First Person

Trump Voters and I Have One Thing in Common: We’re Scared of Losing Medicaid

I recently read about a county in Kentucky that is typical of the kinds of depressed white communities that have dominated the news since Trump’s election. Owsley County is 83 percent white, mostly rural, and rigidly conservative.

On the surface, I don’t have much in common with its residents. I’m a black American. I’m pro-choice, pro-LGBT rights, and a feminist. I’m a lifelong progressive. According to multiple media outlets, Owsley’s residents see my beliefs as a direct threat. But we also have deep a bond.

Poverty.

The median household income in Owsley is just $19,146 per year. The unemployment rate is double the national average, the majority of children live below the poverty line, and in 2011 more than half the county’s residents received food stamps. When Medicaid was expanded under the Affordable Care Act, a whopping 66 percent of residents became eligible. And if you ask them about it, they express deep appreciation. Again and again.

“It’s been a godsend to me,” said a school custodian who suffered from a thyroid condition that practically immobilized her. Medicaid let her get treatment—and it paid for her cataract and carpal tunnel surgery.

Another resident lamented that without Medicaid, she couldn’t pay for the doctor’s visits to keep her hyperthyroidism in check. “If anything changed to make our insurance more expensive for us that would be a big problem,” she said.

Resident after resident in news article after news article acknowledged the price they would pay if these services disappeared. But in the past two years, the residents of Owsley overwhelmingly voted for a governor, and then for a president, who want to eliminate the Affordable Care Act.

Now that the heat of the election has passed, they are anxious. And I understand why.

I’m on Medicaid—a new recipient since the expansion. I have a feeling that several thousand poor white Kentuckians—like this black American—still suffer a twitch of anxiety when they hear the words “payment is due at the time of service,” at the doctor’s office. If you are uninsured and facing a health crisis, those are the scariest words you can hear.

I remember that feeling.

We languished in fear, and said prayers instead of visiting a physician.

I used to save the change from every purchase I made. I called it “health clinic money,” and I’d collect it for weeks so I could pay for my next $50 doctor’s visit. For more than a decade, my blood pressure readings were at heart attack levels. The doctors at my clinic wanted to see me every month, but I couldn’t always afford it. So I skipped my appointments.

In 2011, I learned my high blood pressure was due to kidney cancer. I was still uninsured, so getting the treatment that could save my life entailed a maze of forms that delayed my surgery for months. I eventually got help from a program in my state called “the Indigent Health Care Fund,” but the funding was spotty before Medicaid was expanded. When I applied, I was told the program was no longer accepting new clients—which happened often, once money for the year ran out—so I didn’t know my surgery had been given the green light until three weeks before it happened.

That’s what life was like for millions of us (and what it has remained like for Americans living in the states that stubbornly refused to expand Medicaid under the ACA). We languished in fear, and said prayers instead of visiting a physician. That’s inhumane. Free or low-cost health care for those who can’t afford it is a matter of basic decency.

If you don’t believe me, ask my friends in Owsley, Kentucky.

The incoming Republican Senate, House, and the new president are determined to repeal Obamacare, and it’s still a mystery when—or if—it will be replaced. Undoing Medicaid expansion and replacing it with a fee paying system will return millions to the days of saving their change before seeking help. Preventative care (the kind that could have caught my cancer earlier) or regular monthly appointments (the kind that could protect me from a cancer recurrence) will be curtailed or gone.

Instead, the poor everywhere will see the familiar front desk sign that reads “Payment is Due at the Time of Service.” And we’ll go home.

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First Person

42 Million Americans Experience Hunger Each Year. I’m One of Them.

I wake up and sense the space heater just inches away—the only source of heat in the entire apartment. With just enough money to pay the rent, it’s a luxury if the utilities are on. My two small children roll over to watch me as I straighten out the toddler mattresses on the floor where the three of us sleep.

“Momma, I’m hungry.”

My chest tightens, a visceral reaction to these words, because I know I cannot feed them what they need.

“Okay, baby.”

I leave the bedroom, making sure to quickly close the door behind me, and I’m hit with an icy chill. Shivering from the lack of heat, I walk into the kitchen knowing exactly what I would—and would not—find there.

Pancakes it is.

While I’m preparing the last of the mix, I realize that there is only enough for one person. I split the pancakes between two little napkins while my own stomach growls ferociously. I walk back into the bedroom. The food is gone almost as soon as I hand it to them.

“I’m still hungry, Momma.”

But I already know. I tickle them in hopes that they forget the churning feeling within their little bellies. My heart breaks.

Getting them ready for the doctor is more ritualistic than the everyday grind. I’m careful to part their hair perfectly, placing the curls into well-groomed styles. Then I pull out two brand new outfits—Christmas gifts from Grandma—that I was saving for a doctor’s appointment or a food pantry visit (whichever came first). I did not qualify for the local food pantry this month, so the doctor’s visit it is. Once my children look as perfect as possible—as normal as possible—we set out in the Volkswagen my sister gifted us. The gas is just about gone.

I think about the $70 I lost by missing work that day.

It is hard to miss the luxury vehicles in the doctor’s office parking lot, or the families tossing half-eaten breakfast sandwiches and lattes into the trash. Once we’re inside I watch a woman at the front desk rummage through crisp dollar bills, searching for one small enough for her co-pay. I think about the $70 I lost by missing work that day.

I’m anxious for the visit to be quick and painless. I know that the doctor will ask questions that I would rather leave unanswered. My children move sluggishly beside me.

“Momma, I’m hungry.”

With weak arms, I lift my smallest child and hold her close while I check in at the desk. After telling the nurse my children’s names and appointment time, I hurry to find a seat—trembling from the weight of my two-year-old child.

The nurse comes to take their weights and measurements, then shows us into Examination Room Three. I change them into the office robes without messing up their hair, and fold their new outfits with precision. As the doctor approaches, I start to worry about what he would say about their progress—or lack thereof—on the growth scale. Are they underweight? Am I a bad mother because I do not have more to give?

The doctor enters the room.

He is always polite, clean, and empathetic. He cares about the children he sees daily, and wants them all to grow healthily. Yet he is ignorant to the realities that the families face—or at least, to the one that my family is facing.

“All seems great,” the doctor says. “Is everything alright at home?”

“I’m just tired and hungry.”

“Me, too! Be sure to eat breakfast next time,” he says, blithely.

As we leave to go home, I listen to the music of my dwindling gas tank. There are 69 cents on my debit card, $12 on my food stamp card, and a week left in the month. My kids have fallen asleep, and I am already thinking about what I will feed them when they wake—singing an all-too-familiar song of hunger.

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Feature

Meet the New Orleans Group Fighting to Stop Deportations

In western New Orleans, William Diaz-Castro’s work is everywhere. It’s in the sidewalks, the streets, and the campus towers; in the storm-ravaged homes resurrected from ruin. Concrete is his specialty, and during the city’s recent reconstruction, his skills were in high demand.

Diaz-Castro is one of tens of thousands of immigrants who came to New Orleans in the years following Hurricane Katrina, which damaged more than one million homes. After helping rebuild the city, this community is now being detained, prosecuted, and deported en masse.

The federal government now spends more on immigration enforcement than it does on all other law enforcement agencies combined. In addition to funding deportation efforts, this includes more than $2 billion to lock up immigrants in federal detention centers. Immigration and Customs Enforcement (ICE) detains hundreds of thousands of people each year, in part because a little-known congressional directive known as the bed mandate requires ICE to keep a minimum of 34,000 “beds” per day.

In 2012, ICE targeted Diaz-Castro as he was leaving for work. He and his friend were trying to jumpstart his car in the parking lot of his apartment complex when eight armed ICE officers surrounded them. Upon discovering that he was undocumented, ICE promptly arrested and deported him.

This was during the early days of the Criminal Alien Removal Initiative, or CARI, an aggressive ICE pilot program that resembled stop-and-frisk policing. According to ICE, the program was supposed to focus on undocumented immigrants with criminal records who posed a risk to community safety. But according to Fernando Lopez, a lead organizer for the Congreso de Jornaleros (Congress of Day Laborers), an organizing and advocacy group in Louisiana, that’s not how it worked in practice. Lopez says that the result of the program was “totally racial profiling,” and that whenever ICE would see two or three Latino people, “they would just surround them with their guns drawn.” These raids happened all throughout the Latino community—in laundromats, bible study, at a Latino market in the suburbs.

Diaz-Castro and his partner, Linda Guzman, were expecting when he was deported in 2012. He knew that without his support, his partner would struggle to provide for their newborn son. “I couldn’t abandon them,” he says. So he came back, just in time for their son Willie’s birth.

After a few years of relative peace, on March 22, a team of ICE officers swarmed Diaz-Castro’s apartment without a warrant. Three-year-old Willie watched as the officers interrogated his father, handcuffed him, and took him away.

Diaz-Castro’s absence has been hard on his family. Guzman makes $8 per hour in her job at a laundromat—not nearly enough to pay for rent, utilities, food, and a babysitter for Willie. Without Diaz-Castro’s wages to help, Guzman could no longer afford rent, so she—and Willie—became homeless.

***

My only crime is to be an immigrant.

In 2014, President Barack Obama announced his resolve to fix our immigration system. He put forth a plan to grant deferred action to undocumented parents, and he expanded the existing Deferred Action for Childhood Arrivals program. He also vowed to focus on “actual threats to our security,” and promised to punish “felons, not families.” But these words have been little comfort for Diaz-Castro, who’s never even had a speeding ticket, let alone committed a violent offense. As he puts it, “My only crime is to be an immigrant.”

After his arrest in March, Diaz-Castro spent a month in one of ICE’s privately-owned detention centers. Since he had no prior criminal record, he didn’t qualify as a priority for deportation, so ICE referred his case to the U.S. Attorney’s Office and transferred him to federal prison. When he was finally charged with illegal entry 6 months later, he’d already served his entire sentence. He was released from prison, but ICE didn’t let him go free—instead, they transferred him back to detention, using his entry charge as a new justification for deportation.

***

Diaz-Castro has been an active member of the Congreso de Jornaleros since 2013, and they’ve been providing legal support throughout his case. In addition to direct legal support, the group also conducts large-scale grassroots organizing and direct action. They were instrumental in stopping the CARI raids: They ran an escalation campaign that included a large protest at ICE headquarters in which dozens of Congreso members chose to get arrested, risking deportation to draw attention to the brutality of the raids.

It’s partly through Congreso’s help that Diaz-Castro got his charges reduced from felony re-entry to misdemeanor entry. After ICE transferred him from federal prison back to immigration detention, Congreso urged ICE to exercise prosecutorial discretion and release him, arguing that he didn’t meet any of the criteria ICE uses to prioritize people for deportation. ICE relented, and on December 20, they released him.

Under President Trump, demand for groups like Congreso will likely increase. Trump has promised to end sanctuary cities, triple the number of ICE agents, and deport “criminal aliens” on day one of his presidency. Lopez says they must fight against the normalization of racism, hate, and bigotry that will accompany a Trump presidency. To do this, Congreso is mobilizing more people than it has in the past, including people who aren’t as directly affected. “Allies need to step up,” he insists.

Lopez says they’re recruiting people to join a larger movement that’s “not just about immigrants.” It’s a movement that’s broadly anti-hate, anti-racism, anti-family separation; a movement that includes hundreds of groups like Congreso that have been fighting—and winning—local battles against injustice.

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Feature

Conservatives Want to Cut Medicaid. If They Were Serious About Creating Jobs, They’d Expand It.

Sepia Coleman says she’s crazy about her job.

“I love people,” she said. “It’s like a gift, a passion.”

Coleman is a home care aide in Tennessee, helping older and disabled people with daily tasks like bathing and cooking in their own homes. Over the 20 years she’s been on the job, she’s learned about golf by taking a client out to play, gone dancing with another, and listened to others talk about their travels around the world. She takes special pride in helping the men and women she cares for stay in charge of their own lives.

“I come into their homes [and] let them know I’m just there to help them,” she said. “I still respect them, that they have independence and are able to function.”

For all the talk about factory jobs Donald Trump spurred with his rhetoric on trade, one of the clearest ways to improve American jobs has nothing to do with manufacturing. Demand for jobs like Coleman’s—in-home care aides and other direct care workers—is growing fast as the U.S. population ages.

The Bureau of Labor Statistics predicts that the number of personal care aides, who provide non-medical home care, will grow by 458,000 between 2014 and 2024—the most of any single profession. It projects another 348,000 new jobs for home health aides, who do similar work with a greater focus on medical care like checking vital signs and administering medications.

Despite the increase in demand, these jobs are also some of the worst paid in the country: the median annual wage is under $22,000.

These jobs are some of the worst paid in the country.

Coleman currently makes $8.25 an hour, and the hours she gets can change dramatically from month to month as clients cycle in and out of home care. She doesn’t get paid time off, so she has been putting off surgery for painful uterine fibroids. Her car needs work that she can’t afford, and she’s been paying her rent in installments as her paychecks come in. Lately she’s been particularly low on hours, so she often eats only one meal a day.

“I’ve trained my body to do that,” she said. “I’ve been doing this for a while, so I kind of know my ups and downs.”

The new administration’s plans are unlikely to improve working conditions. Eighty-three percent of home care funding, and 64 percent of health care spending overall, comes from government sources like Medicaid and Medicare. Instead of bolstering the programs so that direct care jobs can pay higher wages, Congress is poised to roll back the Medicaid expansion that has extended coverage to about 10 million people. Tom Price, Trump’s pick for Secretary of Health and Human Services, has also signaled that he’ll push to privatize Medicare benefits. And House Speaker Paul Ryan and Tom Price have both promised to convert Medicaid into block grants for states, which would slow the program’s growth and prevent it from automatically expanding to meet increased need during economic downturns.

This would all add up to less money for care workers—whether it’s funding for new jobs, or to make existing jobs pay better. That’s a burden on the workers themselves, and a danger to the people they care for. During economic boom years, nursing homes sometimes can’t pay competitive wages and end up understaffed. As a result, more of the facilities’ residents end up dying when the economy is strong.

Trump, Ryan, and many others say that we need to spur private-sector hiring and keep government spending down. But industries that create profitable products, from air conditioners to financial derivatives, are increasingly funneling money to the wealthy while employing fewer workers. Meanwhile, the human labor jobs where we are beginning to face shortages, in sectors like education and direct care, don’t lend themselves to for-profit enterprises.

An economic policy designed to work for workers would shape the economy so that the work we really need gets done at a fair wage. That means listening to people like Sepia Coleman, who see their own needs and their clients’ as inseparable. Coleman said she wants to be a professional, unionized worker with the leverage to speak up for her clients and make sure they’re getting the resources they need. She also needs to be able to take a day off when she’s sick and pay her bills on time.

“I deserve to live, not struggle,” she said. “Nobody deserves to struggle every single day.”

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Analysis

The Obama Legacy: Protecting Consumers From Big Banks, Payday Lenders, and Debt Collectors

President Obama’s work on behalf of consumers is a central part of his legacy. When he took office eight years ago, our country was in the midst of the worst financial crisis in generations—a crisis Wall Street built by cheating consumers. Working with Democrats in Congress, President Obama took several important steps to make our financial system safer and to stop the kinds of consumer abuses that paved the way for the crisis. None of those changes was bigger than the establishment of the Consumer Financial Protection Bureau (CFPB).

It was a tough fight to get the CFPB passed into law. As Congress considered whether to create a new consumer agency, the big banks spent more than a million dollars a day lobbying against financial reform. But a grassroots network of people and organizations came together and fought back, and the Obama Administration stood firmly in support of a strong, independent consumer agency. Now, consumers across the country know there’s an agency in Washington that has their back.

In the five and a half years since the CFPB has opened its doors, the agency has consistently delivered for working families across the country. It has returned nearly $12 billion directly to families who were tricked by big banks, payday lenders, debt collectors, and other financial institutions. It has acted aggressively to protect service members and their families from illegal foreclosures and other predatory actions. It has fielded more than one million consumer complaints, helping thousands of people in every state quickly and easily resolve disputes and recover unauthorized fees. And it has cracked down on banks that are ripping off their customers—culminating in the agency’s recent settlement and record fine in the Wells Fargo fake accounts scandal.

The consumer agency also plays a critical role leveling the playing field for working families by implementing new rules for financial products. One notable example is with payday lending.

Payday loans are an enormous problem for families and communities across our country. Too often, people obtain these loans to cover things like care for a sick child or a broken car, but then find themselves trapped in a cycle of debt. Americans now spend over $7 billion each year in fees on payday loans, which can have interest rates of 200, 300, or even 400%. And as the CFPB has noted, there are more payday loan storefronts in America than there are McDonald’s restaurants—and that doesn’t even count all the payday lenders that exist exclusively online.

While access to credit is important, too many payday lenders have built their business models around trapping families with debts they can’t ever hope to repay. It’s like throwing bricks to a drowning man. The industry targets communities of color, contributing to the massive wealth disparity between these communities and white communities. Billions of dollars are moving from those who can least afford it directly into the pockets of lenders.

Cracking down on these kinds of payday lenders is one way to give families living in poverty a fighting chance—and that’s exactly what the CFPB is doing. When the agency set out to design a new payday loan rule, it did some of the most extensive research anyone has ever conducted on payday loans. The agency’s data revealed that most people who take out payday loans aren’t able to pay them back by the time they get their next paycheck. Because of that, over 80% of payday loans are renewed after less than two weeks.

The proposed CFPB payday rule is an important step in the right direction. It provides better protections for borrowers—including requiring lenders to assess if a borrower is able to repay the loan—and limits the number of consecutive loans. These restrictions will help ensure that working families can still access payday lending if needed, but the loans will be structured to provide more financial security, not less.

The fight to protect consumers isn’t over—it’s really just beginning.

Despite the work the CFPB has done, the fight to protect consumers isn’t over—it’s really just beginning. All the important work the CFPB does—helping defrauded families, cracking down on the most predatory and abusive practices, bringing more transparency and competition to the market—is at risk if the incoming Trump Administration and congressional Republicans have their way. For years, the big banks and their allies have launched one shameless attack after another trying to gut the CFPB. Recently, just days after the CFPB’s settlement with Wells Fargo for cheating consumers was announced, both House and Senate Republicans advanced bills to weaken the agency. It’s up to all of us to fight back against these efforts and protect an agency that’s put billions of dollars back in the pockets of working families.

Wall Street may not like that the CFPB is standing up for consumers and holding big banks accountable—but the American people do. As a new president takes office, it’s critical that everyone who supports a strong consumer agency continues fighting to protect it and to ensure it can build on its record of success during the Obama Administration.

Editor’s note: TalkPoverty presents this series in collaboration with the Georgetown Center on Poverty and Inequality.

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