The voters of Rock County have been emphatic. Six out of ten have voted to give the president a second term. It has not been a good night for Paul. Even in his own ward, his neighbors have voted for Obama. Paul has won an eighth congressional term, but his victory margin is narrower than in the past. Janesville—and his ward within it—have favored his opponent.
As this election night wears on, the mood sinks inside the Holiday Inn Express banquet room, where the Circle of Women gathered a few evenings ago and where, tonight, hundreds of Republicans have gathered for what is becoming clear is not a victory party. It is after midnight in Boston, but still Tuesday in Janesville, by the time the giant screen at one end of the banquet hall televises Romney on a stage with sixteen eagle-topped American flags as he says that he has called the president to congratulate him. Most of the Rock County Republicans have left the banquet room when, at the end of Romney’s compact concession speech, Paul walks out onto this Boston stage, his lips pulled tight, in the same suit and silver tie that he was wearing this morning when he voted at the library.
Others may have gone home by the time the native son walks out on the stage, 1,100 miles away near the Boston waterfront, but Jay Mielke is sticking around. The county’s GOP chairman has been hanging out in the back of the banquet hall, and he watches Paul on the screen across the room. Jay is savvy. Tonight, he is pensive. He knows that Janesville, even missing so many of its union jobs, is still a Democratic union town at heart. A native son on the GOP ticket, Jay muses, was not enough. The other side, he has to admit, spoke more to the middle class.
48
HealthNet
In the election yesterday, Janesville’s voters chose a new representative to the Wisconsin State Assembly. Like Tim Cullen in the State Senate, Debra Kolste is a Democrat and a former school board member. She works as a lab technician at Mercy Hospital, and once a week she volunteers at HealthNet of Rock County. HealthNet is a shoestring operation, a free medical clinic downtown that, for nearly two decades, has been treating as many people as it can without health insurance or much money. On this afternoon after the citizens of Assembly District #44 have voted her into the state legislature, Deb is at the clinic, because today is a Wednesday, and Wednesdays are the day on which, for two hours, HealthNet accepts new and reenrolling patients.
This chance at free health care begins at 1:30 p.m., and the session has been in progress for just over a half hour when Deb opens the door to the clinic’s waiting room.
“Number eight,” she calls out.
Sue Olmsted hadn’t been sure how early she needed to arrive at a back door behind Milwaukee Street and climb the staircase that leads to the narrow hallway outside the clinic’s entrance so that she could stake out a good spot in line. A spot good enough that she can get inside the clinic and not be sent away to come back another week and try again.
Sue had been in line for nearly an hour by 1:25 p.m. when a strapping young man in a polo shirt named Ryan Messinger came out into the hallway, as he does every week moments before the enrollment session begins, a clipboard under his arm. Ryan is HealthNet’s clinical operations director, and he sports a perpetually cheerful demeanor that gives no hint that he is working fifteen-hour days to help keep this overwhelmed nonprofit clinic running.
Ryan looked up and down this week’s line of people hoping to become patients, including Sue, seated in metal folding chairs and, after the chairs run out, standing or sprawling on the linoleum floor as the hallway bends around a corner and out of sight. HealthNet used to take thirty new and renewing patients each week. Not lately. “Today, we are only able to take thirteen people,” Ryan said in a tone, at once apologetic and firm, that he has perfected while giving some version of this prologue to each Wednesday afternoon session for months. “Just because of our budget constraint. And our funding has been cut again.”
Sue was in time, it turns out, to receive a small slip of paper with #8 on it. Finally, Sue tells herself when she hears her number called a half hour later. Her lucky day. She could use one.
Sue worked for nineteen years at SSI Technologies, a company on the north side of town that manufactures automotive and industrial parts from powdered metal. By the time she was laid off in 2009, two months before the recession’s official end, Sue was performing quality audits and being paid $15.50 an hour, making her one of SSI’s highest paid workers on the production floor. Her job was eliminated. In the three and a half years since then, the only work she has found was three weeks at a temp agency.
She is fifty-three and has been divorced for ten years. Like so many others in town, when she couldn’t find another job, she went back to school, starting at Blackhawk a year ago to study medical administration. Her studies haven’t been going well. She has had to miss a lot of classes because of medical problems, so she is debating whether to withdraw from school, rather than having failing grades on her record. Of her medical problems, the biggest is in her lungs. All those years around powdered metal, she suspects. Whatever it was, she hasn’t had health insurance since SSI got rid of her job, which was particularly unfortunate when she landed at Mercy with recurrent pneumonia. She explained to the hospital that she didn’t have insurance, hoping for a discount, but she was charged full price and, though it killed her to do it, finally pulled out $15,000 from her 401(k) to make a dent in what she owes. Her lungs still aren’t in great shape. Plus, among other ailments, she has arthritis in one foot that makes it hard to stand too long. She is pretty sure she has a touch of depression, and she needs medicine to help her sleep. Being #8 right now at HealthNet is a piece of rare good news.
When Deb calls out her number, Sue follows this wiry woman with short blond hair into the clinic’s inner sanctum. “I’m Deb, I’m a volunteer here,” she says, once they are settled in the first of the clinic’s two small exam rooms and Deb has pulled the door closed. No mention that she has just been elected to represent Janesville in the statehouse; even though Sue voted for her yesterday, she does not recognize Deb in person.
Deb makes clear that the examination about to play out in this little room is not about Sue’s lung troubles but about the stack of documents that Sue has been careful to tuck into a manila folder whose contents will determine whether she is eligible for the lifeline of free care that HealthNet provides people who qualify.
“I do believe I have everything,” Sue says, seated on the room’s one chair. She has a heart-shaped face and chin-length straight brown hair. She is wearing a purple sweatshirt, black jeans, and black sneakers with hot pink trim.
Deb begins the routine of screening questions. “Who lives in your household?”
The question isn’t as easy as Sue wishes it were. When she and her husband split up a decade ago, she got the house and, once their two kids were out of high school, was supposed to sell it, pay off the mortgage, and give him half of whatever was left. But the house’s value dropped so much that, with what she still owed on the mortgage, she couldn’t afford to sell it. So she has stayed. More than a year ago, when her ex-husband lost where he was living and asked whether he could stay for a while, she let him in, figuring that, even though they don’t get along at all, a four-bedroom house was big enough that they could stay out of each other’s way. Her unemployment benefits were running out. He made a mortgage payment, and then another and another.
“I live with my ex-husband,” Sue tells Deb. “It’s for economic reasons only.”
Deb asks Sue for the tax forms she has brought and, after scanning them, looks up with a quizzical expression. “So, you have no means of income?”
“Last year, I got unemployment,” Sue says. “I am a full-time student. I have a little bit of money from school.”
“And your BadgerCare denial letter?” Deb asks.
This is a topsy-turvy aspect of screening would-be HealthNet patients. The state has handed volunteers like Deb a charade that they must play. HealthNet accepts patients only if they are ineligible for BadgerCare—Wisconsin’
s name for Medicaid. Three years ago, Wisconsin created a new part, called BadgerCare Plus Core, that is, in theory, more generous than in most states. The idea is to provide stripped-down health benefits to adults who aren’t raising children at home—people like Sue. Except that BadgerCare Plus Core opened in July 2009 and stopped accepting applications three months later. Ever since, anyone who signs up is put on a waiting list. When Sue applied in September 2010, one and a half years after her job was eliminated, she received a letter from the state saying that she is eligible and that she is #48,874 in line. She has not moved up on the list.
Deb looks at the letter and is fine with Sue being #48,874 on a motionless waiting list. But she keeps looking back over the federal tax forms. Something isn’t right. She tells Sue that she’ll be back in a minute. One of Sue’s feet, in its black and hot pink sneaker, begins to swing nervously.
Deb is looking grim as she walks out of the exam room and finds Ryan in a back room, near a bulletin board on which a sign is posted that says: “Life is not about waiting for storms to pass. It’s about learning how to dance in the rain.”
She thrusts the tax forms in Ryan’s face—the one for Sue and the one for her living-under-the-same-roof ex that Sue brought because HealthNet’s instructions had said to bring proof of all household income. The clinic accepts people if their income leaves them at less than 185 percent of the federal poverty level.
Ryan looks at the form and considers the dilemma: Even if Sue has no income, can she become a patient if her ex’s wages at a Beloit engine-making factory were covering the mortgage payments and were the only reason she hadn’t lost the house? Ryan squints at the forms for a long time before he says, “I think we need to count it as income.”
“I am not liking this today,” Deb tells him. “The people who need help are not being helped.”
Ryan does not try to sugarcoat what’s happening. “We have some people falling through the cracks,” he agrees. He doesn’t like this business of turning people down. He wishes he could let everyone in.
Except that for HealthNet, this is not a time for bending rules. With grants cut and donations down, even as the clinic is holding more fundraisers, Ryan and his boss, the clinic’s executive director, wrote a plan a few months ago to carve $54,000 from the clinic budget this year. They cut expenditures on medicine from $35,000 last year to $9,000, hoping that some of their patients can qualify for drug companies’ private assistance programs for the poor. They have stopped paying for X-rays, hoping that Mercy and another hospital that opened in town early this year, St. Mary’s, will step up and do their part. And under a new rule written by the clinic’s medical director, another volunteer who happens to be Deb’s husband, doctors can order just two lab tests for a patient. If they want any more, Ryan—even though he is a health education specialist and not an MD—combs through the patient’s medical records for evidence of whether further tests are crucial.
Last year, HealthNet provided nearly nine thousand visits for medical or dental care. The wait for a doctor’s appointment, no matter how urgent the problem, is now running about three months.
As Deb walks back to the exam room where Sue is waiting, she passes the bulletin board again. Next to the sign about dancing in the rain is another: “Did you know HealthNet donations from patients are at an all-time low, and the number of patients served is at an all-time high?” it says. “HealthNet survives off of the contributions and donations from everyone. HAVE you donated today?”
Not a time for bending eligibility rules.
Deb hates what she is about to have to tell Sue once she opens the exam room door.
“Well, Susan,” she says as gently as she can, “you have no means of self-sufficiency, but your ex-husband makes a lot of money.” Sue can see where this is heading. She is beginning to look upset.
“He isn’t legally responsible for me,” Sue points out. “I’m just sponging off him. That’s all I’m doing. I own half of a house that isn’t worth anything. I have thyroid, restless legs, and a lot of pneumonia the last three years—a lot of respiratory illnesses.”
Deb is starting to look as upset as Sue. “I will just ask Ryan to clarify,” she says, before she ducks out the door again.
This time, Deb finds Ryan in the back area where, even if HealthNet is buying fewer drugs, it still stores a lot of medicine, including donated pills originally prescribed for people who died or were released from prison before they finished taking the drugs, because, as a free clinic, HealthNet is allowed to collect and dispense any medicine that it can scrounge.
“Just one more time,” Deb says to Ryan, a pleading tone creeping into her voice. “I know I am just putting it off on you.”
“I can take it,” Ryan says, no crack showing in his geniality. “The only thing we can say is, if he kicks her out, she qualifies.”
Deb returns to break the news. “I am so sorry, honey.”
Sue doesn’t speak. She looks down at her lap. She folds her eyeglasses and puts them into a case. She takes back the tax forms and replaces them in her manila folder. When she looks up, her eyes are reddened.
“If something changes in your life . . .” Deb says. Apologizing for not having a tissue for Sue, she tears off a paper towel from a roll on the wall. Deb walks Sue to the clinic’s rear door, patting her on the back.
Sue is gone by the time Deb rips up the enrollment form she had begun to fill out.
She walks back to the waiting room door, opens it and calls out number eleven. “I’m Deb, I’m a volunteer here,” she says to a woman, holding the number eleven slip of paper, who runs a struggling bed-and-breakfast on Courthouse Hill, three blocks from Paul Ryan’s home. The new woman, it turns out, is collecting FoodShare, Wisconsin’s food stamps program. That pushes her income, too, over HealthNet’s limit.
Deb ushers number eleven out the back door. “I am batting 1,000 today—NOT!” she mutters to another volunteer. The volunteer is in a celebratory mood because of Deb’s election victory. Not Deb.
Governor Walker, she knows, has decided not to spend most of the $37 million that the last governor, Doyle, accepted from the federal government to help pioneer a new insurance marketplace under the Affordable Care Act, the big, new national health care law.
Standing in the clinic, on this afternoon after her victory, she wonders what one new legislator in Madison will be able to do.
49
Out of a Job Again
Deri Wahlert is no longer a novice at running the Parker Closet. This is her fifth year, and now she has two hundred teenagers darting in and out for used clothes and canned food and toothpaste. In these years, Deri has learned quite a few things about how to spot when a Closet kid is hurting, one of which is that it’s a good idea to keep an eye on kids’ Facebook pages. Yesterday, she noticed on Kayzia Whiteaker’s page, near a smiling photo of Kayzia with her best friend and a query about whether anyone could recommend a cheap haircut, a post that sounded glum, burdened. Deri sent Kayzia a note, asking if she could stop by.
Kayzia is ahead in calculus, so she has just gotten permission from her math teacher to miss class. At the moment on this Wednesday afternoon, December 12, she is in Deri’s social studies classroom for a heart-to-heart. Deri waits until the two of them are seated at facing desks in the middle of her room before she asks Kayzia, point-blank, “What happened?”
Her dad is unemployed again, Kayzia explains. “We haven’t even made the house payment,” she says, as if this were somehow her responsibility, too.
“Gotcha,” Deri says.
It’s been a rough couple of months. Since Kayzia’s dad was laid off from GM, he has been careful never to leave a job until he had lined up another one. He stayed at his job at the jail, even though his anxiety worsened into full-fledged claustrophobia and panic attacks in the locked spaces. He was prescribed anti-anxiety pills, but they didn’t always work, and his supervisor called Kayzia’s mom late one night last summer to come pick him up and take him h
ome before the end of his shift. Her mom had to sit outside with her dad for a half hour before he could get into the car and, when they got home at midnight, she had to walk the streets of Janesville with him for more than an hour to help him calm down. A sergeant at the jail told her dad that he thought, as a friend and not as his boss, he needed to get out of there.
He’d been searching for another job for a year when he finally got an offer. He left the jail in early September and began to work, for less pay, at United Alloy, a manufacturer of fuel tanks and other metal objects. He worked at United Alloy for one week. He got laid off. Another week went by, and he was called back for some training. He soon noticed that his hands started tingling and going numb—overuse syndrome, a doctor told him. So United Alloy put him on light duty for two weeks but, after that, sent him home. Her dad was trying to get workers’ comp, but the company wasn’t making it easy. So he managed to line up another offer pretty fast—in a distribution center for Grainger Industrial Supply. He gave notice at United Alloy. He’d already had his final day and was supposed to start at Grainger last Thursday. Instead, Grainger told him that they didn’t need him yet. Didn’t know when they would.
Her dad can’t even collect unemployment because he wasn’t laid off.
Kayzia and Alyssa are doing everything they can to help out. At the start of the school year, Kayzia sent a note to the teacher who coaches the Parker debate team that she’s loved. After three years on the team and making it to state, she told him she would not be able to participate this year. “I have family things and school that I need to focus on,” she wrote, thanking him “for everything you have taught me in the last few years.”
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