Michelle’s Story: Closing the Health Insurance Coverage Gap

Michelle Wisda imageMichelle Wisda is a 44 year-old wife and mother. For 14 years, she and her husband raised their son in Chapel Hill, NC, where Michelle worked in the public school system as a behavioral modification specialist and her husband ran his own car detailing business.

In 2009, the recession hit hard, and her husband’s business felt the brunt of it. “He had contracts to detail the city and county vehicles, and when the recession hit, budgets were cut, and his business was really affected by it.” Michelle recalls.

They tried to financially make it work until the summer of 2011. They decided to move back to Asheville and be closer to family. But they soon realized the public schools still had a hiring freeze in effect and Michelle struggled to find employment.

Because of the hiring freezes, Michelle decided it was time to go back to school and get her degree in social work. “I realized that I could make a greater impact on children and their families if I had a degree.”

But this new direction also meant that Michelle would no longer have the insurance she had while working in the public school system in Chapel Hill. Previously, her entire family was covered under her policy.

“When we moved to Asheville, I got my son immediately enrolled into Health Choice, so he was covered. My husband found a job and he was covered, but I was left out.”

When Michelle heard about the Affordable Care Act (ACA), she was excited to enroll, but she was soon disappointed.

Under the Affordable Care Act, it was intended that every person have access to affordable health coverage. The law made it mandatory that states expand their Medicaid programs so that low-income people would be able to get Medicaid. But a Supreme Court decision gave states the option to expand their Medicaid programs, instead of mandating expansion.

In 2013, Governor Pat McCrory and the North Carolina General Assembly chose not to expand Medicaid to those with incomes below 133% of the federal poverty line. Consequently, North Carolina today is among a minority of 24 states not receiving federal Medicaid expansion funding. This decision has created a coverage gap for over 500,000 North Carolinians, like Michelle, whose income does not qualify for ACA coverage. Those in the coverage gap include workers in retail, tourism, food services, and construction industries.

“Because I am enrolled in school and don’t have any income, I was told by the ACA reps that I should enroll onto my husband’s coverage. This would cost us $800 a month, and with only one income, we couldn’t live on what would be left over.”

So, Michelle decided to be without health insurance while she was pursuing her degree.

This was not an easy decision to make, for in 2008 she was diagnosed with a blood clot disorder that sent her to the hospital for emergency treatment. “I almost died,” she recalls.

“I knew it was a risky decision, but I also knew I wanted to stay in school. I didn’t have any options.”

And then in 2014 she started noticing the same health symptoms that she had in 2008. Not taking any chances, she went to the doctor’s and got it checked out. “At the time, I had Emergency Student Health Care at Mars Hill College,” where she was enrolled as an undergraduate. “But when I submitted the claim, it was denied by their insurance provider.”

She was hit with a bill for $5,000.

“Closing the coverage gap is key to me having access to medical care,” Michelle says. “I am a 44 year-old mother and I don’t go to the doctor unless I absolutely have to.”

It has been 5 years and two visits to the emergency room since Michelle has had medical insurance.

Not content to wait for change to happen, Michelle is committed to reaching out to her NC representatives to close this coverage gap. She has joined numerous social issue groups and carries around index cards with stamped envelopes addressed to her representatives.

“If I’m out at the store and I run into someone I know, I’ll start a conversation about this and ask if they would be willing to write their story on the index card. Then I ask them if they will commit to sending their stories and leave the addressed envelopes with them.”

She has started petition signings, phone banking and letters to the editor to local newspapers to inform and engage people on this issue. “Most everyone is affected by this,” she says. “If not themselves, then they know someone who is in school, a stay-at home caregiver, or who is working at a low wage job and is not covered by insurance.”

“I graduate in May of 2016, and hopefully I’ll get a job and benefits and (being in the coverage gap) will all be over for me.” Michelle continues. “But that isn’t the case for all the others that have fallen in this gap.”

UPDATE: Michelle has graduated and is now searching for a full-time position in her field.

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This story is part of a series collected by The Success Equation. Under the umbrella of Children First/CIS, the Success Equation is an initiative that unites community to reduce and prevent the root causes of poverty so all children can thrive. Get involved! Learn about action steps, volunteer opportunities, and help share these messages by going to www.facebook.com/SuccessEquation. To find more, go to www.successequation.org.