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ABLE-BODIED IN THE COVERAGE GAP

Is Medicaid expansion a handout or a leg up?

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Carefully applied shimmery peach shadow highlights eyes that are a peerless, expressive blue as Linda Perry opens up about her life over unsweet tea, hummus and pita bread on the patio of a beaches restaurant. She calls it “couch surfing,” but the fact is that the petite blonde is homeless, staying in shelters, with a friend, or sleeping in her car as she did the night before we met.

The series of events that led to her current predicament is a vague jumble buried beneath pride and reserve, but now, after five long years of living hand-to-mouth, the 60-year-old domestic violence survivor may be on the verge of breaking the cycle — she’s just been hired as a Chick-Fil-A greeter — but you wouldn’t know it to talk to her. Years of disappointment on the streets of Jacksonville have, at least for the time being, destroyed her capacity for hope.

Perry has been beaten, choked and taken advantage of; each time she’s picked herself back up and kept seeking that better life. “I’m stubborn, that’s what it is,” she says.

Even when she wants to give up and join those who spend their days riding the bus, panhandling or wiling away the hours, she somehow finds the strength to keep going.

Just don’t pity her. “Don’t treat me like that, I need to build myself back up,” she says about thrift store clerks’ reactions to her situation.

Perry is one of the “able-bodied,” childless adults who, after the Florida House of Representatives voted against Medicaid expansion on June 5, does not qualify for Medicaid. Only four Republicans detracted the House’s vote; the measure failed 72-41.

“To say they’re able-bodied and they don’t want to work or they’re just laying around not working, that isn’t true,” says Cindy Funkhouser, president and CEO of Sulzbacher Center, which provides services and care to the homeless. “And the people that we have in our program are desperately seeking employment or they are employed.”

On June 9, House Speaker Steve Crisafulli (R-Merritt Island) wrote in a Tampa Bay Times op-ed, “We should be proud that Florida provides a strong safety net for people who cannot provide for themselves. We invest billions of dollars to make health care affordable for children, the elderly and the disabled.”

At 60, Linda Perry isn’t a child. She isn’t elderly, either. Nor is she old enough to retire (the minimum age to receive Social Security is 62). But she wants to hang on and work for five more years so she can qualify for full Social Security benefits.

In spite of being diabetic, hypertensive, neuropathic, diagnosed with depression and macular degeneration (an incurable, progressive condition that causes blindness), Perry has twice been denied disability benefits. The first denial, she believes, is standard operating procedure. The second denial, which occurred in April, she chalks up to the fact that she doesn’t have children and is capable of standing up on her own two feet. So she continues to rely on Sulzbacher Center for medical care and the eight pills she takes every day to manage her conditions, and the emergency room for anything serious.

House Representative Mia L. Jones (D-Jacksonville), the de facto sponsor of the Senate-authored Medicaid expansion bill, pointed out that it is actually cheaper for the state to pick up the tab for preventive care than pay for emergency room visits and hospital admissions. She says that it is fiscally irresponsible for Florida to refuse billions of dollars of federal funding — some $5 billion annually — for Medicaid expansion.

“If we were in a situation where we just had an overabundance of funding available to us and we turned down the funding, that would be one thing … but we know that we have waiting lists in a number of areas,” Rep. Jones says.

Jones says that House Republicans made it
clear they were not going to pass Medicaid expansion in any form, regardless of concessions or compromises, which the Senate was willing to negotiate. Now, according to Rep. Jones, the House is hurrying to “backfill” hundreds of millions of dollars from the budget to keep safety net hospitals, such as UF Health Jacksonville, that treat indigents and have relied on the federally funded Low Income Pool (LIP), from closing down or significantly reducing services and workforce. In fiscal year 2014, UF Health Jacksonville provided approximately 4,000 acute admissions and 105,000 outpatient visits and observation visits to indigents.

Some believe that Republicans are gambling on the success of Governor Rick Scott’s suit to make the federal government continue funding the LIP. A hearing is scheduled for June 19, just one day before the House Special Session on healthcare and the budget ends. But the odds of the suit’s success are unclear. The back-and-forth between Florida and the federal government over Medicaid expansion is a political chess match where the only losers are the people who can’t get healthcare.

Last summer, constant exposure to the summer heat left Linda Perry so severely dehydrated that no amount of water or Gatorade would quench her thirst; she couldn’t walk, was disoriented and falling down. “Someone [a man] took me to a motel room. I don’t know if that was the best idea but at least I got some air conditioning and a shower,” she says, “ … it was horrible.”

She says that the man didn’t hurt her, but admits she was relieved when he abandoned her after receiving his disability check. This is just one example of the kinds of choices people without ongoing medical care are forced to make when they get sick: Go to the emergency room, stay sick, or find another way.

 

Michael Van, a 19-year-old Florida State College at Jacksonville student, was born blind in one eye, hard of hearing and with a severe cleft palate that makes his speech difficult to understand. He also has dystonia, or involuntary muscle movements, and needs medication to maintain mobility.

“[Without medicine] I will fall down every time I stand up and my walking will be limited to two hours,” he says.

Van is currently appealing the state’s rejection of his disability application. His attorney, Florida Coastal School of Law Professor Sarah Sullivan, says that many are denied disability because they either don’t know how to navigate the arduous bureaucratic process or can’t gather enough evidence. Van has a UF Health Jacksonville clinic card, commonly called a Shands card, which provides him with medication but not the surgery that will fix his cleft palate.

“All of my clients that rely on Shands cards because they are not sick enough to qualify for disability (or are trying to prove that they are sick enough but don’t have enough evidence) or don’t have children, etc., will have nowhere to turn [if the hospital closes]. Many of them aren’t homeless, they are employed, but are on the verge. One major medical catastrophe, or a diagnosed chronic illness, and it is financial ruin,” Sullivan wrote in an email.

Van, who graduated from Edward H. White High School with honors, dreams of becoming a medical billing specialist so he can help other people like him. But he is stuck in a catch-22; he can’t afford surgery and, without the ability to speak clearly, which surgery would provide, finding employment may be difficult, if not impossible.

Van, who lives with his parents and two younger siblings, wants to be independent but he’s held back by treatable, fixable medical conditions that, without Medicaid expansion or a successful disability appeal, will continue to hinder him.

Without Medicaid expansion, some 800,000 Floridians like Van and Perry have no consistent, reliable access to medical care. Funkhouser says that health, employment and housing are “hand in glove”: without one, the other two can quickly be jeopardized. For these people, healthcare isn’t a handout, it’s a leg up.

Asked what she thinks might change the minds of the powerful opponents of Medicaid expansion, Perry readily answers.

“They have to go through it. I think about that a lot. All right, just take this person and put them out in their car for six months with nothing. See how he feels. You can’t get any help … you can’t get your food and figure out how to go get it. Maybe not even in a car. And now you’re cold, go find yourself a blanket. They don’t understand.”

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