FALLING INTO THE GAP
Charlene Dill died because of Florida's obstinate refusal to expand Medicaid
Charlene Dill didn't have to die.
On March 21, Dill was supposed to bring her three children over to the Central Florida home of her best friend, Kathleen Voss Woolrich. The two had cultivated a close friendship since 2008; they shared all the resources that they had, from debit-card PINs to transportation to baby-sitting and house keys. They helped one another out, forming a safety net where there wasn't one already. They "hustled," as Woolrich describes it, picking up short-term work, going out to any event they could get free tickets to, living the high life on the low-down, cleaning houses for friends for money to purchase tampons and shampoo. They were the working poor, and they existed in the shadows of the economic recovery.
So on March 21, when Dill never showed up with her three kids (who often came over to play with Woolrich's 9-year-old daughter, Zahra), Woolrich was surprised she didn't even get a phone call. She shot her a text message — something along the lines of "Thanks for ditching me, LOL" — not knowing what had actually happened. Dill, who was estranged from her husband and raising three children, aged 3, 7 and 9, by herself, had picked up yet another odd job. She was selling vacuums on commission. And on that day, she made two last-minute appointments. At one of those appointments, she collapsed and died on a stranger's floor.
Dill's death was not unpredictable, nor was it unpreventable. She had a documented heart condition for which she took medication. But she also happened to be one of the people who fall within the gap created by the 2012 U.S. Supreme Court ruling that allowed states to opt out of Medicaid expansion, which was a key part of the Affordable Care Act's intention to make health care available to everyone. In the ensuing two years, 23 states have refused to expand Medicaid, including Florida, which rejected $51 billion from the federal government over a decade to overhaul its Medicaid program to include people like Dill and Woolrich — people who work, but don't make enough money to qualify for the ACA's subsidies. They, like many, are victims of a political war — one that puts the lives and health of up to 17,000 U.S. residents and 2,000 Floridians in jeopardy annually, all in the name of rebelling against President Barack Obama's health care plan.
Woolrich has spent much of 2014 canvassing for the Service Employees International Union and for Planned Parenthood in an effort to educate people about Medicaid expansion and to enroll residents of poor neighborhoods into the ACA's exchanges. She's seen women with tumors yet to be treated, chronic conditions affecting people living in the gap, and sometimes she had to be the bearer of bad news. March 21 was her day off. She was looking forward to getting away from the politics.
"I was off. Spring break was going to start for me and her kids," she says.
Woolrich was aware Dill was trying to get refills on her medication, but not aware that she'd become ill. Dill had been bumped off Medicaid because she was making too much money — nearly $10,000 a year — and had yet to be able to afford a divorce, which might have bettered her chances. A message to Woolrich from a distant relative confirmed that Dill would not be showing up that Friday because she had passed away, but even that might not have happened if Dill's cell phone hadn't lit up while she lay prostrate on that floor. The people to whom Dill was peddling vacuums noticed the phone and called her relatives, says Woolrich, telling them, "There's a girl lying on our floor. We don't know who she is."
These are the people in the coverage gap — the unknowns, the single mothers, the not-quite-retired — the unnamed 750,000 Floridians who are suffering while legislators in Tallahassee refuse to address the issue in this year's legislative session, which ends on May 2. The working poor — who used to be the middle class — are on a crash course with disaster for no logical reason.
Charlene Dill, at the age of 32, didn't have to die.