Sandy Butler, University of Maine and Luisa Deprez, University of Southern Maine

Originally published in The Bangor Daily News on November 29, 2013

Thomas Ptacek is 46 and lives in Portland. He is single, has never married and has no kids. Thomas’s concerns are about the future — his and those like him. He is plagued by thoughts of his father’s and aunt’s multiple sclerosis and any genetic predisposition he might have to it. He is plagued by thoughts of the hip replacement surgeries both his father and brother have had, by the re-occurring knee pain from an injury he had while in the military, and by the new nagging pain in his ankle.

If any of these occur or get worse, how will he cope? How will he get the medical care he may need?

Thomas’s legs are, right now, his only form of transportation. His limited military benefits, however, don’t cover the costs of seeing a doctor or any diagnostic test that might be required. Preventative care, we are all told, is key to keeping at bay more difficult and costly problems later. But there is not much he can do to heed that advice.

“People think that because I am a vet I can get health care assistance, but there is not a lot the VA will do for me as I don’t have a service-connected disability,” he said. He can see a “primary doc once or twice a year and get blood work done and get some mental health services,” but that is about it.

MaineCare, which he “will lose come January,” affords him access to limited services should he need them. But he is careful about the services he uses, using them only in emergencies. Last winter he slipped and fell on the ice. He fell hard, had a hard time breathing and just hurt — but decided to wait it out, to give it time rather than rush to the emergency room.

“This is,” he said, “the first time in my life I have ever had to rely on outside services.” While he has MaineCare now, he is conscious about “putting forth the effort to not use it.” Thomas said he is hesitant to rely too heavily on MaineCare because he does not know how he will replace the support it provides him when he loses it in January.

Thomas worked an array of jobs when he lived in Lewiston — overnight shift at the Big Apple, opening shift at Pizza Hut. He was struggling. “I was paying the rent, keeping myself afloat but not getting ahead in any way.”

While he knew these jobs had little future, his search for work led him to accept the notion that, while “no job is beneath you, it can be beneath your skill set.” His previous job experience was mostly in his family’s now-defunct vending machine business — a “dying industry,” he said — that did not prepare him well for jobs available on the open market in these “new times.”

He was homeless for a time in Lewiston and began to “feel really bad” about himself. His intentions were always to get a better job, but when he arrived in Portland he found that “his tank was just empty.” He lived at the homeless shelter in Portland for about a year — “got stuck there” — and now understands he was having feelings of “hopelessness and helplessness” even though that was not who he knew he really was.

Not unlike other Desert Storm vets of his age, he seeks mental health counseling to keep grounded and able to confront and take on the challenges that pop up almost every day. For him, life is often “putting one foot in front of the other.” VA benefits are, however, limited for counseling, so what he gets is sporadic at best.

He would also like to get some dietary advice. While he has spent considerable time teaching himself about eating well, he “has reached the end of what he can get on his own.” To supplement his $22 per week food stamps benefit, he eats at least one meal a day at the Preble Street Food Kitchen. But the kitchen staff is limited in what they cook by the donations they receive. The meals are very much appreciated and, while flavorful, are high in carbohydrates and starch — not conducive to someone who wants to watch his weight and maintain his health.

The VA has a dietician but she is only available in Augusta or Scarborough. Both destinations require money for a bus ticket — an extravagance he can rarely, if ever, afford — and, including travel to and from, a day off, which lessens his ability to work as he is doing now.

Yet despite all his personal challenges, Thomas has taken on the larger policy challenge of ensuring that those in situations similar to his get the health care they need to “live a life of value” — one in which they can “work, enjoy family and friends, have stability and engage in society and get assistance when they need it” — not after it is too late or too costly.

He testified before the Joint Standing Committee on Health and Human Services this past year, urging them to pass LD 1066 to ensure “that those Mainers earning the lowest income will have the health coverage they need.” MaineCare, he said gives you a “feeling of safety should something happen. When you come out of any extended stressful situation, there are a lot of things that weigh on you, a lot of things that need to be addressed. Knowing that your medical needs are covered is one less of those weights on you.”

His current work is with Homeless Voices for Justice in Portland, which he described as “extremely rewarding, most important work I have done since working as a psychiatric technician in the Navy.” He has been with the group for about a year and a half and works with them anywhere from 10 to more than 30 hours a week. He gets an extremely small weekly stipend for his work, regardless of how many hours he puts in. A third of that goes to rent through a program with Veteran Assisted Subsidized Housing, leaving him little for much else.

Thomas understands the tenuous nature of his situation. He spoke openly about the possibility of larger issues that will really “undermine my stability and set me into a downward tail spin.” The new knot in the back of his left leg is painful, raising red flags for him but also acting as a reminder “of not having the luxury of getting it checked out” and taken care of in the long term. Buying health insurance on his own is “out of the question.”

It is, he said, “not at all easy to always be concerned about what might happen — and if it does, then what?”

Sandy Butler is professor of social work and is the graduate program coordinator in the School of Social Work at the University of Maine. Luisa S. Deprez is professor and department chair of sociology and women and gender studies at the University of Southern Maine. They are members of the Maine Regional Network, part of the Scholars Strategy Network, which brings together scholars across the country to address public challenges and their policy implications.