Paying for Poverty on the Installment Plan: Stunting the Mind and Imagination

imagesThis is Jessie, again.  Ever since my sister told me about Rochelle’s daughter and her school project I’ve been preoccupied by the differences between the experience of my daughter, Rachel, at eleven and that of Rochelle’s eleven year old daughter, Kalinda.  For Rachel, eleven was the age at which she made two major decisions that have guided her life ever since.  She decided that after she finished college she would go into the Peace Corps, and she decided that after she finished her Peace Corps service she would go to medical school.  She did both.

 Rachel was a smart child and did very well in school, but all her friends were also smart children who did well in school.  So were her cousins.  So had her parents been, and her aunts and uncles.  Rachel never had physical fights with other girls at school, like Kalinda.  But then, Rachel was an only child, born to two professors with PhDs, both in their late thirties, without great wealth, but with plenty of money for all of life’s necessities and many of life’s pleasures.  Rachel lived in the same house for her entire childhood, the same one she visits now as an adult.  When her second grade teacher said she was having trouble with arithmetic, we practiced every day until she was confident about it.  In middle school she started learning both French and Spanish and then went on a school trip to Europe during spring break, where she was able to use these languages in real life—albeit on an extremely limited basis!  Before she left, her travel group had explored the countries they would visit, and we had taken down the globe from its shelf in the dining room several times, to examine the route she and her fellow students would take.  Both of Rachel’s parents and her aunt and uncle had served as VISTA Volunteers in the 1960s and 1970s, and several cousins had been Peace Corps Volunteers.  Both her parents and her aunts and uncle had advanced degrees.  She grew up with the tradition of both service and advanced education.  By the time she was eleven, it was clear to her that this is what life involved.

What has poverty meant for Rochelle’s eleven-year-old daughter, Kalinda, and in fact, for all her children?  They have moved from apartment to apartment and school to school all their lives, as Rochelle has attempted to find rents she could afford and housing that was safe.  There are few books in their home, and despite a valiant recognition of the obligation to go to school, no tradition of learning or excitement or exploration of what is presented at school.  When Kalinda began having trouble with arithmetic, Rochelle, preoccupied with work, economic difficulties, and extended family problems, has had no spare energy for intensive tutoring.  She had always been good at arithmetic, and her attempts to deal with her daughter’s mathematical shortcomings frustrate her.  I don’t know what Kalinda’s plans for her future are, or if she has any.  I doubt she has ever heard of the Peace Corps.  Her academic experience has not been enjoyable, and I’m sure she has no thought of attending college.  She is in the “slow group” at school, and she often gets low grades.

If Kalinda’s economic circumstances were different, would she be the bright little girl Rachel was?  That all of Rachel’s friends were?  If Rachel’s circumstances had been like Kalinda’s, would she have been the reluctant student, aggressive and uncooperative in school, like Kalinda?  I can’t know that.  I have met Kalinda only once, when she and her mother and siblings all went out to lunch with my sister and me more than a year ago.  Kalinda sat across from me in the restaurant, and we talked throughout the meal.  I was struck by both her good manners and her appropriate conversation.   She was friendly, lively, and outgoing.  She certainly didn’t seem “slow.”   Rochelle is the third generation of single mothers in her family, and it seems very likely that Kalinda will be the fourth.  Rochelle is the first person in her extended family to have graduated from high school, though it has done her precious little good.  At this point it is hard to imagine that Kalinda will graduate.

Now the federal funding for SNAP, aka food stamps, and for the after-school program that Rochelle’s children attend has been cut.  And of course, there are the many states, like Texas, that have decided that increased Medicaid eligibility (which would cost these states very little) is out of the question—mostly to make a political point.

So, though impoverished children are covered, impoverished adults are not, and their extremely low incomes make them ineligible for Obamacare.  Less money for food.  No money for afterschool care.  No money for adult health care.  Rochelle’s children are perfectly normal in stature.  We rarely see starving children, short and emaciated, in our country.  We do, of course, see many who, like Rochelle’s children, eat far too much of the wrong foods: too high in fats and carbohydrates, too low in protein, vitamins, and minerals.  But those foods are tasty, filling, and comforting, and cheap enough for their mothers to afford.

The stunting we see in 21st century America is different from the stunting of bodies that existed in the past in this country, and that still exists in too many other countries.  Today’s American stunting is the stunting of the mind and the imagination that comes from our addiction to paying for poverty on the installment plan.  Apparently we Americans are willing to save a little money today by cutting back on social benefits for Rochelle and Kalinda and the millions like them, and pay for their stunted lives in high interest installments in the future: poor health, handled through high cost emergency rooms; an eternal parade of school dropouts with no job skills whose lives must be subsidized by grudging and inadequate state and federal benefits; babies born to unmarried mothers who can’t support them and whose entire youthful lives must be maintained by a different range of grudging and inadequate public programs; and worst of all, the high and tragic cost of lives destroyed by drugs and other criminal activities, and mediated through the criminal justice system    These national installment payments promise to be the eternal price paid by a country that refuses to guarantee decent lives for all its citizens.  And the price doesn’t begin to cover (because costs like these are always in the fine print) the pain and stunting of each individual life, like Kalinda’s or Rochelle’s.

The Emergency Room

images Most of Rochelle’s family use the hospital emergency room as their family doctor.  Many don’t have health insurance and wait until there is an emergency to go to the doctor.  Rochelle’s children are covered by Medicaid; Rochelle is covered by a very basic city indigent care program. Texas only offers Medicaid to children, pregnant women, and the old or disabled; her mother has Medicaid due to disability.  When Rochelle became full-time at her employment with the grocery store she was eligible for insurance coverage through them but chose to stay with the basic care provided to her free by the city.  It is by no means similar to the insurance coverage she would have received had she opted in to her company’s insurance plan.  She is now making more money, but she is still in financial trouble because she has three children to support; she did not think she could afford the insurance and never researched whether or not The Affordable Health Care law would help with the payments. At 29 she also feels somewhat invincible and is content that her children are covered by Medicaid.  Rochelle’s income is low enough so she won’t have to pay a penalty tax due to lack of insurance coverage, however.  Her experience has simply been that one goes to the emergency room when one is sick and then, when one can’t afford to pay the bill, one just doesn’t.  She never went to the doctor when she was pregnant with her first child.  “I was in denial,” she told me.  She first went to the doctor when she went into labor.

Rochelle’s mother is a good example of what a lifetime of being without health care can do.  She is 51 years old but looks 20 years older.  She has been on dialysis for at least three years.  “High blood pressure wrecked her kidneys,” Rochelle told me.  Just recently she had to be taken to the emergency room due to heart palpitations and a pulse that was racing at 190 beats per minute.  The emergency room treated her and released her; Rochelle thought her mother had a follow up appointment but was somewhat unsure.  She wasn’t sure what had caused the problem.  When Rochelle comes over for this week’s interview we will discuss the situation in more depth.  She needs to see how she could be in her mother’s situation in twenty years if she doesn’t get involved in better health care.  At age 29 she has borderline high blood pressure, is considerably overweight, and eats a very unhealthy diet.  The emergency room does not provide basic health care, though the current governor of Texas is on record as saying that he considers it a reasonable health care solution for the poor.. And this is the norm for those living in the culture of poverty.  Rochelle has started earning a little bit more money, but it is hard for her to understand the value of some of the options available to those who live outside of poverty.  Perhaps if she recognizes she could be in her mother’s situation she will be more open to some of these options.  On the other hand, it is understandably hard for someone who is finally beginning to experience a little economic leeway to tie it up in medical insurance she can’t really believe she needs.



Don’t Become Poor In Texas

images-2“I still can’t get health insurance,” Rochelle told me last week.   I was surprised she knew about her lack of coverage by the Affordable Care Act, but it was on the list of things I was going to discuss with her that morning.  I had already researched it and she was correct.   Texas is a state that has opted out of increasing the coverage for Medicaid to include healthy, non-pregnant, young and middle aged women.  Men aren’t covered at all until they become old or disabled in Texas, and they weren’t going to fare any better with the new act, either.  Texas wasn’t expanding Medicaid at all under the Affordable Care Act, mostly known now as Obamacare.  I remember being stunned a year ago when Rochelle had first told me she didn’t qualify for Medicaid.  I thought she was just misinformed.  No, I was misinformed.  Eventually I found something that allows her clinic care and a physical once a year.  It is far removed from health insurance but far better than nothing.

Rochelle’s problem is that she is too poor, too healthy, and too young to be covered by the new law.  Mostly she is too poor.  It makes no sense at all, except if one lives in Texas, and 15 to 22 other states (depending on their final decisions), that is exactly the situation.  If Rochelle were single and childless and making $10/hour she could sign up right away and be eligible for health care in January, 2014; but Rochelle is single, has three children, and makes $9.17/hour so she doesn’t qualify.  The Affordable Care Act just assumed that states would increase their Medicaid coverage to include the people well below the federal government poverty line, if they were not already covered by it. The law didn’t prepare for states to reject the idea of increased Medicaid coverage.  Texas has more uninsured people than any other state in the union, and it looks as if it will remain that way.

I explained to Rochelle why it was that she wasn’t going to be covered by the law.  She had voted twice for Barack Obama and was somewhat taken aback when she discovered the health care law wasn’t going to make any difference to her life. There will be quite a lot of people who are better off and able to get health care because of the new law; Rochelle won’t be one of them because Rick Perry, the governor of Texas, seems to have no understanding of poverty nor the cost to the state and the tax payers when those not covered by Medicaid use the emergency room as their family doctor.  I explained all this to Rochelle.  “Well, I heard he isn’t running again,” she said hopefully.  No, he isn’t, but it is doubtful his most likely replacement will think differently.   And so, again, Rochelle falls through the cracks, and there is no safety net for her.  I find it totally astonishing.  Rick Perry should be ashamed of himself.