Medicaid expansion provides lifeline in rural areas
肯塔基州哈泽德——在获得医疗补助资格之前,弗朗西丝·特里斯一直避免去看医生.
已经有数千美元的医疗债务,而且无力支付医疗保险, 她跳过了每年一次的体检,依靠家庭疗法来治疗病毒感染. 当她的脚骨折时,她重新使用了之前骨折时的矫形靴.
"The only time I would go to the emergency room was if I thought I was dying,特里克说。, 阿代尔维尔的居民, 肯塔基州, a rural town of fewer than 900 people.
In 2019, Trice was diagnosed with heart failure. By then, 肯塔基州 had expanded access to Medicaid.
Jointly funded the federal government and the states, 医疗补助扩大计划为符合条件的成年人提供健康保险, pregnant women and people with disabilities who meet the income requirements. The program also helps self-employed people, 小企业主, 农民, seasonal workers and older adults who don't yet qualify for Medicare.
这一扩大计划被认为大大降低了农村地区18至64岁未参保的成年人的比例. 2019年,在扩大医疗补助覆盖范围的州中,政府数据显示有11个州.8% of those adults were uninsured, compared with 21.5% in states that didn't adopt the expansion.
Because she had health insurance through Medicaid, Trice能够专注于她的康复,而不用担心她如何支付她的长期住院费用和处方药. She said they the medicines alone would have cost hundreds of dollars per month.
她说:“医疗补助计划的扩大帮助了这里的很多人,包括我自己. “我绝对不可能负担得起我必须做的一切."
平价医疗法案, 2010年颁布, 将医疗补助计划的资格扩大到65岁以下、收入总额不超过联邦贫困水平138%的成年人. In most states with the expanded program, in 2024 that translates to an income up to about $20,个人780元, 大约35美元,三口之家630美元.
根据法律规定,联邦政府支付与扩大医疗补助覆盖范围相关的90%的费用. 到目前为止,有40个州和华盛顿特区.C.,已经采用了扩展.
希望和等待在堪萨斯
堪萨斯州德比市的居民梅丽莎·道奇祈祷她的州能利用医疗补助计划的扩张. 她的孩子享受医疗补助, but for the most part her income has been too high to qualify, landing her in the so-called coverage gap.
Dodge's adolescent daughter has several health issues, 包括先天性心脏缺陷,需要她每年去看几次心脏病专家.
为了她自己, 道奇已经把她的所得税退税留了出来,用于支付每年的身体和常规的牙齿护理, 她还动用了自己的积蓄,用信用卡支付意外的医疗费用.
In 2022, 她经历了严重的腹痛,尽管她没有保险,但还是做出了去急诊室寻求治疗的艰难决定. 医生确定道奇的怀孕无法成活,导致医疗紧急情况, 这就需要他们从她的腹部取出输卵管和一升血液.
In addition to the grief of losing a child, 源源不断地寄来的数千美元医药费让道奇不知所措. 得知堪萨斯州对孕妇有不同的收入要求后,她松了一口气,并申请了这个项目. Ultimately, the state agreed to grant the pregnancy benefits retroactively.
"If I can sit in front of a therapist and cry, I'm going to be a better employee at work, a better mother to my children and a better friend and neighbor,她说, adding that it was "a huge weight off my shoulders."
堪萨斯的州长, 劳拉·凯利, 自2019年上任后不久,她就在预算和立法提案中寻求扩大医疗补助计划. But the measures have not won the state Legislature's approval.
Determined to push such legislation forward, 道奇与当地代表分享了她的故事,并在该州参议院公共卫生和福利委员会面前发表了讲话. "To be able to stand in front of the committee and share my story, 去恳求他们, 真的有影响力吗,她说. "I believe (Medicaid expansion) is what's right, and I'm forever hopeful."
帮助医疗机构
By ensuring that more patients can pay for their medical care, Medicaid expansion has also helped sustain rural health care facilities. One recent study found median rates of uncompensated care in 2019 were just 2.88% for rural hospitals in Medicaid expansion states, compared with 6.31% for rural hospitals in non-expansion states.
医疗补助计划的扩张推动了肯塔基大学北福克谷社区健康中心的发展, 它的医疗主管说, Dr. 关键Douthitt. 哈扎德的保健中心, 一个约有5人的小镇,300人, treats all patients regardless of their ability to pay.
Prior to Medicaid's expansion in 肯塔基州, the facility was facing rising debt. “我们是在为那些付不起钱的人提供服务,”杜西特说.
自从该州扩大了医疗补助计划以来,该中心的病人有了更多的保险. As a result, the facility has been considering expanding the services it offers. In the past, they anguished over which services to cut. "It completely changed the landscape for us," Douthitt said.
Most importantly, he said, "We know it's improved our patients' lives.“研究表明,无法获得负担得起的医疗保健的群体婴儿死亡率更高, 更多的慢性疾病,死于心脏病和中风等疾病的风险更高, compared with people who can access affordable care.
她做了心脏直视手术,植入了帮助心脏泵血的装置, Frances Trice有资格获得社会保障残疾保险,并在医疗保险中注册,医疗补助是第二保险公司.
她有时会想,如果早点获得医疗保险,是否会改变她的人生轨迹. “也许我能早点被诊断出来,在一切变得很糟糕之前控制住局面,她说. "I honestly have no idea how people can go without insurance."