Inside the Lives of a Missouri Couple Who Would be Directly Impacted by an Expansion of Medicaid

Dec 20, 2013

The Affordable Care Act, or Obamacare, originally said that every state had to expand its Medicaid program to cover people making up to 138% of the federal poverty level.  But the US Supreme Court ruled in 2012 that the Medicaid expansion is an issue that every state legislature—or state government—has to make for itself.  So, that decision now rests in the hands of lawmakers in Jefferson City, not Washington.

You can find a lot of that Medicaid discussion in our archives on Instead of talking to the lawmakers this time, we’re following up with a couple we interviewed back in May who would be directly impacted by the Medicaid expansion.

You may recall Anita and Keith Sutherland of Van Buren, Missouri:  when we last interviewed them, Anita had quit her job to battle uterine cancer, and Keith was working full-time at a logging company. His job didn’t come with health insurance. Their total household income was $18,000—and they still did not qualify for Medicaid.

They were struggling, and had hit a low point. Here’s part of that interview from back in May.

“You feel like you’re at the point of no return, because it’s just hard…because you want to pay it, and you can’t. I don’t want charity—I’m not here for charity. That’s why I think a lot of people kill themselves—because there’s no hope,” Sutherland said in our May interview.

“It’s hard to make it. I mean, there’s times we can’t even eat dinner. Because the fact is, we don’t have the money—we’ve got to pay our bills, or they’ll shut ‘em off.  And right now, I’m having to work extra so she can go to the doctor so she can get well.  And it’s either eat, or let her go to the doctor—because this therapy is very important for her…I don’t get [health] care. I take care of it all myself. And I have teeth problems. I can’t afford to go to a dentist. So I just take my pocketknife out and pop my teeth out myself,” Keith said in May.

I had a hard time finding them again; their old phone was out of service. I tracked down a relative with a similar name, who put me in touch with Keith. I called and found him in a North Dakota snowstorm with a broken down tractor trailer. He’s gone back to truck driving from coast to coast to help pay the bills. He put me in touch with Anita, who now has lymphedema as a result of her cancer treatment. Lymphedema is swelling in the limbs because the lymphatic system is blocked.  She drove all the way to Poplar Bluff for what she thought would be a treatment session.

“When I called to make the appointment, she told me $200 was enough. And then when I got there, and told her who I was and what time my appointment was, she said it was $500. And I said, ‘Well, can I give you the $200 and pay the rest on Friday, or make payments?’ and they said, ‘No, we need the $500 today.’  And I said, ‘Well, I don’t have it,’ and I broke down crying,” Sutherland said.   

Emotionally, she’s drained. She says she feels like a burden to her family, and has thoughts of ending it all. She’s working again, at the Head Start office in Van Buren, but it’s only part-time work, and not enough to buy a Christmas present with, she said. She's drowning in thousands of dollars of hospital bills, she said.

“I’m stressed out.  Just don’t want to be here, you know?  Because I hate owing them.  And what you do send them isn’t enough. So, do I eat, or do I pay insurance, or pay my bills? What do I do?  If it [weren’t] for my daughter or granddaughter saying, ‘Oh, you’ve got to stay here with us,’ I’d probably [already be] gone,” she said, referring to suicide.

Anita is one of about 300,000 Missourians—many of them working full-time—who would suddenly get health care coverage if state lawmakers voted to expand Medicaid. The upcoming five-month session, which starts in January, will tackle this issue.

Ryan Barker is a health policy advisor with the Missouri Foundation for Health, a non-partisan philanthropic foundation based in St. Louis.

“A lot of people think that the Medicaid program covers all low-income individuals—and that is not true.  So you have to fit into certain eligibility categories. And currently in Missouri, the eligibility categories that would be affected by an expansion of Medicaid are two different categories. One is the ‘parent’ category:  currently, we have a very low Medicaid eligibility for parents.  It’s about 18% of the poverty level. [So], for a single mom with two kids—a family of three—for that mom to be eligible for Medicaid in Missouri [right now], she has to make less than $3,500 a year.  Under the Medicaid expansion scenario, that would expand up to 138% of poverty,” Barker said.

The other category who would be impacted by an expansion of the Medicaid program is the people termed “childless adults”—people who don’t have dependent children, aren’t over 65, and they’re not disabled. Anita and Keith Sutherland fall into that category.

“It doesn’t matter if [people in that category] don’t make any money at all – you aren’t Medicaid eligible. And one of the little data facts about that group is that 60 percent of the homeless in Missouri are not Medicaid eligible, because they fall into that ‘childless adults’ category,” Barker said.

As it stands, Missouri’s eligibility threshold for Medicaid is one of the lowest in the country.

Republican lawmakers in Jefferson City have said they want to reform the Medicaid program here before pumping millions of dollars into it and expanding its rolls.  They’re also concerned, they say, about the cost; the federal government would pay for the first three years of the expansion, then scale down to 90% of the cost after that. For  those in-depth budget figures, and for a breakdown by household income of who would be affected, you can click on this story on our website: