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From the Far Margins

Falling down stairs


You are falling down a set of stairs. You don't have health insurance so hoping that nothing is broken or dislocated takes on special meaning. Your boss cut your hours and your job ended up paying half of what you thought. Your dreams of getting insurance under the Affordable Care Act evaporated... again. And no, you are not one of those Obama-hating conservatives who, mid-air on the way to the concrete floor, blames the president for the potential emptying of every account in your name and the perpetual debt that will follow because what's in those accounts is not going to be enough for this.

No. You know the Idaho legislature is responsible because they refused to use federally funded Medicaid to offer a bit of help to those of you who get in financial predicaments—like anyone who did not make the $11,000 annual minimum for Obamacare. Really, you'd pay for insurance if you could, but it's absurd. By no stretch of the imagination can you stop paying rent or buying groceries every month to do that.

So yes, you hit the concrete and the universe comes to rest on your bank account, not on your shoulder, which seems oddly limp, or the throbbing in your arm. You're calculating this disaster and the person who comes to assist has no idea they've stepped into a crisis beyond broken bones or dislocated parts. You're deciding how fucked you are, how likely it is you'll lose your house. You're estimating the likelihood of your homelessness and never seeing your cat again.

Imagine getting cancer. I mean, there'd be the diagnosis and then the calculations of how much worse slow death would be than the loss of everything you own and the pain of treatment simultaneous with knowing what you've spent a lifetime building would be de-materializing before you. Warm bed; kitchen where you can cook; place where maybe your children took their fist steps, spoke their first words; the place you come to when all you want is to sit in silence, to remind yourself you're there inside that shell of a person who works long hours with little show for it but a warm fuzzy feeling of having done something that matters to someone besides yourself.

Beyond that there's being uninsured when you have children. Your kids have CHIP so they're on Medicaid, and when you're watching slow-motion as the deer sails into the headlights and the breaks squeal—because you imagine the whole creature being sucked into your cab in a way that decapitates all of you—and going off the road in a skid seems better, or even rolling. And you do roll, several times, and the kids fly and you come-to in a field with ambulance personnel in some sort of polyester uniforms telling you to stay still. But all you want to know is are the kids OK. And they are, sort of. They're in the ambulance but you, the polyester-clad ones say, you have a broken neck, a c-spine injury. But still, you say, "NO. Don't touch me. Leave me here. Take the kids. I'll get by. Really." And clearly they think you're insane. You explain: "No insurance."

They back up a bit. "We have forms for that," the female paramedic says. But you're not someone who believes the County Indigent Fund is a free ride. You know better. The whole of your financial existence will be encumbered. The house passed down to you from your great-grandparents will be collateral for something you'll never make enough in your lifetime to pay off.

"Leave me here. Take the kids. I'll get by."

"Ma'am, we can't."

Then you're screaming at them because now you're calculating what it's like to be homeless with small children.

But, for many, it's far simpler. It's that daily choice between medication and food; between doing what you know you should for your health and eating. Those are hard choices. Sometimes it's about psychotropic medications without which you don't make great decisions anyway. Skip those for a month and it doesn't much matter. Sure, if you had health coverage, your practitioner would be aware you're off your meds.

Too many tragedies come down to the cost of medication and health.

So the concrete is there. You flew through the air and you don't care what's broken. "I'm fine," you say, "Just fine." And you have to be. You've contemplated getting the words tattooed: "Leave me alone. If I am broken or unconscious, leave me here. Trust me. It's better."

You're too young to be one of those waiting for that 65th birthday, which means you get Medicare. You wonder if the waiting ones have let this or that go too long and, when the birthday comes and they finally do get to go to a doctor, it will be, "I'm sorry, there's nothing we can do."

A few months ago, Sen. Dan Schmidt turned down the free health coverage lawmakers get just for being lawmakers. I used to serve with Dan in the Senate. A good, humble man. He's waiting until the rest of us have the liberty to break a bone without breaking our whole lives.

Sen. Schmidt, thank you. The symbolism means something to about 78,000 of us in Idaho and 33 million nationwide, where Republican legislatures have thrown us out of hospitals and clinics to make a stupid point about party politics, which, in the end, when you're flying through the air toward concrete, you simply don't care about.