Counters against low-Income healthcare barriers exist for Muncie and other Hoosiers

This article is published as part of a collaborative effort by students in the School of Journalism and Strategic Communication at Ball State University and the Ball State Daily News. Produced in a classroom setting under faculty guidance, the initiative aims to provide hands-on experience while informing the public through responsible, student-driven journalism.

David Robbins, sports coordinator at Ross Community Center and president of the Thomas Park - Avondale Neighborhood Association, recently went to get emergency surgery on his jaw, resulting in an unaffordable $13,000 bill. Having no insurance to cover part of the expense, Robbins took out a loan, costing him $125 a month. 

The life-long Thomas Park – Avondale resident in Muncie, Indiana, said he receives no insurance benefits from either of his jobs. While he doesn’t make enough to easily cover health care costs, he also makes more than the income limit to qualify for Indiana’s insurance program titled the Healthy Indiana Plan [HIP].

Robbins said he’s battled mouth disease for numerous years and can’t afford insurance for the regular periodontal work he needs forcing him to pay out of pocket whenever he needs to visit medical professionals while avoiding seeing doctors in other circumstances to save money. 

“Since I quit going to the doctor, all this stuff in my mouth just kept going untreated, and now here I am 10 years later having to have everything ripped out of my mouth,” Robbins said. 

Robbins is not the only one uninsured or facing socioeconomic-related barriers to health care. According to America’s Health Rankings data, Indiana ranked 27 out of 50 in states with the most uninsured citizens in 2023, and income inequality had the largest cause in Indiana on overall health based on a 2024 annual report on the state’s public health from the same organization. 

He knows neighbors who opt to keep low-paying jobs to remain eligible for state-supported health benefits. This decision prevents them from pursuing better-paying jobs because that means their higher income would cause them to lose their state-supported healthcare. 

“So instead of them progressing their lives and moving on up, instead of maybe being just a laborer and moving up to a managerial position where you'll make $15.50 but now you're at that threshold,” Robbins said in reference to the monthly income limit for HIP eligibility. “Now you don't get state insurance. Now you gotta pay for it.” 

CEO and President of Open Door Health Services [ODHS] Bryan Ayars said a barrier and trend for the uninsured with low income is to put off seeking health care services when they feel fine until they eventually need it, which causes more severe outcomes. 

“The disease or the malady that's further along has done more damage and is more expensive financially to the individual's health than if they addressed it early on or had gotten some preventive care,” Ayars said. “Research has shown that $1 of preventive care equates to at least $8 of care down the road.” 

Ayars further elaborated, suggesting American culture includes focusing on immediate needs like paying bills or affording food versus seeing health providers regardless of how people feel, which hurts the socioeconomically disadvantaged the most. 

“Those that have lots of time or money can be much more casual about how they prioritize their health. They are able to prioritize their health and then reap benefits down the road,” Ayars said. “Not everybody's able to do that.” 

Vice President of Impact at Heart of Indiana United Way Karen Hemberger said factors worsening health in low-income areas are seen as bad decisions from population members rather than an effect through reduced income.  

“For example, lack of access to healthy foods and food insecurity can lead to obesity when the only available and affordable foods are highly processed with low nutritional content,” Hemberger said.  

According to a 2024 peer-reviewed study by Unai Miguel Andres, Cydney McQuire and Whitley Wynns published in Indiana University Public Policy Institute, food insecurity is a major public health concern in Indiana for mainly low-income populations, and it’s associated with higher rates of chronic diseases like diabetes and hypertension. 

Robbins said food insecurity in the Thomas Park – Avondale community is a huge problem, and more of its members would eat healthier if they had greater access to such food. To address it, the Ross Community Center hosts a biweekly food market giving out healthier, more organic foods like vegetables, meats and dry goods to community members. 

“It’s expensive to eat healthy,” Robbins said. “When I show up to work at 8:30 or 9 in the morning, I have people sitting out here waiting in line, and we don’t start till 3 [p.m.].” 

Being the president of his neighborhood’s association group means Robbins frequently interacts with fellow members while helping them get what they need while improving the neighborhood’s quality. Efforts include community-based events, building new houses and expanding nearby health-related services.  

“I'm not one of those people that sits higher up than anybody. I'm actually on the same level as everybody,” Robbins said. “They will take to me a little better because I am one of them. I'm not somebody who's a CEO or a president of some big company.” 

A solution he sees to health care barriers for communities is bringing resources to the community within walking distance at little to no cost to reduce travel and expense limitations. For example, Robbins said he plans on starting a mental health and substance support group at the center with clinical support from potential places like Recovery Café and ODHS. 

“Having somebody knowledgeable in that section to run the support group, it would not make it clinical but would give them the clinical support they needed,” Robbins said. “And it's not just looking at them as a number or a name.” 

Hemberger said other solutions to reduce barriers include eliminating food deserts and making eligibility requirements for public benefits like HIP and Medicaid more reasonable. 

“There is not an easy solution, and it will take a multi-pronged approach to reduce these disparities,” Hemberger said. 

Speaking of Medicaid eligibility, Indiana has an ongoing piece of legislation titled House Bill 1023, which according to the Indiana General Assembly, adds work requirements for Medicaid eligibility. Currently, the bill is still pending with the most recent known action being Representative Julie McGuire added as coauthor in early January with action on the bill so far occurring through just the House of Representatives. According to a 2024 WTHR article, President Donald Trump's promise to cut funds risks a reduced-quality HIP due to a state trigger law enacted if federal funding falls below 90%. 

Ayars said these legislation possibilities produce large consequences for Indiana. 

“All of these things are intended to save the state money, which perhaps in the short term, it will, but it will increase the number of people who don't have insurance,” Ayars said. “For a state that has some of the worst health outcomes in the country, this doesn't make us a good place to live or work.” 

Eliminating socioeconomic barriers to health care starts with ordinary people to Ayars. He said talking to policymakers at all levels, even if it’s easier said than done, can lead to change. 

“The more elected officials hear that we're concerned, the more they're going to listen,” Ayars said. “There are organizations that do this all the time; they need more individuals as more voices.” 

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