SUTTONS BAY — Two years ago, Bruce Gokey went to Munson Medical Center's emergency room for treatment of flesh-eating bacteria and suffered a massive heart attack while hospitalized, his sister Ruth Schaub said.
In January, Gokey's health skidded again. He collapsed in his father's Maple City home. A blood clot had formed in his leg and drifted to his lung, triggering a pulmonary embolism. He was transported, unconscious, to Munson, where he suffered a second heart attack. Declared brain dead the next day, he was unable to hear his four siblings' tearful farewells.
Schaub said she learned at the funeral that her brother had been ordered to take blood thinner two years ago, but lacked the money to fill his prescriptions.
“Bruce was pathetically poor. He told his best friend, but not us,” Schaub said. “I don’t know if he was too proud or too private, but this was completely avoidable.”
Michigan lawmakers are considering a simplified and more expansive Medicaid program that would cover impoverished adults like Gokey who earn less than 138 percent of the federal poverty level. Expanded Medicaid is a key component of the Affordable Care Act and is supported by Gov. Rick Snyder, but opposed by Republican majorities in the state House and Senate.
Under the Affordable Care Act, the federal government would fully fund Medicaid for participating states for the first three years. Thereafter, it would fund 90 percent of costs, saving the state millions. The program is intended to help the 37 percent of Michigan workers who receive no health insurance, according to recent figures released by the Robert Wood Johnson Foundation.
Gokey applied but failed to qualify for state Medicaid, which mostly supports low-income pregnant women and children. Single and childless people under age 65 can't qualify for Medicaid no matter how poor they are unless they're on disability, said Jan Hudson of the Michigan League for Public Policy.
Michigan lawmakers contend they fear the federal government might not keep its promises to fund the program. Others believe Medicaid is the wrong way to go.
“Obamacare double downs on all the dysfunctions of the current health care system,” said Jack McHugh of the Mackinac Center for Public Policy, a conservative think tank. “Rather than go to the root of the problems, it doubles down on them.”
Schaub said her family personifies deep cracks in the health care system. Her brother qualified for Medicaid only after he died. Munson officials successfully made the argument he was disabled because he was blind in one eye.
At the time of his death, Gokey cared for his ailing father at his dad's dilapidated Maple City home. Ken Gokey suffered a heart attack about a month after his son died and spent 15 days in intensive care at Munson.
Gokey, 72, is now on round-the-clock oxygen and sleeps most of the day in a hospital bed set up in the pantry room of Schaub's tidy, Suttons Bay ranch home. His children and grandchildren take time off from jobs to stay with him, and worry he may repeat a grand mal seizure of a few weeks ago.
In a bedside interview, Gokey said his health insurance never fully covered medical bills. In 1962, his wife fell while pregnant with Bruce. The impact forced Bruce's rib into a lung, causing it to collapse at birth. Blue Cross/Blue Shield refused to cover the $5,000 hospital bill.
“They said they didn’t get the paperwork in time,” he said.
Gokey and his wife paid off the bill over years and socked away $40,000 in savings from his job at the Leelanau County Road Commission. Health problems struck again in 1985, when Schaub's mom was diagnosed with breast cancer. Six years later, she suffered congestive heart failure and diabetes and died of renal kidney failure in 1992.
Insurance didn't cover about $80,000 in bills, so Gokey negotiated with sympathetic doctors, drained his savings, and scrimped to pay the rest.
“You lived on damned near nothing,” said Schaub, standing by his bedside. “Saltine crackers and milk.”
“I kept the lights off, too,” Ken said. “I lived like a hobo in the house.”
Now Gokey has racked up $159,000 in medical bills. Medicare will pay nearly all of the $125,000 hospital bill and about 20 percent of everything else — lab services, doctor bills, and outpatient services. Gokey, who lives on a small retirement and Social Security, has no money to pay the balance of more than $7,000 or the incoming bills for his six-day hospital stay in March.
“It’s so ridiculous in price you can’t never pay the bill. A working man can’t," Gokey said.
Gokey privately confessed to Schaub that he is ready to die because he can't afford to live.
"This is his fate after working full-time to the age of 70 and raising six kids. It’s pathetic," Schaub said. "My biggest beef is that people have access to excellent medical care, amazing doctors. But they live in fear of going to the mailbox and finding another collection notice."
Ruth's sister, Jackie Gokey, works for a doctor's office and understands both sides.
“Oxygen places need to get paid. Pharmacies need to get paid. I see that. But how do you get help for a man who can no longer work?” she said.
Schaub said her father likely will die in her home with hospice care, which Medicare covers.The family plans to sell his Maple City home to pay his medical bills. Gokey said he no longer worries.
“We still live in a beautiful country and I’m still glad I wake up in the morning,” he said.