Stuck in the gap, waiting for Medicaid verdict

Chad Riese, a USF graduate with epilespy, doesn’t meet qualifications for Medicaid nor can he afford health insurance.

Though it is important to prepare for unexpected medical expenses and the financial burdens sometimes associated with health care, approximately one in five Floridians do not have some form of health insurance, according to a 2014 White House Council of Economic Advisers report.

Chad Riese, a 23-year-old USF political science graduate, falls into this statistic. 

Like most graduates, Riese worries about paying for college loans and rent. Unlike most graduates, he suffers from epilepsy and has to pay off more than $100,000 in medical debt from costly medications, hospital visits and treatments.

“I’m paying for my monthly costs going to the doctor and prescriptions, but I’ve taken out some loans that I did not plan to pay for some costs that I did not plan,” Riese said. “Every semester before I was diagnosed, I was taking out subsidized loans like the most of us are on campus … but then I had to start taking out unsubsidized loans, which are going to be more costly and have higher interest rates.”

Riese said epilepsy, a neurological condition that disrupts electrical communication between neurons, is a limiting condition with no one simple cure or medicine.

“You cannot die from having a seizure, but having a seizure in a certain situation … behind the wheel of a car, having a bath alone, scuba diving, or skydiving … could kill you,” he said. “I still haven’t found my right drug. I’ve tried three separate seizure medications and I just started a new one recently.”

Riese said he experienced seizures months before doctors could diagnosis him with epilepsy in 2013, a process that was not only expensive due to medical testing and hospital visits but also mentally taxing and stressful.

“I didn’t want to deal with it at first,” he said. “I didn’t want to talk about it, didn’t want to deal with it, and with school and other things on my mind, it was the last thing I wanted to hear about.”

Though Riese suffers from epilepsy and must take costly medication on a regular basis in order to keep his seizures under control, he still does not qualify for Medicaid because he is over the age of 21 and does not have a child.

While he may qualify for lower coverage costs for private insurance, Riese said he does not make enough money to afford private health insurance, which leaves him with extremely limited options. 

Other Floridians, such as childless adults who have absolutely no income and those who make more than 50 percent but less than 100 percent of the federal poverty line, have fewer options for health care, as they do not even qualify for lower coverage costs, which places them in a coverage “gap.”

A November 2014 report by the Henry J. Kaiser Family Foundation collected data from the U.S. Census Bureau and found that more than 650,000 Floridians fell into this health insurance coverage gap.

“I tried applying for (health) insurance in general, and I was denied,” Riese said. “I needed health insurance at the time as a student … for preventative care in case anything did happen. Unfortunately I didn’t have insurance when I started suffering seizures and had hospitalizations.”

As of today, Riese said paying off his medical debt is not his largest priority. Instead, he is trying to pay off his student loans and start saving up for a house. He said, however, he has recently received the help of individuals and grants from hospitals, which have lessened his debt.

“As I’ve started to speak out about this and share my story, individuals are beginning to help me and are wanting to volunteer their services, and quite frankly money, to help pay off some debt,” Riese said.  “I’m very blessed to have met some people who want to help me because again, I don’t think I’ll be making any efforts to do that soon.”

While the Affordable Care Act, passed by Congress in March 2010, expanded Medicaid coverage to all Americans below the age of 65 whose family income is at or below 133 percent of federal poverty guidelines, a Supreme Court ruling in June 2012 made expanding Medicaid coverage an optional act by individual states. So far, Florida legislators have voted against expanding the program.

This year’s debate on expanding Medicaid has carried a tone of urgency due to an announcement from federal agency Centers for Medicare and Medicaid Services. It explained that Florida’s federally generated Low Income Pool funding will end in summer.

The funding pool has provided Florida with more than $2 billion for health care for the poor and uninsured. This means potentially hundreds of millions of dollars in federal funds are currently at stake in Florida’s budget, which creates a powerful catalyst in solving the Medicaid expansion issue.

Though The Oracle reached out to Florida Sens. Andy Gardiner, Tom Lee and Bill Galvano, they were unable to respond by the time of print.

“Medicaid expansion is arguably one of those (issues) worth going to the wall on,” said Lee, chairman of the Florida Senate Appropriations Committee, to the Tampa Tribune. “But first we have to know there’s an appetite, how we would do it, and I don’t think there’s any consensus on what the mechanism would be to take federal money.” 

Lawmakers have been hesitant in the past to expand the program primarily due to its potential long-term costs. While the federal government would pay for 100 percent of Medicaid’s expenses for the first year and 90 percent for three years after, some members of Florida’s Congress are worried the federal government could withhold funding at any time and paying for Medicaid using money from the state budget could be costly in the future.

“At this point in time, we’re not interested in expanding Medicaid as we know it,” Florida House Speaker Steve Crisafulli told the Herald-Tribune.

Still, Medicaid expansion has garnered support from some lawmakers, who view Medicaid expansion as a feasible solution to funding health care for low-income Floridians. 

“It’s important to realize 38 percent of our budget is federal dollars,” Gardiner said to the Tampa Tribune. “Do you just walk away from (expanding Medicaid), or do you figure out a way to make it work?”

Some private business leaders and health industry groups, like the Florida Hospital Association, also support expansion, and a coalition of organizations has crafted a “Healthy Florida Works” plan, which would create a semi-private Medicaid program and finance health care for low-income Floridians through federal funding from expanding Medicaid.

At the moment, it may be too early to determine whether or not Florida lawmakers will decide to expand Medicaid in the state, but the Legislature is currently in session and will come to a decision on the issue sometime before May 1.

“Everyone has the right to be healthy and happy,” Riese said. “I would like the Legislature to see the potential in what (expanding Medicaid) would provide … and the impact that these healthy and happy people could have.”