Chris Stark is a fan of the Affordable Care Act. And though he was successful at purchasing an insurance policy through the healthcare.gov website, which enabled him and his wife Meredith to bring an end to three years of being uninsured, Chris says the couple is weighing the possibility of leaving Mississippi because of its inaction on Medicaid expansion.
Both in their late 20s, the Starks are nursing students at Itawamba Community College, a short drive from their home near Tupelo. For them, the decision of Mississippiâ€™s governor and legislature to not raise the stateâ€™s income ceiling to allow more low-income residents to qualify for Medicaid is unfair and unwise.
Looking to 2016, when they both will have graduated, Chris says he is serious about pulling up roots if the stateâ€™s Medicaid guidelines remain unchanged.
â€œI canâ€™t work as a nurse in Mississippi knowing that the cost of the care I provide might drive someone into bankruptcy,â€ he says. â€œI canâ€™t do it.â€
Mississippi joined much of the South in becoming one of 26 states that have declined to accept an offer from Washington to receive federal monies to expand Medicaid. Had those states raised their Medicaid ceilings, federal dollars would have covered 100 percent of the costs of those newly eligible for the next three years. Approximately 300,000 low-income Mississippians could have qualified. States that have chosen to expand their Medicaid programs will pay no more than 90 percent of those costs after 2016.
The state has two more years to take advantage of the federal dollars to expand the program. Cobbling together enough votes to pass the expansion and then overriding the likely veto from the governor will prove difficult.
â€œGovernor [Phil] Bryant keeps talking about jobs, jobs, jobs, but he didnâ€™t support expanding Medicaid. That could have brought 9,000, maybe 10,000 jobs to Mississippi,â€ Meredith says.
Those additional jobs could have made a difference at a time when many low-wage earners simply cannot afford the cost of insurance. They make too much money to qualify for Medicaid assistance under state guidelines, but not enough to buy private insurance. The Starks shared that status with millions of Americans, until Mississippiâ€™s federal-run health insurance exchange opened on October. They managed to qualify for a subsidy to help offset the cost of purchasing coverage.
The Starks now have a policy that goes into effect in January 2014. The price is right: low co-pays, no costs for essential adult dental services, and coverage for adult vision.
â€œWe received a $552 a month subsidy. Our plan would have been $610.79 a month, but with the subsidy itâ€™s only $58.79 a month for us both, $29.40 each,â€ Chris says.
Chris says he feels fortunate that he and his wife have coverage, and they value the preventative services. However, they face the prospect of out-of-pocket charges up to $4,500 if they incur a major medical bill.
Their 5-year-old son Noah qualifies for Medicaid coverage. The couple made a choice for Chris to watch Noah when heâ€™s not at school due to the high cost of day care; Meredith is the wage earner, netting an average of a $1,000 a month from her job. She works for a hotel chain, but thereâ€™s been a slowdown in tourism due to the recession. A late payroll can nudge the familyâ€™s careful budgeting out of its regular orbit.
The Starks recognize that if Mississippi had expanded Medicaid, the move would have helped them too. Chris and Meredith would not have to live with the risk of having a medical emergency that could cost them thousands of dollars in out of pocket costs before their insurance would kick in. That scenario would devastate the family financially.
â€œWhen my employer held my paycheck for two or three days, I had to ask my parents to help because I was low on gas,â€ Meredith says. â€œIf you live paycheck to paycheck, itâ€™s kind of tough.â€
She says the family almost had to file for bankruptcy after a visit to the emergency room. â€œThe bill was under $600, but we literally didnâ€™t have the money,â€ she says. They paid off the debt after it went to collections with assistance from her family.
Chris and Meredith are concerned about how peopleâ€™s lives are being affected by the politics driving Mississippiâ€™s health care policies.
â€œWeâ€™re bluer than the sky progressives,â€ Chris says, and adds that many of their friends consider themselves conservative Republicans. â€œThey say, â€˜I shouldnâ€™t have to pay for other peopleâ€™s insurance. They should get up and work, get a job.â€
â€œI am part of the working class,â€ Meredith says, â€œor at least the working poor, and Iâ€™m not lazy.â€ She resents being viewed as a stereotype of someone who is on the public dole.
They are grateful to Mississippi for the opportunities provided to Noah. â€œHe loves school,â€ Chris says. Their son is enrolled in a special education program in a public school; he was diagnosed with a learning disability two years ago. Through Medicaid, he attends occupational and speech therapy sessions at a local hospital.
Still, Chris and Meredith are thinking about a move north. â€œNorth Dakota is where I lived before, but I would be more apt to move to Vermont or Canada where they have single-payer systems already in place or being implemented,â€ he says.
Chris says he hears occasional talk from some people he knows about moving to California, for example, a state that took the expanded Medicaid deal, but he is skeptical those families will have the resources to leave. â€œItâ€™s hard to move when you donâ€™t have the finances,â€ he says.
Photo Caption: Meredith Stark and her 5-year-old-son Noah.