The November ballot question to expand Medicaid coverage to Mainers living below or near poverty will allow more than 70,000 people access to affordable health care. MECEP’s recent report, The State of Working Maine 2017, demonstrates just how important good public health is to a healthy economy.
Since 2001, tens of thousands of Mainers of prime working age have left the work force, and these “lost workers” are increasingly citing health concerns as their reason for not working. Too many low-income Mainers are stuck in a cycle of sickness and poverty. Living at or near poverty not only makes it more difficult to afford health care, but the mental and physical stress of living in poverty creates its own health problems. Poor and near-poor Mainers often find themselves increasingly in need of care, and increasingly unable to get it.
Most Mainers, like most Americans, still obtain health insurance coverage through their employer. In 2016, 55% of Mainers had some form of employer-sponsored coverage; among the non-senior population, the share rises to 60%. Employer-sponsored insurance is a good deal for many Mainers. Employer subsidies and the ability to pool the risk of an entire company workforce often make plans more affordable. But many Mainers don’t have this option.
Increasingly, part-time and low-wage employees aren’t even eligible for plans where their employers have them—or they work for a small business that doesn’t offer a plan. In 2016, fewer than one in four (24%) of low-wage, private-sector workers in Maine was eligible for an employer-sponsored plan, down from one in three (35%) in 2001. Additionally, low-wage workers are less likely to be offered—or be able to afford—a family health plan, meaning that their spouse, children, and other dependents also lack coverage options.
By coupling health insurance (and therefore health care) to employment, we have created a health care system in which some of the most vulnerable are least able to access the care they need. One in five (21.6%) low-income Mainers skipped a doctor’s visit in 2015 because they couldn’t afford the cost, five times the rate (4.4%) for middle- and upper-income families. Poor Mainers without health insurance are even more likely to find health care unaffordable. Nearly half (44.5%) of uninsured Mainers with family incomes below $25,000 missed or delayed care because of cost.
The unaffordability of health care for the poor and near-poor, even if they are working, has dramatic consequences on individual and public health. Low-income Mainers are much more likely to have chronic health conditions, like asthma, high cholesterol, high blood pressure, or diabetes. They are more likely to suffer from mental health conditions like depression, and more likely to need help overcoming conditions like obesity or smoking. As a result, nearly one in three (32%) of low-income, non-elderly adults in Maine reports being in “fair” or “poor” health, compared to fewer than one in 10 (9%) of Mainers at other income levels.
Some of these conditions are themselves brought on by a life in or near-poverty. Many are exacerbated by the lack of access to affordable health care. In addition to being less able to meet the basic need of seeing a doctor, poor Mainers without insurance are much more likely to have missed crucial primary care and preventative health measures, like getting a flu shot, controlling high cholesterol, or being tested for transmittable diseases. Strikingly, more than one in four (28%) of uninsured, low-income Mainers has not seen a doctor for a routine checkup in at least five years. These are individuals who are shut out of the health care system entirely. Simple access to health insurance can improve these outcomes.
For too long, health care in the United States has been largely dependent on employment and earnings. Tens of thousands of Mainers are victims of a system that leaves no provision for the out-of-work, those unable to work, and even many who are working in low-wage jobs. With the Medicaid expansion ballot question, this November, Mainers have a chance to fix that. By voting to raise the Medicaid eligibility threshold in Maine, our friends, neighbors, and coworkers will be able to get health care, setting them on the path to improved health, improved productivity, and ultimately a better life.
