Waiting for word on Medicaid's fate

Vicki Abernathy doesn't want anybody to feel sorry for her.

She'd rather you laugh at her jokes or sit down with her to talk politics.

While her mind is sharp and quick, her body is not. Diabetes and a bout with thyroid cancer have beaten down her body, one that put in 16 years' worth of work as a flight attendant.

She can still walk, but barely. She uses a cane. Her steps are like that of a newborn fawn, high and uncertain.

But as it stands today, life is OK. She has a clean, new house, a Honda Element, Internet access and her two white curly-haired dogs named Sissy and Lexi. And, most important, she has her medication.

Meanwhile, state legislators in Jefferson City are deciding her fate and the fate of thousands of people like her who rely on government assistance to stay healthy.

Abernathy is afraid that if she gets cut from the Medicaid system she will either die or lose her house. The medication she takes now, she gets for just a few dollars with government help. Without Medicaid, she says the same drugs will cost roughly $1,800 per month.

Now Abernathy can do nothing but wait.

'Can't spend tomorrow's money'

In Jefferson City, a Republican-led legislature and a Republican governor are trying to pull in the reins on government spending, which they say is spiraling out of control.

The state spent $5 billion on Medicaid last year for about 1 million Missourians.

"We can't spend tomorrow's money," said Sen. Jason Crowell, R-Cape Girardeau. "We're just trying to control the growth. We're not the federal government. We can't borrow from one fund and put IOUs in another."

Many of the elected Republicans, including the governor, made vows to live within the state's means without cutting education. Elementary, secondary and higher education took up roughly 49 percent of the state's general revenue budget last year and 31 percent of the overall budget. Medicaid is 32 percent of the overall budget, according to state Rep. Nathan Cooper, R-Cape Girardeau. One report says it consumed 30.7 percent of the state's total expenditures last year.

State officials say they're playing the hand the best way they can. In the past four years, general revenue has averaged a net loss despite many legislative attempts to improve the business climate in the state. And voters, by and large, have indicated that they won't stand for tax increases.

Crowell says "socialist" advocacy groups are creating false grisly scenarios in order to try to pressure lawmakers.

"Once those scare tactics prove not to be true, then in the long run maybe we can help some of these people" by eliminating some of the fraud, he said.

Diabetes in 1985

Abernathy is a social butterfly. A 10-minute trip to the grocery store results in at least five hugs from people who recognize her.

She grew up in Jackson and has been an active member of the community.

She is a former member of Jackson's Planning and Zoning board. She organized the queen contest for the city's 175th birthday. She won the Jackson Heritage Award last year. She has been a member of the Jackson Noon Optimist, and the American Business Women Association. She lobbied in Washington, D.C., on behalf of the American Diabetes Association.

She also tutors students. It's one of the few things that her diabetic condition will allow her to do.

Abernathy developed diabetes in 1985. Her condition is worse than most, and it turned bad quickly. Her insulin levels can't be controlled with daily shots. Her pancreas is ineffective, so she was equipped with a diabetic pump that consistently puts insulin into her system. When her pump failed not long ago, she began vomiting and got so weak she couldn't hold her head up. She ended up in the hospital, thankful she didn't fall into a coma.

She also has no thyroid. It was removed after she developed cancer.

Still, throughout most of her life, she didn't need Medicaid. Her husband worked, and she was insured through his work. A few months ago, however, Abernathy's husband unexpectedly walked out of her life. He now lives in China. The couple rented a duplex on East Main Street for about $950 per month.

She was still receiving her disability check, but after her divorce she no longer has insurance nor her husband's income to help support her. No one would insure her because of her pre-existing conditions.

She had four months to find a new place.

Abernathy began looking for a new place to live, but with an income of less than $1,000 a month, it wasn't easy. She tried looking for an apartment, but found that almost all of them had stairs. She tried finding a house, but the rent was far too expensive.

Desperate, she placed a telephone call to Jo Ann Emerson. Emerson, a Republican U.S. representative, helped her get a USDA home loan. Abernathy found a new home just outside the city limits. The federal program helped her buy the house for $500 per month.

Currently, Abernathy pays "a few dollars" per month for her medications.

On the regular market, she says her insulin pump supplies would cost roughly $850 per month. Her 24-hour-a-day insulin supply, she says, would cost about $320. She also takes medicine for her thyroid condition. She takes another medicine to prevent kidney problems that could flare up because of her diabetes. Those two drugs, she said, would cost $700. The total of all that is about twice her monthly income.

Abernathy also receives some in-home care. If she had to, Abernathy believes she could find family and friends to help with that service. But she can't do without her medicine.

"I'm not being melodramatic by saying if my medicine is taken away, I'll die," she said.

'We don't know yet'

Medicaid is complicated. There are many different programs, all with their own income restrictions and service limitations.

The state government has been reviewing several items, many of which are changing nearly every day. One bill, SB539, would allow the state to cut programs and that is the legislation that has drawn some of the worst-case scenarios, Cooper said. In the budget process, the House did not cut all the programs, like funding for wheelchairs and prosthetic limbs, that SB539 allowed.

All of this is confusing for people like Abernathy, who is trying to figure out how she'll be affected.

Abernathy's calls to the Medicaid office and politicians have resulted in responses like "We don't know yet" or "Hang in there" or "Sit tight."

The local Medicaid office referred the Southeast Missourian's questions to Jefferson City. A spokesman for the state's social services department said he could not address individual circumstances like Abernathy's due to confidentiality laws. Instead, he provided a list of proposed changes that are "fluid" and changing every day.

Cooper said the House's budget, which is currently being reviewed by the Senate, proposes an income requirement of 82 percent of the poverty level for disabled people on Medicaid. Other reports have said it was 80 percent.

At 82 percent, a disabled person could make no more than $653 per month and receive Medicaid. Abernathy can still "spend down," or spend roughly $250 per month on medication to qualify.

It would still be a generous program. Medicaid would still give her $1,800 in drugs for $200 to $300. But the cuts would put her in an impossible situation. It would leave her with about $653 to live on. And her house payment is $500.

The Missouri Budget Project, a nonpartisan, not-for-profit, budget-review organization, says that more than 120,000 people will be affected by these cuts. Amy Boulin, the group's executive director, said Abernathy is one of many who will be facing major financial-medical problems in the near future.

"The problem is, after the spend-down, these people don't have enough money to live on," she said. "Should she not pay her house bill? Does she lose her house. And if she does, then what? She's kind of stuck."

Abernathy, a Democrat, has taken a vocal stance on this issue. She made the trip to Jefferson City with other disabled advocates and pleaded with legislators. She also spoke at a recent seminar at the Osage Community Centre. After her speech, she received a standing ovation.

She doesn't want to draw attention to herself, she said. She's not aiming for sympathy. She wants people to understand how these decisions will affect real people. There are many handicapped people who can't speak for themselves, Abernathy said.

Abernathy visited with Cooper and Rep. Scott Lipke, R-Jackson, when she visited Jefferson City. She said they were both sympathetic. But they voted for the cuts anyway.

"Any time you're looking at cutting services for people and you're dealing with the issues that have an effect on the lives of your neighbors, it makes for very difficult decisions," Cooper said. "But what I was elected to do was to take a look at all the facets of government and make the government live within its means."

bmiller@semissourian.com

243-6635