When Brandon Allred woke up in the hospital after suffering heat stroke and a series of seizures at work, all he could think about was how much it was going to cost.

It was a legitimate concern: Seven years later, he's still paying off the medical debt.

“It's not just anxiety,” the 35-year-old father said, “but also the conscious, embarrassing fact that I'm living in one of the richest countries in the world and I am a natural born citizen and I have to sit here day by day and think ‘I dream of healthcare.' I dream of a day where I can get all my teeth fixed and not have to worry about that. Or maybe I can figure out what was going on with me with those seizures.”

Allred, a prep cook and the primary provider for his six young daughters, works full-time but falls into Mississippi's coverage gap, where he says health care is but a “pipe dream” and a “whimsical idea.”

The coverage gap is made up of low-income workers who make more than 28% of the federal poverty level — the maximum income allowed to currently qualify for Medicaid in the state — but less than the 100% of the federal poverty level needed to get subsidies that would make private insurance plans affordable. And it's surprisingly big, comprising roughly 74,000 Mississippians, according to a recent KFF study.

If Medicaid were expanded in Mississippi – one of only 10 states that has not done so – Allred and tens of thousands of other working Mississippians like him would be covered. Income-eligible adults without children would also be covered.

It's estimated that 123,000 uninsured Mississippians would gain coverage under expansion – that includes the 74,000 people under the poverty level and an additional 49,000 uninsured adults whose income is between 100% and 138% of the FPL. That means that under expansion, a family of four could make up to $43,056 and qualify for Medicaid.

Critics of expansion argue that anyone, even if they're not offered health insurance through their employer, can purchase it through the marketplace. Those plans exist, but are so expensive that for those in the coverage gap, they practically do not exist.

Other critics of expansion argue that because there is a chance that some privately-insured Mississippians would switch to Medicaid under expansion, that's reason to keep the 123,000 uninsured Mississippians uninsured — and turn down at least $1 billion a year in federal money to cover most of the cost.

Private insurance plans, especially ones with low premiums, have high deductibles that can easily run $5,000 a year. A plan with a deductible on the higher end of that spectrum would equate to about $400 a month – on top of premiums and copays – that an individual would need to pay in order for insurance companies to start picking up the slack.

A majority of uninsured adults make slightly too much to qualify for Medicaid under the present eligibility criteria, and so have no path toward health care.

As it stands, Medicaid eligibility for adults in Mississippi is very limited.

Firstly, Medicaid in Mississippi doesn't currently cover childless adults – period. And even adults who have children would need to be making less than 28% of the federal poverty level to be eligible for Medicaid. For a family of two, such as a single mother and her child, 28% of the federal poverty level would be about $5,700 a year, or $475 a month.

That means that a working mother making incrementally more, such as 29% of the federal poverty level, would not qualify for Medicaid but would have to use nearly her entire salary if she were to pay out of pocket for a private insurance plan through the marketplace. This is an obvious impossibility for someone paying for rent and food and other basic necessities.

Nobody knows that better than Lakeisha Preston, a single working mother who couldn't afford the deductibles on her insurance plan, and therefore was stuck paying out of pocket for a bout of pneumonia that put her in the hospital in 2019.

Over four years later she's still paying off that medical bill – which forced her to move back in with her parents and take out personal loans.

“I had health insurance, it's just that the deductibles were so high,” Preston explained. “I don't go to the doctor all the time, and of course you have to meet the deductible first before the insurance covers you. So I was in that predicament.”

Ironically, Preston works at a federal Medicaid call center. She helps thousands of people, with incomes similar to hers, enroll in Medicaid in states with Medicaid expansion. As a Mississippian, she cannot get that coverage.

Preston said: “As a call center worker, I expect more from the state of Mississippi.”

Mississippi lawmakers have debated the need for expansion — mostly over partisan political reasons — for over a decade, despite the state's abysmal public health metrics and pleas from doctors, hospital leaders and other health providers.

On Thursday, the deadline day for bills to pass their original chambers, Care4Mississippi, a coalition of 36 organizations whose goal is health care for all Mississippians, held a press conference at the Capitol. Doctors and health officials shared experiences from the frontline and urged lawmakers to pass expansion bills.

“As a pediatrician, I have seen firsthand the impact of parents' health on their children,” Dr. Anita Henderson said during the press conference. “Children need their parents, and their parents need to act healthy, mentally, physically, and able to engage with their children. I have seen patients whose parents worked, sometimes two jobs, and lacked health insurance … The men and women in Mississippi are living almost a decade less than the people of Hawaii.”

This is the first year since Medicaid expansion was offered to states under the Affordable Care Act in 2014 that Mississippi Republican legislative leadership is considering it seriously. A House Republican bill overwhelmingly passed the full House and now sits in the Senate – which just killed its own expansion bill, according to Medicaid Chair Kevin Blackwell, R-Southaven.

But Allred said that after a decade, lawmakers aren't moving fast enough or treating the situation for the health care crisis that it is.

“If there was a state that needed to have a red flag pinned on it to say ‘you have a medical emergency to take care of,' it would be Mississippi,” he said. “And we need a rethinking of what health care is for our citizens in the state.”

Allred saw his father lose all his money as he battled cancer in the last six months of his life – despite the fact he'd worked hard at one company for 30 years. Growing up, his mother warned him not to let a medical debt go to collections, and said it always felt like “the medical industry was there to be feared.”

The father of six said he hopes that by the time his daughters are grown, they won't have to choose between paying rent or paying a medical bill. Right now, his children are covered by Medicaid. But he worries if legislation isn't passed, they'll be in the same predicament he's in once they turn 18.

“I don't want them to follow in the same footsteps as me when they shouldn't have to,” Allred reflected. “When they're being told their whole life they're being raised in the greatest country in the world but they're also being told the greatest country in the world can not take care of you.”

This article first appeared on Mississippi Today and is republished here under a Creative Commons license.