Copays Hinder Kentucky Families & Local Economies from Thriving

Floyd County, Kentucky has a population of about 36,500 people, with the density being concentrated in the county seat, Prestonsburg. It’s a wet county with retail and restaurant alcohol sales (not always a given in eastern Kentucky counties). Floyd County is home to a community college with a planetarium, a state park and nature preserve with a lake and marina, a renowned outdoor amphitheater that brings in New York and Los Angeles talent every summer to staff their musicals, a 700-acre golf course on top of a reclaimed strip job, and a state of the art acoustics music hall, the Mountain Arts Center, that attracts talent like Chris Stapleton and Jason Isbell. 

“I was working in the mines and I had enough money that I got insurance through my company and we was paying hundreds of dollars a month for copays.”

Brandon, his wife Odessa, and their son Granger are a young family living in Floyd County. When they were newlyweds, Brandon, like the majority of Floyd Countians, worked in the coal mines. Part of his income package was health benefits for his family, which came with the standard issue – copays. In an interview, Brandon talked about the family copays through his employer insurance. “I was working in the mines and I had enough money that I got insurance through my company and we was paying hundreds of dollars a month for copays.” The price of their copays were so high that they offset the benefit of the employer contribution to his monthly premium, and cut into the family’s living expenses and savings. 

Eventually, Brandon left coal mining for a new position as a mechanic/supervisor/HR manager at a local power company. His new position offered health benefits, but his salary was such that his wife and son were still eligible for Medicaid coverage. “I take care of all the paperwork, the hiring, the firing. I go out on call, I’m on call 24/7. I currently have insurance through them, but I do have to pay a copay every time I go to the doctor,” he said. When Brandon found himself with a severe toothache and jaw pain, the out of pocket copays prevented him from seeking treatment, and he self-medicated with over-the-counter Orajel and ice for months. 

Odessa, on the other hand, was able to receive necessary, specialized OBGYN care around the same time, thanks to Medicaid. “People need to realize that Medicare and Medicaid is what we need because the copays, it keeps me from going to the doctor quite often. I don’t want that copay, but I have to have insurance. I do mechanic work. I take care of a lot of stuff and it’s dangerous stuff. I think everybody should be able to have Medicaid … to be able to afford other things that they need in their life.”

The difference in the copays required by his employer-sponsored insurance versus Odessa and Granger staying on Medicaid made a noticeable difference in their family’s quality of life. “If it wasn’t for [Medicaid], I don’t know what we’d do because my wife and my kid, they wouldn’t be able to go to the doctor and get their medicine that they need without these big copays.  It’s added a lot of stress to me because if I get sick, I’m going to have to pay out to go to the doctor. But then if my wife or my son gets sick, then I won’t have to pay for their copays for them to see the doctor for their medicine.”

With the impressive amenities available in such a small area, Floyd County should have an expanding tax base and surging economy. Poverty ought to be rare, and manageable where it exists. There should be culture, outside influence, and local traditions all working together to grow a community where everybody thrives, and yet, 31.7% of county residents live at or below the poverty line, and even more — 37.1% — receive income-based sponsored Medicaid coverage. But, starting a business is daunting.  With a declining population and low wages, putting your savings and emotional energy on the front line, no matter how good the idea, is an intimidating, if not impossible, endeavor. ‘Brain drain’ in the area is real — young people leave a rural area for college or jobs after high school and never return to live, never contributing to the local tax structure.

“If we guarantee Medicare or Medicaid for everybody, we would have a lot more people out here opening a business up and they would help the economy.”

In his experience, Brandon thinks the fear of large copays factors into this. “If we could guarantee everybody more guaranteed healthcare coverage, that we can have more of these younger generations … opening their own businesses … they can go out and work and not have to worry about having that simple, simple item in their life. That’s going to help them so much… If we guarantee Medicare or Medicaid for everybody, we would have a lot more people out here opening a business up and they would help the economy. I mean these local towns, they are so little right now because we don’t have enough people out here working, opening their own businesses up just because we don’t have Medicare and Medicaid because they’re worried that they’re going to have to pay the big copays, and they ain’t going to be able to support their family because they’re going to have that extra money coming out.”

“People could use their copay money to buy groceries, pay their bills, gas… if everyone could get Medicaid, it would solve that problem.”

Since his interview, Brandon’s employment has changed and he finds himself enrolled in Medicaid with his wife and son. He’s had his toothache looked at by a dentist, discovering that it needs to come out via surgery, which he is happy to have scheduled. He’s also caught up on ‘regular’ doctor’s visits that he’d been avoiding. Odessa and Granger continue to receive their regular healthcare, and the lack of copayments for the whole family is a great financial relief. “There’s a lot of people out here that have to pay a copay and they don’t want to have to spend that extra money for their medicine or go to these doctors just because they need that money for other expenses in their life. I mean, people could use the … copay money to buy groceries, pay their bills, gas, whatever they need…if everybody could get Medicaid, it would, that would solve that problem. Plus it would help everybody that needs their medication that can’t afford it.” 

Recently, SB55 successfully passed Kentucky legislation and was signed into act by the governor. The bill “prohibits the cabinet or a managed care organization contracted to provide services from instituting copayments, cost sharing, or similar charges to be paid by any medical assistance recipients, their spouses, or parents, for any assistance provided.” Legislation like this is incredibly helpful to families like Brandon’s, keeping medical costs from being fiscally prohibitive, further ensuring that people will continue to take care of their health.

Brandon’s attitude towards everyone — not just his own family — is generous. He sees and has experienced first hand the positive economic impact that affordable healthcare can have on families, small businesses, and communities. His hope for future legislation is that everyone can have the same comfort his family currently has, living without the fear of an overwhelming medical emergency crashing in, and devastating them financially. “Everybody needs the free coverage. That’s one thing that they have to have, just to be able to cover their medical bills that [and the] medicine that they need. I mean, it should be a hundred percent free, Medicare, Medicaid, health insurance …  [It] would be a hundred percent guaranteed free if, and in my book, that’s what I would give.” 

Everyone needs and deserves healthcare — affordable, accessible healthcare, and since we all do better when we all do better, our local economies will also reap the benefits of manageable coverage for all.

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