In the Medicaid Gap: 2 Burley Friends Struggle Without Insurance

April 20--BURLEY -- Layne Andrews first felt the pain in his left foot four years ago as he made the long walk from Wal-Mart to his home.

"When I got back, I laid down and the pain was just really intense," he said, as he waited to see a doctor Tuesday in Twin Falls.

Andrews, 25, hasn't had health insurance since the pain developed. It got to the point where, after two or three hours, Andrews would have to either hop around or stop moving. The gout in his foot developed into tophi, deposits of uric acid crystals that damage bones and cartilage when gout is untreated.

Andrews applied for Social Security but was rejected because he was told he didn't qualify; he could still work a sit-down job. He tried that, working at McCain Foods in Burley for about 2 1/2 months, and had to quit because the pain in his foot was so intense he couldn't concentrate.

Still, Andrews said, he's in good health compared with his close friend Krista Smith, who came with him Tuesday and who is in the same boat when it comes to health insurance. She was born with myelomeningocele spina bifida, the most severe form of the birth defect, and has other medical problems including a shunt in her head and a kidney infection that goes untreated because she can't get medicine.

The last time she was in severe pain and had to be hospitalized, Andrews had to convince her to go get checked out. Because she has no income and owes more than $100,000 in hospital bills, she said, Cassia Regional Medical Center won't see her anymore. So Andrews took her to St. Luke's Magic Valley Medical Center in Twin Falls. Doctors found she had, as well as the untreated kidney infection, an ulcer from a colostomy tube that was put in six years ago. They removed the tube and the ulcer will heal, but Smith is stuck trying to find natural ways to keep her bowels unobstructed, since she can't afford medicine.

"I'm tired of going to the hospital and not getting taken care of and just getting more debt," she said.

Andrews and Smith are two of the estimated 78,000 Idahoans who fall into the "Medicaid gap" -- they don't qualify for Medicaid, but without any incomes, they can't buy insurance on the state exchange either.

"That's why Idaho has to expand Medicaid," said Layne's mother, Cathleen Andrews.

The possibility of expanding Medicaid has been before the Legislature for the past few years, but it hasn't gone anywhere. This year's session started with a proposal from Gov. C.L. "Butch" Otter to use state money to extend primary care coverage to the uninsured, and a Medicaid expansion bill got a first-ever committee hearing. The session ended with the House killing a proposal to authorize the state Department of Health and Welfare to apply for a federal waiver to implement a state-designed Medicaid expansion plan, although Speaker Scott Bedke, a Republican from Oakley, has said he intends to appoint a work group of legislators to study the issue during the interim.

Idaho Democrats typically favor expansion and Republicans are split, with some favoring some sort of hybrid state-designed expansion plan and others who oppose creating a new government program for fear the federal government wouldn't continue to cover most of the cost of expansion as it has promised.

It took a couple of years for Andrews' gout to get diagnosed correctly, and longer than that to get the surgery to remove the tophi. One doctor, he said, told him not to walk on the foot if he wanted it to stay usable.

At first, Andrews said, he had been working with the hospital's assistance program to pay for his care, but his surgery cost too much for that. His first scheduled surgery had to be canceled because he had no way to pay. In February, Cassia County Social Services approved his application for assistance, and he is required to repay at the rate of $50 a month.

Andrews got surgery earlier this month, but only time will tell if any permanent damage was done from going untreated for so long. He wants to go to college and become a dental hygienist, but he worries about taking on more debt now.

Andrews is a strong supporter of Democratic presidential candidate Bernie Sanders, who has made a "single-payer" national health care plan a major part of his platform. Last week, he emailed the superdelegates to the Democratic National Convention to tell his story and urge them to support the Vermont senator.

"He's not for everyone who's already well-to-do," Smith said.

Smith already needs to use a wheelchair to cover longer distances, and because her spine is twisting in two different directions, she expects to be completely wheelchair-bound within the next few years. It is possible that surgery could delay this, but without coverage that's not a possibility.

Smith has avoided applying for county indigent assistance, fearing taking on more debt she'll never be able to repay.

"I can't even afford to make small payments right now," she said. "Not even $50 a month."

County Indigent Fund Cases and Costs

COUNTY FY '14, cases FY '14, spending FY '15, cases FY '15, spending FY '16, cases (YTD) FY '16, spending (YTD)

Blaine 24 $208,738.63 24 $221,636.93 12 $75,298.83

Camas 3 $18,568.68 1 $11,600 0 0

Gooding 41 $291.462.20 62 $337,819.74 19 $85,071.81

Lincoln 11 $167,398 42 $87,719 N/A $25,885

Minidoka 55 $258,778.33 63 $316,213.06 21 $136,076.70

Twin Falls 405 $4,166,370.97 369 $3,332,710.15 204 $1,553,673.38

Note: Jerome County did not answer a public records request by press time. Cassia County did, but the numbers were organized differently than the other counties.

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