Over the last decade, Elizabeth Lewis has built a career as a nurse practitioner, focusing on women’s health. “I knew when I went into university that I wanted to take care of patients who were vulnerable. When I graduated with my undergraduate nursing degree, I started my career at a safety net hospital in Kansas City, Truman Medical Center in Labor and Delivery. Then, as a nurse practitioner, I’ve worked at several Federally Qualified Health Centers and Title X facilities. I have loved developing relationships with my patients so much. They have been my life for many years. I feel like if you take care of women and mothers, then you’re taking care of a community because mothers are the center of their community.”
“Waiting for Medicaid during pregnancy has been such a big hurdle for us in health care. I’ve always worked at federally qualified health centers or in public health, so a lot of the patients that I see are not able to get health insurance until they’re pregnant. Because of the way that pregnancy Medicaid is set up in Missouri, people would think, ‘Oh I can’t get an appointment until I have coverage.’ You would sometimes not see patients until the second or the third trimester because they were waiting for their Medicaid card before they made an appointment.” Elizabeth has seen the impact of delayed care in expectant mothers over and over again. “You have negative outcomes with infants or deliveries because of health issues that went unmanaged early in pregnancy. For example, if a mom was not getting their blood pressure checked early in the pregnancy and chronic hypertension went unchecked, it could lead to preterm labor or growth restriction in the baby. Or if someone comes in pregnant with elevated blood sugars after twenty-four weeks, you don’t know if they had pre-existing diabetes or gestational diabetes, and it could lead to problems with fetal growth, preterm birth, or NICU [newborn intensive care unit] stays for babies for a variety of reasons. That is not to mention birth defects that could be avoided with early prevention tactics, like prenatal vitamins.”
In all of her years of working as a nurse practitioner, one mother’s story lives with Elizabeth. “She was a young mom and fell off of Medicaid postpartum, but she had this highly traumatic experience of having a baby preterm and her child being in the NICU. She became unemployed and homeless because she spent all of her time and energy taking care of this sick baby.” Without Medicaid to cover the cost of ongoing care and support for this new mother, Elizabeth had little to no options for connecting her patient with needed services such as mental health treatment and access to contraception. “She experienced this huge trauma and if she wanted to delay pregnancy until this baby was safe and healthy, she didn’t have access to highly effective birth control because of the cost because she lost Medicaid. She also didn’t have care to manage her trauma or postpartum depression. Those are some of the cases that haunt me.” This was just one of the numerous patient experiences she remembers, noting, “Many patients would break your heart, with the limits on what you could do for them without coverage.”
Elizabeth spent years doing what she could for vulnerable women and families as a provider, regularly petitioning hospital and clinic leadership to make needed services and resources more accessible to patients without insurance. “I would go to meetings and say, ‘I need you to find a way to make this affordable for our patients because this is something that they need.’ And the response was always, ‘Well, the bottom line. That’s not possible.’ That’s what the patients need, and I burned out fighting for what should have been the basics of what patients needed.” She now works in the health advocacy space, and she is ready to see Medicaid expansion implemented for the patients she formerly served.
“All you have to do is look at the scientific evidence and the outcomes that have improved in other states. You’re saving money in the long run because you’re improving outcomes and providing preventative services before people are really sick and before premature babies are born. We should prevent those things if we can. We want to get people in the door when their blood pressure is starting to elevate, when someone is diagnosed with pre-diabetes, or when giving early and optimum prenatal care can make a difference. We need to be listening to women and families and people, early and often.”
“I don’t feel like health care should be treated like a commodity. We are a developed nation, and we should start acting like that. People should not be disadvantaged because of their health insurance. If you want your society to be the best society, it starts with making sure everyone is healthy and productive. Health is a basic human right, and we should treat it that way. Optimum health makes a better workforce, better parents, better community members. It’s tied to everything.”
With Medicaid expansion passed and implementation on her mind, Elizabeth had a special message for state leaders. “It’s really important for legislators to think about the future. Leadership is an act of service. If you are not serving the people you are working for, then you’re not being a good leader. Listen to the people who you are charged with leading and take a look at what you want your community to look like. If you want your community to be safe, supported, connected, make sure your constituents and neighbors are healthy. That’s step one.”