Say you’re a woman between 50 and 64 years old needing to decide which prescription to refill. You have high blood pressure, high cholesterol and low thyroid, and you need prescription medications to help manage all three conditions. You are, however, uninsured and cannot afford all three.
Which one is the most important? For people who are uninsured, this is a common problem. Should they take their heart medication or seizure pills? They have to decide. This situation is even more severe in Washington County.
Washington County has the highest uninsured rate in the state at 17 percent. Nationwide, health insurance coverage for women has declined since 1980. During the 20th century, the health care system has largely been based on employment and marriage such that individuals with jobs or who are married to spouses with jobs have access to high-quality, affordable health insurance. Women with employer-sponsored insurance are almost twice as likely as men to be covered as dependents, making them more vulnerable to losing coverage following the death or retirement of a spouse, loss of a job or a divorce.
Washington County was one of the few counties in the northeastern U.S. where the life expectancy of women decreased between 1983 and 1999. For the first time since the 1918 Spanish influenza epidemic, Washington County women cannot expect to live as long as their mothers did.
Many women in Down East are generally employed in part-time seasonal work and are not eligible for employer-sponsored health insurance. This work consists of working in the blueberry industry, making balsam Christmas wreaths, processing crabmeat or working in a tourist industry. Others are employed year-round as personal care attendants and housecleaners. These women often have several jobs, juggling schedules to squeeze in as many hours as possible into their workweek.
The uninsured have limited access to care and are likely to delay care and seek acute care more often than those covered by health insurance. Without medical insurance, women are less likely to seek care or follow up with prescribed tests, treatments and appointments. When they do seek care, they often are more sick than insured peers of a similar age. As studies have shown, access to primary care and consistent face-to-face contact with a regular care provider are associated with better health outcomes and enhanced chronic disease management and health outcomes in general.
Incidences of chronic illness such as hypertension, diabetes and COPD increase with age and disproportionately affect the 50- to 64-year-old group. The lack of financial protection from unexpected health care expenses that increase with age can have devastating effects on health and finances.
In the past two years, the Maine Legislature voted five times to expand Medicaid. Gov. Paul LePage vetoed the expansion, and the Legislature could not override the veto.
Under the Affordable Care Act, the federal government is picking up the entire cost of new enrollees through 2016 and never less than 90 percent thereafter. Maine was the only state in New England and one of 23 nationally to so far decline federal money to expand Medicaid under the federal law. LePage’s decision to shrink Medicaid instead of expanding it was a radical departure from a decade-long effort to cover more people in this small rural state of farmers, lobstermen, craftsmen and other seasonal workers.
The decision not to expand MaineCare will sustain the gap in insurance coverage, and many of those who were not eligible for MaineCare prior to implementation of the Affordable Care Act are not be eligible for reduced premiums.
Among Washington County’s uninsured women, the financial priority is not health care and making sure they have their medication but paying the heat and utility bills. Ironically, as the Affordable Care Act is implemented to usher in a new era of health care, near elderly, working poor and unemployed and underemployed women may be unable to afford even the lowest premiums and will continue to subsist on the margin of health.
The next time you fill a prescription or get your routine blood tests done, think about these women who are uninsured and deciding which treatment they think is most important.
Mary Shea is an assistant professor and graduate program coordinator in the School of Nursing at the University of Maine.