“Even though the federal government would have helped fund the expansion [of Medicaid], 19 states opted for ideological reasons not to do so, arguing that they are pushing back against government bloat and the fostering of dependency. A result was that the residents with the lowest incomes in those 19 states were now caught between two nonoptions: They made too much to qualify for Medicaid…but they also made too little for publicly subsidized insurance on the exchanges…. This paradox is referred to widely as the coverage gap.”
— from a recent New York Times Magazine article
Last summer, a writer for the New York Times Magazine, along with a professional photographer, visited Shanette Smith in her rural Toronto home. They shadowed the single mother of two for most of an afternoon and well into the evening. The reporter asked Smith about her dream of attending nursing school, about living near a state park, about the single-car accident that claimed her young husband four years earlier, about trying to go back to school after that tragic day. The reporter made notes on the small house that Smith shares with her in-laws: one bathroom for five people, a collection of Pepsi memorabilia in a curio cabinet, etc. The photographer floated around the edges of the conversation, capturing Smith and her two young daughters in moments of artful mundanity. They were charming, the writer and the photographer, remembered Smith, and polite. And, by 10:30 p.m., they were gone. That was in July.
FIVE MONTHS later, an area man headed up to the Hill Top Café, a small restaurant-cum-bait shop overlooking Toronto Lake. He’d recently begun reading the New York Times. A story released online that day caught his eye: “Life in Obamacare’s Dead Zone.” The story, a long first-person piece by Inara Verzemnieks, narrowed its attention on the lives of three women whose personal circumstances rendered them ineligible for marketplace health insurance in their home states. “Excluded from the Affordable Care Act because of politics,” read the article’s subhead, “thousands of poor Americans grapple with the toll — physical and psychological — of being uninsured.” One of the women featured was from Kansas City. Interested, the man read on. The second woman, a grandmother raising her two grandkids, lived in Iola — just 30 minutes down the road from where he sat. The last example told of a 28-year-old single mother, a widow, whose plans to go to nursing school – despite her having cleared all of the other hurdles – were being thwarted simply because she could not afford health insurance, which the program required of all its new entrants.
This last case, of Shanette Smith, hit closer to home for the man, in every sense. Smith, who at that point was within literal walking distance of the man, had also been a schoolmate of his daughter’s at Yates Center High. The man asked the café’s owner to call the Smiths’ home (a manageable request in a place like Toronto, even when your last name is Smith) and arrange a meeting with Shanette at the café. When she walked in, he asked at once: How can I help?
AROUND that time, a man in New Jersey, who’d also read the article, was wondering the same thing. So was another man in Michigan. And a woman in Canada. How could they help Smith, whose fortunes were bound by being born in one of the 19 states that had refused to expand Medicaid eligibility?
“The outpouring for Shanette, since the article has come out, has been amazing,” said Cyndy Greenhagen, an Iola-based patient navigator at the Community Health Center of Southeast Kansas, whose main office in Pittsburg recently established a site to receive the many donations that are pouring in for Smith. “People from all over want to know how they can help, and they want to know why this is happening in Kansas.”
It was Greenhagen, those many months earlier when Smith was hoping to get into nursing school, who had to inform the young mother that she failed to qualify for insurance, that she’d fallen into the coverage gap.
“It’s hard,” said Greenhagen. “I have people who come in every year just to update their information, hoping—‘Am I going to be able to get it this year?’ I have one guy who comes in and he really needs insurance, bless his heart. Probably in his thirties. He has some significant health problems. He needs a specialist and the kind of specialist he needs doesn’t go around giving out cheap appointments. Every year I see him, I think: ‘Oh, gods that be, let him get insurance.’ But no.”
The Times article, though, struck a nerve, said Greenhagen. It put a face on a problem that too often gets sketched in numbing statistical language. “The great thing about Shanette’s story,” continued Greenhagen, “is that she’s someone who just wants to do the right things: she wants to raise her kids and she wants to be a nurse.”
In the days after publication, an unnamed donor offered to pay for Smith to have insurance going forward. And so, as of this week, after five years of living precariously without it — living in a constant, low-level fear of a medical crisis — Smith has health insurance.
“All of it is more than I could have ever asked for,” said Smith. “I’m so thankful.”
Greenhagen and Smith staged a reunion in the navigator’s Iola office not long after the article came out. The mood this time was decidedly cheerier. “We shut the door,” recalled Greenhagen. “We just talked for a long time and laughed. We couldn’t believe the offers of help that were coming in. And Shanette is not the kind of person who just takes. She wanted to make sure everything was going toward its intended purpose. The whole process has been amazing.”
But both women agree that Smith was lucky, and that waiting around for the New York Times to profile you is a fairly inefficient way for those who fall into the coverage gap to go about getting insurance. The solution, instead, needs to be a political one.
“And it starts with getting people to understand what this really means, “ said Greenhagen. “A lot of people say, ‘Come on, we have to be responsible for ourselves.’ Well, you can be as responsible as you want, all day, and you can’t pay $600 a month for insurance if you make $7.25 an hour. It’s just math.”
But the future of Medicaid expansion in Kansas faces grim odds. Even though the failure to expand Medicaid has, according to the Kansas Hospital Association, cost the state more than $1.6 billion in federal funds, Gov. Sam Brownback remains unbudgeable in his opposition to the program, and many fear that the tenets of the ACA itself are imperiled with the recent election of a president who has vowed to dismantle the law wholesale.
SMITH recently completed her pre-admittance test for nursing school. She’ll find out in February whether she’s been accepted. If accepted, she’ll begin school in the fall. “It’s been a long journey,” said Smith, speaking at her home two days after Christmas. The family had recently wrapped up their annual round of holiday candy making — chocolate-covered pretzels, peanut butter crackers. An enormous Ziplock bag stuffed with puppy chow slumped in one of the dining room chairs. The girls busied themselves with their new toys. Megan, 7, showed off a furry mechanical dog whose eyes slowly blinked when you pressed its nose. And Madison, 9, set her Easy-Bake Oven on the kitchen counter and thought hard about which packet of ingredients she would include in her maiden dish. (“My Grandma Sheila got all of these different packs for me,” said Madison. And then she said: “But, wait—how did she know Santa was bringing me an Easy-Bake Oven?”)
“I’ve always told my girls to be cautious and pay attention to what’s going on around them,” said Smith. “You know, just because of everything that’s going on in the world. But, after the article, when all these people started reaching out to help, it was my girls — it was Madison, I think — who told me: ‘Mom, there really are good people out there.’ It was a lesson, I guess, or maybe a reminder, for all of us.”
