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The perils of Florida’s refusal to expand Medicaid

Charlene Dill is one of an estimated 2,000 people who expected to face dire health issues due to lack of access to care

Photo: , License: N/A

Photo: , License: N/A


Charlene Dill didn’t have to die.

On March 21, Dill was supposed to bring her three children over to the South Orlando 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 to afford tampons and shampoo. They were the working poor, and they existed in the shadows of the economic recovery that has yet to reach many average people.

So on March 21, when Dill never showed up with her three kids (who often came over to play with her 9-year-old daughter, Zahra), Woolrich was surprised she didn’t even get a phone call from Dill. 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 a commission basis for Rainbow Vacuums. On that day, in order to make enough money to survive, she made two last-minute appointments. At one of those appointments, in Kissimmee, 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 the period of a decade to overhaul its Medicaid program to include people like Dill and Woolrich – people who work, but do not make enough money to qualify for the Affordable Care Act’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 annually in jeopardy, all in the name of rebelling against President Barack Obama’s health care plan.

Woolrich has spent the better part 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 Affordable Care Act’s medical-care exchanges. During the course of her work, she saw women with tumors that had yet to be treated, many chronic conditions affecting people living in the gap, and sometimes she found herself having 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.

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