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, 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.





  1. So– all 23 states (out of 50) which have declined to expand Medicaid are “Republican run” as in: having Republican governors and legislatures? Nearly half of the states in the country have NOT expanded Medicaid– and this is Rick Perry’s “fault”? None of that is very logical.

    • Governor Perry is only responsible for Texas having turned down the Medicaid expansion. The other governors are responsible for their own states.

      • OK–so you agree that 23 states (quite a few) also have declined to expand Medicaid. Some of these are probably not “Republican” states, and their elected officials have decided that Medicaid expansion is not desirable–just as Perry has. There was an article in the WSJ yesterday about declining Food Stamp use in states, like Texas, which are economically stable and which have enabled people to participate in the work force because of a good local economy, subsequently getting off of the welfare rolls. Most people want to be in an environment where they can be gainfully employed rather than in a declining welfare state. Being on Medicaid or other welfare is not ideal for the taxpayers or the welfare/Medicaid recipients. A good state economy is the most beneficial to all.

        • Yes, and Rick Perry has turned down 200,000 to 300,000 upper middle class jobs–enough to end unemployment in Texas, by refusing Medicaid expansion.

          • I am not even going to ask you to verify your numbers, I will ask you this, though, where is the money for those “jobs” coming from? Government jobs, paid with Government money, paid for by the people. Pretty soon everyone will be employed by the Government to enforce the Governments agenda, and those who actually contribute to the economy will be taxed to Death or Switzerland. New Utopia.

          • Perry has not “turned down” any viable jobs. Texas and other conservative well run states lead the nation in job creation.

        • Actually, the 20 states which have refused expanding Medicaid, and two of the three which are undecided, either have a Republican governor or Republican legislature. So yes, this is a partisan issue.
          Aas for foodstamps: in 1971, a college kid could get $200 a month in about 20 minutes. Here in Texas in 2014, a family making something like $20 grand a year for four people–essentially homeless people–make too much to qualify. Texas has never welcomed poor people.

          • In 1971 college tuition was 1/10th of what it is today.Part of education”inflation” has more to do with govt. policies and tenure policies gone wrong then anything else combined with lax immigration policies. You need to have a basic history and economics tutorial,Mr. Gorman. Perhaps a basic math course also. For the record, in 1971 very few college students or grad students needed to be on food stamps, because life was more affordable–something which would be nice to see today or in the future when govt is reined in.

          • What exactly do you see in today’s world that gives you any hope that government will ever be “reigned in”?

          • Economically there is usually a “tipping point” where a turn around is possible because the status quo is intolerable.

  2. First I must admit I have not finished the story because I got mad and had to put it down for a minute but I want to mention (in case this story does not) that the issue of affordable healthcare extends beyond the “poor” and unemployed/uninsured. I work and make a decent amount of money and I have a pretty good insurance policy. I pay a pretty hefty premium every month and with only a few minor health issues, I still can not afford to go to all the doctors I am supposed to see or pay for the diagnostic and preventative medical care I need. I have had to borrow money to cover my share. I know everything in this article about our governor is true and failure to expand Medicaid is a huge problem but the entire system is out of control. From where I am sitting it sure does fell like that as a country we simply do not care about providing quality healthcare to anyone but the wealthy. I recently paid twice as much for an MRI because I chose to run it through it through insurance so it could go against my deductible. What kind of scam is that and who is running this circus anyway?

    • To Stacy: The increases in insurance premiums and subsequent increase in deductibles has nothing to do with Gov. Perry or Medicaid expansion (which you probably would not qualify for -because you seem to be a hard worker- even if it was expanded–no offense). The insurance companies were 100% behind the PPACA legislation passed by the Obama administration and Democrat controlled Senate and Congress in 2010. To my knowledge no Republican voted for this cumbersome piece of legislation . Your premiums are high due to the mandates for coverage which are not applicable to much of the population. The fact is employers soon may not be able to subsidize your coverage–which will leave you further on your own. Meanwhile insurance companies are making more money than ever at your expense. As far as your MRI is concerned, most insurance companies have significantly reduced payment to outpatient facilities and non hospital physicians to a degree which makes it difficult for most physicians to stay in business. If you received an MRI in a hospital-the AHA has effective lobbyists, as do the health insurers- or in a hospital owned/affiliated outpatient or “mini ER” facility you will have to pay hospital prices which are 3-10X higher than ordinary unaffiliated outpatient facilities. The accreditation standards of cheaper outpatient facilities are equal to and frequently better than those at the hospital. Also many physicians direct patients to more expensive hospitals,surgery centers or imaging facilities where the primary care physician or surgeon has a part ownership. The referring doctor has an ethical obligation to disclose ownership or other financial ties to such facilities and this should be posted on the wall of the physician’s office. You should always ask, however. None of this,however has anything to do with Medicaid expansion in Texas or elsewhere.

    • I realize the two are not directly related and because of that, perhaps I should not have posted on this thread. I am just very frustrated. America claims to be the greatest nation in the world but we can not get this health care issue and many other equally

  3. Important issues handled in a suitable manner. I would love to blame Perry and while he is definitely part of the problem, it goes much deeper. Frankly I am embarrassed to be part of a nation where profit seems the only motivation for anything.

    • There are many people in this country who have sacrificed so that their fellow citizens could have a better life. Profit is not the ONLY motivation for anyone I know.

      • When Baggers & Repugs are mentioned, Mother Therrisa immediately comes to mind. Good point skeptic. You’re a real piece of work skeptic…you know that? I’m praying for you.

        • Oh goody –the FWW TROLL has come back to life with its personal contributions to humanity which are less than ZERO. Pray for yourself– Benny.

          • Why don’t you get a decent job and amount to something reader? What do you eat? Pull yourself up by your bootstraps. Where is the Startle-Gram hang out now, the bus station?