As it stands, Medicaid in Texas covers only children under 9 or people older than 65, those who are pregnant or disabled, and a thin layer of Texas’ poorest families. A family of three can have an income of no more than $313 a month to qualify — only about 19 percent of the federal poverty guideline and so little that, as one official said, it probably includes few beyond homeless families. Single, non-pregnant, non-disabled, non-elderly adults don’t qualify at all, regardless of how little they make.

The result is that Texas, by far, has the widest health insurance gap among the states, with both the highest rate of uninsured, at nearly 25 percent, and the largest number of uninsured people.

When the ACA — Obamacare — was signed into law in 2010, it called for Medicaid expansion across the country, which would have covered all those who earned up to 138 percent of the federal poverty guidelines — $15,856 for a single person or $32,499 for a family of four.

Moorhead: “Expanding Medicaid ... could be one of the biggest economic engines in the state.” Sean Hennigan
Moorhead: “Expanding Medicaid … could be one of the biggest economic engines in the state.” Sean Hennigan

Those earning more, up to four times the poverty standard, became eligible for federal subsidies to help pay for private insurance, with those making the least getting the largest subsidies. Companies paying insurance for their employees became eligible for subsidies as well. The federal government picked up the entire cost of the expansion for the first three years, diminishing gradually to 90 percent by 2020.

As soon as the ACA became law, Republicans began challenging its constitutionality in court. More than 50 court challenges thus far have resulted in only one partial — but important — victory for the Republicans. In June 2012 the U.S. Supreme Court upheld the act in all but one provision. States could opt out of expanding Medicaid without losing any existing Medicaid funds.

The decision allowed Perry and other governors to take a political stance that has affected healthcare availability for millions of people. Perry has said he’s convinced that the federal government would not be able to pay its promised share of the costs of the expanded benefits.

“The people it affects most are those people who can least afford to pay cash for medical care,” said State Rep. Garnet Coleman, a Houston Democrat who has worked since 1993 to make healthcare available to all Texans.

Coleman said he thinks Perry turned down the Medicaid expansion because the governor doesn’t believe in state-funded healthcare.

“We saw that as far back as 2003, when he turned down an opportunity to get children insured whose parents earned up to 400 percent of the poverty level,” Coleman said. “There was a program called Buy-in CHIP that would have been paid for by the parents — meaning the state wouldn’t have spent much money, if any at all.”

The legislator said there were enough votes in both houses of the Texas Legislature to pass Medicaid expansion — which means a lot of Republicans backed it — but Perry threatened to veto it if it got to his desk. “Which is why it never made it to his desk. People didn’t want to cross him,” Coleman said.

“I don’t know that Rick Perry really cares whether people get health insurance or not,” he added. “He cares about his politics. … I for one don’t understand using people’s lives for political purposes.”

Burnam called Perry’s stance political posturing of the worst kind, “That is Perry being his worst Rick Perry self,” he said.

A University of Texas track athlete found out about the holes in Texas’ Medicaid coverage when he lost coverage under Texas’ Children’s Health Insurance Program or CHIP. He had to have health insurance to stay on the track team, but the financial aid package that allowed him to attend UT-Austin wouldn’t stretch to cover private health insurance.

“My parents were poor and on Medicaid, and I was on CHIP insurance,” said the student, who asked not to be named for fear of embarrassing his family. “But as soon as I turned 19, I lost that, and I’m not eligible for Medicaid as it currently stands. That left me in a hole, because my parents can’t afford to help out.”

After months of searching for an answer, and just before he would have been off the team, he got pointed toward an insurance company that met the very basic sports requirements for just $38 a month.

“It doesn’t really cover anything, but now that I have it, if I get hurt, UT will pay all the medical bills,” he said. “It’s a crazy system, but that’s how it is. But none of this — the threat of being kicked off the team, of losing the grants, and then being unable to go to college — needed to happen.”




  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?