Marc Sigoloff hopes he gets a chance to thank President Obama in person one day. “I really do believe that he saved my life with what he did,” he says.
Fifty eight-year-old Sigoloff, a freelance writer who lives in Illinois, was surprised when he got a notice in the mail last year telling him he was eligible for public insurance coverage. When first he signed up for food stamps, he was told that he didn’t qualify. But after Illinois lawmakers accepted the health care law’s optional Medicaid expansion, Sigoloff was one of the estimated 468,000 low-income residents who gained access to coverage this year.
One of the first things he did was go to the doctor. He knew he had issues with high blood pressure that he had been neglecting during the 11 years that he hadn’t gone to regular check-ups. But he didn’t expect to discover that he also had a brain tumor.
Sigoloff was referred to a neurosurgeon and received radiation treatment. So far, everything seems to be going well. “I’ve been pretty lucky. It turned out my tumor wasn’t cancer,” he said in an interview with ThinkProgress. He’ll have a follow-up MRI in December. For the first time in years, he’s also managing chronic conditions like diabetes and high cholesterol.
“I always had a feeling I was a walking time bomb, and it turned out I was right,” Sigoloff said. “If it hadn’t been for gaining insurance and being able to go to the doctor, I might not be here.”
Sigoloff said that one of the best things about gaining health insurance has been the renewed sense of security. He no longer has to worry about the unknown medical issues that may be taking a toll on his body. He feels relieved.
It’s a hard thing to measure relief, but there’s some research to back up his claim. A large study in Oregon that tracked the effects of people gaining access to insurance found that getting that coverage made them feel healthier, happier, and more financially secure. There is limited evidence suggesting that when one member of a family lacks insurance, that may contribute to higher levels of familial stress.
There’s also similar anecdotal evidence from some of the other people who are gaining insurance coverage under the health law for the first time in years.
Charles McClinon, a 50-year-old Ohio resident who lives with epilepsy, told ThinkProgress, “The peace of mind is worth more than anything. I could be a millionaire, but if I don’t have peace of mind, what good is it? And that’s one thing this type of insurance is good for. I know I can get the kind of care I need.”
CREDIT: Courtesy of Charles McClinon via Enroll America
In 2010, McClinon’s epileptic seizures intensified, making it too difficult for him to hold down a job or complete the university classes in which he was enrolled in at the time. To make matters worse, his student health policy dropped him under a pre-existing condition clause. After that, McClinon struggled to afford the treatment he needed, especially after his medications started to give him debilitating side effects. He eventually became homeless.
After Ohio’s governor became one of the first Republican leaders to accept the Medicaid expansion, however, McClinon gained coverage in February. He can now afford the multiple medications he needs to manage his condition — and this summer, he also had a cutting-edge surgery that will hopefully prevent his seizures and eliminate the need for all the drugs he currently takes. Thanks to his Medicaid coverage, he didn’t have to pay for that procedure out of his own pocket.
McClinon, who worked his whole life before his seizures worsened, is looking forward to feeling like his old self again. “It’s not even just about medical care — it’s also been helpful for me on the mental health side,” McClinon said, referring to his newfound peace of mind. “I don’t know what I would have done if I lived in another state.”
Carol Fisher Hardaway did live in one of those other states. Plagued with multiple sclerosis and having difficulty finding work, she didn’t qualify for coverage in Texas because the political leaders there have refused to expand the Medicaid program. She ended up relocating to the Maryland area, where her son lives and where state officials have implemented the expansion, so she could have affordable access to health care.
“My MS got worse over the past year and now I really do need medications. Each of my shots costs $1000 and I get them once a week,” Fisher Hardaway told ThinkProgress. “But I pay $3 a month with my coverage. Now I can see a neurologist. Now I can go to the doctor and not worry. It’s huge. That’s a success story.”
She described her new coverage as “literally a miracle” when it comes to treating her chronic condition. “I’m not cured — I’ll never be cured. But I don’t writhe in spasms 12 times a day,” she said. “I think that’s pretty good!”
Nonetheless, Fisher Hardaway doesn’t think everyone should have to follow in her footsteps and move across the country to gain access to health benefits. Indeed, health experts believe that she’s the exception rather than the rule. According to a recent study conducted by Harvard researchers, most low-income Americans who are locked out of affordable insurance won’t move to a different state to take advantage of the Medicaid expansion there. This is a fairly predictable policy dynamic that’s evident in other areas; for instance, people don’t typically cross state lines to take advantage of more generous tax breaks, either.
Most people won’t move for Medicaid because they don’t understand how much they could benefit in another part of the country — particularly if they live in the red states that have actively resisted allocating funds toward public education campaigns about Obamacare. On top of that, moving requires a lot of financial resources, and most impoverished Americans simply can’t uproot their lives in that way.
Some anti-Obamacare Republicans have told their constituents they should simply travel to another part of the country for health insurance. This past summer, after Missouri lawmakers blocked Medicaid expansion from moving forward, state senator Ed Emery told a supporter of the policy that “individuals and families are free to consider moving to states with differing and even contrasting government policies.”
In Fisher Hardaway’s opinion, lawmakers like that are digging in their heels against the expansion because they don’t understand what it means to people like her.
“If Rick Perry had to go without insurance like I did, he would change things pretty quick, I think,” Fisher Hardaway told ThinkProgress in reference to her former state’s governor, who called Medicaid expansion a “fool’s errand” last year. “It’s very selfish to me. There are hundreds of thousands of people like me who are still struggling, stuck between a rock and a hard place.”
There’s a policy term for the people who are simply stuck. They fall into what experts call the “coverage gap” — they earn too much money to qualify for their state’s more restrictive Medicaid program, but too little money to receive federal subsidies to help them purchase private plans on Obamacare’s new state-level marketplaces. Those people are essentially locked out of Obamacare’s promise of health reform altogether.
“We anticipate that approximately four million people fall into this coverage gap,” Rachel Garfield, a senior researcher for the Kaiser Family Foundation who specializes in data related to uninsured Americans and Medicaid beneficiaries, said. “A few things stand out. They’re by and large concentrated in the South, which reflects the fact that many of the states not expanding Medicaid happen to be in the South. And they’re disproportionately likely to be people of color, particularly black.”
Most of the people who are being denied Medicaid coverage don’t fit the conservative trope of the government beneficiary who solely relies on money from public programs. They’re mostly in working families, which means that they or someone in their immediate family is employed. Some of them are working full time. According to Garfield, these people are simply “very unlikely” to get insurance through their jobs — either because they’re employed at small firms that aren’t required to offer it, because they’re juggling multiple part-time hourly jobs, or because they’re in low-wage industries that have very low coverage rates.
Last fall, a New York Times analysis confirmed that the Americans stuck in the Medicaid coverage gap include hundreds of thousands of the working poor — like cashiers, cooks, nurses’ aides, waiters and waitresses, and janitors. Many of them are single mothers. They are “the very kinds of people that the program was intended to help,” the Times reported at the time.
The individuals who are gaining Medicaid expansion understand these realities better than anyone.
“People think Medicaid is just for the poor and god forbid if you need it, because if you’re on it you must not have a job,” Fisher Hardaway said. “But I think that’s a misconception. There’s a much bigger umbrella, and there are people like me who are on the cusp.”
McClinon agreed. “There are a lot of people who have gone without coverage for so long that they assume this is just the way it is. But that’s not the way it has to be,” he said. “That’s why we have this type of legislation that’s been put into place.”
CREDIT: Courtesy of Carol Fisher Hardaway
It’s still a little too early to have much concrete data about the other people like Sigoloff, McClinon, and Fisher Hardaway who have recently gained health insurance through the Medicaid expansion. We do know that uninsurance rates are falling faster in the states that expanded Medicaid, which suggests that people are getting connected with new coverage, but we don’t know exactly what they’ve done with that coverage so far. The Kaiser Family Foundation is currently conducting a survey to try to figure out how Medicaid coverage is impacting those people’s lives.
Researchers can make some educated guesses about what they may expect to find among this population. Along with one of her colleagues, Garfield recently conducted a review of the previous research in the field and concluded that gaining Medicaid coverage has an overall positive effect.
“Within the policy community, there is this debate that pops up every now and then about whether getting Medicaid is of any value — this idea that if you have Medicaid, you’re no better off than you are if you’re uninsured,” Garfield explained. “But I think it’s pretty clear that, compared to having no coverage at all, gaining Medicaid makes you more likely to see a provider, to get your preventive services, to get the services you need when you’re sick, and also to not face as much financial hardship when you do need care.”
Unsurprisingly, a new study from the Harvard School of Public Health found that a large majority of low-income Americans support Medicaid expansion. But it still has somewhat of an uncertain future. Although the policy’s proponents are hopeful the growing evidence about its benefits may eventually convince every state to accept the expansion, it remains to be seen whether resistant GOP leaders will fall in line. And, in the states where the leadership may switch parties, residents wonder if their coverage will remain in place.
In Illinois, Sigoloff is certainly thinking about the politics of health care reform. Gov. Pat Quinn (D) is up for re-election this year, and Sigoloff is worried that his Republican opponent will roll back Medicaid benefits if he takes control of the governor’s mansion.
“I keep wondering if he would take away my health insurance. I think he probably would if he had the opportunity,” he said in reference to GOP candidate Bruce Rauner. “I’m very much concerned about that. You know, people don’t vote because they don’t think elections affect them, but this would affect my life considerably.”
Sigoloff said he doesn’t hear too many of his friends discussing health care reform. If he ever brings it up to tell them how it saved his life, they usually tell him they’re happy he’s okay, but they don’t want to go into the politics.
Fisher Hardaway — who agreed to speak to ThinkProgress on the condition that she would be able to say exactly how she felt about Texas’ Republican governor — made her feelings about the politics very clear. “Any politician who digs in their heels and refuses to do something to help people should never be elected again,” she said.
Still, she doesn’t necessarily feel comfortable spreading the word about Obamacare with the people whom she encounters in her everyday life. “With MS, I don’t often walk up to people and tell them as a conversation starter,” she noted, adding that she understands why people have been “frustrated” with the law following the website problems that plagued the first months of the health insurance marketplaces’ open enrollment period. She said that America’s insurance system has been “broken” for decades.
McClinon thinks Medicaid expansion is a step in the right direction, especially since extending health insurance to additional people can help ensure they’re productive members of society.
“I think that a healthier country will definitely make us so much more profitable. When you feel good, and when you don’t have to worry about whether or not you’re going to get care, it’s a lot easier to do things,” he said. “I’m not saying we’re all going to be holding hands and singing kumbaya or anything. But this definitely makes it a lot better.”