What she did is known as spending down -- literally impoverishing oneself in order to qualify for Medi-Cal, the state health insurance program for the poor. A single person qualifies if monthly income doesn't exceed $812 and assets total $2,000 or less. With her medication bills, it wasn't hard to get to that level.
"Once I no longer had the HMO, I was paying retail," she says. "I take 27 drugs a day. It just wiped me out." Once she had nothing, Medi-Cal covered her drugs.
The coverage worked pretty well -- until the new Medicare prescription drug benefit took effect Jan. 1. It provides limited drug coverage for people on Medicare. If those people previously qualified for state Medicaid programs, called Medi-Cal in California, they were switched to the federal drug plan. A March 21 report by the California HealthCare Foundation found that those people, called "dual eligibles" in bureaucratic-speak, have access to a narrower range of pharmaceuticals than they had before.
Again, Jackson is back to studying her options.
She has taught, written, sung gospel and traveled extensively before coming full circle back to poverty. "I've adjusted my life to where I don't need a lot of money," Jackson says. Along the way up and back down the income scale, she's experienced just about every configuration of healthcare coverage available in America.
*
JIM JOHNSTON
JIM JOHNSTON met his wife, Frieda, in college in Nebraska, shortly after World War II. Those were days when tobacco companies had ad campaigns such as L&M's "Just what the doctor ordered," Camel's "More doctors smoke Camels than any other cigarette," and Viceroy's claim to provide "double-barreled health protection." Frieda Johnston, 82, smoked two packs of Pall Malls a day and didn't quit until 1988.
Two years ago, it caught up with her.
"She woke up and couldn't catch her breath," says Jim Johnston, 80, of Ogden, Utah. They were in Oceanside, where they spend the winter months each year, when the crisis hit. "We whipped into the emergency room, and while I was signing one piece of paper, they already started working on her," he says. She needed surgery for an aortic valve replacement, spent two weeks in the ICU and then suffered a terrifying cardiac arrest.
"They did CPR right on the floor, and then she went back to the ICU for two more weeks." Finally, she spent two weeks in rehabilitation. She's been doing pretty well since.
