Rethink what it means to have access to quality health care: reader opinion, November 27, 2014

Coming home. For most of us, it is a return to comfort, familiarity, and, above all, safety.

When we met Jenny, an American citizen who spent the last ten years of her life in Hungary where her father moved with his job, "coming home" was precisely how she described returning to the United States. Jenny believed America would offer the best chance in her struggle against Crohn's disease. However, her home is in Alabama, and health care here is not quite what she expected.

Since the age of 9, Jenny has battled Crohn's disease, a disease of the intestines characterized by painful, debilitating flares. Jenny is no stranger to doctors' offices or hospitals. However, in her first few weeks back in America, she has encountered a whole new type of health care.

Jenny is 22 years old. She does not yet have a job, and she lives with her grandmother. Before starting work or college again, she needs medical care to keep her Crohn's disease under control. The catch -- without an income, she cannot qualify for Medicaid or any subsidies on the federal health insurance exchanges in Alabama.

Like 191,000 other Alabamians, Jenny falls into the "Medicaid Gap." Alabama is among the 21 states that have decided not to expand Medicaid (i.e., extending Medicaid eligibility to those earning less than 138 percent of the federal poverty limit). This decision creates the dilemma where nondisabled, childless adults earning more than $11,490 qualify for subsidies to help them purchase health insurance. However, those earning below this cutoff miss out and, on top of this, are also ineligible for Medicaid. Parents with incomes between $3,820 and $23,550 find themselves in the same situation as their neighbors without children. Quite simply, the lack of Medicaid expansion eliminates health insurance options to the poorest and most marginalized citizens of Alabama.

As medical students, we have only begun to face the difficulties that come with providing health care for the poorest among us, but we were moved to take action after hearing some of the stories from Jenny and others. Stories of real people. People who want to contribute to growth in our state, but are currently forced to suffer at the margins because they cannot get basic care for serious problems.

Stories with one common message: Alabama, it is time we reconsider our assumptions, listen to our neighbors, and trust in our ability to work together for a healthier future.

With this idea that personal stories have the capacity to change hearts and minds, Rethink Coverage was created. At its core, Rethink Coverage is a patient-medical student alliance. We encourage the citizens and leaders of Alabama to see our healthcare system through the eyes of their friends and neighbors who cannot obtain the care they need. As physicians-in-training from different backgrounds and with different political beliefs, we find common ground through the privilege of learning and helping some of the greatest teachers -- our patients. We stand together with our patients of today and for our children, communities, and practices of tomorrow.

With our patients, Rethink Coverage challenges you to rethink what it means to have access to quality health care. Talk to your neighbors. Visit our website,, to read the stories of Jenny and others like her. Join our efforts by reaching out to our governor and your state representatives. In the meantime, we will encourage our state leaders, starting with a letter sent to them along with this article.

As for Jenny, she hopes to find a job and finish college. She is still adjusting to her new life in America. Despite the ups and downs of her Crohn's disease, she remains optimistic. Her determination to take control of her health and build a new life in the U.S. is a reminder of the persistence, willpower, and hard work that embody our great state and nation. It is also a reminder that no matter who we are -- whether a recently returned American citizen from Hungary or a long-time resident -- Alabama is our home. We owe it to ourselves to make it one where health care is more accessible to everyone.

Davis Bradford and Ynhi Thai are members of Rethink Coverage is an Alabama nonprofit, with fiscal sponsorship under A Place for Help, a 501(c)3 nonprofit focused on providing medical and legal services to underserved populations.

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