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Life in the Medicaid Gap

Theresa BrownGold's painting "Medicaid Gap" for her art project, Art As Social Inquiry.

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

Update 2021

Florida has still not expanded Medicaid. Almost 400,000 Floridians have no realistic way of getting health insurance. Mariamee is still one of them.

Mariamee's story was featured in a JAMA Network article called, Portraits in Health Policy. Read Mariamee's story below to see what life is like in the Medicaid gap.

Artist Note (2017)

March 26, 2017. I am writing this portrait story two days after a failed Republican effort to remake US healthcare policy with a bill called the American Health Care Act.

CNN reported, “Seven years of Republican efforts to eradicate President Barack Obama's proudest domestic achievement ended Friday before a single vote was cast. House Speaker Paul Ryan sensationally pulled his Obamacare repeal bill from the floor Friday afternoon, a day after President Donald Trump had threatened to walk away from health care reform if he didn't get a vote.”

This portrait story subject has fallen into the “Medicaid gap” because her state did not expand Medicaid as provided for under the Affordable Care Act. States' expanded Medicaid programs determine eligibility by income. Mariamee could get health insurance if Florida had expanded their Medicaid program. It has not.

Mariamee falling into the gap means she remains uninsured. Her income level is too low to allow her to jump onto the Affordable Care Act's online exchanges and get a subsidy to help her pay her premiums. As an able-bodied adult, Mariamee also does not qualify for traditional Medicaid in Florida. writes, "Able-bodied, non-elderly adults who don’t have dependents are not eligible for Medicaid in Florida, regardless of how low their income is."

Now that the Affordable Care Act survived the GOP assault, and remains the law of the land, will more states help people like Mariamee and her family by expanding Medicaid?

Here is Mariamee's story.


Theresa BrownGold's painting "Medicaid Gap" for her art project, Art As Social Inquiry.
A study. Oil on canvas, 24 ins. x 20 ins.

(from a 2017 interview)

Certified Recovery Peer Support Specialist, Age 43, Uninsured

Mariamee loves her job. She is a peer specialist for those living with mental illness. A peer specialist “is an individual with lived recovery experience who has been trained and certified to help their peers gain hope and move forward in their own recovery.”

Mariamee’s 20 hour/week job is funded through a state grant. She earns under poverty level wages. As a part-time employee, she does not qualify for employer-provided insurance.

The Affordable Care Act (Obamacare), provided a means for working yet uninsured low-income people like Mariamee to get health insurance. The healthcare law contains a provision called Medicaid expansion that extends states’ Medicaid insurance programs to low-income people who otherwise would not qualify for traditional Medicaid.

The US Supreme Court, however, ruled that states are not required to expand their Medicaid programs to give full insurance coverage to low wage earners like Mariamee. The Court made that provision of the Affordable Care Act optional.

Florida, where Mariamee lives, has not expanded Medicaid. That means Marimee's state is throwing her into the Medicaid gap – earning too much to qualify for Florida’s old Medicaid program, and earning too little to get subsidized insurance on the Affordable Care Act’s online marketplace. As a result Mariamee remains uninsured.

Obamacare made no provision for those low wage earners living in states that rejected Medicaid Expansion. The law's authors never figured on a Supreme Court ruling permitting states to opt out of the healthcare law's Medicaid expansion provision.


What is life like for those in the Medicaid Gap?

Mariamee is a diabetic. She gets samples from her doctor. If she is desperate, she goes to the emergency room for supplies.

Mariamee is also the caretaker for her aging mother and two daughters. One daughter has severe respiratory problems and the other, diabetes.

Mariamee’s mother has been very ill. Mariamee’s caregiving duties prevent her from getting full time employment. The cost of hiring a caretaker for her mother would negate any additional money she would earn working full time.

Mariamee's oldest daughter aged out of traditional Medicaid while in school, and is also uninsured. Her daughter could no longer get medicine to treat her lung disease since she aged out of her state’s health insurance programs. Without Medicaid Expansion in Florida, Mariamee's daughter had nowhere to get insurance.

Mariamee’s younger daughter still meets Florida’s age requirement to get insurance through a state program, but the $813 monthly deductible is making the insurance useless. The family cannot pay the out-of-pocket charges.

“As a family we have been through hell and back. First my mom's second stroke, then homelessness, then the death of my only sister, then a third stroke, then my daughter's pneumonias, nine of them, then lung surgery. In December, my mom’s fourth stroke, then my daughter in the hospital four times, then our move, then my other daughter in the hospital, car accident, and now fifth stroke... But there are always angels around us. God will not abandon us.”

Mariamee and her family have accumulated thousands in medical debt because they have had to use the emergency room as a doctor’s office at times. An uninsured person using the emergency room for care still gets billed.

Mariamee's uninsured oldest daughter has gone to the ER several times since aging out of traditional Medicaid, and losing access to medicine to control her respiratory problems. (Before losing insurance and regular access to medicine she was stable and productive.)

Mariamee has become an advocate for Medicaid expansion in Florida. She also advocates for her community on other issues as well. “I’ve had a lot of practice because of my daughters.”


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