Stuck in the middle 

Shawn Spears and her son.
Photo by Mark Hancock

Between the Oklahoma County Election Board and Oklahoma Health Care Authority buildings, Shawn Spears, 24, works as a clerk at Langston University.

She also studies psychology full time at Rose State College and plans to finish her bachelor’s at Langston. The student has a 5-year-old son and is pregnant with her second child — due in November.

“I’ll go however long it takes,” said Spears. “And I’m making my kids graduate. I don’t care what they say. If I can do it, you can do it.”

Since her clerk position is part-time, she doesn’t have employer-sponsored insurance. While Spears is pregnant and up to two months after her child is born, she’s eligible for SoonerCare, Oklahoma’s Medicaid program. After that, she is unsure how she’ll receive health coverage.

Like Spears, Myeshia Jackson, 22, is the mother of a 14-month-old daughter. She studies full-time at Oklahoma City’s Heritage College to become a medical technician. When she was pregnant, she used SoonerCare, but since then, she has been unable to afford medical insurance.

“I had an infection right after my daughter was born, after the insurance (SoonerCare) was cut off, and I had to go to the ER, but I couldn’t pay the bill,” said Jackson. “I’m really concerned about health care, and I know I do need it.”

Similar to many college students, Jackson has had jobs through a temp agency — all of which haven’t offered health insurance. She’s currently unemployed and seeking a job. While the Affordable Care Act allows children to stay on their parents’ insurance until age 26, Jackson said she couldn’t join her parents’ plan because it will cost them more money.

Along with not qualifying for SoonerCare after their pregnancies, both women’s incomes are too low for them to receive subsidies to help offset costs in the federally run health insurance marketplace (also called Obamacare), which opened for enrollment this month.

Mothers across Oklahoma struggle to obtain care. The state is ranked low in the U.S. for women’s health in a number of factors, including less access to gynecologists and high infant and maternal mortality rates.

Healthy mom, healthy child
While children, unlike many parents, are eligible for Medicaid programs, they can be negatively affected by the health and medical bill strains of an uninsured parent, show studies by the Kaiser Commission on Medicaid and the Uninsured.

“They (parents) are the main source of emotional, physical and financial support,” said Melissa Thomas, case manager at Central Oklahoma Healthy Start. “We have such young mothers still trying to go to school and get their lives on track, but it can be a chore to assess what is important. If the kids need shoes, and if I get sick, what do I do?” Spears and Jackson receive assistance from Healthy Start, which helps mothers and children find health and social services access. While Thomas said she has seen improvements in women’s health coverage since she began working for the program 15 years ago, she still believes there is a need for more.

“We do have a high rate of reoccurring pregnancies,” said Thomas. “It is unfortunate that after that postpartum period, they get that six-week check-up and then they’re discharged from care and can’t afford birth control, and subsequently, they’re pregnant again.”

SoonerPlan provides family planning services, including birth control and wellness exams, to women and men not enrolled in SoonerCare. But Oklahoma’s Department of Human Services requires a parent “absent from the home” to pay child support before parents are eligible for the SoonerPlan. Relationships with fathers aren’t easy to define, Thomas said.

Spears is still in a relationship with her children’s father, but they don’t live together, and she didn’t want to file for child support. This made her ineligible for SoonerPlan after her first pregnancy.

Thomas notes while there are low-cost community health clinics that provide care to thousands of Oklahomans, “If she’s already in a financial hardship, it’s not that easy to say, ‘I’m going to go pay for birth control and get a pap smear.’”

State health care
Since Oklahoma did not expand its Medicaid program, along with half of U.S. states, most adults making below 100 percent of the federal poverty level ($23,550 for a family of four) are ineligible for insurance marketplace subsidies or Medicaid.

Oklahoma offers another plan for low-income families — Insure Oklahoma — but the enrollment cap (35,000) doesn’t meet the more than estimated 150,000 uninsured Oklahomans who will not qualify for low-cost care from other programs. State officials disagree on the best solution going forward.

“The unfortunate reality, whether you love or hate the law (the Affordable Care Act), there is a lot of bad information on both sides, and so really it has been difficult to have a level-headed policy conversation about health care access,” said Carter Kimble, Oklahoma Health Care Authority spokesman.

While politicians and health analysts debate this issue, Oklahoma women like Spears and Jackson continue to struggle with basic health needs.

Look for additional Oklahoma health care coverage in the coming weeks, including what state leaders say about the SoonerCare (Medicaid) program’s future, understanding who is ineligible for low-cost health insurance and how the Affordable Care Act affects employers.

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Angela Chambers

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