Why One Million Texans Will Get No Insurance Help Under Affordable Care Act

Latoya White, 34, in front of a poster protesting the decision of Texas officials to reject federal dollars to expand Medicaid, the government insurance program for the poor.
Today is the last day to enroll in a new health plan under the Affordable Care Act, if you want coverage to begin January first. After that, enrollments will continue on a monthly basis through March. But there is one group of people who may be left permanently behind and will probably continue to be uninsured.

It wasn’t supposed to be this way.

Originally, the Affordable Care Act had two solutions for people who didn’t have health coverage through their jobs.

For middle-income people, they could shop for plans in an online marketplace, and some of them could get a federal subsidy to help pay for it.

And for the poorest of the poor, states would expand Medicaid to cover them.

But the Supreme Court made that optional, so 25 states, including Texas, are not expanding Medicaid.

That means people like Latoya White of Houston will get no help from the law. White has sickle cell anemia.

She recalls a frightening attack that eventually sent her to the emergency room.

“Without insurance, I wasn’t able to go to the doctor like I needed to. So I laid in my bed trying to take the pains that I was going through. Finally I couldn’t take it anymore.”

White is 34, has three children and lives below the poverty line.

She was hoping the law would help her get regular care from a hematologist, and it would if she lived in a state that is expanding Medicaid.

“Governor Perry is making it hard for all of us without health insurance. I don’t have that type of money to go to the hospital every single time I have a sickle cell crisis.”

A new study by the Kaiser Family Foundation reveals that White is one of almost five million people nationwide who will be left behind because their states aren’t expanding Medicaid.

A fifth of them, or about one million people, live in Texas.

Anne Dunkelberg is associate director of the Center for Public Policy Priorities, a left-leaning think tank in Austin.

She says it’s disturbing that the majority of the people who will be left behind in Texas and other states are people of color, either African-Americans or Hispanics.

“We frequently shy away from discussing issues of race and discussing issues of poverty but it’s pretty clear that this raises a serious question about the commitment of Texas and southern states to reducing poverty particularly among those working families.”

There is one other way White might obtain Medicaid.

She could apply for federal disability benefits, because her sickle cell disease has made it hard for her to find a new job.

But White says she doesn’t want to, and that shouldn’t be her only choice:

“I just don’t think I should have to go on disability to get healthcare insurance. I don’t think that’s right, I don’t think that’s helping in the long run. I still have years in me left, I would like to work.”

If politicians in Texas change their minds, they could decide to expand Medicaid to people like White at some point in the future, and the federal government would pay almost all of the cost.  

Bio photo of Carrie Feibel

Carrie Feibel

Health & Science Reporter

Carrie Feibel is KUHF's health and science reporter. She comes to Houston Public Radio after ten years as a print reporter...