Arkansas's working poor are hoping the state says yes to expansion 

Melissa Farrell was at the end of her rope several years ago, battling a drug addiction and unable to find a job. Along with her two children, she checked herself into Our House, a Little Rock shelter that provides housing and job training. Today, she has a job and an apartment, and she's been clean for more than two years.

"I still live one day at a time," she told me when I visited her recently in her east Little Rock apartment. "I crossed a lot of barriers. Not everybody gets to do what I've done. It's by the grace of God."

When I asked her what prompted her to turn her life around, her son Kaleb happened to come in the room and joined her on the couch. "There's one," she said. "Where's the other?" Her daughter Zadie came in and sat down next to them.

Farrell put her arms around her children. "That's why we had to do better," she said.

With little education and a felony arrest in her background, it wasn't easy, but she was willing to work. While at Our House, she got her high-school diploma and got her conviction expunged. Initially unable to find a job, she started working through a paid internship program at Our House that features on-the-job training to gain work experience. The stipend was $500 a month. In an unusual turn, she convinced Our House to hire her to work a weekend shift as shelter supervisor at minimum wage, on top of her internship. She would eagerly volunteer to cover for folks and pick up extra hours, thankful for the opportunity to work. She still can't believe "the blessings that God gave me there at that place."

But once she started working, Farrell lost her health care because her income was almost three times too high to qualify for Medicaid in Arkansas. How much did she make that first year that booted her off the rolls? Around $9,000.

"I try to be self-sufficient," she said. "You're damned if you do, damned if you don't."

Arkansas has the second stingiest Medicaid program in the nation, and many low-income parents find themselves in a position like Farrell's: uninsured and too poor to purchase their own health insurance or health care but not poor enough to qualify for Medicaid in the state. Farrell had knee surgery while she still had coverage but lost it before she could start her physical therapy. She paid for one visit out of pocket. "They had some compassionate people that tried to teach me what to do at home," she said. "But I probably need physical therapy."

Nowadays she works just under 40 hours a week in a supervisory role at a residential rehab center. She makes $8 an hour and gets no benefits. Paying the bills and providing for two kids, she doesn't have money left over for private insurance. "There's no way," she said. "I'm doing good to get by."

She avoids seeking any sort of medical care because of cost concerns. If she ever had a major health issue, "I'd just have to go to the emergency room. And then they tell you to follow up with your primary care physician. But I can't afford that."

Farrell, a working mother of two struggling to make ends meet, is the sort of person who stands to gain health insurance if the Arkansas legislature is willing to accept federal money to expand coverage. (Arkansas already offers insurance to children in poverty, through the ARKids program.) I asked what it would mean to her. "Wow," she said. "It would take a lot of stress off of me to start with. I'm 44 years old and I have little kids to get grown. It's hard to plan the future with the uncertainty." She told me she worries about not being able to have routine checkups. And she worries about what would happen if she had a medical problem that she couldn't afford to treat. "I could be right back where I started."

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