医疗补助计划的扩大为农村地区提供了生命线
HAZARD, 肯塔基州 — Until she qualified for Medicaid, Frances Trice avoided seeing a doctor.
Already thousands of dollars in medical debt and unable to afford health insurance, she skipped her annual physical and relied on home remedies to treat viral infections. When she broke her foot, she reused the orthopedic boot she had from a prior fracture.
“只有当我觉得自己快死了的时候,我才会去急诊室,特里克说。, 阿代尔维尔的居民, 肯塔基州, 一个少于900人的乡村小镇.
2019年,特里斯被诊断出患有心力衰竭. 到那时,肯塔基州已经扩大了医疗补助的范围.
联邦政府和各州共同出资, the Medicaid expansion program provides health insurance coverage to eligible adults, 符合收入要求的孕妇和残疾人. 该项目还帮助个体经营者, 小企业主, 农民, 季节性工人和尚未符合医疗保险资格的老年人.
The expansion program is credited with a substantial reduction in the rate of uninsured adults ages 18 to 64 in rural areas. In 2019, among states that expanded Medicaid coverage, government figures show that 11.这些成年人中有8%没有保险,而这一比例为21%.5%的州没有采取扩张政策.
因为她有医疗保险, Trice was able to focus on her recovery without worrying about how she could afford her lengthy hospital stays and prescription medications. 她说,单是药品一个月就要花费数百美元.
"The expansion of Medicaid has helped a lot of people around here, including myself,她说. "There would have been absolutely no way I could have afforded everything I had to have done."
平价医疗法案, 2010年颁布, expanded Medicaid eligibility to adults under age 65 whose earnings total up to 138% of the federal poverty level. 在大多数有扩大计划的州, 到2024年,这将转化为大约20美元的收入,个人780元, 大约35美元,三口之家630美元.
By law, the federal government pays 90% of the costs associated with expanding Medicaid coverage. 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
Derby, Kansas, resident Melissa Dodge prays that her state takes advantage of Medicaid expansion. 她的孩子享受医疗补助, 但在很大程度上,她的收入太高,不符合资格, 让她陷入所谓的保险缺口.
道奇青春期的女儿有几个健康问题, including a congenital heart defect that requires her to see a cardiologist several times a year.
为了她自己, Dodge has set aside her income tax refund to pay for an annual physical and routine dental care, and she has also dipped into her savings and used credit cards to pay for unexpected medical expenses.
In 2022, she experienced severe abdominal pain and made the difficult decision to seek treatment at the emergency room despite her lack of insurance. Doctors determined that Dodge had an unviable pregnancy causing a medical emergency, which required them to remove her fallopian tubes and a liter of blood from her abdomen.
除了丧子之痛, Dodge felt overwhelmed by thousands of dollars in medical bills that steadily trickled in. She was relieved to learn that Kansas has different income requirements for pregnant women and applied for the program. 最终,州政府同意给予怀孕津贴溯及既往.
“如果我能坐在治疗师面前哭泣, 我会在工作中成为一个更好的员工, 成为孩子们更好的母亲,更好的朋友和邻居,她说, 她补充说,“这让我卸下了沉重的负担."
堪萨斯的州长, 劳拉·凯利, has pursued Medicaid expansion in budget and legislative proposals since shortly after she took office in 2019. 但这些措施尚未获得州议会的批准.
决心推动这样的立法, Dodge has shared her story with local representatives and spoken in front of the state's Senate Committee on Public Health and Welfare. “能够站在委员会面前分享我的故事, 去恳求他们, 真的有影响力吗,她说. “我相信(扩大医疗补助计划)是正确的,我永远充满希望."
帮助医疗机构
通过确保更多的病人能够支付他们的医疗费用, 医疗补助计划的扩大也有助于维持农村医疗保健设施. 最近的一项研究发现,2019年无偿护理的中位数仅为2%.在扩大医疗补助计划的州,农村医院的比例为88%,而这一比例为6%.未扩张州的农村医院占31%.
Medicaid expansion has buoyed the University of 肯塔基州 North Fork Valley Community Health Center, 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, 治疗所有病人,不管他们的支付能力如何.
在医疗补助计划在肯塔基州扩张之前,该机构面临着不断上升的债务. “我们是在为那些付不起钱的人提供服务,”杜西特说.
Since the state expanded Medicaid, far more of the center's patients are covered by insurance. As a result, the facility has been considering expanding the services it offers. 过去,他们为削减哪些服务而苦恼. “它彻底改变了我们的格局,”杜西特说.
最重要的是,他说,“我们知道它改善了病人的生活." Research shows that groups without access to affordable health care have higher infant mortality rates, more chronic illness and greater risk of dying from illnesses such as heart disease and stroke, 与那些能够获得负担得起的医疗服务的人相比.
After having open-heart surgery to implant a device that helps her heart pump blood, Frances Trice qualified for Social Security Disability Insurance and enrolled in Medicare with Medicaid serving as the secondary insurer.
She sometimes wonders whether having health coverage earlier would have changed the course of her life. "Maybe I would have been able to be diagnosed sooner and get things under control before everything got really bad,她说. “老实说,我不知道没有保险的人怎么能活下去."