One Maine family’s struggle for health care

Samarali "€œSam"€ Daniels, 23, hugs her son Hector, 5, in the kitchen of their Augusta apartment. Their family is among 25,000 Mainers teetering on the edge and now in jeopardy of losing access to affordable health care.
Troy R. Bennett | BDN
Samarali "€œSam"€ Daniels, 23, hugs her son Hector, 5, in the kitchen of their Augusta apartment. Their family is among 25,000 Mainers teetering on the edge and now in jeopardy of losing access to affordable health care. Buy Photo
By Sandy Butler and Luisa Deprez, Special to the BDN
Posted Sept. 27, 2013, at 12:11 p.m.

Editor’s note: In this yearlong series, to appear monthly, the authors will introduce you to people who are apt to be your neighbors, are struggling to make ends meet and have been affected by specific state policies. To share your story, write to Sandy.Butler@umit.maine.edu or call 581-2382.

The Daniels-Perez family is, like many Maine families, struggling to make do despite full-time employment.

Samarali “Sam” Daniels, her husband Ramon Perez, and their two children, Hector, 5, and Marrianna, 3, live in Augusta. Ramon works 40 hours a week at Sam’s Club, walks two miles to and from his job every day, as they do not own a car, and makes about $11 per hour. That’s more than the state minimum wage of $7.50 but far less than the $17.15 calculated by the Maine Department of Labor in 2010 as a livable wage for a family of four.

While his company offers health benefits, they are unaffordable. Premiums to cover the family would eat up about a quarter of their income. The coverage would be minimal and each family member would have a $1,500 deductible.

While the family is currently covered by MaineCare — Maine’s Medicaid program — Gov. Paul LePage’s veto of Medicaid expansion in June means that Sam and her husband will likely lose this coverage at the start of 2014. The Ramon-Perez family is among 25,000 Mainers that are teetering on the edge and now in jeopardy of losing access to affordable health care.

Legislative decisions affect real people and can have severe consequences.

For many years, Ramon went without health insurance. There were many consequences. Earlier in his life, for example, he suffered an occupational injury at a factory job when a steel beam fell on and pinned his leg. Sam feels her husband was told to return to work too soon after that injury without getting adequate medical treatment — something that has contributed to the current problems with his knees and legs.

Knee pain is an ongoing health issue for Ramon. Medical testing indicated he has cartilage loss and fluid pockets in his knees. Sam worries, “We are always talking about what will happen if his knees give out on the way to work or something. What are we going to do? And the biggest issue is what are we going to do if we don’t have insurance? How are we going to pay for it?”

With health insurance through MaineCare, Ramon is able to get the help he needs for these chronic conditions, which enables him to continue to work. Last December, when the pain in his legs was very severe, he was able to visit a health care provider who diagnosed stress fractures in his legs from overuse.

Ramon was able to treat the problem with rest, before it got worse, and ultimately returned to his job. He has been prescribed insoles for his shoes, which are mostly covered by insurance and have worked to reduce back, knee and foot pain.

It would be very difficult for the family to cover the cost of those insoles (more than $100 per pair) without health insurance, as Ramon goes through several pairs each year.

Sam worked in retail at Sears until the day before she delivered her son five years ago. She is anxious to return to the workforce but has been unable to as both of her children have special needs that require considerable attention from her. Her son has numerous health concerns as well as development delays and behavioral issues that have made it difficult for him to attend traditional day care.

A physician and dietitian both recommended that Hector take a nutritional supplement, but it is not covered by insurance and costs the family about $125 per month. Sam reports that since starting the supplement, Hector has gained weight and started to grow, and his cognitive processing has improved.

With her son entering kindergarten and her daughter in Head Start four hours a day beginning this fall, Sam plans to begin her journey back into paid employment, possibly through volunteer work.

She said, “Hopefully, once my daughter hits kindergarten, I’ll be able to get back into the workforce. I want to go back to work so bad. I miss working, I really do.”

Their income generally falls between 100 and 138 percent of the federal poverty line, which would have made them eligible for the proposed Medicaid expansion passed by the Legislature this past spring but ultimately vetoed by the governor. Without that expansion and the federal funds that would have supported it, the state will be dropping coverage for working-poor parents such as Sam and Ramon.

While Hector and Marrianna will maintain coverage through MaineCare, Ramon and Sam will likely lose their health insurance in January.

Like other uninsured Mainers, they will be able to obtain health insurance through the soon-to-be established health exchange, but Sam does not think they will be able to afford the premiums, even with subsidies. Their income barely covers their basic needs, and they pinch pennies to make sure they can afford Hector’s food supplement.

Sam said, “It is not that people don’t want to get health insurance. It is just that we can’t. I mean my husband wants to work. The only time he goes to the doctor is for things that would keep him from working. He usually just goes when it is so bad he can’t take it anymore.”

If this family loses Medicaid, as is now quite probable, Ramon will lose access to the health care that allows him to remain employed. That would be devastating for the family and could lead to a financial crisis requiring them to need other publicly funded assistance. This would be a sad and costly consequence both for the family and the state. And they are not alone.

Sandy Butler is professor of social work and is the graduate program coordinator in the School of Social Work at the University of Maine. Luisa S. Deprez is professor and department chair of sociology and women and gender studies at the University of Southern Maine. They are members of the Maine Regional Network, part of the Scholars Strategy Network, which brings together scholars across the country to address public challenges and their policy implications.

http://bangordailynews.com/2013/09/27/opinion/one-maine-familys-struggle-for-health-care/ printed on July 24, 2014