For poor Americans, the ER is too often the source of our medical care — and debt


Americans in the Medicaid gap are risking their lives because they can't afford health care. President Joe Biden's agenda may help address that problem.

The last time I had health insurance was when I was 18 and on my parents' health care plan. Two years later, I discovered what it means to live without medical insurance, when I had an emergency surgery to remove an appendix on the brink of rupturing.

I was unable to pay for the appendectomy. The hospital provided me with indigent care through the Indigent Care Trust Fund, a program for uninsured and low-income Georgians, but it did not cover everything. I owed the hospital thousands of dollars after my release.

That was 23 years ago, but the financial fallout from that medical debt follows me to this day. I made small payments when I could, but that wasn’t enough for my creditors. They started adding interest every month, and my medical debt snowballed. Barely into adulthood, my credit was already ruined.

I'm one of nearly 300,000 Georgians who falls into the Medicaid gap. I don't earn enough to qualify for Affordable Care Act subsidies, and since our state has refused to expand Medicaid, I can't access that program either. I'm also my husband's full-time caregiver and his disabilities preclude my working. Without a job, I can't qualify for Medicaid or many other kinds of assistance in Georgia.

I've sought out countless patient advocates and government employees who all confirm there's nothing they can do to help me unless the state changes its policy and extends Medicaid coverage.

Existing in this Medicaid gap means the only thing I can do is pray I don't get sick enough to need a doctor. I've ignored my health problems for years, and it almost killed me. Over the years, I've avoided the doctor's office as much as possible. If I had to see a doctor, I would go to the ER. Indigent care used to pay some of my medical bills, but they've stopped covering ER visits.

One time, I went to the ER with a horrible case of bronchitis. I saw the doctor, and he wrote me a prescription. But when I couldn't pay anything before I left the ER, they refused to give me the prescription. I cried my eyes out that day and left with nothing. To be honest, the prescription probably would have been too expensive to fill anyway.

I stayed away from doctors after that — until I couldn't any longer. In 2019, I had irregular bleeding but couldn't afford to see a gynecologist. A year later, I started having breathing issues. I couldn't even walk from one side of the house to the other without struggling to breathe.

I found a local clinic that offered a discount to people like me. I struggled to even come up with $25 for the visit. After doing blood work, they immediately sent me to the hospital. I was severely anemic. The doctor couldn't believe how low my blood count was. She said if I hadn't come in, my organs would have started to fail and I could have died.

I had two blood transfusions, but left before they could finish treating me because I needed to take care of my husband. My primary care doctor put me on birth control. Thankfully, that fixed the issue, and I am no longer anemic. However, I have no idea what caused the problem or if it will recur. Once again, I owed thousands of dollars, thanks to a brief ER visit that saved my life.

My medical debts have all been turned over to collections now. I had fixed my credit at one point, but now it's shot again because I can’t afford the ER bills. I get letters each week asking me to pay up, but I can’t.

Since my governor, Brian Kemp, has rejected the life-saving solution of expanding Medicaid in Georgia, my last hope comes from President Joe Biden's economic agenda. That agenda would make ACA plans available to Americans like me who fall into this gap, at no out-of-pocket cost.

I know I am not the only one going through this. There are more than 2 million Americans in the Medicaid gap, including some 275,000 in my state of Georgia alone. And while many states refuse to fully expand Medicaid, Americans risk their health, and even their lives, because they can't afford health care.

Extending health care coverage to people like me would save taxpayers thousands of dollars. More importantly, it would save lives. And it would allow people like me to prioritize their health and safeguard their financial well-being when a medical emergency becomes dire.

Belinda Sherley lives in Quitman, Georgia, with her husband.