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Minding the Gap: The Hole in Idaho's Health Insurance Coverage

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I once rode the trains in the London Underground. To remind passengers not to fall because of the difference between the platform height and the train, a British woman’s voice broadcast from overhead kindly prompted us to “mind the gap.”

The gap is on my mind this morning. I am running out of medication, and it’s terrifying.

I depend on my medication to sleep, among many other things. The three
prescriptions I am on serve a purpose: they ultimately keep my many beasts at bay. When I am without my obsessive-compulsive disorder (OCD) medication, even for a day, I feel as though there is a rubber band in my brain about to snap. The medication for bipolar disorder keeps the potentially extreme mood swings at bay. The nerve pain medication is used off-label for general anxiety, of which I generally have massive amounts.

Without these medications, I survive. But I become so mired by paranoia and worry that there is no way to thrive, and if I had to withdraw from any of these drugs suddenly, I would certainly not be able to function.

This is not an exaggeration. I have been accused of being an unwitting slave to pharmaceutical companies. But these accusers have never had the good fortune to have three anxiety disorders and a mood disorder. So I pay little attention to that and more attention to my small stash of medicine, which becomes alarmingly smaller by the day.

I often think I can survive on less medication. But even a small reduction in my OCD medication causes unpredictable and unwanted thoughts. I then torture myself with the guilt provoked by these thoughts, and the descent begins.

Surely someone who is disabled without medication could somehow have easy, affordable access to health care coverage, right? I mean, surely we in this country don’t simply let our mentally ill fall through the cracks and wander the streets in agony.

Let that sink in.

When I fall, I can easily break. Because I have a daughter currently on military insurance, I am not able to procure affordable access to my medications. I was told by my local pharmacy that a refill for one month’s worth of one of my medications would cost over $2,000 without insurance.

I am grateful that after my lengthy divorce my daughter retained her health insurance benefits. But because she already has coverage and does not qualify for Medicaid, I do not qualify for Medicaid. To obtain a tax credit through the health insurance exchange in Idaho, you must make above a certain amount of money. Because I am a certain amount of poor, I fall into Idaho’s wide gap in affordable health insurance coverage.

According to, 78,000 Idahoans currently fall into this insurance gap. Many of us have jobs but simply don’t make above the designated income level to qualify for affordable care. These are the folks who work 40 hours per week at minimum wage jobs, or people like me, who have not yet been able to procure or maintain full time work. And though we may not meet the criteria to qualify for actual affordable care, we certainly matter.

This afternoon I have an appointment to enroll in an insurance program before my medication runs out. I am grateful I can qualify for insurance despite my pre-existing conditions and that my insurance will go into effect almost immediately after I apply. There is still the possibility I will have to change to another mood stabilizer or anti-psychotic, as my most expensive medication may not be covered by a company with coverage I can realistically afford.

The Affordable Care Act laid the groundwork for many, but it is past time for Idaho legislators to mend this bridge. Too many of us have important and immediate health issues to address. For the sake of the children who depend on us, and for the preservation of our mental and physical well-being, we cannot afford to fall.

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Originally published: November 21, 2016
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