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.
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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.
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.