Each month, Fernando Flores and his family play a game of risky financial calculation. Flores, 20, should have aged out of Medicaid at 19, but his doctors have continued to accept his Medicaid card and provide him the pain medication and quarterly visits he needs to manage his illness.
At any moment the clerical error that Flores says allows him to receive health care could be caught, and this fact hangs like a storm cloud over the family.
Flores suffers from neurofibromatosis type 1, a disease that leaves him with small tumors that grow on his nerves and make random appearances all over this body. He also has one leg that is shorter than the other, which causes him back problems.
If he continues to be able to see the doctor at no cost, Flores, his mother and his brother can keep their heads above water. If not, his family must choose between what Flores says could be a financial crisis or chronic pain for him.
The Flores family lives in DuPage County, west of Chicago. Fernando Flores is in school on-and-off, when his illnesses allow, studying to be a physical therapist. His mother has been unemployed since leaving her job on a factory assembly line, and his younger brother, 18, is still in high school.
He doesn’t know what would happen, he says, if he were pushed off Medicaid. “We’ve always struggled financially. I guess I just would stop seeing a doctor then, ‘cause there is no way of paying for one.”
If Flores is no longer able to get Medicaid, he’ll fall into a large group of childless adults aged 19-65 who don’t have the means to buy insurance on the private market but aren’t eligible for Medicaid.
The Illinois House is considering SB26, a bill that would offer a solution to Flores’ dilemma. SB26 would expand Medicaid in Illinois to allow childless adults aged 19-65 whose incomes are 138 percent of the federal poverty level eligible to apply for the health care program.
In annual income terms, this means individuals who make around $15,000 or less.
The legislation passed the Senate on Feb. 28 and is waiting for its third reading in the House. This week it was approved by the House’s Human Services Committee, by an 8-6 vote. Gov. Pat Quinn favors the legislation.
The Medicaid expansion is a key part of the Affordable Care Act, President Barack Obama’s attempt at reforming a health care system in which millions of people are without access to health insurance.
In Cook County, 341,063 individuals will be newly eligible for Medicaid if the bill becomes law, according to Illinois Health Matters, a coalition of groups in favor of an inclusive health care reform. In DuPage, where Flores lives, 24,186 people will be able to enroll in the Medicaid program.
Bill sponsor Sen. Heather A. Steans did not respond to requests for comment.
Margaret Stapleton, director of community justice at the Sargent Shriver National Center on Poverty Law, a Chicago non-profit that promotes economic justice, said if the bill passes it will make “a world of difference” for individuals who now have, at best, patchwork care that doesn’t adequately deal with their health needs.
“It’s a shameful fact that the poorest of the poor don’t get health care because they are the unpopular poor,” she said. Though they may not have children or debilitating disabilities, doesn’t mean we [as society] shouldn’t? care for them, Stapleton said.
Right now, the health care options for the uninsured are the emergency room, the most costly choice; or a federally funded health center, which falls short on providing more than the basic primary care. For someone with a chronic condition, said Stapleton, neither of these options can adequately deal with their health needs.
She is hopeful that the legislation will pass.
In the past, conversations at the state level about Medicaid coverage were beset with worries about the cost, coming mostly from Republican members of the General Assembly. But under the Medicaid expansion plan, the federal government will cover 100 percent of the state’s coverage costs for the first three years, which the Shriver Center estimates will be $4.6 billion for Illinois. After the first three years, Illinois will have to cover 90 percent of the cost of providing health care for the people who joined after the expansion, with the federal government shouldering the rest of the cost.
Fernando Flores has been ill since birth, and that’s about as long as he’s been depending on government aid for health care. If his pain can be controlled, then he says his plans for the future will be within reach.
“I hope to become a physical therapist or be in the medical field,” said Flores, “so I can help others like myself.”