Nearly 70,000 low-income Rhode Islanders — many of whom work at low-wage jobs with no health benefits — gained coverage when the Affordable Care Act allowed states to expand Medicaid. Three people share their fears about losing that health-care lifeline.
Carmine Porreca rarely misses a day of work.
The 49-year-old, divorced father of four once worked for eight months with a painful hernia because he felt he couldn’t afford to take time off for an operation.
“There were times I was in pain and I’d have to walk out of work,” he said, “go lay in the truck for a little bit, and then I’d go back to work.”
Fortunately, he had health insurance that covered his treatment.
Porreca, a cook who lives in North Providence, is one of nearly 70,000 low-income Rhode Islanders — many of whom work at low-wage jobs with no health benefits — who have gained coverage since the Affordable Care Act, known as Obamacare, allowed states to expand Medicaid. Their coverage currently costs $450 million — or one-fifth of the state’s $2.3-billion Medicaid program.
Now, Porreca and others like him could lose their coverage under a Republican plan to roll back that Medicaid expansion and limit future federal financing for the safety-net program. Able-bodied adults also could be required to work in order to qualify for Medicaid.
Medicaid is often associated with the poorest of the poor, people without jobs or incomes. But in fact, more than 60 percent of Rhode Islanders covered under the Medicaid expansion work at low-wage jobs, according to a February 2017 report by The Kaiser Family Foundation. (The national average is 59 percent.)
Among them are Mallory Fink, a 25-year-old waitress and aspiring artist in Newport, and Amey Morris, a divorced mother of five adult children in North Smithfield.
In many ways, Fink is like a lot of 20-somethings trying to find their way after college. She shares a rental apartment in Newport with two roommates, waits tables, and spends her free time pursuing her passion: painting and collage.
Fink, who studied film and art for four years at the University of Rhode Island but doesn’t have a degree, pays almost $2,000 per month for her student loans.
Her parents, who divorced when she was in high school, have had their own financial problems. Then her father became ill.
“I’ve been working since high school,” Fink said. “Pretty much since I was 18 I’ve been paying for everything.”
Her father died when Fink was in college; her mother now lives Georgia. “She really didn’t want to have anything to do with our insurance or school loans,” Fink said, explaining why her mother didn’t put Mallory on her own insurance plan, as Obamacare allows for children until they turn 26. “She just preferred my brothers and I were more independent. “
For 1½ years after Fink left URI, she had no health insurance. She was 22 and living with her mother for a year in Georgia when she landed in a hospital emergency room with severe stomach pains and constipation. She was sent home with a laxative and a bill for “a few hundred dollars.”
But the stomach pains returned. And she felt unusually fatigued.
In 2015, someone she knew at Thundermist Health Center told her that she could qualify for free health insurance through Medicaid.
A doctor referred her to a gastrointestinal specialist who performed a colonoscopy and diagnosed her with diverticulosis, a disease of the lower intestine. She also was anemic.
She changed her diet and now takes a vitamin B12 supplement. Her stomach problems subsided and she noticed a “dramatic increase” in her energy level.
At 64, Amey Morris has no plans to retire.
She works two part-time jobs — as a school bus driver and a nurse’s aide at an elementary school — and cares for her 22-year-old disabled son and 18-year-old adopted daughter, Brittany, who has special needs.
A former emergency room nurse, Morris said her care-taking schedule keeps her from taking a full-time job.
“I pretty much live paycheck to paycheck,” she said. “I never thought that I’d need Medicaid or any kind of assistance.”
She was 51 when her ex-husband remarried and he could no longer keep her on his private health insurance plan.
Morris has a history of depression, and her doctor had prescribed an antidepressant. He agreed to continue to write her prescription, but it cost her $20 to $30 per month — roughly what she earns in one hour of driving a school bus.
For 11 years, she had no insurance.
She considers herself fortunate; she managed to stay healthy. But she worries “all the time” about getting sick or injured, she said, “because I know what the bills can be. And all it takes is one incident.”
In 2014, she became eligible for coverage under the Medicaid expansion, which provides coverage to adults without disabilities or dependent children who earn up to 138 percent of the federal poverty level — about $16,643 for an individual.
In July, she turns 65. In a way, she says, it will be a relief. At least she’ll be eligible for Medicare. But she’s worried about her son, Zach, who has cerebral palsy. Medicaid pays for his daycare so she can go to work. Otherwise, she says, she’d have to put him in a group home and “I don’t want to do that.”
Porreca, the cook, says that if he loses his Medicaid coverage he knows he won’t be able to afford to buy a plan. “I would probably end up going without it again.”
On Twitter: @LynnArditi