Imagine awakening each morning gasping for breath. We’ve all felt momentarily that sense that we can’t quite get enough air into our lungs: maybe we’ve sprinted up a flight of stairs, or walked into a smoky room. You can probably even remember having some inkling of this feeling for hours or days, in the throes of a bad cold. But suppose you felt this way every day of your life; suppose that the simple task of swinging your feet onto the floor and standing up left you struggling for air. That’s what it is like to have chronic obstructive pulmonary disease (“COPD”).
Lots of things can lead to COPD, including a life of hard work in an environment that’s hard on the lungs – maybe a constantly dusty woodworking shop, maybe a barn full of hay and wood shavings. Once you have it, COPD limits the hard work you can do, because when your breathing is impaired, just walking across the room becomes a project. Fortunately, modern health care technology can provide relief, in several ways. There are drugs to help keep airways open. When COPD progresses beyond what these drugs can do, there’s supplemental oxygen, thanks to equipment that can provide a portable supply of compressed oxygen to mix with the air you breathe, making it rich enough to supply what your blood and body need, even though the airways aren’t what they used to be. Oxygen can make all the difference – if you can afford it. If you can’t, you gasp, or you become lethargic, or both.
I met Kathy, who has COPD, last fall, when she spoke at an event to announce a petition drive for access to health care for more Maine people. If you’ve read about that referendum, you may remember her story. She works full time, but she doesn’t make enough to afford both the medicines she needs and $100 per month for oxygen. So, she does without. She gasps for breath; she slows down. She told me that her doctor says this compromise of going without adequate oxygen will cause more health problems for her, but she has no choice. The money just doesn’t stretch that far. I have a friend who is a gifted primary care physician. I asked him what he thought about asking a person with oxygen-dependent COPD to go without that oxygen. He called it “a crime.”
Maine’s Governor and his administration like to refer to people like Kathy as “able-bodied”, suggesting that if you are not classified as “disabled” it would be extravagant to help you cover your health care costs. Under present Maine law, because Kathy is an adult without children to take care of, she doesn’t qualify for MaineCare even if her income is below the federal definition for poverty, $12,060/year or $232/week. If Maine accepts the funds available under Obamacare (or the Republican replacement for it), people like Kathy would qualify for health care coverage. That’s why she, like the over 65,000 people who signed petitions to put the question on the ballot, supports accepting those funds.
Last week in Augusta, the Legislature held a work session on the Governor’s proposed budget for MaineCare, in which he not only continues to reject the funds available under Obamacare but goes further, to take health care coverage away from even more workers with low incomes, this time, even those with children to care for. The Governor wants to make parents who aren’t disabled (or aged) ineligible for MaineCare if they make more than 40% of the federal poverty level – more than $715 per month. In short, the Governor would add parents making far less than the federal definition of poverty, and young people aged 19 and 20, to the list of those in Kathy’s situation. How will it affect their children if a parent can’t breathe, or can’t avoid the debilitating effects of untreated diabetes, or get whatever other care their health circumstances may require? What about young people with health challenges that may impede their entry into the adult workforce?
The air we breathe is, we like to think, free. For the moment, let’s go with that; we can talk another time about what it costs to keep the air from being so polluted that all of us would be gasping for breath. Let’s recognize with gratitude that most of us get up in the morning and draw a breath and it doesn’t cost us a thing. Having oxygen to mix with your air so that you can function with COPD is quite a different matter. Oxygen, or an oxygen generator, is expensive. This isn’t surprising, because it takes energy, labor, and capital to condense oxygen into a purer form and safely provide for it to be metered out in the appropriate dose to make someone with impaired breathing comfortable again. Is $100 per month too much to pay for that relief, for that continued capacity to work and play? Not if you have it. But if the money you make is gone after paying rent and buying food, you have to gasp, or sit still, or both.
Does it, as the Governor and his Department of Health and Human Services tell us, inflict on Kathy a “culture of dependency” to pay what it costs for her to breathe like the rest of us? Or does it, instead, amount to helping a neighbor to keep working, keep playing, keep living the healthiest and most productive life she can, by covering health care costs that her modest wages can’t support? Kathy is like the neighbor you surely know, who has health challenges yet works as hard as she can for modest wages. She can’t afford health insurance, and giving her that key to the best health she can have won’t make her “dependent.” It will free her to work as hard as she can for as long as she can.
If Maine accepted the federal funds that are still available through Obamacare (and may continue to be if Congress listens to those who are pressing them to fix the Affordable Care Act instead of destroying it), then folks like Kathy could receive health insurance, paid for mainly with those federal funds. If Maine rejects the Governor’s further cuts to MaineCare for parents and young people, the most well-to-do among us will have to forego some tax cuts, but we will also forego the reduced economic activity that will result when, first, there are fewer health care jobs because fewer people have coverage and, second, people with health problems have to reduce or give up working as their conditions worsen. Would it really be a bad idea for Kathy to have MaineCare? Is it a bad idea to keep providing MaineCare to parents and young people living in poverty? I don’t find these questions hard to answer.