When you can't access health insurance, small aches you're forced to ignore become emergencies
Here, one contributor reminds us that we need affordable access to health insurance for more than just emergencies.
When I moved out of my parents’ house at 18 years old, a lot changed. I was saying goodbye to my four younger siblings, finally buying a cell phone, and beginning college in Boston. But there was another change I hadn’t anticipated: I would no longer be covered by my parents’ Medicaid-funded health insurance.
We’d moved from Massachusetts to South Carolina several years before I left for college, and my parents — who had always struggled financially — failed to find jobs that provided health insurance for our large family. Thankfully, my mother was always on top of her game and quickly signed us up for insurance through Medicaid. It was difficult to find doctors who accepted our government-subsidized insurance, but we still saw our pediatricians, optometrists, and dentists as regularly as we did when we had a corporate-funded, widely-accepted plan.
Because my family was so poor, it was understood that, once I moved out, I would become financially independent.
I would no longer be a resident of South Carolina, and my parents would no longer claim me as a dependent. I had to fend for myself.
When I returned to my home state for college, I quickly signed up for MassHealth, the Bay State flavor of Medicaid. It was difficult to navigate the forms, but I did my best. Soon, I was covered, which put my mind at ease.
But while it was easy enough to sign up, maintaining coverage turned out to be a much greater challenge. The Medicaid program was full of red tape, annual forms, incoherent paper correspondences about the status of my coverage, and 1-800 phone numbers with lengthy wait times.
In other words, I was dealing with a convoluted and thick bureaucracy — something that poor folks are often forced to navigate.
While in college, I lost health insurance coverage twice.
More often, I was entirely unsure of how to access my coverage because I’d frequently receive letters that contradicted themselves — but I lacked the time required to wait for a customer service agent to take my call. I bounced between MassHealth and Commonwealth Care (the state-subsidized health connector program that served as a model for Obamacare) and the eligibility for each varied depending on age and income. It seemed that, as soon as I felt secure with one insurance program, I was bounced back to its sister program.
I never really knew where I stood, or for how long I would stand there.
Whenever I received notice that my coverage was ending, my mind zeroed in on every ache or pain I had been neglecting because I was too busy with classes, extracurriculars, and work. I stocked up on hydrogen peroxide and drank a lot more water; I was meticulously careful when slicing vegetables or crossing the street.
Preventative care became an obsession because I lived in fear of ER bills that I knew I couldn’t afford.
My parents couldn’t have helped me pay those kinds of bills either, since they too barely made ends meet.
Then, in my second year of college, I woke up one morning feeling like had a ping pong ball stuck to my cheek. I cried as I Googled my symptoms.
I’d felt some discomfort in my gums for a few days, especially towards the back of my mouth, but I hadn’t worried about it. That morning, though, I woke up unable to chew or even open my mouth.
It was a medical catastrophe that struck overnight.
The internet (aka the Primary Care Physician of the uninsured) told me that I had almost definitely developed an infection — probably because something got jammed around my incoming wisdom tooth.
I tried every homeopathic remedy I could find. I chewed chamomile tea bags, I rinsed with salt, I drank an ill-advised mixture of baking soda and water. I even stopped by a health food store and purchased some nondescript pills for “mouth pain.” Nothing worked.
I was already missing shifts at the bookstore where I worked, since my malady made it impossible for me to to interact with customers. Backed into a corner, I started researching prices for dental care.
I felt foolish, calling around for appointment quotes. That was something people did when they wanted their car painted or their couches steamed — not when they needed antibiotics. I was ashamed of myself each time the receptionist on the other line shuffled through paperwork to locate their rates, invariably speaking to me with thinly-veiled skepticism.
I eventually made an appointment at a seedy, inexpensive dentist’s office. It was the cheapest one I could find.
I stared at the ceiling while the doctor made “tsk-tsk” sounds, prodding my swollen cheeks apart to better see into my mouth. It hurt so badly to open my mouth even a half-inch; I thought I was going to cry from a combination of shame and physical pain.
“You’re going to need to get these out,” he said.
“I can’t,” I said, barely annunciating.
“This is going to keep happening. Your wisdom teeth have got to go,” he said, again.
He raised an eyebrow and sighed. He told me he would write me prescriptions for antibiotics and painkillers, which I balked at.
“I won’t even take the painkillers,” I said, knowing full well that, even if I wanted them, there was no way I could pay for two prescriptions out of pocket.
“Fine,” he said. “You don’t have to fill it.”
I looked at the ground as I left his office, my shame eclipsing the pain of my swollen mouth.
I knew that it wasn’t entirely my fault that had I lost my coverage, but I felt like I embodied the worst stereotypes associated with someone in my class. I felt irresponsible, lazy, stupid. I felt like I had failed to take care of myself and that I was paying the price for it.
Without health insurance, the seemingly innocuous can empty your bank account. Colds turn into sinus infections or pneumonia, a day at the beach turns into a UTI.
When you don’t have access to affordable health care, you find yourself suddenly playing an all-or-nothing game of chance.
Is that mild feeling of discomfort going to fade away overnight, or are you going to wake up with a walnut-sized infection inside your mouth?
When we discuss socialized health care, we often speak about terminal illness, and rightfully so.
Several years ago, my aunt was diagnosed with cancer. Initially, no one knew how she would afford treatment. My uncle is self-employed and, in the midst of taking care of their adopted grandchildren, my aunt went without comprehensive coverage. Thanks solely to the Affordable Care Act (ACA), my aunt was able to find coverage even after her diagnosis — something that may not have been possible a decade ago.
As of now, she is several years in remission. She frequently says that, if it weren’t for President Obama, she probably wouldn’t be alive. She lives in fear of having that health care access stripped away by a vengeful Congress.
It’s important to remember, though, that disasters come in all shapes and sizes.
After leaving the dentist’s office that day, I emptied my bank account, entirely unsure whether I would be able to afford groceries or my commute to school the next week. I stood in line at the pharmacy and juggled discounts, asking the technicians over and over whether the antibiotics they were selling me were the cheapest generic version available. It wasn’t that spending several hundred dollars on my wisdom teeth wasn’t in my budget; it was that the dollars simply weren’t there. I was trying to do the impossible.
That afternoon, I whittled down the cost of my treatment until I could just barely swing it without overdrafting my checking account. Even then, I knew I was lucky. If anything worse had happened, if anything else had gone wrong, I would have been entirely out of luck, entirely unable to pay up. I’d be potentially saddling myself with even more debt than I had taken on to attend college in the first place.
Without health insurance, daily life is a series of potential booby traps. Don’t catch your finger in the car door; don’t spill the boiling water; don’t skip a day of flossing. Make sure to follow the walk signals; don’t drink too much — don’t do anything that could possibly result in a visit to the doctor. But the reality of the situation is that disaster strikes whether you plan for it or not, regardless of how careful you are. I struggled through the seemingly endless forms, notices, and phone calls because I knew that if I didn’t, I could find myself in the exact same situation again.
Still, even with my best effort, my coverage still lapsed. The systems in place aren’t designed to be simple, which in and of itself is a form of classism.
The solution, however, isn’t to do away with the protections in place, but to improve them and make them more easily accessible.
That can be done if our government applies a little bit of compassion.