FEATURE: Single Mommy Solitude

By on April 5, 2016

How Wyoming’s refusal to expand Medicaid is hurting struggling moms.

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JACKSON HOLE, WY – Tyduce is only four weeks old. His dark blue eyes light up a room, and he loves to cuddle. With a roof over his head and a crib to sleep in, he is unaware that he and his mother are homeless, or that they will lose their health insurance in two weeks.

In Teton County, one of the richest counties in the U.S., legislators have refused to expand federal Medicaid coverage to struggling young women like Tyduce’s mom, Rachel Osburn. So local organizations like the Good Samaritan Mission Housing and Homeless Shelter, where Osburn lives, must step in.

Osburn, 22, says her employer does not provide paid maternity, and the state of Wyoming will not offer financial assistance beyond food stamps and six weeks of “pregnancy Medicaid.” As the first single mother at GSM’s Women’s Shelter, Osborn says she can’t afford to pay rent and daycare.

But Osburn’s plight is a common one for low-income mothers here. Moms who are one step away from homelessness in a state where lawmakers continue to wage a battle over Medicaid expansion.

Women left behind

Wyoming became the first state to grant women the right to vote in 1869. Women could also serve on juries and hold public office positions.  Nellie Tayloe Ross became the first female governor of Wyoming in 1924.

Since then “equality” has been dubbed the state’s motto. In fact, the state seal itself—”Equal Rights”—symbolizes the political status women have always been privy to in Wyoming.

But as young moms look for help navigating a tangled socioeconomic web, it seems Wyoming is losing its bragging rights as the Equality State. Lawmakers in Wyoming continue to deny Medicaid expansion—one of the main tenets of the Affordable Care Act—a move that largely keeps benefits to single and low-income mothers out of reach. Consequently, local public assistance programs shoulder the burden of aiding women and low-income earners.

Medicaid mainly covers children. The next largest group is those with developmental disabilities and, finally, pregnant women. Under the existing system, the federal government pays 50 percent of health costs. Under expansion, the feds would assume 90 percent of costs. People must make less than $16,000 annually, to qualify. The federal poverty line for a household of three is $19,530.

In February, the Wyoming Senate voted 19-11 against expanding health care coverage to more than 17,600 uninsured Wyomingites.

Key Wyoming legislators on both sides of the issue, including opponent Senator Leland Christensen, R-Alta, and proponent Rep. Andy Schwartz, D-Jackson, say that the primary reasons for continued legislative opposition are two things: A lack of confidence that the federal government will honor its commitment to cover 90 percent of the cost, and a general concern that folks who would be covered under Medicaid expansion may not be working to their fullest abilities.

Thirty-two states, including Washington D.C., have opted to expand Medicaid coverage to adults with incomes up to 138 percent of the federal poverty level. In 2015, that’s about $27,720 for a family of three. According to the Urban Institute Research Center, “Medicaid expansion will reduce state and local costs for hospital care for the uninsured by sharply reducing the number of people without health insurance. In 2008, state and local governments shouldered $10.6 billion, or nearly 20 percent, of the cost of caring for uninsured people in hospitals.”

Urban Institute Researcher John Holahan explained how states benefit from Medicaid expansion. “By shrinking the number of uninsured people and having the federal government pick up the overwhelming bulk of the tab, the Medicaid expansion will ease cost pressures on states stemming from uncompensated hospital care, mental health care, and other health care services,” he wrote in a recent study. “There are a number of states that have state-funded programs that will no longer be necessary, and virtually every state and localities within those states make payments for uncompensated care to support the uninsured. A lot of that can go away and those savings would offset any new state spending on Medicaid.”

Schwartz acknowledges that many low-income people around the state would stand to benefit from Medicaid expansion. However, Christensen, along with Sen. Dan Dockstader, R-Afton, and Rep. Marti Halverson, R-Etna, have voted against it, and the measure has been stalled until the next legislative session in January 2017.

Christensen argues Medicaid is a damaged system. “It’s hard for me to vote to increase something that is broken,” he said. “If we take on Medicaid expansion and the federal government can’t pay their side, education and roads could be cut. By constitution we must maintain a balanced budget. We are looking at cuts in service statewide.”

Christensen added that many doctors have to cap their intake on Medicaid patients due to low reimbursements from the system; private insurance pays doctors more.

But Democratic lawmakers like Schwartz disagree. “Medicaid is not broken,” he said. “It functions. It does what it is supposed to do, fairly well. Medicaid goes to people who genuinely need it.”

Indeed, Wyoming residents like Osburn have depended on it for the delivery of their newborn children.

“It is a matter of circumstance,” Schwartz continued. “Some people are not able to make enough to afford insurance because everything else costs money too—food, transportation, housing. It’s appalling to me that some people think low-income workers could ‘work harder’ or ‘manage their money better.’ The people [that think that] have never been poor.”

“There are limited resources, limited facilities and limited availability. These women are stuck.” - Georgia Ligori, Good Samaritan Mission

“There are limited resources, limited facilities and limited availability. These women are stuck.” – Georgia Ligori, Good Samaritan Mission

Local services save the day

Georgia Ligori, administrator of the Good Samaritan Mission and program director of the Women’s Shelter, is hopeful for women thanks to the community resources available to help them. She lauds the local churches, the Department of Family Services, CLIMB Wyoming, and the GSM’s efforts to help women access food, work and daycare.

Nonetheless, the former social worker and licensed counselor laments the number of women in need. “How do we help our young mothers succeed?” she wondered. “There are limited resources, limited facilities and limited availability. These women are stuck.”

Osburn, for instance, lost her home after Tyduce’s father had to stop working. The monthly rent was higher than she could afford alone, along with other bills.

Dr. Bruce Hayse has been serving low-income people in Teton County for 30 years, and has sat on the board of St. John’s Hospital for eight years. He agreed, “I see a lot of women who are struggling; so many single mothers. You can’t survive in Jackson without a job. The minute you get a job, you get dropped from Medicaid.”

Rising before the sun, Hayse works long hours to meet the needs of the uninsured and those who can’t cover medical costs. “The American insurance system was built after WWII on the basis that everyone would get insurance through their jobs,” he said. “This model no longer works. If we want to have a fair and just society where people can function to their full capacity, we must acknowledge this fact. It hurts people and it hurts society for people to remain unable to obtain the medical care that they need.”

Hayse says there is no excuse for turning down Medicaid. The state’s arguments, he maintains, are feeble. “Their opinions and decisions don’t amount to any rational reason.The state is quite willing to fund highways,”  he said. “You have to wonder what goes on in the minds of the people willing to deny medical care to individuals.”

Ligori agrees. “Wyoming Medicaid and lack of funding seems to be the biggest issue and biggest stumbling block for women,” she said.

Enter CLIMB Wyoming, a statewide nonprofit program focused on giving low-income single mothers life skills and job placement to move them out of poverty and reach self-sufficiency. The program serves women from Teton, Sublette and Lincoln counties. Some women commute from Pinedale and Afton to participate.

Many low-income mothers in Wyoming hope to secure better-paying jobs to cover the high cost of daycare. They must make the painstaking choice between full-time work soon after childbirth, or begin the CLIMB program for six to nine months before they can work full-time again.

Tyduce’s father is working to resolve legal matters and unable to help with his son’s care. Osburn is on every waiting list in town for daycare, even though she knows she cannot pay for services, which average around $70 a day. Additionally, her work hours conflict with regular daycare schedules. This is a conundrum for Osburn and other single mothers.

Osburn will return to work before Tyduce turns five weeks old. She hopes to qualify for health coverage following her upcoming job performance review. This is a sharp contrast to the days of living in her car after she lost her Idaho home. During those times, Osburn says all she and Tyduce’s father had were “the clothes on our backs and what was in the cooler.”

Upon Osburn’s return to the workforce, however, she won’t be able to participate in the CLIMB program, though she has enrolled. Osburn must hold down a full-time job to maintain residency at the Mission. But full-time work disqualifies her from the CLIMB program.

For Osburn’s son, Tyduce, the deck is stacked against him. Forty-two percent of children born to low wage parents remain at the bottom of the socioeconomic ladder as adults, according to  statistics compiled by CLIMB. Tyduce’s mother is among the 62 percent of employed single mothers in Wyoming who work in low-paying jobs with no benefits.

According to the Census Bureau, in 2014 22 percent of all working families were headed by females; 39 percent of low-income working families were single mom households.

Karen*, another valley resident, is a mother of seven who was able to use Medicaid when a terminal illness threatened her life. Like Osburn, she says the key obstacles she faces are housing and finding full-time work with benefits in Teton County.

“When I was pregnant and high risk, Medicaid was a lifeline,” Karen said. She has lived in the shelter, used food stamps, and happens to be a cancer survivor. She also started her own soap business, and graduated from Teton County’s CLIMB program, largely possible because she was self-employed. She hit a point where she wanted benefits, and the costs of her soap business were going up. “I knew I had to change something,” she said.

Karen received Medicaid when she was diagnosed with cancer. “It was such a whirlwind,” she explained. Echoing Osburn’s sentiments, she said, “I wouldn’t have gotten any coverage without Medicaid. I had to have surgery and radiation. How could I have paid for that?” Karen is currently receiving insurance through the Affordable Care Act.

“Single moms often face many barriers, and possess minimal resources that could support them pulling their family out of poverty,” said Laura Conrad, CLIMB’s local program director. CLIMB seeks to break the cycle of generational poverty. Karen is one of the women who has benefitted from the program.

Osburn is no stranger to the other obstacles Conrad references either. She has another daughter who lives with relatives outside the state. Until she has her own home and a higher income, she cannot provide for her daughter on her own. Osburn’s efforts to resolve several legal matters have also left her trapped. She has to choose where to spend her hard-earned dollars—on legal fees, on housing, or on her children.

Hayse agrees with the necessity for expansion for many more women like Osburn and Karen. “I’d like to see Medicaid coverage for single and low-income mothers,” he said. “It’s a real travesty. The money is there to provide adequate medical care. The state is forbidding it for no good reason. They have a bad attitude toward low-income people in Wyoming.”

Medicaid expansion proponent Rep. Andy Schwartz, D-Jackson.

Medicaid expansion proponent Rep. Andy Schwartz, D-Jackson.

Poor and disqualified

Osburn looks forward to returning to work. She says she loves the people she works with and enjoys her work environment. She feels far more “at home and peaceful in Jackson” than she felt in her hometown of Blackfoot, Idaho. While she is content with her newfound community and surrogate family at the Mission, she would love to have a home and health insurance. “But it all comes down to money,” she said.

Women striving to increase their wages often find themselves at a standstill, much like the Wyoming legislature’s halt to approve Medicaid expansion. “If you are making just a fraction above what you need, you are disqualified for health care,” Ligori said. “This is frustrating for people who are trying to get their lives in order. I would like to see increased funding for the Wyoming Medicaid program because too many people fall through the cracks.”

Expanding Medicaid in Wyoming could take some weight off many public assistance programs currently aiding women and low-income earners—folks who have nowhere else to turn. Programs like the Department of Family Services/Workforce Services Community Safety Network, Teton County Public Health and Victim Services, Community Resource Center, WIC, Vocational Rehabilitation, and Turning Point.

The Healthy Teton County (HTC) initiative, a partnership between St. John’s Hospital and Teton County Public Health, developed the Community Health Needs Assessment (CHNA) in 2015. The study surveyed 1,200 individuals and more than 40 human services organizations across Teton County. One of the key issues identified in the report is that “the primary health need of the uninsured population in Teton County is access to health services.”

“Insurance is not accessible in this state unless you have substantial income,” Hayse lamented. “We will see more of this as the Wyoming economy continues to go downhill. There will be a lot of stress placed on hospitals in the future.”

At St. John’s, the administrative team is committed to aid those who can’t afford to pay their bills. “The largest pool of money goes to help people,” Hayse explained. “We are all in unity as far as our desire to put people first. It’s a community hospital; this has been a longstanding effort. That’s a real credit to the board and the administrator Louis Hochheiser.”

On the other side of the debate, Sen. Leland Christensen, R-Alta, deems Medicaid a ‘broken system.’

On the other side of the debate, Sen. Leland Christensen, R-Alta, deems Medicaid a ‘broken system.’

In 2014, the hospital used a portion of the $3.67 million in county property tax revenues it received to provide care for struggling folks in the community. SJMC also plans to increase routine preventive screenings and boost immunization rates for those over the age of 65.

However, Schwartz is worried about the future of Wyoming hospitals outside of Teton County. “Hospitals are in jeopardy of closing,” he said. “They have working cash for less than a month, and [the Wyoming] legislature has had to appropriate money for hospitals.”

Wyoming Governor Matt Mead echoed this concern in his 2015 State of the State speech: “The fact is, the Wyoming Hospital Association reports $200 million in uncompensated care. If small hospitals close, our rural towns will suffer tremendous loss and opportunity for the future.”

The situation hits hardest for low-income, uninsured mothers like Osburn and Karen who can’t find a way out of the maze. According to the Wyoming Medicaid Expansion Report issued in 2012, “The uninsured truly in poverty will most likely remain uninsured without the expansion of Medicaid.” If expanded to adults under the 138 percent federal poverty level, it “would permit the working uninsured to access health care coverage.”

Christensen, however, defends fiscal conservatism concerning health coverage. “Due to significant increases in unemployment, there isn’t enough money in Wyoming savings to address some of the medical challenges around the state,” he said.

“The money is there to provide adequate medical care. The state is forbidding it for no good reason.” - Dr. Bruce Hayse (Photo: Sargent Schutt)

“The money is there to provide adequate medical care. The state is forbidding it for no good reason.” – Dr. Bruce Hayse (Photo: Sargent Schutt)

Who decides who is worthy?

The CHNA states that  because Wyoming has not chosen to expand Medicaid, there are thousands of residents who remain uninsured because they fall into a dangerous grey area. These are folks who do not qualify for Affordable Care Act coverage or Medicaid.

“Everyone deserves health care and mental health, especially people who are struggling. It helps the community when everyone is covered,” Karen said. “Medicaid takes care of this. If people are going through a hard time, they are going to be better in the community with access to medical services.”

Schwartz echoed Karen’s sentiment. “If we can provide better access, we will have a healthier population that is more productive in the workforce. And if they are getting proper health care at the proper time, it will mean less cost for hospitals,” he said.

Medicaid expansion could also serve as preventive care for low-income and uninsured Wyomingites who are uncertain how to approach their health needs when short-term coverage, such as Osburn’s pregnancy Medicaid, runs out. The CHNA states, “The uninsured may defer care because they are worried about payments; these delays in care may lead to more severe chronic conditions.”

For Tyduce and his mom, leaning on the Mission as Osburn works as much as she can, is all they can do right now. “I don’t know what the future holds for us,” Osburn admitted. “It’s hectic trying to jump through one hoop after another and ending up in a rut.”

Nonetheless, Osburn remains optimistic. “It’s a challenge every day, but ultimately we will get through it all. My son gives me hope.” PJH

*Name has been changed.

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