Shantay Lowell’s kitchen is organized like most working parents, with Oreo cereal in the cupboard and sippy cups on the counter, but one drawer stands out.
“Most people in their top drawer have silverware. I have medical supplies,” said Lowell as she slid open a drawer filled with supplies used to treat her Type 1 diabetes.
The 30-year-old single mother of two young boys also suffers from lupus and rheumatoid arthritis. Her 3-year-old son, Cooper, has achondroplasia, a bone growth disorder that results in dwarfism. She’s meticulous about organizing her meds.
Lowell never expected her family to face these medical challenges. And she never imagined she’d end up as a living example of what it’s like to be on her own with no health insurance.
“I don't qualify for any of the Obamacare plans, plus I don't qualify for Medicaid,” she said.
Lowell had just dropped her sons at daycare and was at her Farmington home getting ready for work earlier this month. As she described her decision to tell her story in support of Proposition 3, which would expand Medicaid to more low-income Utahns, she swung open her refrigerator door, where below the ketchup and mayo she kept her stash of insulin in two rows of boxes.
“I have a neighbor who actually just brought these over last week,” she said. “She knew I was kind of in this situation and she just said, ‘Hey, I’ve got some extra insulin, here ya go.’”
That situation is Lowell’s recent divorce, which resulted in her being dropped from her insurance. While her two sons are still covered by her ex-husband’s insurance and supplemental Medicaid coverage, she was placed into what’s known as the Primary Care Network.
It’s bare bones, she said, with no access to specialists and only four of her monthly prescriptions covered. She’s had to start rationing insulin to make ends meet.
Between a modest alimony, child support and a part-time job, she brings in just over $18,000 a year — at least on paper, the actual number is much less, she said.
Prop 3 would expand Medicaid for those earning up to 138 percent of the federal poverty level — about $20,000 for a family of three like Lowell’s or $25,000 for a family of four.
Idaho and Nebraska are also voting on Medicaid, joining a growing number of red states that had initially resisted expansion of the program through the Affordable Care Act.
“I think the biggest misconception is that the Medicaid expansion is only going to affect those who essentially aren't working, but that’s not the case” she said. “It's actually going to expand Medicaid in the direction that will help more people who are hardworking individuals that are just trying to survive.”
Strong support, but at what cost?
With medical marijuana drawing much of the attention this cycle, Prop 3 has mostly flown under the radar with little organized opposition. The last poll over the summer showed more than 60 percent in favor.
To cover the state’s share of the expansion, Utahns will be asked to raise the sales tax from 4.7 percent to 4.85 percent — and that worries Sandy Republican Robert Spendlove.
“While I think their goals are in the right place, I think it’s going too far and I think it’s too expensive, when what we’ve already done in the Legislature has fully covered the gap,” he said.
Spendlove, a member of the Utah House, crafted the bill that expanded Medicaid up to 100 percent of the federal poverty level during the last Legislative session. He argues that most people earning above that threshold already qualify for subsidies through the Affordable Care Act.
But Courtney Bullard of the Utah Health Policy Project said it’s not that straightforward, as Shantay Lowell’s story demonstrates. Bullard works with Utah Decides, the group behind Prop 3.
“In Utah, you can’t just be poor to get Medicaid,” she said. “You have to be poor and pregnant, you have to be poor and disabled, you have to be poor and meet these other stipulations that make it difficult to get into the Medicaid program. We’re making it simpler.”
Rep. Spendlove said that may come at a steep price.
“Unless we have a way to mitigate costs and control risks — and if the program grows higher than we anticipate — where do we find the money?” he said.
Bullard said they specifically calculated the tax increase in the initiative to cover more than the projected cost of expansion.
“We do know that the cost of care is increasing and we tried to compensate for that,” she said. “So in our sales tax, which is going to pay for 10 percent of the expansion — the federal government will pay for the other 90 percent — we overshot.”
Bullard said the state’s proposal also faces a legal obstacle due to a work requirement that is currently under federal review. The work requirement waiver has slowed down efforts in Kentucky and other red states that pursued partial expansions.
Prop 3, they estimate, would cover an additional 150,000 people.
“I'm no good to my two kids when I'm dead”
For Farmington mother Shantay Lowell, it can’t come soon enough. She said the stress of not having adequate health coverage has only made things worse.
“Stress has caused a major health imposition for me because it causes all of my disorders to flare up and my health just kind of spirals out of control,” she said.
Lowell, a Republican and Mormon, said she was raised believing in the notion of self-sufficiency and has had to talk with family and friends to combat stigma around social programs like Medicaid.
“Unfortunately, I never thought I would find myself in a situation where I needed state assistance and help to maintain my health right now,” she said. “I'm no good to my two kids when I'm dead and without having adequate health care. I won't last very long.”
Lowell says she’s not looking for a handout but a way to bridge the gap until her kids are old enough to attend school and she can work full-time again.