“A Broken Hip Shouldn’t Cost As Much As A House”: Bryan Tarnowski Shoots Medicaid Story for NBC News

Dec 6, 2019
Photographer Spotlight

There’s no getting around it. Healthcare is a complicated topic, one that can branch off into a dizzying, seemingly endless web of tangents. What’s not complicated is this: millions of Americans are suffering because, for a variety of reasons, they cannot afford to pay their medical bills. Already familiar with the debate surrounding Medicaid expansion due to where he lives, Bryan Tarnowski met and photographed some of those Americans for NBC News, who found the New Orleans-based photographer through Wonderful Machine.

Medicaid expansion is something I’m pretty familiar with. Because many of the southern states chose to not expand Medicaid after the Affordable Care Act was put into place during Obama’s presidency, it became an unavoidable topic. Fortunately, a couple years ago, our new governor in Louisiana did eventually decide to expand, which was an excellent thing as many of the deep south states have the highest levels of poverty.

Louisiana is one of 36 states (along with Washington D.C.) that has expanded its Medicaid coverage, meaning it receives $1 billion annually from the federal government to, you know, take care of its people. The 14 states that have yet to expand — Wyoming, South Dakota, Wisconsin, Kansas, Oklahoma, Missouri, Texas, Tennessee, North Carolina, South Carolina, Georgia, Florida, Alabama, and Mississippi — are leaving that money on the table and, predictably, are worse off for it.

The key thing I learned after working on this story is that there is now data that shows states that expanded their Medicaid program through the federal ACA grants are saving money on Medicaid programs, as compared to the states that did not expand.

As highlighted in the NBC article, a 2017 Health Affairs study found “expansion states did not experience any significant increase in state-funded expenditures, and there is no evidence that expansion crowded out funding for other state priorities.” In other words: expanding Medicaid is not too expensive for any state and is as close to a slam dunk investment as you're going to find. Here are some facts to back up that sentiment:

Thanks Cliff!
Sources: (1) (2) (3)

Among those 2.5 million Americans is Darlene Velasco, one of a handful Mississippians (the non-expansion state featured in the NBC article) Bryan shot for the piece. Darlene has Type 2 Diabetes but cannot afford to treat it. Without medication, her condition worsened over the years to the point where it essentially took away her vision. She was declared legally blind in May.

Darlene Velasco

Over three days, Bryan — as part of his first assignment for NBC — went around Mississippi to speak with victims and lawmakers about the fight for Medicaid expansion. Everyone he spoke with (key phrase: spoke with) was pro-expansion, even a Republican candidate by the name of Bill Waller, shown below.

I had complete freedom to make the pictures I felt would best support the story. I knew it would be very portrait-heavy because the story itself is a bit abstract, and I had to cover a lot of ground between portrait subjects, which didn’t leave much time to find reportage type images.

Ben Waller

I think the fact that Bill Waller, a Republican in Mississippi, was running with a plan to expand Medicaid is proof that that access to healthcare is not a partisan issue. It is simply a human right. Hopefully, this trend continues as the idea of health care for all becomes more mainstream and will run across party lines.

Thanks Lindsay!

Silence, as they say, is deafening. So while state representative Robert Johnson and Attorney General (then-gubernatorial hopeful) Jim Hood, the two Democrats pictured above, happily stumped for Medicaid expansion, Hood's opponent in the governor's race did not take part in the story. You can probably figure out why. 

I think the thing that stuck with me the most was the fact that [Gov. (then-candidate)] Tate Reeves refused to be interviewed or photographed for this story. To me, this gesture makes me think that he knows arguing against expanding Medicaid and access to healthcare is not a partisan issue and simply should be done. But because it has been made into a partisan issue and he’s running as a Republican, he has to toe the line and fall in with policies that simply will not benefit the people of Mississippi. 

Unfortunately for Darlene and a large number of Mississippi residents, Reeves won the election and will continue to neglect his constituent's needs because he doesn’t want his state to pay $100 million per year, a 10 percent match of the federal money given annually to states that expand Medicaid, staring in 2020. This investment would go a long way toward helping people like Sam, a waitress who makes $900 a month yet must somehow pay six figures because of an injury she suffered at home.

Sam tripped over her dog one evening and broke her hip. The hospital bill is now at $140,000! Access to affordable health care is not the only issue here. The cost of medical care in the US is so astronomical when compared to other countries. A broken hip shouldn't cost as much as a house.


Because our health care and insurance systems are so privatized, the fees for care are extremely high so that private insurance and hospitals can get paid. This disproportionately affects lower-income people who are underinsured and are therefore left with hospital bills that force them into financial disrepair and, many times, bankruptcy. 

One of the poorest states in America, Mississippi has the highest percentage of residents with past-due medical debt in the country. Not surprisingly, many folks there simply go without insurance — one study found that more than half the people in Mississippi identified exorbitant health care costs as the reason they don’t fill out a prescription, see a doctor, or complete a medical test.

There is no reason for states not to expand their Medicaid programs through the support the federal government is offering because it ensures more people have an opportunity to be insured while lowering the overall cost of Medicaid for the state. It's a no-brainer for Mississippi, which has some of the highest rates of poverty and some of the biggest budget deficits, to expand their Medicaid programs.

I asked Bryan what people who read this story can do to help. His response began with a one-word answer: vote.

Even if your state has chosen to expand Medicaid, look at your local House and Senate elections to ensure you continue to vote for those who will keep access to healthcare a priority in your state. And of course, with the presidential election approaching, consider voting for a candidate who has policy plans to ensure more people have access to affordable health care.


Photo Editor: Matt Nighswander

Check out more of Bryan's work at bryantarnowski.com.

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