As lawyers argue Medicaid expansion case, uninsured Mainers forgo health care

As lawyers argue Medicaid expansion case, uninsured Mainers forgo health care

Thousands of low-income residents who don’t have health insurance are skimping on medications or passing up on treatment as they wait for access to Medicaid coverage that voters approved 11 months ago.

By Joe Lawlor for Press Herald

Eric Spahn knows he should be taking better care of his deteriorating health, but without insurance and very little income, he’s been unable to do so.

Spahn, 62, of Brunswick, said he’s delayed treatment for hepatitis C, declining kidney function and cataracts for years while waiting for Medicaid expansion.

“I’ve been letting things go,” said Spahn, a retired truck driver and courier, both low-paying jobs that didn’t offer health insurance. He retired when his health worsened a few years ago. He also has diabetes, but has been able to get medication for that. “If I’d had Medicaid all along,” he said, “maybe my kidneys wouldn’t have declined so much.”

Maine voters approved expansion by a margin of 59 to 41 percent in November 2017, but Republican Gov. Paul LePage, a steadfast expansion opponent, has blocked implementation. The group that campaigned for the expansion, Maine Equal Justice Partners, sued the administration this spring, after LePage refused to implement it.

As the LePage administration and a health care advocacy group fight a seemingly endless court battle, 70,000 Mainers who would be eligible are waiting to see when or if they will become eligible for Medicaid health insurance.

As the monthslong legal wrangling continues, thousands remain uninsured, which means that many will put off taking care of health problems or leave themselves susceptible to medical bankruptcy if they fall severely ill.

Spahn, who is single, said his income is currently about $5,000 a year, from a trust that his late father set up. He eats at the Brunswick soup kitchen to save money.

Jeremy Lester, 49, of Portland, said he’s a recovering alcoholic, was recently homeless and is now living in public housing while trying to get his life straightened out.

NO INSURANCE? HE’S USED TO IT: Portland’s Jeremy Lester, 49, a recovering alcoholic now living in public housing, hopes to find work soon. Staff photo by Ben McCanna

Lester said he takes blood pressure, anti-depressant and anti-anxiety medications, which cost about $20-$30 per month. He said he hopes to work soon, but last week he was scrounging for returnable bottles to get some extra spending money.

“I haven’t had insurance in so long you kind of get used to it,” Lester said.

FOR SOME, FIGHT IS PERSONAL

Medicaid expansion would benefit many adults who were kicked off Medicaid – about 36,000 childless adults and some parents – when the LePage administration tightened eligibility requirements in 2013, making it harder to qualify, and those who have fallen on hard times since then and need health insurance but can’t get it.

Mainers who qualify include a wide range of low-income people, such as single parents, adults who have significant health problems that are not quite severe enough to qualify for disability, and those who are caregivers for a disabled relative.

Medicaid expansion would open up eligibility to those who are earning up to 138 percent of the federal poverty limit, or $16,753 for a single person, $28,676 for a family of three. More than 3,500 Mainers who would be eligible for Medicaid starting July 2 applied for benefits this summer but were issued denial letters by the Maine Department of Health and Human Services. According to the referendum, July 2 was slated to be the start date for expansion.

For Naomi Loss and her daughter, Bethany, who has severe cognitive issues, epilepsy, memory issues and a language disorder – the Medicaid expansion fight has become personal.

A COVERAGE GRAY AREA: Naomi Loss’ daughter, Bethany, 26, no longer on her parents’ insurance, would be eligible under an expanded Medicaid. Staff photo by Ben McCanna

Loss, of Lisbon Falls, said Bethany turned 26 this year, which means she can no longer stay on her parents’ health insurance plan. Loss said Bethany has been turned down twice for Medicaid disability, and so she’s in this gray area where the government doesn’t consider her disabled, but she can’t work a regular job. With no income, she wouldn’t qualify for subsidies under the Affordable Care Act, but would be eligible for Medicaid when it expands. Bethany has applied for Medicaid under the expansion, as well, but was denied.

“This has been a long, ongoing battle,” Loss said, explaining that Bethany’s epilepsy medications cost $1,200 per month. “I always knew the expansion was important, but I didn’t appreciate what it really meant until I had to jump in the middle of it.”

COBBLING TOGETHER HEALTH CARE

Marion Puglisi, 61, of Portland has atrial fibrillation, and while she said she has been able to cobble together health care by going to community health clinics, it’s not the same as having health insurance, and she would benefit from expansion.

“I’ve managed to patch some things together so far, but I’m in fairly good health. I’ve been lucky,” Puglisi said.

SHE TAPS ‘FREE CARE’: But community health clinic programs aren’t the same as having health insurance, says Portland’s Marion Puglisi, 61. Staff photo by Derek Davis

Puglisi owns her own business refurbishing antique furniture, but her annual income is only about $6,000 to $8,000, depending on how many clients she gets.

Puglisi said she uses “free care” programs that are available through MaineHealth, the parent company of Maine Medical Center. While not insurance, the programs, such as Care Partners and MedAccess, help low-income patients who don’t qualify for health insurance get some care, such as primary care, preventive screenings and reduced-cost medications.

Puglisi, who has been without health insurance since the early 2000s, said an annual checkup by the free care program helped diagnose her atrial fibrillation, and she gets a three-month supply of two medications to control the irregular heartbeat for $50.

Still, it’s not the same as having health insurance, Puglisi said, and Medicaid is not welfare, as LePage and other conservatives have referred to it.

“People should have health care,” Puglisi said. “If it’s welfare, why is everyone over 65 entitled to it and not me?”

THE ROLE OF MAINEHEALTH

Carol Zechman, director of Access to Care Programs at MaineHealth, said that while programs like Care Partners and MedAccess can help, they are no substitutes for Medicaid. Missing from the MaineHealth free care programs are mental health services and substance use treatment programs, and it’s more difficult to see specialists under the free care programs. Also, Medicaid covers the full cost of prescriptions, and even reduced-cost prescriptions can be difficult to afford for low-income Mainers, Zechman said.

“These are not replacement programs for Medicaid,” Zechman said. The array of free care programs at MaineHealth serve about 5,000 people per year.

Zechman said despite the LePage administration’s refusal to implement expansion since July 2, when the expansion was supposed to take place, MaineHealth has been helping people who should be eligible sign up for Medicaid. So far, their clients have gotten rejection letters.

“We have been on an all-out blitz to sign people up,” Zechman said, explaining that the free care programs, once Medicaid is expanded, will still exist, but will mostly transition to a program that will help enrollees navigate the dizzying array of health insurance options. Many don’t know what they’re eligible for, whether it’s Medicaid or low-cost ACA insurance, she said.

Michelle Gagne of Biddeford cares for her disabled husband, who she says has significant mental and cognitive health problems. They are living on his $750-per-month disability check. For the most part, Medicare and Medicaid do not pay for spouses to take care of their disabled husbands or wives.

“I have to be with him 24/7,” Gagne said. Meanwhile, she has health problems of her own, such as asthma and post-traumatic stress disorder, and she would benefit from having Medicaid.

Loss, a nurse and the Lisbon Falls resident who’s caring for her disabled daughter, said they’ve drained savings accounts trying to afford her daughter’s specialty medications, which cost $1,200 per month, even after a discount. They were able to avoid those costs for the rest of this year because of a six-month deal with the drug manufacturer, but her daughter will need Medicaid soon.

“Having good health care should not be limited to only those who can afford it,” Loss said.

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