!B for Benefits
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agk's phlog
12 May 2021 @ 1329
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written on Galaxy J3
while Evy sweeps
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I went back full-time at work in February. Evy is full-time
nights at her hospital. Now that we're married we both lost
SNAP benefits (food stamps). That's a sudden drop in our
grocery budget of almost $400 when we're eating for three.
In two months when the baby is born Evy will go on unpaid
maternity leave. Her union helped her understand eligibility
and how to apply. She keeps Medicaid (state health
insurance) for the rest of our pregnancy. By the grace of
God we live in a state that expanded Medicaid under the
Affordable Care Act.
I probably lose my Medicaid because we married. We'll do
the financial arithmetic and look close at eligibility
requirements this week. I can't afford my employer-
sponsored health plan's deductible and the coverage isn't
great, so I might just let myself be uninsured again for
five months, be careful, and cut my meds in half as needed.
After maternity leave, she'll hopefully be able to transfer
to a PRN position at the hospital and work only a handful
of days per month. She'll breastfeed and do most of the
newborn care this time around. Her parents live two hours
away. I'll still work fulltime and be in nursing school,
God willing and the creek don't rise.
Three months after our income drops off a cliff we should
again be eligible for SNAP food stamp benefits. I should
be able to reapply for Medicaid then too, and hopefully
get reinsured in time for my annual women's health checkup,
prescription renewal appointment, and dental cleaning. The
baby will have CHIP state health insurance if we do things
right, which will pay for vaccinations and pediatrician
visits.
We're super grateful for these benefit programs. It changed
my life to move to this Medicaid expansion state. For 16
years before I moved here I was uninsured. I went over 10
years without my meds, which surely shortened my life. When
I did get them it was often on the black market. I only
dependably got basic healthcare in the few years after my
friends and I started a free health clinic in a disaster
zone. We used the temporary outpouring of post-disaster
donor generosity to fund it.
Outside those three years, I tended to my own dental
infections, bought antibiotics on the black market, did
small surgeries on myself, called a friend for home care
when I had a potentially life-threatening bowel obstruc-
tion, and toughed out years of partial deafness. I didn't
have the knowledge or $40 worth of equipment to do the easy
outpatient procedure that restored my hearing when I moved
here. Without an insurer to negotiate for me, and prices
jacked by billing cartels, clinical care wasn't an option.
This fall I'll pay for nursing school at the state school
with a federal loan. The hospital where I work will repay
some of the loan if I get excellent marks, stay fulltime,
and do a year of indentured service after graduation. The
repayment program isn't contractual -- they may change
policy and not pay with no penalty. I'm trusting them, but
at their mercy. We're an at-will employment state. I have
no union. I can even be fired without notice or cause. I
wish I could go part time and be more involved in our
daughter's first two years, but that would just kick the
can down the road.
Evy and I are incredibly privileged. We got our bachelor's
degrees without debt. We managed thanks to federal Pell
grants, work-study, and going to one of only two highly-
selective "work colleges" in our country that guarantee
the cost of education (in our case, $100,000) in exchange
for labor.
Cassie received a Pell grant, worked in some of the most
difficult public service jobs in our country continually
for twelve years in healthcare shortage areas since grad-
uation, paid faithfully on her debt all twelve years, and
was summoned to court by the Sheriff during the pandemic
when the owners of her debt changed terms without sending
notice.
Anne wrote the Low Resource Medicine essays on this gopher
hole. After many years responding to emergencies on ambu-
lance and fire services in a destitute urban district and
the poorest rural county in her state, she works in Alaska
for months every year, timezones away from her seven-year-
old, to pay down half a million in med school student loans.
Public guaranteed benefits like Medicaid, CHIP, WIC, SNAP,
and the Pell grant are foundational to my life, ability to
work in my field and help patients, and start a family with
my spouse. The benefits could be better: automatic not
application-based, expanded to higher income levels or
universal, not means-tested. Nonetheless, they're bulwarks
against abusive rent-seeking industries that immiserate and
kill many in my country---and against capricious employers.
A safety net helps people feel secure enough to imagine
living well and generously.
Missouri and Idaho recently passed Medicaid expansion by
ballot initiative. The people know Medicaid expansion changes
lives. The Missouri legislature blocked the will of the
people for now. The Iowa legislature is moving to do the same.
I hope the people remember their power, and undistracted by
immiseration under parasitical rent-seeking industries, remove
the traitorous lawmakers.
The worst rent-seeking should be outlawed and illegal rent-
seeking prosecuted. Debt accumulated under outlawed terms
should be forgiven, debtor prison sentences commuted, debtor
criminal records expunged. This would be the Jubilee pract-
iced in the ancient world and proclaimed by Jesus.
We must also have our Bismarckian social insurance. With-
Without social benefits, we become serfs and холо́пы on
manors of some sort for generations to come. Don't feel
shame or resentment about benefits. Recognize them as
guarantors of freedom. Social benefits must be won, ext-
ended, and defended.
