Patters Barnes works two jobs, running the register at a retail store and cooking at a fast-food restaurant in Dallas. Neither employer provides her with health insurance, but they do influence her healthcare choices: Combined, the income from the two modest jobs is not enough to enable her to afford private insurance, but neither does she qualify for Medicaid in Texas.
Of course, almost everyone in Texas between the ages of 10 and 65 is currently disqualified from that system.
Which leaves Barnes between the rock and the emergency room when she gets sick. Last year when she noticed a change in an area of skin on her breast, she found a mobile clinic where she could get a free mammogram. The results raised enough of a flag that clinic workers sent her to a hospital to have it looked at. No one said the scary word “cancer” when hospital personnel recommended she come back in six months. But they did drop another scary word: $500, the cost for that checkup. She doesn’t have the money, and she didn’t go back.
Texas is one of the 23 states that have not expanded their Medicaid eligibility in order to fully implement the Affordable Care Act. Democratic legislators here say they had enough Republican votes to do just that in 2013, but because Gov. Rick Perry had adamantly stated his opposition, the effort went nowhere.
That has left roughly a million Texans unable to secure health insurance because they are not qualified to receive Medicaid as it currently exists and do not earn enough to receive federal subsidies offered by the ACA. It’s a situation that health practitioners estimate will cost 9,000 Texans their lives each year for lack of adequate medical care.
In an April 2013 press conference, Perry said that expanding Medicaid “would benefit no one in our state,” because taxes would skyrocket, and “our economy [would be] crushed as our budget crumbled under the weight of oppressive Medicaid costs.”
However, studies from a number of sources suggest that, instead, the Medicaid expansion would have produced something that Perry has always liked: thousands of permanent new jobs in Texas over the first decade, mostly in the well-paying medical and medical-billing fields.
Moreover, without the expansion, researchers found, local governments and hospitals will end up spending many times more on care for low-income Texans than the state would have spent on its share of higher Medicaid costs.
“The eight largest chambers of commerce in Texas begged Perry to expand Medicaid,” said State Rep. Lon Burnam of Fort Worth. “They all recognized that as a huge economic engine. Turning down Medicaid expansion was the stupidest thing that you could do economically.”
Last month, county judges from the six most populous counties in Texas wrote to the Texas Senate Health and Human Services Committee, urging members to find some way to insure Texas’ poorest citizens.
“The governor was terribly excited when Toyota decided to open a plant here in Texas that brought in about 2,000 jobs,” said Bee Moorhead, executive director of TexasImpact.org, a statewide interfaith social-action network. “Expanding Medicaid would bring in hundreds of thousands more jobs than that plant. It could be one of the biggest economic engines in the state. It’s incredible that Texans are not hounding their legislators to force Perry’s hand on this issue.”
There are people hounding Perry and Republican lawmakers in Texas, supporters of “Obamacare” readily admit — but for the most part they come from the deep ranks of those who, as Moorhead said, “simply want no part of Obamacare.”
That includes Michael Openshaw of the North Texas Tea Party.
“Who believes the feds when they have been wrong on every projection related to this bad law?” he said. The cost to the country, he predicted, would be either higher taxes or “massive debt that will crush the next generation.”
Not surprisingly, therefore, Perry is standing by his guns, although nine other Republican-led states have moved to expand Medicaid. Pennsylvania made the decision a few weeks ago, making about half a million working poor and lower-middle-class citizens in that state eligible for insurance benefits in January. Arkansas and Kentucky have also made great strides in getting their uninsured covered.
Perry’s office did not return a call asking whether the governor would reconsider his position, in light of the jobs figures and progress on insuring the poor in other states.
“He’ll never change,” an aide said in casual conversation.