to the healthy decisions she’s made so far to become sober. Instead, she’s worried about handling life after rehab, and about what she’ll do if her wisdom teeth need to be removed.
“I really just need to have a little help during this time of my life, until I am able to take care of myself. That’s my intention. I want to be self-supported and be in a great place in my life someday,” she said.
She wants to reunite with her 5-year-old daughter. She wants to go back to college and finish the degree she started. She wants to become a social worker, and to help people the way counselors and social workers and others have helped her.
“When I was younger, I thought by now I would have a degree, have my career started, possibly be married. . . . I never imagined (Medicaid) would be something I would have to look for,” she said. “I had always strived for a normal life, but this disease doesn’t discriminate, and I just couldn’t do it on my own.
“If I knew I had health insurance, it would make all the difference in the world. . . . This is life or death. I know if I relapse again, I will most likely die.”
(Sarah Palermo can be reached at 369-3322 or firstname.lastname@example.org or on Twitter @SPalermoNews.)