Audrey Sparks and her husband Kenny say they don’t know what would have happened if it weren’t for the expansion of Medicaid in 2014 that gave Kenny insurance for the first time in 15 years.

Kenny is relatively healthy – he doesn’t have diabetes or hypertension, health conditions that plague many other residents of Jackson County, Kentucky. But in 2014, he was helping a friend load a truck when a piece of metal grazed his arm, leaving a three-inch-long scratch. His arm swelled to twice its normal size and became infected. Kenny spent five days in the hospital after a two-hour surgery to remove the staph infection in his arm.

Since then, Kenny has gotten his tetanus shot, in addition to every other vaccine he’d gone without for years. And the Sparks had no medical bills because of their Medicaid coverage.

The Sparks have lived in Jackson County their whole lives, and now have a small business selling folk art each week at a nearby craft fair.

Half of the county’s 13,352 residents are now covered by Medicaid, which in 2014 started including adults making up to $15,000 dollars a year — people like Kenny.

Lisa Gillespie |

Audrey and Kenny Sparks standing in the front yard at their home in Jackson County.

“Had we not had (coverage), we would have been destroyed,” Audrey Sparks said. “Who can afford things like that? Spread that [money we make] over 30 days and try to take care of a farm, a family and everything else. And $20-something flu shots, they’re on the back burner.”

Health Care vs. Social Issues

Of all the states in the nation, Kentucky has made the most progress in getting people health insurance through the Medicaid expansion provided for in President Obama’s Affordable Care Act. Because the law allowed more people to get health insurance largely through Medicaid, the state’s uninsured rate has gone from more than 20 percent in 2013 to less than 8 percent now.

But in Jackson County in 2015, the population overwhelmingly voted for Gov. Matt Bevin, who ran on dismantling that Medicaid expansion. More recently, 89 percent of Jackson County voters chose President-elect Donald Trump, who has vowed to repeal the Affordable Care Act – known as Obamacare in this county.

Bevin has submitted changes to the Medicaid program, including putting in place monthly payments – premiums – and only providing dental and vision benefits if people work, volunteer or do job training activities 20 hours a week after a year.

The Sparks say because of the importance of health care in their lives, they would have voted for Hillary Clinton for president in hopes of keeping coverage. But knowing that Jackson County — and Kentucky — would go heavily for Trump, they didn’t bother voting.

“We would have not voted for Trump, and basically, the medical thing is the thing,” Audrey said. “We was telling people, he doesn’t want this [Medicaid expansion]. People that make beyond $100,000 a year, that’s nothing to them. They just pay it and go on. But whenever you’re scratching, it’s really rough.”

Even if they had voted, the Sparks would’ve been in the minority in another way in Jackson County. In another year, in another high-stakes election, health insurance coverage just wasn’t the issue that decided residents’ political preferences there.

Jerry Blevins, a truck driver from McKee, said he voted for Trump in part because of his promise to repeal Obamacare, but he hopes that lawmakers come up with a different health coverage program. Blevins likes the ideas that Bevin came up with, like having a health savings account. He also likes the idea of giving states chunks of money — block grants — toward Medicaid to use however they want.

“I think that people that don’t have money deserve it but I think we can go about doing it different, maybe give them some of the power back to the states and stuff like that,” Blevins said. “The way the political system is going, it seems to be stuck in a rut. I think that a businessman running the country — if you run the country like a business, I think it’ll change, turn around.”

McKee insurance salesman Ted Hays voted in favor of Trump and Bevin because of their positions against the health care initiatives, though he said social issues like abortion and gay marriage were even more pressing.

“I like the idea that everybody needs an opportunity to get insurance but that’s the only positive thing I can see about it really,” he said. “I don’t believe in getting away from our traditional Christian values; I see our country going down a bad path, you know?”

‘I put in hundreds of dollars a year’

Neither Hayes nor Blevins have insurance coverage through the Affordable Care Act. But nurse practitioner Gloria Margison sees the effects of the legislation every day at work. She wouldn’t say who she voted for, but she said the issue she votes on is health care. 

Lisa Gillespie |

Gloria Margison

“I don’t get the sense that [voters] relate [the election] directly to their health insurance,” she said. “If they were really concerned I would have thought they would have looked at that issue.” 

Margison works with a doctor at the McKee Medical Clinic, which sees a large number of people with Medicaid coverage. Before the expansion in 2014, many of her patients were uninsured. 

“Not only did I provide the service for free, but then I would call the pharmacy and pay for their medicine,” Margison said. “So I put in hundreds of dollars a year, I’m certain.” 

She also had a person who solely worked with pharmaceutical companies to get patients free medications, and would stock up on samples to give out. Margison tried to limit prescriptions to the medicines that WalMart sells for $4. Local churches would pass around a donation basket for her patients. 

This year, for the first time in the 15 years she’s worked in Jackson County, Margison didn’t have to do any of that. 

She’s worried she’ll have to again if Trump’s plan to repeal and replace the Affordable Care Act goes through. She tried a few times to tell patients that their Medicaid coverage was because of the ACA, but it didn’t seem to make a difference.

I think you have to want to make an informed decision and if you chose to be swayed by what the politician says at face value over and over, then nothing I’m going to say is going to make a radical difference,” she said.

Audrey Sparks said she saw misinformation spread during the campaign. Even though she said probably 75 percent of the people she knows got insurance through the ACA’s Medicaid expansion, most voted for Trump. 

“My granddaughter, she’s 7, and a lot of people thought that if Hillary won, we would have all been decapitated because she’s going to let the bad people in to come and cut our heads off,” she said. “Her other set of grandparents told her that.  And that’s ignorance. I hate to say that about eastern Kentucky, because we already have that stereotype. But that is stupid.”

It hurts her feelings a bit, their votes for Trump. She takes it personally, because they all know what happened to Kenny and what could happen to him in the future without insurance.