My family lives in central Appalachia, in places too tiny to be called towns. These rural “hollers” are the heart of this beautiful but hardscrabble mountain region. Roads are so difficult to navigate here that medicine is delivered by drones. So when the Republican party throws up its barriers to Medicaid, it will be rendered useless to many rural people in the region. Work requirements, co-payments, cancellation of transportation services and lockouts to coverage will cause people that I love to lose their health insurance.

My cousin William could be kicked off right away if Medicaid is tied to a work requirement. A few years ago he quit one of the good and only jobs in rural Appalachia, cashiering at a large retail store, because he refused to work off the clock. His mom died shortly afterwards from her third bout of cancer, and then his dad died six months later on. Homeless in the blink of an eye, he started to sell bootleg DVDs at flea markets. The FBI caught him, and now he is a felon who cannot find a job. Next week he may also lose his access to preventative healthcare for his genetic predisposition to cancer.

My mom would also be denied Medicaid under the work requirement today. She raised us on Medicaid and welfare in a HUD trailer deep in a holler. Her parents died when she was a toddler and my dad left when I was three. Being a single mother without a car or a support system to provide daycare meant that she could not work, even if jobs were readily available, which they were not.

She would also not be able to pay the co-payments that for the first time would be required for single moms like her. She picked up tin cans on the side of the road to collect cash to feed her family, and rolled pennies to buy school supplies for us, so it would have been impossible for her to pay a $14 co-payment to go to the doctor.

When my sister’s asthma acted up, my single mom made an appointment, and soon a Medicaid van picked us up to go to the pediatrician. The van ride was warm in the winter and it comforted me, looking out the window at the mountains knowing that my sister was on her way to get her new inhaler. But the proposed Medicaid overhaul will idle Medicaid vans.

My aunt Laura and uncle Don take the Medicaid van to the methadone clinic. An underground coal miner, my uncle’s doctor told him that the pain pills that he took for his back were not addictive. He shared his pills with my aunt to erase the pain of her frequent migraines, and soon enough they were both doctor shopping to get multiple prescriptions for OxyContin.

It took losing their home and their jobs, wrecking two cars, and multiple visits to the emergency room for overdoses to prepare them to quit the powerful drugs. They also lost their driver’s licenses and most of their friends, so Medicaid is their only source for transportation to drug therapy.

My close friend Whitney rides in the Medicaid van every Wednesday to occupational therapy. Seven years ago she couldn’t shake off what she thought was the flu, but she didn’t have insurance to go to the doctor. Turns out she had contracted viral meningitis from a mosquito bite and she ended up in the ICU for a month in a coma. Now she has traumatic brain injury and severe epilepsy as a result of the prolonged infection.

Occupational therapy teaches Whitney coping skills like organization to combat memory loss and what she calls “the ticks crawling in my head.” She forgets her doctor’s appointments and to take her medicine sometimes. If she forgets the new Republican requirement to renew her Medicaid eligibility and is locked out of coverage for six months, she could seize uncontrollably and die.

Congress will justify this bad faith Medicaid by claiming that Whitney has to be more responsible. But my family and friends are fighting against circumstances beyond their control and they cannot be judged or admonished for it. In fact, what happened to Whitney could have happened to anybody.



It is not the people but Congress who is responsible to legislate against luck so that a mosquito bite cannot destroy a person’s life. Nobody controls when they get sick. It is up to the government to put their finger on the scales against this inevitable fate for health justice for all, including the forgotten people of rural Appalachia.

