Richard Cotterill was 24 when he was diagnosed Hodgkin’s lymphoma in May 2013. Once Cotterill was unable to remain on his parent’s insurance he signed up for Ohio’s Medicaid expansion under the Affordable Care Act. The Enquirer/Cara Owsley
The Enquirer/Cara Owsley
How the Medicaid expansion in Ohio allowed one man to face the challenges of cancer and its consequences.
In four years of dealing with cancer and its consequences, Richard Cotterill, of Springdale has relied on a good attitude, his parents, his old dog Ranger and the mechanisms of the Affordable Care Act.
“Without this health insurance, my parents and I would probably be in massive debt, or I would be dead,” Cotterill said. “Some of the medicine I would need, if I did not have this health insurance, would cost thousands of dollars. And we just don’t have that kind of money.”
Cotterill, 28, and more than 700,000 Ohioans benefited from the Medicaid expansion in the Buckeye State to get health insurance. Yet uncertainty clouds the ACA’s future, even after the Trump administration’s first effort to repeal the law crashed.
As Congress debates its repeal and replacement, here are some details on how the law has affected the Buckeye State and its residents
Discussions have been revived on Capitol Hill to repeal and replace the health-insurance law. Congressional Republicans have reintroduced the repeal bill with some tinkering. Even if Congress does nothing, President Donald Trump, who blamed Democrats for the failure of the repeal attempt last month, has hinted that he may “let Obamacare explode” or withhold payments to insurers to force Democrats to negotiate.
More than 20 million Americans now have health insurance through the ACA. The reach of Medicaid, in particular, figures in the conversation. Cotterill is a key example of how Medicaid expansion was important for white men in Ohio. A report by the nonprofit group Policy Matters Ohio found that a majority of enrollees under the Ohio expansion were white, male, with a high school degree or less and without custody of a child. These men had higher levels of chronic disease than patients who had previously been on Medicaid.
Cotterill said that any reform that shrinks Medicaid would likely kick him out, but, “I try not to worry about things unless I can do something about it. But I’ve had enough challenges. I don’t need any more right now.”
Loving ‘Doctor Who,’ George Takei
Born in England, Cotterill was six months old when his parents Nigel and Sarah moved to Cincinnati. He loves all things English. On a wall of his cluttered room of his mother’s house in suburban Springdale hangs a drawing that a talented friend made of Cotterill’s first name with the Union Jack.
He folded his 6-foot-3 beanpole body into a desk chair with a foam square in the seat for extra padding. On one bookcase sit “Doctor Who” tapes. The window sill features an autographed photo of “Star Trek” star and Twitter king George Takei. Surrounding Cotterill are dozens of bottles of prescription medicine. To his right, a wheeled pole holds a bag of thick, opaque fluid.
One day in 2012, Cotterill was working in a restaurant and training to be a massage therapist when he got rear-ended while driving. A chiropractor noticed a lump on Cotterill’s left collarbone, which looked like a leftover from the car accident. But the lump grew, so Cotterill saw a medical doctor and underwent tests. After a long wait, “I called back, and he said, ‘Oh, yes, you have Hodgkin’s lymphoma,’ I was like: Huh. This will be fun.”
The state test for licensure as a massage therapist was four days later. He passed. The first photo on his phone shows his grinning face as he holds his certificate.
At his diagnosis, Cotterill was 24. Because of the ACA, he stayed on his parents’ health insurance through three bone-marrow biopsies, two six-month courses of chemotherapy, one round of radiation, two bone-marrow transplants, “and I still consider myself fortunate.”
“The best medicine I have found is to have a positive attitude, sort of a carefree attitude, but at the same time, you care about what’s going on,” he said. “But it’s not really in your control. Go with it, hit it one step at a time. Don’t think too far ahead. Don’t overplan.”
A faithful friend, at his side
At the front door to the house hangs a “Beware of Dog” sign. Ranger, the family’s retriever-beagle, stayed at Cotterill’s side through the treatment, “with me every step of the way.”
As Cotterill’s 26th birthday neared, he would need his own insurance. He wasn’t working, so his option was Medicaid. “You know, mid- to late-20s, typical procrastinator. Eventually, my dad and I did sit down and look it up online, and found all we needed and signed up.”
At about the same time, the lymphoma went into remission. But a consequence of the treatment arose one day when “I ate something, and my tongue felt like it was on fire. From then on, anything that touched my tongue hurt like hell. Even water hurt.”
The disorder is called graft versus host disease, which can occur after transplanted cells attack the recipient’s body. In Cotterill, the rejection manifested itself in mouth sores so severe that he stopped eating. He smiled at the memory. “I felt like I needed another challenge.”
A stomach port was installed so he could feed himself 12 pints of unflavored liquid nutrition every day. That’s what was in the bag hanging from the medical pole. He hasn’t had solid food in two years. He dropped from 210 pounds to 125. He’s now at 137 and feeling better, despite the disorder that forces him to spit into a bucket every few minutes. He isn’t well enough to get a job, but some days, he can unfold his massage chair and work on his mother’s shoulders.
Yet Cotterill is optimistic that he can beat the disease. He dreams of a traditional English breakfast – “eggs, bacon, beans on toast, glass of orange juice, nice and simple. Comfort food.”
Again, Ranger stayed with him. But age was catching up with the old dog, taking his vision and hearing. “About a year ago,” Cotterill said, “I was saying to Ranger: “I bet when I start to get better, you’re going to get sicker.’ ”
Thinking about the future
Medicaid pays for his 10 prescription medications that he takes every day, including a liquid steroid, an anti-fungal agent and an anti-viral drug. He has regular endoscopy so that the tissue-rejection disorder doesn’t close his throat.
Cotterill said he’s concerned over how Trump has tackled health care. “He should do more reading. He needs to spend time on what’s important instead of looking at his phone all day. He needs to take the time to listen and not talk over people.”
In early April, Cotterill decided he was well enough to plan to move out on his own, to an apartment closer in town. “I needed a motivation because if I just sit here all day, doing nothing, hooking up to eat and taking my meds, I won’t do anything. I’m glad to have a motivation, to get up, move, pack. I’ve actually gained a little weight.”
But Ranger won’t be going. On April 3, Cotterill made the difficult decision to euthanize him. “He was 17. Couldn’t walk anymore.” Even so, Cotterill shores up his attitude. “I’ve always looked on the positive side on everything. There’s a bright side. A silver lining. Like when we got back from the vet, my mom was crying, and she needed to be cheered up. So I said, ‘At least now, you get to sleep in.’ That’s the humor in our family.
“I have my days. I’m not always happy-go-lucky, cheerful all the time. Once in a while, I put a day aside, and let myself be sad. But there’s no point in being depressed and negative. I believe the best thing you can do is put a smile on someone’s face. Even if I don’t feel like it, I still try.”