Fiscal conservatives caution that Virginia could be on the hook for billions if Virginia expands Medicaid and the federal government reneges on its pledge to cover 90 percent of the costs.
But supporters say the human toll if health insurance is not expanded would be even greater.
Many of the Virginians who would qualify for Medicaid defy the stereotype that recipients do not work and just want a handout. Many have jobs but still cannot afford insurance. Others are too sick to work.
And while expansion foes fear the cost of expanding Medicaid, keeping people off can be costly as well.
That’s because many uninsured people turn to the most expensive option — emergency rooms — after delaying treatment that might have nipped problems in the bud.
Here are the stories of some Virginians who lack health insurance.
A hard worker
Terry White of Chesapeake had kept fit for much of his adult life with push-ups and a little running on top of jobs as a carpenter, heavy-equipment operator and shipyard worker.
But years of wear and tear on his body from such physically taxing work caught up with him, anyway, and at a very inopportune moment: In 2008, he was perched 500 feet in the air on scaffolding in the Newport News shipyard, trying to ignore severe arthritis and nerve pain as he did touch-up painting on an aircraft carrier when both of his legs gave out.
“They had to send the paramedic people up there to get me,” he said.
White, 50, chuckles, now able to appreciate the spectacle of it all. In much the same way, he musters amused detachment as he flips through medical bills that have stacked up since, debts that will probably never be behind him.
“Oh my God, this is terrible. Wait till you see this,” he said. “Can’t do [anything] but laugh about this stuff. This one is $71,000 — surgery. This is the chemo, this is $51,000. And this is Urology of Virginia. I owe them $2,400.”
Gallows humor is about all White has left. Since his descent from the scaffolding, he has been unable to work. Along with the crippling osteoarthritis, White also has been diagnosed with diabetes, congestive heart failure and prostate cancer.
He needs a walker to get around but is still considered “able bodied” by the standards of the federal government; his application for Social Security disability has been denied repeatedly since 2008. That makes him ineligible for Virginia’s existing Medicaid program, which is not available to able-bodied adults no matter how poor, unless they are caring for small children. White’s four children are adults.
Never married, he shares a two-bedroom apartment in Chesapeake with a sister, her daughter and 2-year-old granddaughter. For the past eight years, his bed has been the couch.
He gets some care from a free clinic, and a longtime family doctor sees him “out of the goodness of his heart.” White takes 24 medications a day, most of them provided at a discount by his local CVS. He has considered skipping some pills to save money, but a doctor advised him against that, particularly with the congestive heart failure meds that keep him from “drowning.”
“He told me point blank: ‘If you don’t take it, you won’t be here.’ ”
'It's all about money'
Carlton Griffin was born with a learning disability that has limited his reading level to that of a third- or fourth-grader. He has found work in warehouses, for moving companies and in restaurants since earning a special-education diploma from a Virginia Beach high school.
Now 37, Griffin makes $8.50 an hour prepping food at Dough Boys, a pizza place on the boardwalk. He gets full-time hours during the busy summer season, earning about $680 every two weeks. But he said he can’t afford the insurance offered to employees, at least not on top of $430 in child support he must pay monthly for his three kids.
Yet like anyone else, he has medical needs. Last week, he cut his right hand, requiring five stitches. His asthma is so severe that he needs an inhaler with him at all times. For both, he turns to the emergency room.
“Everybody [in the ER] asks me the same thing, ‘You came here for your asthma attack. Why don’t you have a regular doctor?’ ” he said. He tries to be polite: “I don’t have insurance,” he says.
Sometimes he leaves the hospital with an inhaler, other times they give him a breathing treatment on a machine and write him a prescription for an inhaler. That’s all but useless. “You fill the prescription — $80,” he said. “I can’t pull that out.”
He turns to a couple of relatives, who get inhalers through their own insurance for asthma or bronchitis, to give him one of theirs. He has looked into visiting low-cost clinics in the area, but the $30 to $50 co-pay is still too much.
After he cut his hand on a friend’s shattered coffee table, doctors stitched him up, then referred him to a hand specialist because he had damaged a ligament.
“It’s the ligament that helps your hand go like this,” he said, opening and closing his left hand, the injured right wrapped in soft brace.
He left a message for the specialist but doubted the doctor would see him. “My hand [will] probably end up healing by itself and I just have to deal with however it heals,” he said.
It’s a 10-minute walk from the crowded three-bedroom trailer where he lives to Dough Boys, where he chops tomatoes and mushrooms, cooks chicken and stuffs calzones for people vacationing in high-rise hotels that fetch $300 or more a night in the high season.
The disparity eats at him as he sits in the dark trailer with the tiny family dog, wryly named Cash Money, perched on his lap.
“It’s all about money,” he said. “I guess the doctors . . . look at it, ‘Why help a person that can’t afford it when I can help . . . [someone who can pay] and I can take my family on vacation?’ It’s like sometimes you’ve got to have a certain amount of money in Virginia for your life to matter.”
Ups and downs
With a new job at Virginia Tech, Donna Gail Broussard was getting back on her feet in March, after cancer years before left her unable to publish the magazine she had started in Southwest Virginia.
She was not about to call in sick with a toothache.
A Harvard graduate and single mother who’d seen tremendous ups and downs, she did not have money for a dentist, anyway. The $16.35-an-hour part-time job, writing promotional material for the university’s food services department, offered no health benefits.
Broussard, 55, tried to ignore the pain for her first month on the job. But the ache was an abscess and it wasn’t going away.
“My face just swelled up like a basketball and my daughter said, ‘You can die from this,’ ” she said.
Desperate, Broussard took leftover antibiotics from a friend of a friend. She eventually turned to a free clinic in Christiansburg where a dentist promptly pulled the tooth.
“They were horrified,” she said. “They couldn’t believe I had to get to that level.”
Broussard grew up in a working-class Louisiana family and won a full ride to Harvard. Two years into her studies, she got pregnant and married her boyfriend.
Then came a second baby and a divorce.
Broussard made her way back to Harvard — two kids in tow. They lived in graduate-student housing and she received food stamps. “I was in classes reading ‘The Other America’ and ‘Pedagogy of the Oppressed’ while I’m a welfare mother at Harvard,” she said.
She graduated in 1995, a decade behind schedule. She spent much of her career doing satisfying but low-paying social work before deciding in 2013 to launch Ageless Woman.
“I . . . [was] on top of the world with this really burgeoning small business that was going to make me rich, and I was going to use that money to save the world,” she said.
In May 2014, as the fourth issue of the magazine was headed for the printer, Broussard was diagnosed with endometrial cancer, which affects the lining of the uterus. Her surgery was paid for with the insurance she had through the magazine. In the aftermath, she could not work, the magazine went dark and she lost her insurance.
In March, she got the job at Tech and had not seen a doctor for years until the abscessed tooth forced her into the free clinic in late April.
These days, she sometimes finds herself comparing her low station to the heights reached by so many of her Harvard classmates.
“Conan O’Brien was in my freshman dorm,” she said. “I can’t go to the doctor. . . . I feel ashamed, like I’ve done something bad. When you’re abused — whether it’s by a man or by a system — you feel ashamed.”