Wisteria Davis was a student at Delaware Technical Community College when the coronavirus pandemic hit and upended lives across the country. By November, she and her girlfriend had decided to leave Newark, Delaware, to live in a larger city with more options for their education.
"We made the decision to move pretty quickly," Davis, 24, told Insider. "The pandemic itself really just turned everything on its head. Maybe it was the fact that everything had changed. So we were like, 'All right, I guess we should make a change too.'"
They moved in with her girlfriend's family in Orlando, Florida. But for Davis, who has a history with several health conditions, the move came with a catch she hadn't expected.
Soon after she arrived in her new home in the Sunshine State, she was devastated to learn she wouldn't be able to enroll in Medicaid as she had in Delaware.
Florida, like 11 other states, hasn't expanded Medicaid, a government health insurance program that pays for healthcare for people with little or no income in most states.
For some people, buying private insurance isn't an option because it's too pricey. And living uninsured can dampen the allure of a low-cost living that many seek in places like Florida and Texas.
As the COVID-19 pandemic continues, healthcare enrollment experts are encountering people laid off from their entertainment jobs in New York and California looking for a cheaper state to live in. They are then hit with the healthcare sticker shock in their new homes.
The medical costs from one injury or a hospital visit can quickly eat up people's savings, especially for those who have lost their jobs. Going uninsured is an even riskier bet for people with chronic health conditions or those struggling with the long-term effects of COVID-19.
In some cases, people regret the move enough that they pack up and return to where they came from, healthcare experts who help people sign up for health insurance told Insider.
A 'devastating' conversation to have
Healthcare navigators tasked with helping people enroll for health insurance in states like Florida, Texas, Georgia, and North Carolina have for years had to break the difficult news both to current and new residents.
"That's one scenario that I just ran into so often; people who came from New York or wherever it is and find out for the first time when they're sitting there with you that there's really not a whole lot of help here for you in the state, even if you're working," former navigator Scott Darius, who is now executive director of the advocacy group Florida Voices for Health, told Insider. "And that was a devastating conversation to have. It never got less devastating to have that talk."
But the problem is taking on a whole new dimension as certain red states without Medicaid expansion have become go-to destinations during the pandemic. People are relocating for a host of reasons. Some are moving to be closer to family or to live in cities and towns with larger and cheaper living spaces. Others want to send their children to in-person schools or pay lower taxes.
Stacey Thompson, a navigator program coordinator from the Houston-based nonprofit Change Happens told Insider the organization tried to help a client find health insurance coverage after she moved to Texas from Michigan during the pandemic. Ultimately, however, the client ended up returning to Michigan to re-enroll in Medicaid, Thompson said.
Melanie Hall, executive director of the nonprofit Family Healthcare Foundation in Florida, told Insider she has met people who have been laid off from their entertainment jobs and faced that dilemma when they moved to the Sunshine State from New York and California during the pandemic.
They are going on auditions and many aren't sure when they'll get their next paycheck, she added.
"They're looking for a less expensive place to live while they're waiting out this period of time," Hall said. "They're looking for the ability to have a very easy lifestyle and they just are not expecting when they get here to find out that they're not eligible for any kind of help with their medical coverage."
Data from the US Census Bureau shows that hundreds of thousands of people have moved during the coronavirus pandemic. Texas added an estimated 374,000 new residents during the first half of last year and Florida gained an estimated 241,256 residents from July 2019 to July 2020.
"There are so many things about coming to Florida that are very attractive for families and individuals. And we certainly understand that," Hall said, citing examples like low home prices and the lack of a state income tax.
"But when you move to a place and suddenly you don't have access to something as basic as health services, it's certainly in the back of your mind as to whether or not it really is going to provide the quality of life that you want," she added.
Some states have safety net coverage offered in certain counties. Other people can sign up for private plans offered under the health insurance marketplaces created through the Affordable Care Act, commonly known as Obamacare. But while these plans are heavily subsidized by the government, they're still more expensive than Medicaid.
'It was just total hopelessness'
Before the Affordable Care Act, Medicaid worked very differently from state to state. Generally, though, it paid for care for people with disabilities, pregnancies and childbirth, children, and nursing homes.
It still pays for those services and more under the ACA. In most states, people can sign up for Medicaid if they make less than $17,774 a year. People earning the minimum wage qualify, as do students with little income, people who've given up their jobs to become full-time caregivers, people who choose not to work, or people who have lost medical coverage after losing a job during the pandemic.
But the coverage isn't available in every state today because in 2010 several red states sued against the law. In response, a 2012 Supreme Court ruling made the decision to expand Medicaid optional in each state.
As a result of that decision, 12 states haven't expanded Medicaid. The Kaiser Family Foundation, which studies healthcare, estimates that this decision has resulted in 2.2 million people in the US falling into the same uninsured gap as Davis does.
When Davis moved to Florida she had wanted to leave Delaware for both educational opportunities and for her mental health. She had lived in Newark for most of her life where her childhood was punctuated by homelessness, abuse, and poverty. That trauma caused her to develop PTSD, she said, and continuing to live in her hometown triggered panic attacks.
Now that she's in Orlando, Davis has been studying to return to college and wants to become a veterinarian or go into horticulture. But the move has been tough on her health. Back in Delaware, Medicaid paid for Davis to have mental health treatment and gallbladder removal surgery when the symptoms from both conditions made her unable to work.
Now she has no health insurance in Florida and for a time ran out of a medication she takes to treat anxiety and depression. That led to a debilitating withdrawal.
"I didn't really know what to do," Davis said after learning she couldn't get Medicaid in Florida. "It was just total hopelessness on top of being neurodivergent and having these illnesses that I have. It was just a huge blow to everything."
She told Insider that she wants to get a job to support herself but without having enough medication — and the health insurance to pay for it — she cannot manage her mental health conditions.
"I can't get medicine without Medicaid because I don't have a job and I can't get a job without having medicine," she said. "So it's kind of like this cycle and I end up falling through these cracks."
The plan is to stay in Orlando for now, but once her girlfriend finishes school they may decide to move to a state that expanded Medicaid, Davis said.
Help coming in the COVID stimulus
Some people who fall through the cracks will be able to gain new health insurance options that are set to kick in temporarily as part of the coronavirus rescue package President Joe Biden signed into law on March 11.
One of those options would benefit people on unemployment insurance starting later this summer, though the Biden administration hasn't released a specific date for the program. Under the stimulus law, the federal government will pick up the full cost of premiums for people who sign up for a private insurance plan on the ACA marketplaces.
People will also have the opportunity to stay in the same healthcare plans they had from their employers through a program known as COBRA. Under the stimulus, the government will pick up the full cost of insurance premiums through September.
The main downside of some of those private plans, however, is that depending on how much people make they can come with high out-of-pocket costs when people go to an emergency room or doctor's office. In contrast, people on Medicaid pay little or no fees to get healthcare in most states.
Another provision in the stimulus encourages holdout states to expand Medicaid by giving them extra money for the program over the course of two years. Democrats in Congress hoped the funds would head off arguments from Republicans who've said states cannot afford the cost of expanding Medicaid.
Republicans in Alabama have said they're looking at the possibility and the Wyoming House voted in favor of expansion and the bill heads to the state Senate next.
It's not clear how many other states will follow. Florida Republicans, who run the state, say they won't be pursuing the expansion, but there's a push to put the question directly in front of voters in a ballot measure in the 2022 midterm elections.
Going the ballot route has become increasingly common as a way to bypass state lawmakers on Medicaid. Six other red states, including Maine and Nebraska, took that route.
Darius, the executive director of Florida Voices for Health that's among the advocacy groups pushing for the Medicaid expansion, said he is reminded of how many Floridians are living paycheck to paycheck every time there's a natural disaster, whether it be a hurricane or the pandemic.
"It's enough for us to keep pushing," Darius said. "And the fact is, there has just been so many more of those individuals over the last few months that there's no way we can stop at this point."
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