Struggling NJ Residents Choose Between Medical Care And Eating

By Kristine Villanueva

Bill and Rose Morgan of Monroe Township are a retired couple who didn’t take risks with their money. They did everything by the book. They both worked stable jobs, retired at a reasonable age and lived modestly.

But they’re struggling to get by.

Their living room is small, with a couch and a TV and a reading chair where Bill rests with his walker nearby. To his left is what looks like a bowl of Cream of Wheat on a wooden TV tray. His wife always makes sure that he’s eating — after all, he had leukemia and has a heart condition that required a quadruple bypass.

But that’s what you do for your spouse of 60 years when they’re sick. Everyone needs to eat healthy food but especially people like Bill, who needs a balanced diet to ensure recovery.

A significant portion of New Jerseyans find themselves in similar situations. Of the state’s 3.2-million households, 28 percent are what the United Way of Northern New Jersey would describe as asset limited, income constrained but employed — or ALICE. There’s a growing number of families in the state who are unable to afford basic necessities like housing, food, child care, health care, internet access and transportation.

For a large portion of New Jersey residents, their financial situations are frighteningly precarious. People who don’t qualify for government assistance often find themselves having to choose between these necessities to pay for other expenses.

On the surface it may seem like Bill and Rose shouldn’t have to worry. Middlesex is one of the richest counties in New Jersey. However, a majority of people living in the county are food insecure. Sixty-two percent of residents make too much money to qualify for Supplemental Nutrition Assistance Program or SNAP benefits, formerly known as food stamps, according to Feeding America, a nonprofit organization with a nationwide network of food banks.

The connection between food and health seems obvious. But for people like Bill Morgan, who don’t have ready access to fresh food, the inability to pay for nutritious options can be detrimental to their health.

“I can’t buy anything I want,” said 82-year-old Rose Morgan. “I have to look for the price, for whatever’s on sale but now, he’s going to have to have special food, because he needs to gain weight. Because he’s way underweight, as you can tell.”

She explained that Bill lost muscle after a recent hip surgery and doctors were concerned that if he didn’t gain weight, he would have muscle spasms. Rose was feeding her husband about six times a day. Planning healthy meals on top of paying a mortgage and taking care of other expenses was difficult for the retired couple.

Like many New Jersey residents, the Morgans often find themselves picking between buying nutritious food and paying for health insurance. Both are necessary for Bill’s recovery, and evidence suggests that food insecurity complicates the ability to manage illness, according to a 2018 report from the Center on Budget and Policy Priorities, a nonpartisan policy-research institute that focuses on low-income people in the United States.

The report says that people who lack consistent access to adequate food spend roughly 45 percent more on medical care per year ($6,100) than people in food-secure households ($4,200). This research also shows a strong correlation between food insecurity and chronic health conditions among age groups ranging from children to seniors.

After Bill retired, he found himself in a fragile financial situation, making paying for health care and food a persistent problem. Now, even with Medicaid, the Morgans pay around $400 a month for Bill’s heart medication.

Before retirement, Bill was working in Newark as a tool-and-die maker on constructed metal forms called dies that cut, shape and form metal with other materials. After his industry flattened out, the couple moved to Monroe Township, where Bill got a job as a custodian for the Old Bridge school district. After working there for a little over 22 years, Bill was laid off when the school district started using outside contractors for their janitorial staff.

“He lost all his medical and half of his pension because of that,” Rose said. “And because it wasn’t 25 years, he lost. Think of that.”

A tough financial situation makes achieving a healthy lifestyle difficult for people who have medical issues. Thirty-seven-year-old Debra Oliveda of New Brunswick has a number of ailments, including upper respiratory issues, irritable bowel syndrome, a bacterial infection called Helicobacter pylori in the lining of her stomach and polycystic ovary syndrome. She also had the Epstein-Barr virus as a child, which is associated with a swollen throat and lymph nodes, and has flare-ups every so often.

Cost is a factor in treating these conditions. Oliveda says a poor diet triggers her muscle pain.

“If I eat processed foods, foods that are full of herbicides, pesticides or preservatives, it will make the symptoms worse, it will create the conditions that make me feel worse, make me feel uncomfortable, make me feel sick,” she said.

She explained that her husband was the main source of income in their household. Once they divorced, she had a hard time landing on her feet. Having been married for only five years, she didn’t get much from the settlement and eventually found herself without a home. A friend who previously did not have a place to live took her in.

Oliveda said she doesn’t qualify for Medicaid because she doesn’t meet the income requirements. Her experience acquiring health insurance through the Affordable Care Act on healthcare.gov has been confusing. Now, she pays about $150 a month for health insurance.

“It’s very expensive. And I can’t even go to the doctor because there’s a specialist copay of $35 that I can’t afford, and I have to choose [between] going to the doctor and eating,” she said.

Before she divorced, she was working retail and volunteering for a nonprofit focused on environmental issues. Her volunteer work was her passion: Oliveda left her retail job to work at the organization full time.

It wasn’t until after she was hired that her company told her that she wasn’t guaranteed full-time hours. She makes $15 an hour at the nonprofit, working roughly 29 hours a week. United Way’s report says that roughly half of all jobs in the state pay less than $20 per hour. Oliveda makes way less than the $28.86 an hour she would need to afford a modest apartment.

While looking for another job, Oliveda said that she found herself in many situations where she had to make difficult choices. One of her ongoing challenges is affording a way to travel around the state.

“I have to choose one over another, and that $35 will go to food, or to put gas in my car. So, it’s not, it’s not affordable,” she said. “I had to make the choice between living in a place or a car — and I need my car, because in New Jersey [we are dependent on our cars] because of our infrastructure.”

The Morgans face similar setbacks. They get fresh fruits and vegetables from New Life food pantry in Helmetta. The elderly couple needs a car to get there. The only form of public transportation they have is the M2 bus and the closest stop is a 20-minute walk from their home.

The challenges the Morgans and Oliveda face aren’t unique. The U.S. Department of Agriculture says that access to affordable and nutritious food depends largely on vehicle access.

“You pray every day that you won’t get ill, that you [won’t] need to put out money that you don’t have,” Rose Morgan said.

Over 3-million people could lose their SNAP benefits nationwide under a new proposal from the Trump administration. U.S. Secretary of Agriculture Sonny Perdue claims the plan would close a “loophole” that allows states to make participants receiving minimal Temporary Assistance for Needy Families benefits automatically eligible to participate in SNAP.

Perdue says that closing this loophole would prevent “abuse of a critical safety-net system, so those who need food assistance the most are the only ones who receive it.”

Welfare fraud happens but it’s rare. According to the U.S. Government Accountability Office, in 2016, just 10.6 percent of welfare claims made were improperly filed or fraudulent.

On average, a SNAP recipient in 2017 received $126 a month in assistance — roughly $1.40 per meal. To qualify for SNAP, net income after deductions must fall below the poverty line. Households without a member who is elderly or has a disability must have assets of $2,250 or less. Households with an elderly or disabled member must have assets of $3,500 or less.

Right now, states can remove or relax SNAP asset limits beyond the ones set at the federal level. But under the Trump administration’s proposal, states would no longer have that flexibility.

A 2018 study from the Urban Institute says that setting SNAP asset limits could hurt people who are already experiencing economic hardships. And when faced with such limits, struggling families might choose not to accumulate assets or might spend down their assets to become or remain eligible for SNAP benefits.

A person making a gross income that is 130 percent above the federal poverty line — for a single person, that amounts to roughly $16,000 in income and more than $2,250 in assets — would also no longer be eligible to receive SNAP benefits under the USDA proposal. That puts people like Oliveda and the Morgans in a bind.

As the report from the Center on Budget and Policy Priorities shows, there’s strong evidence that cutting SNAP benefits could harm health and eventually raise health-care costs. On average, low-income adults participating in SNAP spend nearly 25 percent less in medical-care costs in a year than non-participants.

Many people who are trying to break out of poverty have a hard time qualifying for assistance.

“I mean, sometimes people are working just to pay rent, sometimes you don’t even have money left over to pay [for] other things, or to buy food — but still, you can’t get food stamps because you have two jobs, and you’re over the guidelines,” said Lizette Thomas of Highland Park.

Thomas works as a supervisor at a Rite Aid and for Women, Infants and Children Nutrition, or WIC, a program that helps pregnant moms and infants. She says working two jobs is tiring and often feels like she’s caught between two hard choices. She needs to work two jobs to take care of her autistic son and her elderly mother, who has osteoarthritis and osteoporosis.

Since she works two jobs, she makes too much money to qualify for certain benefits, like SNAP, but still has trouble paying for basic needs.

“Well, because you work two jobs, they have guidelines,” Thomas said. “And I only have one child, and my mom, if you don’t meet their guidelines, if you’re over their guidelines even by a penny, you don’t get it.”

Thomas said that her mother also doesn’t qualify for benefits. Thomas moved to the United States from Panama in 1989. Her mother joined her about four years ago but to qualify for SNAP or Medicaid, she needs to be a U.S. resident for at least five years.

Instead, they use charity care, or free or reduced-cost treatment for “only necessary hospital care.” Charities also don’t cover medication — and Thomas said that the quality of the treatment she receives isn’t as good as what she would get if she had private insurance.

According to the United Way of Northern New Jersey, 44 million people in the United States care for a parent, spouse, child, sibling or friend with a physical or developmental disability, chronic illness, mental illness or aging-related challenge. Caregivers often put their own physical, mental and financial health at risk.

Since moving to the United States, Thomas has more or less been on her own. When she was pregnant with her son, her boyfriend died after being stabbed.

“It was a nightmare, a complete nightmare, being pregnant, six months pregnant,” she said. “It was very sad. But I got over it. I still think about it every day, it’s something that you’ll never forget. But I try not to dwell on it.”

After she immigrated, she started attending Middlesex County College. One semester, she got sick with Lyme disease and took a break. Afterward, she didn’t go back to school.

Now, she wants a better life for her son. They are currently looking for grants and scholarships to help pay for his college tuition. Despite the obstacles, Thomas says she’s grateful for her life.

The costs of living for ALICE households require a delicate balancing act. People who fall into this category are making the best of what they have.

“You know, I just wish it was different, wish I had a different job, wish I had finished school, but like I said, life is what you make it, and hopefully before I leave this earth, it will change,” Thomas said.

Originally appeared on 37voices in September of 2019; this was pre-pandemic times (BC: Before Corona)

Kristine Villanueva

Kristine Villanueva is the project editor for Resolve Philly’s initiative Equally Informed, which aims to provide news to communities in the city that are affected by the digital divide. Before Resolve, she have worked on engagement at The Center for Public Integrity, POLITICO, Free Press News Voices New Jersey and Spaceship Media. In addition to digital strategy and community engagement, Kristine also has experience with social media management, newsletter writing and distribution and managing multi-partner collaborations.

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