For Rural, Uninsured Missourians, Medicaid Debate Brought Few Solutions

Oct 16, 2017

A few years ago, when the political debate was raging over whether to expand Missouri’s Medicaid program as part of Obamacare, we brought you the story of Anita Sutherland of south-central Missouri.  She was one of the estimated 300,000 Missourians who would have suddenly been covered if Missouri lawmakers had accepted those federal dollars to expand the government program.

We first met Anita and her husband, Keith, at the Good Samaritan Care Clinic in Mountain View, a 45-minute drive from their home in Van Buren.

Anita Sutherland, who passed away in 2017 at the age of 56, talked to KSMU multiple times about her struggles to pay for medical treatment.
Credit Jennifer Moore

Anita had delayed going to a doctor for months, despite severe bleeding that made her pass out during her job as a home health worker. When she eventually ended up in the hospital, she was diagnosed with advanced uterine cancer. Both Anita and Keith worked around 40 hours a week. Neither had health insurance.

Despite that their household income was only around $18,000 a year, they did not qualify for Medicaid coverage.

You may recall this portion of our interview with Anita and Keith from May of 2013 at the volunteer clinic where they received care for free.

“You feel like you’re at the point of no return, because it’s just hard…because you want to pay it, and you can’t. I don’t want charity—I’m not here for charity. That’s why I think a lot of people kill themselves—because there’s no hope,” Anita said in our first interview.

“It’s hard to make it. I mean, there’s times we can’t even eat dinner. Because the fact is, we don’t have the money—we’ve got to pay our bills, or they’ll shut ‘em off.  And right now, I’m having to work extra so she can go to the doctor so she can get well.  And it’s either eat, or let her go to the doctor—because this therapy is very important for her…I don’t get [health] care. I take care of it all myself. And I have teeth problems. I can’t afford to go to a dentist. So I just take my pocketknife out and pop my teeth out myself,” Keith said.

Anita’s story resonated across the state. In his 2014 State of the State address, Governor Jay Nixon used Anita as an example of struggling Missourians who would benefit from an expansion of Medicaid.

The last time we talked to her, Anita was depressed because she was having to choose between spending her money on food, electric bills, or therapy for lymphedema, swelling that came as a result of her cancer treatment.  Keith had taken to truck driving across the country to make more money.

Anita Sutherland passed away earlier this year. She had just turned 56. 

Jennifer Wilson works in the deli at a convenience store in Van Buren, Missouri. She and her husband both work hourly jobs that do not provide health benefits.
Credit Jennifer Moore / KSMU

Her daughter, Jennifer Wilson, said Anita had been having chest pain for a long time.

“And it was probably about eight, eight-thirty that morning. She said she got a sharp pain. Went straight across her chest and went straight up the left side of her head. And she said, I mean, it was intense. So she called her husband and was like, ‘Hey, I need to go to the hospital.’ Well, she drove the truck from there all the way over to the mill,” Wilson said.

The Carter County Coroner confirmed that Anita’s cause of death was cardiac tamponade. According to the NIH, that’s pressure on the heart from fluid or blood buildup. Without Anita’s full medical records, it’s hard to say whether her death could have been prevented. But like Anita’s cancer, this condition gets much more serious the more a person delays treatment.

Ryan Barker of the Missouri Foundation for Health says delaying treatment is often a way of life for many uninsured Missourians.

“Because they’re so worried about cost and not having insurance, they often put off the preventative care or even getting care for chronic conditions like high blood pressure or diabetes because they just aren’t sure they can afford it,” Barker said.

Some uninsured seek treatment at volunteer or charity clinics.  But in very rural places, like Van Buren, these clinics may be an hour’s drive away, or farther.

A new CDC study found that Americans living in rural areas are more likely to die from five leading causes than their urban counterparts.

Jennifer Wilson, of Van Buren, says her late mother, Anita Sutherland, was the hardest working person she ever knew.
Credit Jennifer Moore / KSMU

Two factors that put rural Americans at higher risk are less access to healthcare, and that they are less likely to have health insurance, according to that CDC report.

Jennifer Wilson, Anita’s daughter, appears to be following a similar path to that of her mother. She and her husband each earn about 250 dollars a week, but neither has health insurance. They don’t qualify for Medicaid, and the 65 dollar sliding scale fee at the clinic down the road is still too steep for them.

Wilson tells me she’s got a problem with her IUD, or intra-uterine device, and needs to see someone about it, but that will just have to wait.

Republican lawmakers who blocked Missouri from expanding Medicaid said they first wanted to reform the Medicaid program before pumping a bunch of federal dollars into it. So far, those major reforms have not happened, said Barker.

Other alternatives for health care for the rural, working poor are public-private partnerships or faith-based groups organizing more volunteer clinics; but in rural places across much of the Ozarks, those, too, still don’t exist.