Texas is the nation's most uninsured state, and San Antonio residents live with the consequences of leaders' refusal to take federal money to expand coverage.
People without insurance coverage often end at emergency rooms when they have medical issues — the priciest place for them to end up.
"I haven't had Medicaid in a few months, so I just try to do everything at home," said Martinez, 28. That includes trying to cope with a diagnosis of anxiety while taking care of three children, including two with special health needs. Texas Republicans, particularly those in leadership roles, continue to successfully run for reelection on red-meat issues that include saying no to additional publicly funded healthcare. Texas is one of 10 states, mostly in the South, which have turned down Medicaid expansion funds from the federal government. That's not been an oversight by Lone Star State leaders but a deliberate choice by Gov. Greg Abbott, a Republican, and the GOP-dominated Texas Legislature.
Also, some pregnant women who would normally qualify for Medicaid during their pregnancy lost coverage when the automatic re-enrollment offered during the past three years ended in April. Meanwhile, down-ballot candidates have adopted the same"ultra-conservative talking points that public [spending] for health care is bad," she said."We have a governor who doesn't want to take billions and billions and billions in federal dollars."
The coverage gap faced by 1.4 million Texans arose after the passage of the Affordable Care Act, popularly known as Obamacare. The resulting coverage gap in Texas starts at 16% of the federal poverty level, the lowest threshold in the country for adult parents to qualify for Medicaid. Adults not raising children and parents over the Medicaid threshold can buy individual ACA insurance, but they have to pay full price because they make too little for federal subsidies.
"I've put off my eye exam twice now after seeing how much they wanted to charge [for the visit] with no insurance," Nanda said."Now it has increased and is a minimum of $179 without insurance."Texas lawmakers justify their refusal to expand Medicaid by saying they're being fiscally conservative and protecting taxpayer dollars. Even so, someone's still picking up the bill to provide medical access for some of those who have fallen through the cracks.
In contrast, University Health, Bexar County's hospital district, has a tax rate of 27 cents per $100 of valuation. That makes up about 18% of the revenue, while the rest comes from sources including state and federal insurance programs and commercial insurance, according to Hernandez. Rural health systems can't access enough tax dollars to provide a wide variety of services closer to home or to take on a heavy load of uncompensated care, Henderson said. Since 2010, Texas has faced 26 temporary or permanent rural hospital closures, according to TORCH data. Another 76 facilities are considered to be in crisis and at risk of closing.Elysse Adkins speaks to a Texas Health and Human Services advisor about her health coverage options at a recent San Antonio Food Bank event.
It also keeps people out of hospital emergency rooms. Even though ERs should be a last resort, they remain the place where many uninsured end up receiving their health care. University Health also contracts with community health organizations such as CommuniCare and CentroMed to provide indigent care through clinics they operate around the county.
However, obtaining medical care is not so easy for the uninsured. About one in five have challenges that keep them from obtaining care, such as a lack of transportation or not having enough money to afford medications that they're prescribed. One such initiative in partnership with Feeding Texas is the Referral Partner Program, which is doing needs assessments for thousands of Texans through 19 member food banks around the state, including the San Antonio Food Bank.
Like Texas' state government, Oklahoma's Republican-controlled legislature and state leadership dodged covering the working poor for years. The measure passed with 50.49% of the vote, with those voting"yes" coming primarily from urban counties, including those where Oklahoma City and Tulsa are located.
There's no provision in state law that allows initiatives that originate directly from citizens to get on the ballot. Uninsured people attend a San Antonio Food Bank event aimed at helping them see if they qualify for Medicaid coverage.One incremental step forward in expansion — and a step years in the making — is the state's recent extension of post-partum Medicaid eligibility for mothers from 60 days after birth to a full year.
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