As rural Missouri grapples with COVID-19, it’s throwing our health care system under a harsh spotlight, illuminating and worsening the flaws that have been there all along.

Because tests are so limited, they are being rationed. It makes sense logically — the daughter of an accountant can easily see the rationale and necessity of using resources wisely: You put restrictions on how you access tests.

You need a note from your doctor, who will first do tests to rule out other possibilities such as influenza, strep throat and mono. But for many Missouri residents, those multiple steps for “proof of illness” are insurmountable obstacles.

COVID-19 proves that rural Missouri needs Medicaid expansion. Now.

If you are uninsured (or even underinsured, as many Missouri residents are), you are less likely to get tested for COVID-19 than those with coverage.

Without insurance, you don’t have a primary care doctor to evaluate you and test you for strep, mono and the flu, and you might not be able to afford those tests out of pocket.

If so, and you really need to get tested, you may have to go to the emergency room — where they are required to treat you without proof of insurance. You have to decide if you’re willing to risk that level of exposure now, knowing hospitals are filling up with confirmed and suspected cases.

Because of this added risk, you will likely wait until you are too sick to avoid it ... or you will never get tested, potentially spreading the virus.

This is especially the case if you cannot miss work without risk of losing your job and continue going in with mild symptoms.

It is worth noting that many of our essential workers find themselves in this exact position — uninsured and in hourly jobs without paid sick leave.

Access is about more than just geography, though that remains an issue for our rural communities. When we ration tests — like we ration health care at large — we leave out our most vulnerable friends and neighbors and leave ourselves at higher risk.

Never has it been more obvious that we, as a community, state and nation, are only as healthy as the sickest among us.

Everyone deserves access to life-saving care. We could open the door to access by expanding Medicaid, giving insurance to hundreds of thousands of Missouri residents and leveling the playing field as we all fight coronavirus.

Do not be fooled by the recent move to “expand Medicaid” as a response to COVID-19 — Missouri will only offer Medicaid coverage for 90 days to people who both test positive for COVID-19 and live at or below 85% of the federal poverty level.

For reference, in 2020, that is $10,846 a year — or just over $208 a week for an individual. While patients who test positive for COVID-19 absolutely need coverage, this disincentivizes people from getting tested for fear of being negative and on the hook for those testing bills.

It is a big gamble if you’re making $200 a week — assuming you are still working right now.

We need actual Medicaid expansion — it lowers the risk for all of us, letting us do what we’ve always done: look out for our communities.

Dina van der Zalm, MSW, MPH, is a health care organizer for the Missouri Rural Crisis Center.


About opinions in the Missourian: The Missourian’s Opinion section is a public forum for the discussion of ideas. The views presented in this piece are those of the author and do not necessarily reflect the views of the Missourian or the University of Missouri. If you would like to contribute to the Opinion page with a response or an original topic of your own, visit our submission form.

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