Poor in West Virginia | The Charlotte Observer

City Of Welch County Seat Mcdowell W Va

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Below are selected excerpts of a great in-depth article by The Charlotte Observer takes a hard look at the promise of jobs, versus the loss of health insurance, and how it affects the people in McDowell County, West Virginia. Well worth the informative read...


Nurse practitioner Keisha Saunders, who grew up in the community, examines Clarence Workman at the Tug River health clinic in Northfork, West Virginia. Bonnie Jo Mount The Washington Post

They are poor and sick, and may have been saved by Obamacare. But Trump promised jobs

The high rates of chronic diseases in McDowell County, West Virginia, have made it the county with the shortest life expectancy in the nation. It’s also a place that voted overwhelmingly for President Donald Trump, whose promise to repeal the ACA will soon affect thousands of them.

Another morning, another list of patients and problems in the hands of 35-year-old Keisha Saunders. Diabetes, depression, heart disease. Robert needs lower blood pressure. Buffy needs prescriptions filled. Mary needs to lose 50 pounds, so she can get what she really needs, a new hip.

Again, the list extends to the bottom of Keisha’s notepad, as it has so many days since the Affordable Care Act mandated that everyone have health insurance. Unlike in Washington, where health care is a contentious policy debate, health care where Keisha is a nurse practitioner is a daily need to be filled. The high rates of chronic diseases in McDowell County have made it the county with the shortest life expectancy in the nation.


Heartburn is just the latest problem for Clyde, a patient Keisha sees every three months. Like so many in this corner of Appalachia, he used to have a highly paid job at a coal mine. Company insurance covered all of his medical needs. Then he lost the job and ended up here, holding a cane and suffering not only from heartburn but diabetes, arthritis, diverticulitis, high blood pressure and high cholesterol.

Because of the ACA, Clyde’s visit is covered by Medicaid. Before the law, most West Virginians without children or disabilities could not qualify for Medicaid, no matter how poor they were. The ACA - better known here as Obamacare - expanded the program to cover more people, such as Clyde, who can depend on Keisha to fix his heartburn without having to worry about the cost.


It was 2003 when Derrick started to feel pains in his back and groin, and Keisha, then a 22-year-old licensed practical nurse, started to understand what insurance could mean. Derrick was 24 - too old to be covered by his father’s insurance but unable to afford his own. He thought his only option was to go to an emergency room. His parents remember him returning home, having been told there was nothing wrong with him. When the pain didn’t go away, Derrick tried a different ER. Keisha would later learn that doctors thought her brother was seeking pain pills. Months passed.

All the while, a tumor inside his kidney was growing. A few months after the cancer was finally discovered, Derrick died at 25.

Keisha didn’t allow herself to wonder what might have happened if he’d had insurance. She focused on remembering their last days together, when the doctors said the cancer was too advanced to be stopped by treatment, so she treated him with chocolate instead. M&Ms by his bedside.


Now Trump is in the White House and Keisha is pressing her fingers into the stomach of 24-year-old Ruby Thompson. Nearly every patient Keisha sees has been impacted in some way by the ACA, and in Ruby’s case, the ACA’s Medicaid expansion is the reason she has insurance.

According to the list on Keisha’s notepad, Ruby is just here to refill a prescription, but Keisha checks her as if they are meeting for the first time. She tries to feel for anything abnormal around Ruby’s stomach, which is a little too thin, but Keisha knows cigarettes can cut into a person’s appetite.

“Are you still smoking?”

“Yeah,” Ruby answers, tugging at a gold necklace that spells MOM.

“Do you want to stop?”

“I will eventually, I guess.”

Ruby is another patient who voted for Trump because of his promise to bring back jobs. She hasn’t yet lost hope that she can become a secretary, but for the past two years she’s been working at KFC. She has health insurance only because she was fined on her taxes for not having it, at which point she found out that because of the ACA, she qualified for Medicaid.


And here is another version of uncertainty in the clinic, this time a patient’s. If she signs up for Medicaid, which covers low-income, pregnant women, she’ll be covered through her pregnancy. But after that? Her access to insurance will depend on what happens over the next months in Washington, where so many plans for the ACA’s replacement are floating around. One, unveiled in the House this month,would roll back the Medicaid expansion slowly, meaning Amanda could keep her public insurance after the baby is born. In a few years, however, someone like her might not be able to do the same, and instead might receive tax credits to help offset the cost of private insurance.

But that’s just one plan. There have been plans based on “block grants” and plans based on “per-capita caps.” Some plans give people tax credits based on their income. Some base the tax credits on their age; some on where a person lives. There’s the plan once proposed by Trump’s secretary of health and human services, which would get rid of the Medicaid expansion entirely. There’s the plan Vice President Mike Pence implemented when he was governor of Indiana, which penalizes anyone who doesn’t pay for Medicaid coverage, even if all they can afford is a dollar a month. There’s even a plan that proposes keeping the Medicaid expansion just as it is.


Read all the details in this well written article by visiting The Charlotte Observer.

Source: They are poor and sick, and may have been saved by Obamacare. But Trump promised jobs