December 12, 2018
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With Medicaid expansion in legal limbo, one unlikely plaintiff keeps putting off the doctor

Callie Ferguson | BDN
Callie Ferguson | BDN
Old Town resident Ann Avery shows off an X-ray of her injured foot, where she's had multiple surgeries to insert nine screws in her ankle following a 2011 accident at the Old Town mill. Workers compensation has covered the cost of the surgeries, but the injury forced Avery to leave her job and lose her health insurance.

Ann Avery has stopped going to the doctor.

She badly needs to go, but she can’t afford it.

In her purse, the 58-year-old keeps a handwritten list of the 16 different health problems for which she requires medications or care — everything from diabetes to leg pain to anemia. But during the past decade, Avery, who lives in Old Town, routinely chooses to ignore symptoms and put up with pain rather than deal with the stress of adding to a pile of medical bills she can’t afford to pay.

“So I just don’t go to the doctors,” she said, leaning forward in a worn armchair at a Bangor coffee shop. “Unless I have to go. Like I have to go next month. Because if I don’t go, they won’t renew my prescription.”

She takes at least seven different prescription medications and has had recurring medical problems since she injured her foot in 2011 at the now-shuttered Old Town mill, where she had worked for 30 years. “Each time they add a new one, or try to change it, I kind of panic,” she said.

That was supposed to change July 2 — the date an expansion of MaineCare, the state’s Medicaid program, was supposed to take effect and cover an additional 70,000 low income Mainers. Avery is eligible under the expansion. She originally was denied Medicaid coverage because of the benefits she receives through workers comp disability insurance from the accident.

But Avery is still waiting. Although Maine voters took the first-in-the-nation move to pass the expansion in a November 2017 referendum, Republican Gov. Paul LePage — who has vetoed the Legislature’s past attempts to expand the program several times, claiming it would drive the state into debt — has stalled its implementation. Maine is the only New England state to turn down the federal expansion dollars under the Affordable Care Act to expand Medicaid.

“It kills me,” Avery said. “It’s voted on and everybody is all happy that it passed. But it didn’t. It passed on paper. But we still have nothing, and LePage is getting away with it.”

But only for so long, in part because of Avery. She was one of several plaintiffs in a recent lawsuit designed to force the Republican governor to implement the law, after he missed the spring deadline to submit a plan to the federal government.

In late August, Maine’s high court ruled in favor of the plaintiffs — a group spearheaded by Maine Equal Justice Partners — and the governor reluctantly submitted a plan. But the ruling kicked key questions back to the lower courts, such as finding a way to pay for the start-up costs and creating a sustainable funding mechanism. Resolving those issues could further delay implementation of the expansion.

Avery is an unlikely plaintiff. For instance, she said, she was part of a series of layoffs at the mill in 2005, and as an unemployed single mother, qualified for MaineCare insurance.

“The day I got the card in the mail, I called [The Department of Health and Human Services] and cried,” she said during a recent interview. “I apologized. I felt defeated that I had to go get help.”

More than a decade later, her mind has changed. “I feel bad, but I’m sure as hell not going to apologize if I need help,” she said, explaining why she was willing to join the lawsuit when a member of Maine Equal Justice Partners reached out to her.

But that’s about as far as she wants to be involved, she said. She does not watch the news because it infuriates her. The political arenas where this twisting and turning fight for her health care is playing out, she said, bear little resemblance to her hardscrabble life in rural Penobscot County.

Avery’s troubles began in November 2011. She was back working at the mill, when a 500-pound machine that created toilet paper bales fell on her foot. The injury put her on desk duty for a year until she realized she would need a series of surgeries.

After the first operation in November 2012, Avery had to quit her job at the mill, and lost her health insurance. This time, she didn’t qualify for MaineCare, she said. But her injury meant finding work that would secure her new insurance was a challenge.

“After each surgery, it was eight weeks, nonweight-bearing, flat on my back,” she said, flicking through pictures of her X-rays on her iPhone that show the nine screws placed in her ankle. “[And] when you have a lot of trouble walking and you’re in pain all the time, it’s very hard to go out and apply for a job.”

Workers compensation has covered the cost of her surgeries and sends her a check for a few hundred dollars every month. But it isn’t enough to cover her other medical expenses related to the health problems that have arisen since her injury.

However, she said it’s enough to make her rates under the Affordable Care Act too costly.

“I’m stuck,” she said.

Since 2012, Avery has cobbled together income — and sometimes, health insurance — from intermittent jobs at hospitals and a casino, but would ultimately quit because of her continuing health problems.

Last November, Avery, now a grandmother, developed a serious pain in her lower back. It was so serious that she asked her son to take her to St. Joseph Hospital in Bangor.

“I was desperate. That’s why I went,” she said, knowing she could not afford the bills that she would end up paying off in installments.

Just a month ago, in August, Avery developed another serious pain — this time in her stomach. And this time, she didn’t go. “I’m trying to avoid having those bills hang over my head.”

The grandmother will likely confront this decision again, after a lower court judge decided last week that the legal battle over health care will extend into the fall.

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