Impossible Choices: What families face in the healthcare system

For parents and caregivers, the cost of medical care oftentimes forces them to make impossible choices. For me, I had to choose between my medical situation and my child’s treatment.

By: Trina Bruner | November 2023

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Every mother I know says she would put her child’s life before her own, but I didn’t—because I couldn’t. 

With rising costs of living expenses and medical care, working families, even some who have private or employer-provided insurance, are struggling to afford the healthcare they need. For parents and caregivers, the cost of medical care oftentimes forces them to make impossible choices. For me, I had to choose between my medical situation and my child’s treatment.  

Choices like the one I, and so many others, have had to make harshly impact North Carolina’s future—because when parents or caregivers can’t get treatment for their physical or mental health needs, their children often won’t make it to their doctor’s visits either. As Medicaid expansion takes effect in North Carolina, I believe that it will go a long way towards bridging that gap, improving the lives of families across the state, and ultimately keeping caregivers from making impossible, difficult decisions. Medicaid expansion will benefit us in the here and now, as well as for many years to come.  

We know that about more than a third of those covered under Medicaid expansion are parents, and it’s well documented that when parents and caregivers have health coverage and use it, the children in their care are also more likely to have and use coverage.   

What I want to convey to you is that while Medicaid expansion is a win for families in North Carolina, we must pay attention to how and why we got here—and remember what families went through while we waited for this solution. This is my story.  

My family has seen the good that can come from a program like Medicaid, because in 2005, Medicaid helped me safely deliver my second child.  

After ten years married and one child born through a high-risk pregnancy with many health complications, my husband and I found ourselves going through a financial hardship. Our small business had closed its doors, and we were left with debt to pay—all while we had to figure out how to start over, from scratch. 

Oh, and we were unexpectedly pregnant with our second child.   

I had one job, my husband picked up a second, but none of them came with health insurance. We still were barely scraping by, with just enough left for diapers for our oldest child. Adding another child felt dangerous, irresponsible even, and we wondered if it would be fair to our oldest child to go bring a sibling into the world. Another mouth to feed was going to stretch us even further—but we were so excited to meet our baby boy. We couldn’t imagine a world without him, even if it was hard to focus solely on the joy of new life in our family while also dealing with the heaviness and worry surrounding our financial situation.  

As small business owners, we’d paid for our first child’s arrival without insurance, which further contributed to our financial hardships at the time. We were no longer in a position to self-pay for a delivery or any additional care, so I went without prenatal care well into the second trimester. Having already been through one high-risk pregnancy, I want to underscore the anxiety of going through a second pregnancy without care. My family was terrified. I never would have anticipated that the two of us, who had always worked as much as we could, would ever need assistance to meet our family’s needs—but Medicaid was there, and I needed prenatal care.  

Asking for this help was incredibly humbling, and hard. One of the intake clerks assured me that everyone comes upon hard times eventually, and that’s why this program exists. Her words comforted me, and she really set the tone for what I would experience with all the caregivers who took care of me during my pregnancy and recovery, as well as those who ensured that this special surprise baby of mine had a healthy early childhood. Everyone who monitored my son’s progress from birth through toddlerhood and those critical pre-K years helped keep him on a path to good outcomes.   

Medicaid made it possible for me to have a baby at a time when I wasn’t even sure how we were going to provide for my firstborn. It kept my children healthy while my husband and I rebuilt our lives. Because of Medicaid, our children grew healthy and strong, while my husband and I got back on our feet. We could not have guaranteed that outcome without this program.

Fast-forward seventeen years, and that ‘surprise baby’ is a junior in high school. Our family is in a much different position than when he arrived in this world, but, unfortunately, so is the status of healthcare accessibility in North Carolina.  

In 2022, I had to choose between healthcare for myself or my child.  

My husband has been with his current job for about a decade now, and they provide decent insurance plans. Our family has to choose a high deductible plan in order to make the rest of our ends meet, so my husband and I play the game of waiting to get medical care for ourselves until our children’s needs have caused us to meet our deductible. Things that aren’t covered by our plan are delayed, particularly tests that aren’t covered, and sometimes they never happen at all. But we make sure the kids are healthy and get all their check-ups in. Like every parent, we do the best we can.  

Our “surprise baby” had exhibited a few tell-tale signs of ADHD during elementary and middle school—like being incredibly active, and sometimes procrastinating. His grades were always high, and he didn’t present any real behavior issues, so no one ever even suggested this was a possibility. We just thought he was really creative and talkative, because we couldn’t see how he was struggling internally. 

However, the rigor of high school classes and pressures of working, maintaining a social life, and giving his best in extracurriculars, began to show us that more was going on than we thought. The inability to focus in class meant so much more time working on assignments at home, keeping him up late. Testing anxiety got worse, as did forgetfulness and mental health struggles. It stretched our family’s budget to pay the $3,000 for an assessment, but it was a relief for him to know that there was help available for his struggles. 

And just when it seemed help was on the way for him, that’s when my health crisis hit. Last fall, I had an injury to both my foot and back while at work, and not long after that, my knee started swelling and causing me terrible pain. I had to choose: was I going to pay for my child’s care, or was I going to pay for my treatment? Ultimately, I had to choose my health because I had to work so we could make ends meet. The whole experience was gutting. 

There were lots of tests, x-rays, and visits to specialists. There were days I was unable to walk without limping, and even days where I couldn’t walk at all. I began having to call into work and had to call on others at home to carry my share of the chores.  

Fortunately, physical therapy brought me so much relief, and it gave me tools to help keep me walking and working – but it took time to get there. Months of PT visits added up, and we could not pay for both my care and for my son to see an ADHD specialist. We checked out books and listened to podcasts, and did everything we could to support him, but I will always feel guilty that I had to make him wait to get the help he needed.  

I had to choose between my own ability to walk and my ability to get my child the care he needed so he could focus in school. All of this was happening during his junior year—the year that colleges review a student’s GPA for potential scholarships. I had to choose myself in the year that he had his most rigorous classes ever, the year he had to take the SAT and ACT, the year that was most critical to his future educational career. But I needed to work, and I needed to walk. And I had to choose myself over my child.  

Medicaid gave my family a choice when we were pregnant in 2005. It helped us get through a tough and uncertain part of our lives—and using Medicaid helped keep me and my baby healthy through all of it. But later in our lives, when we weren’t eligible for Medicaid and when we only had a limited set of options, the only choices we could make as a family would come at the expense of one of us. I wouldn’t wish that circumstance on anyone.  

None of us know how high inflation will get, what the cost of living will be, and how expensive essential care will become. But what I know is that because Medicaid expansion is taking effect in North Carolina, more than half a million families will be able to make the choices they need for their health.  

My hope is that Medicaid expansion isn’t the end. There are families like mine across the state—and none of them should ever have to live with the guilt of being forced to not choose their children. None of them should ever be forced to make the impossible choices that my family had to make. There’s more we can do, more we should do, to make sure that healthcare is affordable and accessible for everyone.

Trina Bruner is a member of the 2023 cohort of NC Child Storytelling Fellows. The fellowship supports individuals with direct, lived experiences as they share their stories with organizations, community members, and thought leaders about how health policies like Medicaid play a role in their lives. 

Featured image was photographed by Jessica Badger-Rotenberg.