Spirit in Action

Curing the Healthcare Blues

A look at the ills of our healthcare coverage system, with special attention to the coverage gap resulting from opposition to the ACA/Affordable Care Act. Tom Rowley shares his song & video about The Healthcare Blues, and his passion for fixing the system, working in rural Missouri, near Cabool.

Duration:: 55m
Broadcast on:: 08 May 2016
Audio Format:: other

[music] ♪ Let us sing this song for the healing of the world ♪ ♪ That we may hear as one ♪ ♪ With every voice of every song ♪ ♪ We will move this world along ♪ ♪ And our lives will feel the echo of our healing ♪ ♪ With every voice of every song ♪ Welcome to Spirit in Action. My name is Mark Helpsmeat. Each week, I'll be bringing you stories of people living lives of fruitful service, of peace, community, compassion, creative action, and progressive efforts. I'll be tracing the spiritual roots that support and nourish them in their service. Hoping to inspire and encourage you to sink deep roots and produce sacred food in your own life. ♪ Let us sing this song for the dreaming of the world ♪ ♪ That we may dream as one ♪ ♪ With every voice of every song ♪ ♪ We will move this world along ♪ Today, we're going to focus on healthcare for spirit and action, but we'll make sure to toss in some fun in dealing with something that can be really heavy and frustrating. First, we are going to continue with our series "History and Our Best Future" featuring Myron Buckholz, retired from 34 years of teaching high school history, but very much in the thick of swirling debates about the future of our country. So Myron, a lot of people the last six years or so act as if Obamacare or the Affordable Care Act is a brand new aspiration for our nation. We all know, or at least we should know, that all of the developed nations of the world and the leading economic forces of the globe have universal healthcare for their citizens, except the USA. But Myron, my understanding is that the US actually tried to move in that direction several times in the past, but that we somehow just never made it. Can you say something about the historical direction of healthcare in the US and where that might or might not be headed? One of my close friends is a retired Army doctor, Tom Chisel. And a number of years ago, we were having coffee and he said something to the fact that he heard it described as the healthcare industry and he said, "Gee, I always thought I was a doctor." And I've always thought that to be very profound because in our modern sense, everything is profit-driven. And through the course of world history, healthcare wasn't driven by profit. It's only really the very recent times post World War II, probably more since the '80s, that the profit margin has been the most important factor in our "healthcare industry." Patient care can take a back seat to that. If you look at the models that were talked about, and I do know that Teddy Roosevelt talked about a national healthcare system, and he was president at the very turn of the last century, that without removing the profit motive, we are not going to have significant change in how we have healthcare. With the profit motive, you have to have people go without. You cannot, by nature, cover everybody because poor people can't afford to pay for healthcare. So healthcare is really good for those who can pay for it. The HMO idea that came out of the Nixon administration in the '70s worked for a while. I remember I was in that system, and I thought that this was better. And then, of course, that fell apart. Again, I think mainly because of the profit motive. And so we struggled along with ever-increasing healthcare costs and with an ever-increasing number of people who do not have access to healthcare, unless it's the emergency room. And now we have the Affordable Care Act, which has made a difference for many. But it still left people uninsured, and I tend to think that it will go the way of the HMO, that after a number of years, the insurance companies who are most interested in the profit, and they have to show an increasing profit every year in our present system. It's not enough to be profitable. You must show an increase in profit every year, otherwise you feel like a failure. And they say our shareholders will be angry. This is not sustainable. It can't continue. And so something's got to give. So I'm aware that Colorado has on their ballot coming up here in November. I believe it's called Colorado Care. It's going to be designed as a single-payer system working inside the confines of Obamacare, or the Affordable Care Act. Vermont tried it and dropped it, but some interesting reasons as to why. I'm not necessarily sure I agree with all of them. And at some point, people will have to look at the fact that you have a significant number of people who do not have access to the medical care. And that is going to cause some change eventually. We just can't leave people out. Thanks to Myron Buckles for his weekly edition of History and Our Best Future. Now on to our guest for today's Spirit and Action Show. The topic is health care for all, and we'll focus in on the situation in Missouri. The idea got kicked off because of a link that I received to a video from Tom Rowley called The Health Care Blues, a fun and serious song and look at health care. And then we'll get Jen Bursdale, Executive Director of Missouri Health Care for All on the phone. We start off with a phone call to Tom Rowley, who lives in the vicinity of Kabul, Missouri. Tom, thank you so much for joining me today for Spirit in Action. Mark, thank you for having me. I'm delighted and surprised. Surprised when you make great music like that and send me the link? I mean, really. It's a great fun video. How long was it in the making? It took a long time. It took a lot longer than I ever imagined it would. We had a couple of big shoot days and then it seemed like the editing just took a long time because it's all volunteer. So, you know, we kind of had to get it done as we could. And I guess it happened over a shutter to think back on it, but it happened over a few months. Well, that's nothing for five minutes' worth of video, and that's incredibly little, in fact. Did you have to pay your actors immense amounts? Well, if zero is a big number to you, I did send out an email to some friends. They sent me about $300 that I was able to give to the videographer for very kind gifts of love. But that was it. I mean, I think, you know, that's less than his day rate. And he has, you know, at least a couple of weeks in this, you know. So, that was just a love offering. So, are you going to take it on tour, or do you have you taken it on tour? No, but, you know, I'm hoping that it will spread on YouTube and that it will be part of a movement to get people talking about the coverage gap. People are welcome to use the video in any way they choose. It's out there for them. It's high definition, too. It looks great when you project it on a large screen. So, I hope people will feel that they're free to use it. Yeah, I hope it does come to that purpose. Obviously, you're very motivated, not only in terms of putting this together, but just generally working for Missouri Health Care for All. What's your role in that? Was this self-interest, or is this interest of the community? Where do you come by this interest? Well, I think Missouri Health Care for All helped focus my interest. It's been a burn in my butt. I've worked in construction all my life. And with the exception of a few years when I worked in a large city in a union setting, almost all of the workers I've worked around have not had health insurance. I think a lot of people somehow view poverty as somebody did something wrong, or somebody's lazy. And I can attest that there's plenty of people that have trouble earning a living that are not lazy in the least and are important parts of our community. It just irks me no end that when a health issue occurs, that often leads to huge debt and terrible problems because just a lot of people are not covered. That's been a concern among for a long time. And when the Affordable Care Act came in, I mean, it's a massive piece of legislation and it's certainly got its problems, but it's managed to get just a ton of people covered who didn't have coverage before. In my own case, I've been self-employed for a long time, keeping health care, was always a struggle for me and my wife. And we ended up with catastrophic care. And at the time when the Affordable Care Act was just coming into play, we had what would have been $7,500 out of pocket for each of us if there was a serious health issue. And we were paying about $10,000 a year for that coverage. And it was just killing us. And, you know, we felt like the option of not having health care was just as scary. And my work has been slow. I live in a really rural area where it just hasn't recovered since '08. Because of that, my income's been very low. And I currently have the best insurance I've ever had. And I've never paid less for it because of the Affordable Care Act. But the Affordable Care Act helps people down to about 138% of the poverty level. Below that, the states were supposed to expand their own health safety nets to reach up to that point with federally supplied money. That money's available. Thirty-some states have gone ahead and gotten that done. But 19 states, including Missouri, including Wisconsin, their legislatures have refused that money. And they've left these people, many of them hardworking people, out in the cold when it comes to having health coverage. The information I looked up on it, I was wondering about the concerns about budgets. Because, you know, when you're in tight financial times, you don't want to expand your budget unnecessarily. The provisions that are included in the Affordable Care Act are that for the first three years, the federal government pays 100% of the Medicaid expansion. For the next three years after that, it would be 95% of it, the feds cover, and 90% after that. So, from 95% for the next three years down to 90% for the seventh, eighth, and ninth years on the program. So, states would be paying very little along the way for a number of years, and that hasn't deterred them. I think it's been a big political act in the same way that the number of times that the House of Representatives has voted to repeal the Health Care Act. So, the other thing that I read, which, again, this is in terms of advocacy. So, I'd have to go check the figures. But when you don't have that health care coverage, that means people do go into emergency room or hospitals. They have to take them in. So, the expenses are landing, but they're just landing on some other person's head, some other entities head. Well, I just want to say that we pay for health care for the uninsured, and we do it all the time. It's reflected in your insurance premium if you're able to buy insurance. It suddenly explains why an aspirin pill might cost $10 when you're at the hospital. And we pay for this in a lot of other ways that are directly related. What happens when a poor person goes to get emergency care often? They will get immediate emergency care. They won't necessarily get follow-up care, and obviously they're not getting preventative care. Then that costs the community too, because find out that these people often get saddled with horrific, at least for their income scale, horrific medical debt. It may be the, but it is at least a major cause of foreclosures and bankruptcies. And so, I'm suggesting that one way or another, our society is going to pay for these people. And obviously, my recommendation is that we pay for it out front, where people are getting preventative care. And at first, you know, when people first get health care, they have to learn how to use it, and there's catch-up time there. But eventually, I think we're actually going to save money, because people will have a need to have prevented care. If we pay for coverage out front, rather than around the backside, and get these people covered, there will be cost savings from giving people preventative care and giving them care in proper circumstances, like through a physician, rather than the very, very expensive care they get in emergency rooms. Then there's another issue, there's an entire other issue, that these federal dollars, and by the way, health care is not free. We have to pay for it. Just because it comes from the federal government doesn't mean that, you know, it's free. As a society, we have to pay for it. But when these states allow the federal money, and I'm actually talking about many billions of dollars, arrive in states, it stimulates the economy. And there's a lot of hospitals have the ability to create a lot more jobs. They expand their hospital services. They upgrade their equipment. And it has a positive effect on state economies. Missouri State University did an in-depth study about the impact of expanding our state health care system to meet the Affordable Care Act. They came to the conclusion, it has to be a really big economic boon for our state. The Missouri Chamber of Commerce, which is not known as a drastically progressive organization, signed on to this and actually hired a lobbyist whose name is Kit Bond. He was a Missouri Republican governor. He now does lobbying. And he's been lobbying our state legislature, and I think it's important. The issue is really important here, and I don't like to try to think of it as a party against party issue. And there are Republicans who have looked at the economics of this and realize it's a win-win. Well, hopefully it will be a win. All of this sounds very, very serious. And rather than just a serious, I think we need to listen to the song now. Tell me who's performing in the song. Who are the actors, the musicians involved? Yeah, I mean, you're right. I want to point out that I can get a little work about this topic, you know? But one of the goals here was to make people laugh and to get their attention and to get them talking about this issue. And this is a funny video, and I play a character that's very loosely based on Bob Cratchit. I call him B Cratchit, and there is the cat, and there is Dr. B. Love. And believe it or not, that girl's name is actually B. Love. So that fit in real well. I also have a little cameo as Uncle Sam and as what I call the public service worker who works in the town of Rach and Rowan. So that's about everybody. Are those real Missouri towns? Rach Rowan? Well, the reason it has a town for everything, but I've never been to Rach and Rowan. But my suggestion in there, if you catch some of the things go by quickly, but if you catch the town sign it says population in the millions. And I think it's not that hard to fall into Rach and Rowan, which is what I do in the video. Well, unfortunately, I can't project the video over the radio station here, but people can go to it. I have a link on the NortonSpiritRadio.org site to healthcare blues. We're going to listen to it right now. Tom Rowley is our guest speaking about the health care blues that have resulted from the healthcare coverage gap in Missouri. Here it is, health care blues. I went down to the kitchen to get myself a drink. I dripped on the camera. It hit my head on the sink. My world was finished, and then we were screaming on my hand. They took me to the doctor. This is what she said. Keep up your endurance, and I'll give you my assurance. I'd really like to help you, but you ain't got your assurance. [music] Keep up your endurance, and I'll give you my assurance. I'd really like to help you, but you ain't got your assurance. I got the health care blues. I can't afford to pay my debt. I got the health care blues. I can't afford to pay my debt. I'm sick of this crap. I'm falling into the coverage gap. [music] Let's see, kids, food, rent, car, prescription drugs, college debt, interest or taxes. Any way you do it, there's really nothing to it. You just do your best and hope that you'll get through it. Hey, is that a foreclosure sign on my house? [music] I got the health care blues. I can't afford to pay my debt. No, no, no. I got the health care blues. I can't afford to pay my debt. I'm sick of this crap. I'm falling into the coverage gap. Obama tried to help me and my governor, too. But the Missouri legislature, they wouldn't let it through. 300,000 people without any relief. But he'll be sick now. That's a Christian belief. To all of those people here is a trick. You don't need insurance if you don't get sick. [music] Ow, that must have hurt. Do you think he's going to be alright? I don't think so. It was just an accident. That's why they call them accidents. Do you guys have insurance? Oh, yeah. We've got blanket coverage. Hey, someone got a blanket over here. We need to get this guy covered up. I got the health care blues, yes. I can't afford to pay my debt. I got the health care blues. I can't afford to pay my debt. To all of those people here is a trick. You don't need insurance if you don't get sick. Stay well, be healthy. So many people have the health care blues. Tom Rowley led up the charge to produce health care blues. Could you mention the names of the other folks in there? Well, Wildflower Self, she plays the cat and her daughters be love. And me, I guess we're the only actual people in the video. So I had fantastic -- I mean, if you have a health care problem like I had, trust me, get a good videographer. And my friends, Neil and Deanna Rosenbaum, at somewhere in the woods productions, have given and given and given of their time. And they're very talented, very creative. And I had never done a video of any sort before, really. And I had concepts in my mind and got a little obsessive about it, really, to get it pushed through and get it done. But it was changed by their expertise and knowledge. And I'm sure it was a much better video because they were involved. Whose mouse did you steal, mechanical mouse did you steal, to play that part? You know, I spent weeks shopping on the internet for silly little props. You know, a top hat, a coat and tails, you know, mechanical mouse, a stethoscope. I went to the junk stores around here and bought hospital scrubs. And, you know, just thought, what am I going to need? What am I going to need? So, I mean, you know, we just found that online somewhere and bought somewhere. With a pack of four, I gave the rest of my grandkids. And cat whiskers and a gurney and probably everything. I don't know what -- Yeah, that's right. I mean, the person who lent me -- it was a casket dolly that I turned into a gurney for two. That does not bode well. Well, it looks pretty funny, though. And he also lent me a sight for the tombstone scene. And, you know, I made a lot. I had a couple of signs printed, but a lot of the other signs I just hand painted. And, you know, we just put it together the best we could. I mean, it was really no budget. I, I mean, I spent a little bit of my own money, but, you know, I just didn't have a time to spend. So, I just went out there and just tried to figure out and get it done. So, folks, I do want you to see the video. You've heard the music already. But seeing the words that are flowing by, the images, the cat and mouse and health care and bonking heads and everything else. You can see that when you watch the video. Come via NortonSpiritRadio.org and you'll see Tom Rowley and his crew. And they'll give you a good laugh at the same time that you're hearing some fun music. Mark, if they wanted to search for it, I mean, obviously, the link is kind of long. They just go the health care blues, like on Google, and then put Tom Rowley, R-O-W-L-E-Y. It'll probably be the first thing that comes up. There's a lot of stuff out there with similar titles. So, if they'll just search the health care blues, Tom Rowley, R-O-W-L-E-Y. It'll probably come right up. And I have a hard time pronouncing your last name as Rowley, in part because I grew up in Wisconsin. Across the street was the Raleigh family, R-O-W-L-E-Y as well. And I'll just send a shout out to Bob Rowley, who is probably listening to this. He's not in Wisconsin anymore, but he is one of my listeners across the nation. Hi, Bob. The video starts out with the Missouri state motto. You can recite it, I'm sure? The welfare of the people shall be the supreme law. And I think it's very telling, and I really wanted it in there. And then Neil said, "Well, that's where we should start." So, I've got a great little community radio station here in Kapole, Missouri, where I first heard your show. And many other wonderful, wonderful shows. Community radio is an amazing thing. And I can't believe in a rural area that I'm in that we have such an amazing station. Sorry to go off course there a little bit. I think it's always good to lift up KZGM. And what number are they on the dial? 881 KZGM. And the gal that does Ozark Uplift played my show. And to fill out the time, I finished my tune, "The Healthcare Blues." It was one of the things that was on the soundtrack. But to just tell you a little bit about Linda, she ran a solid waste district for seven counties for about 20 years. And I used to tell her, I said, "Linda, your legacy is in megatons of trash." And she used to laugh. It's an amazing, amazing sense of humor. She loved that. But it's true. She made this place healthier and cleaner environment. Just an amazing, amazing person. Well, budget issues came up and she lost her job after 20 years. So suddenly she found herself without healthcare. And she tried to get on with the Affordable Care Act, with the marketplace insurance, had a ton of trouble. Finally, at like three o'clock in the morning, she said, "I'm going to call them now." The way that they weren't busy, she got on right on and finally got signed up. A month later, she found out that she was dying of cancer. This is just the way it happened. And she wanted to tell her story about how appreciative she was that she wasn't caught without any healthcare when she discovered that. She even sent a beautiful letter to Obama that he answered personally because I think it meant so much to him. She had counseling, she ended up choosing not to get a bunch of chemo and stuff. She was only given months, but she ended up living like 18 months at home. And, you know, I guess dying is not a lot of fun. But she, on the other hand, she had about the highest quality experience with her death that I could imagine anyone having. She confronted it straight on, never tried to hide from it, and really made the very death out of her life just like she did in her career. And so I did dedicate the video to her. She was the inspiration that really got me going. I'm thankful for the inspiration. It's a fun video, it's informative, and it addresses one of the crucial gaps that was supposed to be taken care of. We tend to think there is a safety net, and it's so sad when there's big holes in the safety net so that people plummet to their ill fortune, maybe death, even. Right. There's another issue for people that look into health care internationally. You find out that America gets really low grades for the quality of health care. And it's surprising to a lot of people, they don't realize that there's an assumption that, you know, we have the best health care system in the world. We don't. We just have the very, very most expensive health care system in the world. Even though we're the only developed nation that does not cover all of our people. But we have a systemic problem, and when you have hospitals that are giving away free care, giving away care that they're not getting reimbursed for, that is not the stuff that an excellent health care system is made out of. So we're always like catching it up rather than advocating and working to make it really good. And everyone is affected by the quality of our health care system. Having coverage gaps in so many states, it is a drag on the quality of our health care system. Absolutely. I think you can point me to someone who can give me answers to the broad swath of questions that I might have. We've referred several times to Missouri Health Care for All. Jen Burstale is the Director of Missouri Health Care for All. And I think we'll either get her or second command on the phone in just a moment. Fantastic, Mark. So again, Tom Rowley has been our guest so far for spirit and action. Health Care Blues is the song and the video accompanying it. They put together. You can follow the link from nordenspiritradio.org. Missouri Health Care for All.org is one place where you can get information just in Missouri. This is, of course, 19 states nationwide that are dealing with exactly the same issue. Thank you so much, Tom, for putting your creative, your serious, and your fun efforts into making health care blues for us. Mark, thank you so much for being there and having a show like you have. That constantly reminds me, especially on my bad days, that there's a lot of people out there doing a lot of really good things. Thank you very much for that. You're welcome, Tom. That was Tom Rowley, creator of the Health Care Blues song, living pretty close to the town of Kabul, Missouri. And right now, we'll continue looking at further aspects of the health care dilemma in Missouri for today's spirit and action by heading to the phone with Jen Bursdale, Executive Director of Missouri Health Care for All. Jen, thank you so much for joining me today for spirit in action. Thanks so much for having me. You're working on health care coverage, the fact that there's this hole in the middle of the donut for coverage in the state of Missouri. And I understand that just last week you had two health emergencies in your family. Did that end up affecting you? You know, any time we have a health emergency in anyone's family, it certainly affects us. I was out of work for my illness and then to take care of my son. And every time I get sick, I'm so grateful, of course, that my family does have health insurance. That we were able to take my son to the emergency room without having to worry about how we would pay for it when he was having trouble breathing. And really, with the work I do, it's always such a reminder that there are so many people in this state and around the country who aren't as fortunate. And I think in Missouri, it's something like maybe 300,000 that are not covered or how big is the group that are left in the gap between Medicaid and the ACA? Yeah, the estimate in Missouri right now is about 300,000 people. And we're talking about folks who really have no way of getting affordable health insurance. They don't qualify for the discounts that have helped so many people and they don't qualify for Medicaid in Missouri. And so they're really left without any options. And where does that kick in for Missouri? What is the top end, I guess, maybe for Medicaid and then the bottom for the ACA? So it'll blow your mind. Missouri has one of the lowest eligibility levels for Medicaid in the country. So if you are what they call a custodial parent, so you've got a dependent child living at home, you can't make more than about $300 a month for a family of three. So just over $3,600 a year is the cutoff for a family of three for those parents to qualify for Medicaid in Missouri. So if you're a family of three surviving on $4,000 a year, the state right now considers you too wealthy to qualify for Medicaid. But you have to be making around $20,000 for that family of three to qualify for discounts in the marketplace. So that's why we've got so many people that are really stuck in the middle. That's crazy. Why is that $3,600? I mean, like you said, no other states are nearly that bad. That's crazy. Maybe because a medical care is free there? No, medical care is not free. I think it's about as low as the federal government will let us go and still have that partnership with them for Medicaid. So unfortunately, our state has just made a lot of really draconian cuts to our Medicaid program over the years. And it just leaves us with this really, really stingy system that leaves a lot of people who really need the help out in the cold. What does this mean in terms of real people? I mean, I guess if you're working a minimum wage job full-time, you're in the gap, right? You're in the gap, exactly. So we know most people who are in the gap are working, or they're in school, some are taking care of family members. But the majority are working, and they are working those minimum wage jobs. If you work a minimum wage job full-time and you're a family of three, you make too much to qualify for Medicaid, but not nearly enough to buy your own health insurance. And there are people working jobs that we all know. So the folks that check you in at the hotel or clean your hotel room, a lot of childcare workers, people working at restaurants and fast food joints, landscapers, all of those folks, home health workers, are a lot of folks like that that are stuck in this awful gap where they just can't get any kind of health insurance. And so you must run into real people. They come up to you and say, "Hey, you're addressing my issue. Any particularly evocative stories?" Yeah, we hear them all the time. A couple that really stick with me. One is a young woman I met a few years ago named Jamie. She lives in a rural community in Missouri. She's now in her early 30s. She's actually a domestic violence survivor now raising her kids on her own because last I heard her ex was in prison. She actually works three jobs. She's in college trying to finish her bachelor's degree. And she needs surgery for a back injury resulting from that abusive marriage, and she can't get it because she's uninsured even though she's working three jobs. So I really think about Jamie often and how badly she needs care. Recently, we've also been working with a woman named Melinda who lives on sort of the far outside suburbs of St. Louis. Melinda has a college degree. She worked at a hospital for years, started getting sick, and so she lost that job with benefits. But she was still working when she was diagnosed with type 1 diabetes. Unfortunately, she was uninsured, so she's been unable to get the insulin that she needs consistently over the last four years. And she was diagnosed, so she's stretched that insulin out. She's used the wrong insulin because she could get a deal on it. She's even gone without. And as a result, she now has weakened bones. She broke her hip. She's in her early 50s, but now she needs a walker to walk, and she can't work anymore. And it's one of those stories where, first off, a human impact is so great. We had a woman who college educated, had a great career, and with a little bit of help, could be doing great. And also, from the state perspective, it's so clear how short-sighted it is because Melinda is now applying for disability. She'll probably qualify, and when she's on disability, she'll get Social Security and Medicare and Medicaid for the rest of her life. Plus, she's got all of these bills from, you know, if you have diabetes and you're not using your insulin, you end up in the emergency room. She'll never pay off those hospital bills. So, instead of the state helping her with the cost of insulin for a couple of years, we've got thousands of dollars of hospital deaths that will never be paid off. And now, you know, the state and federal government will pay her disability payments in Medicare and Medicaid for the rest of her life. It's just a terrible system. Talk about an extreme case of Pennywise Pound Foolish. Exactly what it is. No, I'm not assuming that you're an expert in Medicaid and how that pays out things or who that covers, but does it just make sense to make sure you don't have any income so that you don't exceed the 3600 annual limit to be covered by Medicaid? Does it make sense that you just have to make sure you're not in the job market at all in order to get some kind of coverage? So, unfortunately, we know people that have to make that choice. I should mention that if you don't have dependent children or a disability, it doesn't matter how little money you make. You can't qualify for Medicaid. But, you know, we actually know a woman in southeast Missouri who she is a mom. She qualifies for Medicaid. She's got some health conditions. So, she's not just able, but she absolutely can't go without healthcare. And she'd really like to look for a job. Unfortunately, she knows she would lose her Medicaid so she's not looking, but, you know, that means she's raising a family with very little income. You know, I think she gets some help from family and friends. She has, I believe, a part-time job, but her family would be a lot better off if she could look for better work. And, ultimately, folks might find jobs with benefits if they're able to get back into the workforce, but people are really afraid to lose the coverage they have, especially if they've got health conditions and they need that care. Now, I assume that the ACA helped out a certain sliver of the population. Do you have some ideas of the dimensions of that group of people who are helped to actually have coverage now because of the ACA, thereby reducing the gap? Yeah, so there's a lot of people, actually, who have been covered as a result of the Affordable Care Act. It's millions nationwide. Here in Missouri, it's also about 300,000, I think, just under 300,000 enrolled. And so, you know, what that is. And there's a lot to the Affordable Care Act, including some provisions that just offer better protections for those of us who have health insurance to make sure that it covers the things that we need. You know, and that's all really important. But in terms of covering people who were uninsured, one of the best pieces is we now have this health insurance marketplace where people can go and shop for insurance if they're not getting it through a job. And if you make between 100 and 400% of the federal poverty level, you can qualify for discounts on your health insurance. And so it's really meant to help folks that are, you know, in that income level where they can't afford to pay toward their health insurance, they can take some responsibility for affording their own health insurance. But maybe they can't afford the full cost. And so it allows them to get insurance at a price that they can afford. It's on a sliding scale, so the more you make, the less help you get. So that's really helped a lot of people. And we've talked to people who were uninsured for years and finally have affordable health insurance. And, you know, some really dramatic stories there also. We have a woman who's a member of our organization who had been uninsured for several years. She got health insurance as soon as the marketplace went up. And a few months later was diagnosed with breast cancer. And her marketplace insurance sign covered her treatments. So, you know, for her, that marketplace not only saved her health, it saved her family's financial stability. The Affordable Care Act was written so that there wasn't supposed to be a gap. All states were supposed to have Medicaid expansion, which was supposed to be for those folks that really can't afford to put any money toward their health insurance. And so, you know, you'd go all the way from Medicaid up to where people start getting a lot of help in the marketplace. And then they get less and less help the more they make. And then when you make a certain amount, you pay for your own insurance, but you've got these new protections. The Supreme Court decision in 2012 that made the Medicaid expansion optional for the states. And so now that's left us with about, there's 19 states right now that have not yet taken the opportunity to expand their Medicaid program. So, they're left with these gaping coverage gaps. And here in Missouri, where our Medicaid eligibility is so low, it's really a huge chasm that a lot of people are falling into. Maybe you can tell us the difference about being covered by Medicaid and the ACA. Would your insurance be better if you're covered by Medicaid? I mean, the federal government was offering to do 100% coverage of the expansion for three years, then 95% for three more years, and then 90% I think after that. So, this seems like it would have been really cheap for the state of Missouri and all the other 18 states where this gap exists. It would have been really cheap for them to expand this coverage. What was the advantage to the state not doing this? There is no advantage to the state in not doing it. It's actually an exceptional deal for the state's economy. Folks who are far more savvy about economics than I am have looked and said that even when the state is paying that 10%, which is the most will ever pay for this expansion population, that we save so much money in other programs that we come out ahead. So, for example, we have folks in Missouri enrolled in a special Medicaid program for people who are blind and low vision that the state pays 100% for. We've got services being provided to our Department of Mental Health to people who are uninsured, that the state is paying most of the costs. If we took advantage of the Medicaid expansion opportunity, those folks, a lot of them would go into this new population where the state would go from paying 100% to paying 10%. Meanwhile, we bring back billions of Missouri's tax dollars. We save and create a lot of healthcare jobs, thousands of healthcare jobs statewide. So, I mean, it's really, it's just a fabulous deal for the state. Not to mention, there's data showing that it would save some 700 lives a year. And that's what gets me out of bed in the morning is trying to save those lives. We've got people dying every year that we put off doing this. And here I thought that it was your child that gets you out of bed in the morning. Well, it's not you or is it you or your wife who ends up getting up when the child cries at five in the morning. It actually is usually me. So, I should say he gets me out of bed and saving lives is what gets me out the door. How about that? Okay, that's good too. Now, I really know nothing about the politics in Missouri, and I'm sure this place heavily on why Missouri healthcare for all is needed. And folks, that is the website, MissouriHealthcareForAll.org. Just a wild guess, but I'm assuming that somehow you have a Republican leadership there that has been opposed to this expansion. Or is it the Democrats? Or is it just a breakdown in both of the parties? Generally speaking in Missouri, so overall, so folks know we have a moderate Democrat governor who's been very supportive of Medicaid expansion of closing the coverage gap. And then we have Republican super majorities in both the House and the Senate. That means they've got enough votes to override a governor's veto if the parties stick together. Generally speaking, the minority party of the Democrats has been universally supportive of closing the coverage gap. The majority party is where we've encountered more resistance, especially publicly. We know actually that there are a lot of members of the majority party of the Republican party in Missouri who know that this is the right thing to do. They care about saving jobs, they actually do care about their constituents who can't get health insurance. Especially these folks that are working, they're doing everything right. We just talked yesterday to a woman who's a veterinarian who is in the coverage gap because she chooses to practice in a rural area where she doesn't make a lot of money. So we've got folks that know what's the right thing to do. Unfortunately, we've got a lot of gridlock, a lot of really partisan, just nasty stuff going on in the Capitol. And it's made it hard to get any kind of compromise on a lot of issues over the last few years. And of course, in an election year, it's harder than ever. So we're doing a lot of work behind the scenes building relationships with legislators. We see how important it is when legislators hear from real people that are impacted by these issues. You can't write off someone who's standing right in front of you telling you their story. So that's why we identify as a grassroots organization. We think it's so important for those real people to have their voices heard. And we really do believe that this is something that the state will fix at some point. Our goal, of course, is to sort of nudge that along and help them fix it sooner rather than later. Because, as I said, people are losing their lives every year that we delay. I read on the website somewhere recently that Missouri was one of the several states that look like there might be room for expansion this year. How good are the options for that? Is it looking at all promising? Or is this -- I mean, this may have been that Missouri Health Care for All has led this grassroots movement to get people out there speaking about it. Any promising science? You know, I can't say that there's very promising science this year. And we're just about a month before the end of legislative session. And it's really related to some issues -- some completely different issues. The gridlock has gotten sort of worse than ever here in Missouri. We've got not only the presidential election coming up, but the governor's election, a lot of representatives and senators who are termed out, so a lot of open legislative seats. So that has just really led to partisan posturing that's kind of greater than ever. So we always knew this was going to be a tough year coming into it. So we're really looking at a multi-year strategy as much as we hate to put it off, as I've said it rather, win in two years than not at all. So that's why we're doing a lot of this relationship building work and collecting and sharing people's personal stories and really getting people involved in the movement, hoping that once we get this election behind us we'll have a better shot going into next year. We're speaking with Jen Burstale of Missouri Health Care for All. Jen is Executive Director of Missouri Health Care for All. Your organization, how big is it? So we have about 13,000 individuals statewide who have joined us. We've got over 200 organizations that are involved, including a lot of faith community, small community groups, and then groups working on sort of an array of issues who plug into us for our expertise on health care issues. We've got a 13 member board of directors statewide in both rural and urban areas, and we're really excited we are now a staff of six full-time folks, and we've got also an almost full-time health care organizing fellow with us. I started just over three years ago as the only employee, so we've grown really fast, and we're really proud that unlike a lot of organizations that sort of call themselves statewide, we are actually doing grassroots organizing not only in our urban and suburban areas, but also in rural areas throughout the state where there's so much need not only for health care, but also just to get people involved in the process and to help those legislators understand it despite what you might have heard about the makeup of rural voters. There are actually a lot of people that really do want to see progress made on health care issues. Well, as you know, we spoke earlier to Tom Rowley, and I guess he's one of those rural folks who's very adamant that this is something that needs to be addressed. Could you tell me a little bit about the different organizations that are supportive to Missouri health care for all? Could you name a few? Sure, so, you know, we've got sort of everyone from, we've got a couple of the Catholic charities organizations in the state, actual individual churches, including Unitarian, Universal Church of Christ, UCC, Episcopal Presbyterian, Jewish congregations, some Methodist churches, some AME, some AME Baptist churches, so really a lot of religious diversity, and we do identify as a faith and community-based organization. So certainly not everybody who's a part of the organization identifies as a person of faith, but a lot of folks do, and we all sort of share this belief that access to health care is a moral issue, and it comes from a value-based place for us. We really think, you know, it's a matter of putting people on people's lives over politics. There's a lot of those folks, and then, you know, we've got some more sort of traditional organizing groups like Missouri Jobs with Justice and some faith-based organizing groups. Those are those groups that work on a lot of issues, but, you know, sort of partner with us on health care issues. And then, you know, neighborhood associations and some direct service organizations in both rural and urban areas. So it's really, it's a big mixture, and it's part of the reason that we were founded was to sort of bring together all of these people and all of these organizations that may not agree on everything. You know, we've got pro-life organizations and pro-choice organizations and at Missouri Health Care for all these sort of agree to put those views aside to work on these issues where they all agree. Yeah, I mean, it should be easy to find a consensus on this, I think. Now, in your list of various churches, I didn't hear Quaker meetings. Does that mean that St. Louis Friends meeting hasn't weighed in yet? I don't believe that they have. We would certainly love to have them. We actually have a past board member who's active in a Quaker meeting here in St. Louis, but they haven't actually joined us yet, so we would love to welcome them to the movement. I'll have to talk to them. I've had interviews with one or two people from that meeting who've been part of other items, not about health care specifically, but it's time to grow your support even further. Great. Thank you. I understand, Jen, that you are Jewish and that probably either the temple or synagogue you're part of is, they better be on board with this because you're such a good speaker. They must have been one over, even if they hadn't already had the idea. How does this come from your Jewish faith or intersect with your Jewish faith in terms of trying to provide this health care? Actually, the movement was founded at my congregation. Before I worked at Missouri Health Care for All, I worked at my synagogue. The movement was founded there just a couple months before I started. It came out of a group of faith and community leaders who actually came together to hear from a man named Finney DeMarco who founded Maryland Health Care for All. He came way back in April 2007 before the Affordable Care Act was anywhere on anyone's radar and really impressed and excited people about what they had been able to get accomplished in Maryland by really building this big coalition of people and organizations that shared values around health care. The folks that were in the room that morning said, "Well, we're not leaving here until we start this here." They actually got it started. I came on the scene a couple months later and the Rabbi Susan Talvey at that congregation sort of asked me to help out. I had the honor of helping to build the organization as a board member and a local leader while working at the congregation. They continue to be really involved. Rabbi Talvey continues to serve on our board, but she likes to joke that she hired me away from herself when this position came open. Just from being involved and hearing people's stories, I'd gotten so passionate about both the mission and the issue in the organization that had to sort of go for the job when it opened up. I'm curious about how this has affected the economy in Missouri. From what you said earlier, I have the sense that you think it would actually be an economic stimulus to close this coverage. I've observed in Wisconsin where I'm located that our economy has suffered from attempts by our legislature and governor to stimulate the economy. In fact, it's had reverse effect that we've been lagging compared to other states. What's been the situation in Missouri? We certainly have seen healthcare jobs leaving the state, unfortunately. We've seen a couple of hospitals close and a lot of hospitals had to do layoffs. It's not all because of the coverage gap. There's a lot going on. Really, at the end of the day, it is hard to sustain a community hospital and a rural community. But we also know it's critically important if you have a heart attack and the nearest hospital is 75 miles away. It really no longer matters whether or not you have health insurance. So it's really important that we save those hospitals. One of the clearest things that we've seen actually is hospital systems that are cutting jobs in Missouri and adding them across the border in Arkansas, which did close their coverage gap. We've heard from nursing students that would like to stay in Missouri but are looking out of state because they can't find jobs here. So certainly seeing those impacts and knowing that we could be doing a lot better as a state. And just as every year that we delay, we lose lives that we can never bring back, when a hospital closes, you can't just reopen it. The staff is gone. The equipment is gone. So unfortunately, every hospital we lose now, it's not like we can expand Medicaid in two years and they'll just magically reopen. That's permanent damage to this community. So hospitals really are gone. It's some valiant work that you're doing, Jen. Again, Jen Berstale is Executive Director of Missouri Health Care for All. MissouriHealthcareForAll.org, the links on NorthernSpiritRadio.org. Of course, beautiful work that you're doing, it's inspirational. I'm so glad that you could bring up the positive moments. I would like you to go from having a majority of good days to virtually all good days and with a bright future for the 300,000 people who are interested. People who fall in the health care coverage gap. Thank you so much for joining me, Jen, for Spirit in Action. Thanks so much for having me. I really enjoyed our conversation. And there was so much good commentary by both of today's guests, Tom Rowley and Jen Berstale, that I had to pull some real gems of discussion out of the broadcast and add them as bonus excerpts. And I want to warn you ahead of time that there's some truly excellent and inspirational bits there, including, especially the "There is Hope" comment on the NorthernSpiritRadio.org site. Listen and enjoy and we'll see you next week for Spirit in Action. The theme music for this program is "Turning of the World" performed by Sarah Thompson. This Spirit in Action program is an effort of NorthernSpiritRadio. You can listen to our programs and find links and information about us and our guests on our website, northernspiritradio.org. Thank you for listening. I am your host, Mark Helpsmeet, and I welcome your comments and stories of those leading lives of spiritual fruit. May you find deep roots to support you and grow steadily toward the light. This is Spirit in Action. With every voice, with every song, we will move this world along. With every voice, with every song, we will move this world along. And our lives will feel the echo of our healing. (upbeat music)