In Florida, A Former Fast-Food Worker Lands In Medicaid Gap
The Affordable Care Act got a big boost from the Supreme Court in June. But some states are still dealing with fallout from a previous Supreme Court decision that left it up to states to decide whether or not to expand Medicaid.
In Florida, which opted not to expand, about 850,000 people were left in health care limbo that some call the coverage gap.
Cynthia Louis, 58, is one of them. She worked for Burger King for most of her adult life, plus a year in high school.
"I worked for Burger King 25 years and loved every day of it, just coming, you know? Not because of the money, but just the people and working, just working," she says.
A year-and-a-half ago, though, while working at a Burger King in the northern part of Miami, something felt off.
"All of a sudden I just started feeling sick. And I said, 'What's going on?' And then I started sweating." She says her stomach hurt and after sitting down for a while, she tried to stand up, but couldn't. Her knees hurt too much.
She left work early that day and hasn't been able to go back since.
"They miss me. I miss them, you know," she says. "I just hope and pray if I can come back when I get well, I'll be glad to come back,"
Louis is 58 and her joints still hurt all the time.
She used to have health insurance through Burger King, but after a while she dropped it because it was too expensive.
Now she needed insurance, but Medicaid wasn't an option for her in Florida.
"It's not right. Because it's a lot of people out here who don't work, and it's a lot of people out here sick and don't get Medicaid," she says. "So they can't go to the doctor, and they're getting sicker and sicker."
The popular description of Medicaid is that it's health insurance for the poor.
But in fact it's more complicated.
To qualify you usually have to also have meet another condition: be pregnant, have a dependent child or a disability. And within each of those groups, there's even more restrictions.
For example, in a family of four, the most the parents can make to qualify for Medicaid in Florida is just under $8,500. A single parent who makes $6,000 a year and has one kid earns too much to qualify for Medicaid. And if someone is single with no dependent kids and isn't disabled, no matter how little he or she makes, he or she can't get Medicaid in the state.
And that's Louis's situation.
So when enrollment started for Obamacare in 2013, she thought she had her answer.
"I called, I kept on calling because people kept telling me that I can get it," she recalls. "And I kept telling them, 'Well, they told me I can't get it.' And they said, 'No, you can get it!' So I called again."
In the end she tried three times.
"So you mean to tell me, I worked all my life, and I can't get Obamacare? Something wrong with that picture," she says.
The reason Louis didn't get Obamacare is that in Florida, only part of The Affordable Care Act ever went into effect.
The federal government helps some people pay for health insurance with subsidies if they make just above poverty level up to four times the poverty level.
For those making less, they were supposed to get Medicaid.
But that second part never happened because Florida is one of 21 states that has chosen not to expand Medicaid after a Supreme Court decision opened that option.
Florida's legislature discussed it seriously this time around but adjourned in late June without expanding Medicaid coverage.
That means Louis, and hundreds of thousands of others, fall into this gap where they don't get Medicaid and they don't qualify for subsidies.
She does qualify for charity care at Jackson Hospital along with a lot of other people.
"You go to Jackson, you see a million people down there. I see so many people at Jackson, it's ridiculous," she says.
And, charity care lacks some of the advantages of Medicaid, says Louis's Doctor, Katherine Chung-Bridges.
"It's being able to access specialist care. It's being able to access you know the appropriate labs the appropriate studies in a timely fashion," she says.
With her Jackson charity care card, Louis can only go to certain primary care clinics and most of them don't have specialists on staff. She was referred to a rheumatologist at Jackson Memorial Hospital almost a year ago. Wait times there usually range from two weeks up to six months, says Ed Odell with Jackson Health.
"It depends on the specialties," he says. Urologist, pulmonary specialists and ear, nose and throat clinics have longest waits. Those clinics only see patients four hours a week since they're mostly teaching and academic clinics."
At the same time, the federal government is giving Florida less money for charity care because of the assumption that more people would have Medicaid.
In January, Louis was finally able to book an appointment with a rheumatologist.
That appointment is this month.
This story is part of a reporting partnership with NPR, WLRN and Kaiser Health News. Daniel Chang of the Miami Herald co-reported the story.
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Transcript
WADE GOODWYN, HOST:
The Affordable Care Act got a big endorsement last month from the Supreme Court. But some states are still dealing with the fallout from a previous Supreme Court decision, the one that made it optional for states to expand Medicaid. In Florida, that leaves about 850,000 people in health care limbo. From member station WLRN in Miami, Wilson Sayre has one Floridian's story.
WILSON SAYRE, BYLINE: Cynthia Louis worked for Burger King for most of her adult life, plus a year in high school.
CYNTHIA LOUIS: I worked for Burger King 25 years, and I love every day of it, just coming, you know, Not just because of the money, but just the people and working - you know, working.
SAYRE: Her last three years with the company were here, at the Burger King in a neighborhood in the northern part of Miami. A year and a half ago, this is where she was when something felt off.
LOUIS: All of a sudden, I just start feeling sick. And I said what's going on? And then I started sweating. And then my stomach - like, I had gas.
SAYRE: After sitting down for a while, she tried to stand up, but couldn't. Her knees hurt too much. She left work early that day and hasn't been able to go back since.
LOUIS: They miss me. I miss them, you know. I just hope and pray if I - you know, if I can come back here when I get well, I'll be glad to come back. (Laughter).
SAYRE: Cynthia just turned 58, and her joints still hurt all the time. She used to have health insurance with Burger King. But after a while, she decided not to reenroll. It was too expensive. Now she needed insurance. But because she has no income, she couldn't get help from the government through Medicaid.
LOUIS: It's not right because it's a lot of people out here that don't work, and it's a lot of people out here sick and don't get Medicaid, so they can't go to the doctor. And they're getting sicker and sicker. And sooner or later, they're going to die or whatever symptom they've got are going to get worse and worse.
SAYRE: The popular description of Medicaid is that it's health insurance for the poor. But in fact, it's more complicated. To qualify, you usually also have to have another condition - be pregnant, have a dependent child or a disability. And within each of those groups, there's even more restrictions. For example, in a family of four, the most the parents can make to qualify for Medicaid in Florida is just under $8,500. Single-parent, one kid, making $6,000 a year - that is too much to qualify for Medicaid. Single, no dependent kids and not disabled, no matter how little you make, no Medicaid. And that is Cynthia's situation. So when enrollment started for Obamacare in 2013, she thought she had her answer.
LOUIS: I called, I kept on calling 'cause people were telling me that I can get it. And I kept telling them, I said, well, they told me I can't get it. They said no, you can get it, so I called again.
SAYRE: She thought something had to be wrong, that they didn't know what they were talking about. In the end, she tried three times.
LOUIS: So you mean to tell me, I done worked all my life, and I can't get no Obamacare, no kind of insurance? Something's wrong with that picture.
SAYRE: The reason Cynthia didn't get Obamacare is that in Florida, really only part of the Affordable Care Act ever went into effect. The federal government helps some people pay for health insurance with subsidies if they make just above poverty level, up to four times the poverty level. For those making less, they were supposed to get Medicaid. But that second part never happened because Florida is one of 21 states that has chosen not to expand Medicaid after a Supreme Court decision made that an option. Florida's legislature discussed it seriously this time around, but adjourned in late June without expanding. So Cynthia, and hundreds of thousands of others, fall into this gap where they don't get Medicaid and they don't qualify for subsidies. She does qualify for charity care at Jackson Hospital. And so do a lot of other people.
LOUIS: You go to Jackson, you'll see a million people down there. I see so many people at Jackson, it's ridiculous.
SAYRE: And it lacks some of the advantages of Medicaid, says Cynthia's doctor, Katherine Chung-Bridges.
DR. KATHERINE CHUNG-BRIDGES: It's being able to access specialist care. It's being able to access the appropriate labs, the appropriate studies in a timely fashion.
SAYRE: With her Jackson charity care card, Cynthia can only go to certain primary care clinics, and most of them don't have specialists on staff. Cynthia was referred to a rheumatologist at Jackson Memorial Hospital almost a year ago. Wait times there usually range from two weeks up to six months, says Ed Odell with Jackson Health.
ED ODELL: Now, it depends on the specialties. For example, GU, which is urology, ENT and pulmonary have the longest waits. This is because the clinic only meets four hours once a week since they're mostly teaching and academic clinics.
SAYRE: At the same time, the federal government is giving Florida less money for charity care because of the assumption more people would have Medicaid. So Cynthia just has to wait for a spot to open up at Jackson.
LOUIS: You should be able to get an appointment quicker than six months, a year and it's not right.
SAYRE: In January, she was finally able to book an appointment with a rheumatologist. That appointment is this month. For NPR News, I'm Wilson Sayre in Miami.
GOODWYN: That story was part of a reporting partnership with NPR, WLRN and Kaiser Health News. It was co-reported by Daniel Chang at the Miami Herald. Transcript provided by NPR, Copyright NPR.
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