Welcome to Where It Hurts, a weeklong series that tells the stories of people in the United States who have gone without health insurance when they needed it most. You can read more from the series here.
Going without has always been the story of health care in the United States. Even with the gains made under the Affordable Care Act, a greater percentage of Americans are uninsured than citizens in most other similarly wealthy countries. We pay more and receive less in return. Things could still get worse.
Recent estimates from the Congressional Budget Office predict that by 2018, the Republicans’ proposed American Health Care Act would increase the number of uninsured people by 14 million. That number will grow to 24 million come 2026. An analysis from the White House puts that increase even higher, at 26 million. That’s nearly the entire population of Texas, the second largest state in the country, losing their coverage all at once.
These are the stories behind those numbers.
Amy is 32 years old. She asked that we not use her real name.
I first started taking medication and seeing a therapist for my depression when I was in high school. Insurance was really easy then. Looking back, it was a real luxury to not have to worry or think about it because I was covered by my father's plan.
Like any chronic illness, depression can be cyclical. You can go into remission. It can reoccur. There were always peaks and valleys. By the time I had graduated college, I went through a period of having, I guess, not super-rational anxiety. It was getting hard to take care of daily activities and living.
I had insurance through my job, but even with insurance it can be difficult to get the mental health care you need. I was too sick to be treated by some providers, not sick enough to be treated by others. Things got bad in the beginning of 2014. Small things were overwhelming, every task was monumental. I would have to have a conversation with myself every morning: You have to get up. You have to go to the bathroom. I was paranoid. I was afraid of people at work. I felt like I was being watched all the time. I couldn’t bathe myself. I wore dirty clothes every day. I couldn’t feed myself. I was thinking a lot about suicide.
Eventually, I was on the way to a routine monthly meeting with my psychiatrist, standing on the subway platform and I thought: If I don't go upstairs and get in a cab I am going to jump in front of a train. I didn’t feel like I could stop myself from doing it.
I got myself above ground, and when I explained to my psychiatrist how I was feeling, that’s when it happened. I spent two weeks in a psychiatric hospital. I was still employed at the time, but I maxed out my coverage in those two weeks alone. When I was done I didn’t feel like I was in an acute crisis, but none of the problems had been solved.
I continued with treatment until November of 2014 with a little help from my family. I don't think they knew quite how bad it had gotten, but they were able to help me stay in treatment. Over the course of that time all my symptoms got worse. I couldn’t show up to work and was eventually fired. Because I had no money, I couldn’t afford Cobra. I eventually got myself enrolled in a health care plan from the Affordable Care Act exchange, but I only paid one month of premiums. The plan eventually lapsed.
I couldn't stay on top of the insurance payments because I couldn't stay on top of anything. I couldn't help myself, and asking for help was so far outside my ability to care for myself. I could barely leave my bed. Eventually I became suicidal again. That mindset, I’m trying to think of the word, it builds on itself. That was true for me. I ended up in a Rite Aid in the middle of the night buying cans of butane that I planned to inhale and end my life. The thing that stopped me was how filthy my apartment was. I felt too guilty and ashamed to have people find my apartment like that.
My psychiatrist recommended that I be hospitalized again. I had no job, I had no source of income, I had no way to pay for it. All of it was building on itself. My number one fear once I was hospitalized was how I was going to pay for it. Being hospitalized is just horrific. And I kept thinking about the bill for my first hospitalization. I was insured that time—I had to pay $3,000 out of pocket—but it cost $50,000 total.
I remember thinking that I didn't know how I was going to pay for it but I also knew that if I left the hospital I would die. A doctor at there told me that the hospital would apply for a charity grant and it would be covered. I think they were trying to reassure me. I still remember thinking: What am I going to owe? This is a bill that could ruin my life.
Once I left the hospital, I was still extremely sick. Eventually a bill did come and it was for $60,000. And I just ignored it. I have no idea if it's been forgiven or not. I think it has been, I hope it has been, but I really have no idea. I moved back home to live with my mom, and she lives in a state that accepted the Medicaid expansion. I feel extremely lucky. I’m now able to have all of my medications paid for by that insurance. It covers an intensive treatment program through one of the major hospitals here.
I’m approaching the end of that treatment now and feel like I’m well enough to enter into real life. But the treatment program that I’m in will end in August. My hope is just: Please don’t let anything happen with the Medicaid expansion. I need to finish this treatment. But I still don’t work full-time. One of the reasons I don’t is so I can continue to qualify for Medicaid, but also because I’m not really well yet. Recovery is slow.
In addition to the treatment, I take seven different medications, none of those can go. None of them are a luxury. They are all essential. They're saving my life.
The National Suicide Prevention Lifeline is a national network of local crisis centers that provides free and confidential emotional support to people in suicidal crisis or emotional distress. They are available 24 hours a day, 7 days a week at 1-800-273-8255.