"Pray You Don't Get Sick"- Healthcare Strategy for Uninsured


(Interview 9/2015. Oil on canvas, 40 ins x 30 ins.)


Update 2021

Fred is still very active advocating for Medicaid expansion. Florida still has not expanded the provision in the Affordable Care that extends insurance to low-income people based solely on income.


Fred qualified for Supplement Security Income (SSI) since we last spoke. That means he receives a modest monthly income and Medicaid health insurance. The Social Security Adminstration (SSA) oversees the SSI program. Fred needed an examination by a SSA physician. Fred said, "The SSA doctor said I was close enough to Aspergers to qualify."


Fred first applied for SSI in 2013 with the help of a lawyer who ended up not advocating for him very well. The process dragged on into 2017. In 2017 Fred got a second and much better lawyer who positioned him to finally get the benefit in 2020. Fred's efforts to get SSI and the Medicaid health insurance that automatically starts with SSI spanned 7 years.


Fred spent 34 years being uninsured.


“I thought Medicaid would be expanded, I would get insurance, and I would have dignity.” Florida governor Rick Scott refused to expand Medicaid in his state.

Fred has severe asthma, a learning disability, an eye tracing disorder, and high blood pressure. Since receiving Medicaid, Fred has been able to get a check-up. Turns out his numbers for Type 2 diabetes are through the roof. Fred said this about his Type 2 diabetes, "I don't smoke or drink. But helping my dad caused a lot of stress. I didn't make the best food choices." Fred's dad has been in and out of hospitals.


Before being insured, Fred leaned on friends and family for financial help to pay for his prescriptions. For 2 years he relied on Publix Super Market's free prescription program.


Fred became a minister in the time since our interview. He helps organize public events to raise awareness around social issues. He also helps those in need in his community as best he can.



Artist’s Note (2015)

Fred’s portrait story is another look at what it means when politicians put ideology over people. Under Florida's non-expanded, old Medicaid rules, Fred does not qualify for health insurance. Under the Affordable Care Act's expanded Medicaid provision, he does.


“My insurance has been piecemeal. Patchwork care. Pray you don’t get sick. Hope you don’t get sick. Trust the Lord you don’t get sick.” This has been Fred Christian’s insurance strategy for most of his adult life.


The Supreme Court of the United States made the ACA's Medicaid expansion provision optional. Some holdout Republican-led states have refused to expand Medicaid. Florida's governor is one of them.


Medicaid Expansion is the Affordable Care Act’s mechanism for funding and delivering care to low income individuals who have no insurance, cannot afford to buy a single policy directly from an insurance company, and do not get health insurance through a job.

The Affordable Care Act expanded access to healthcare. Florida's governor refuses to expand Medicaid leaving hundreds of thousands without access to healthcare.


One wonders what Fred’s life would have been had he been able to have regular access to medical care starting as a teenager? An eye-tracking disorder went undiagnosed for decades. Nevertheless, Fred presses forward. He is an indefatigable advocate for Medicaid Expansion on social media.


“I’m poor. I felt like crap admitting that to myself. I always hoped for the best – maybe get that job. But it never got better.”

The painting for the project is a redo of the one I did in the basement. I have a few paintings I call the basement paintings. I just could not see in the basement studio. I strained and the paintings look it. The second painting is Old Fred . I was above ground in the light. I don't know why he came out so old. Love the painting but Fred is younger. Maybe I painted his inner, worn-out self. I love the last painting for the project. It's quirky. It works. It's Fred.


Basement painting Fred came out too old. Final painting

I did a lot of scraping-off-paint in the basement.


 

A study. Oil on canvas, 24 ins. x 20 ins.

(from a 2015 interview)

Activist, Disabled but does qualify for Social Security Disability, Uninsured, Age 46


Fred Christian is a well-know activist, blogger, and advocate for Medicaid Expansion in Florida.


Medicaid Expansion is the part of the Affordable Care Act (ACA or Obamacare) The ACA gives very low-income people access to health insurance who otherwise would have limited or no access.


However, the US Supreme Court ruled in a challenge to the healthcare law that expanding Medicaid is optional. Republican governors politically opposed to the healthcare law refused federal money to expand their Medicaid programs leaving people like Fred uninsured and in desperate need of care.


Fred is a college graduate who struggled with a learning disability and asthma since childhood. Fred suffered from an eye tracking disorder his entire life. But he did not get a diagnosis until he was 44. His eye disease makes reading difficult, and driving impossible.


“You know, you need a full time job to get insurance. I can’t drive. I can’t count money. I can’t remember exact sequences. I couldn’t see the BBQ sauce on the shelf. I couldn’t even stock shelves in the grocery store. People thought I was crazy because I did screwy stuff physically. I had coordination problems. I can’t cross a 4-6 lane highway, or operate machinery.” Fred got a job bagging groceries for a while. “At least I could put pork with pork, and chicken with chicken.” Fred gave up his job when he moved to Florida to care for his disabled father.


Fred has no full time job, and no insurance. “I’m a 43 year old with a college degree, and I’m afraid I’m going blind.” Fred admits, “I’m poor. I felt like crap admitting that to myself. I always hoped for the best – maybe get that job. But it never got better.”


Fred says he was so happy the day the Affordable Care Act became law. He has been uninsured for so long, and not getting proper medical care.


“I thought Medicaid would be expanded, I would get insurance, and I would have dignity.” Florida governor Rick Scott refused to expand Medicaid in his state.


The Kaiser Family Foundation reported: “In Florida, 764,000 uninsured adults (20% of the uninsured in the state), who would have been eligible for Medicaid if the state expanded, fall into the coverage gap. These adults are all below the poverty line and thus have very limited incomes. Because they do not gain an affordable coverage option under the ACA, they are most likely to remain uninsured.” (2021 update. An additional 1,362,000 would be covered if Florida expanded Medicaid.)


Fred earns no income. He lives with his father in Florida who receives disability benefits. Fred is his father’s caretaker. Fred is uninsured. His father is 65, and insured through Medicare.


Fred realized his governor’s decision not to expand Medicaid meant he would continue to be uninsured. “I can’t get insurance. I was very angry that day. I have been uninsured since 1986.”

~


Fred had health insurance up until age 16. When Fred’s father retired, and qualified for Social Security disability benefits, he needed to find a way to insure Fred. He purchased an individual insurance policy for Fred in 1985.


Fred was insured when he had the first asthma attack at 15 years old. The insurance company denied the claim saying the asthma was a preexisting condition. But Fred had never had a prior episode. The insurance company relented, and paid the bills, but they raised the insurance premiums so high, Fred’s dad could no longer pay them. He dropped the insurance, and Fred became uninsured at 16 in 1986. He has been uninsured ever since.


Three months after becoming uninsured, Fred had a major asthma attack. His dad rushed him to the emergency room, and haggled a cash price with the hospital.


With his son uninsured, Fred’s dad was paying cash for specialists, and running up debt with the immunologist. Fred was also being treated for allergies. But he still managed to go to community college, and eventually get a degree in communications from Rowan University.


Fred had many serious respiratory episodes that resulted in emergency room visits. Fred was uninsured, and had no ability to pay the bills. The hospital wrote off the charges as charity care. His dad and a friend helped pay for Fred’s doctors’ visits and medicine. “We have a lot of credit card debt – food and medicine purchases.”


During Fred’s 30 year struggle to get access to healthcare, he received some free medicine from drug companies for 2 years. “This stopped when my pulmonologist didn’t want to fill out the paperwork anymore for free drugs. He sent me a form letter.” He then saw his father’s primary care doctor for medicine. “I used the emergency room for dire sickness.”


Fred benefited from a program called Low Income Pool (LIP) in Florida. The LIP is not a health coverage program.The LIP reimbursed hospitals and health centers for uncompensated care they gave to people like Fred who could not pay.


But the Affordable Care Act’s Medicaid expansion provision provides low-income people with the health insurance they need to access care, making the LIP program unnecessary. Florida is losing their federal funding for the LIP program because Medicaid Expansion is the new and better option for delivering access to medical care to Florida’s low-income population. But the governor will not expand Florida’s Medicaid program as outlined and funded by the Affordable Care Act. Hospitals that provide care to the uninsured through their emergency rooms, and help critically ill people like Fred, stand to lose reimbursement from the diminished Low-Income Pool.


Fred fits the profile of a Kaiser Family Foundation finding. “Nonelderly adults of all ages fall into the coverage gap. Notably, over half are middle-aged (age 35 to 54) or near elderly (age 55 to 64). Adults of these ages are likely to have increasing health needs, and research has demonstrated that uninsured people in this age range may leave health needs untreated until they become eligible for Medicare at age 65.”


Fred was fortunate to find a public health program that enabled him to see an eye specialist. He scraped together the $40 co-pay. After going years untreated, Fred learned that he has an eye tracking disorder that will not cause blindness.


~


Fred is a religious man. He heard a question a news program asked on MLK day. “What will you do to advance the dream? “It all fell in place at church.” Fred felt inspired to become a “voice for the voiceless.”


Fred is active on social media, writes letters-to-the-editor, and starts petitions to advocate for Medicaid expansion in Florida. “I was so naïve in the beginning. I didn’t realize how hard I had to work just to get people to sign a petition. But I have to get this done.”


Fred has a Supplemental Security Income hearing mid-June 2016. “SSI stands for Supplemental Security Income. Social Security administers this program. We pay monthly benefits to people with limited income and resources who are disabled, blind, or age 65 or older. Blind or disabled children may also get SSI.” If approved, Fred is hoping to also get the medical attention he needs. “In most States, SSI beneficiaries also can get medical assistance (Medicaid)- to pay for hospital stays, doctor bills, prescription drugs, and other health costs.”