I was contacted through Facebook by a woman in Galveston County with a health care issue.
She is 63 years old and her only source of income is her monthly $988 Social Security check. She has been in excellent health and, except for work-required physicals, had not seen a doctor in 20 years ... until she broke her ankle.
She received treatment from a nearby emergency room where the doctor put a temporary splint on the ankle and referred her to an orthopedist. The orthopedist looked at her X-rays and said she had to have surgery which would cost at least $10,000.
Of course, the women did not have the money for the procedure. She returned home thinking that, if she was very careful, the ankle might eventually heal. After eight weeks, she removed the splint but, as one might expect, the ankle was still very discolored and swollen and she could not put any weight on it. A Medicaid case worker told her they couldn't help her and suggested that she move to another state to get help.
In Texas, unless a person has yearly income of less than $1,300, he or she cannot receive help from Medicaid.
Beginning in 2014, Obamacare expands Medicaid to cover individuals with yearly incomes up to $14,860. The federal government pays 100% of the additional Medicaid cost for the first 3 years. Beginning in 2018, the state pays a gradually increasing share but never more than 10% of the total cost.
Last year, when the Supreme Court ruled that Obamacare was constitutional, it also said that the states were not required to implement the expansion of Medicaid. They could opt out.
Governor Rick Perry has said that Texas doesn’t need or want to expand Medicaid. And Lt. Governor David Dewhurst recently declared that, in his opinion, expanding Medicaid is "off the table."
Even Jan Brewer, the conservative governor of Arizona, has chosen to accept the federal funds and expand Medicaid next year. She realizes that those not treated through Medicaid will end up receiving care from local hospitals, leading to higher fees for all patients and higher health insurance premiums.
According to an economic analysis by the Perryman Group, Texas would see a return of $1.29 for every $1 spent on Medicaid expansion, and the burden on local governments would be reduced by $1.21 for every dollar the state spent expanding the program.
The Texas Tribune recently cited a study commissioned by the Methodist Healthcare Ministries of South Texas and Texas Impact, which estimated Texas would receive $100 billion in federal aid over ten years at a cost of only $15 billion. The average yearly cost of $1.5 billion to expand Medicare is less than the amount that Governor Perry now wants to return to Texans because of its current ‘surplus’ of tax money.
According to the Methodist Healthcare Ministries and Texas Impact report, unreimbursed health care costs to counties and hospital districts totaled $2.5 billion in 2011, and counties spent another $254 million on indigent care and unreimbursed jail health care costs.
The Texas Medical Association and nearly every health care organization in the state have called on Texas to expand its Medicaid program. According to a January poll by the American Cancer Society Action Network, 58 percent of Texans support extending Medicaid services.
It makes sense to expand Medicaid both from a business perspective and for humanitarian reasons. The part of my story that many do not get is that ERs often do not solve a person’s medical problems. ERs treat people and send them home, perhaps with a prescription to fill or the name of a doctor to visit.
But without money to pay for medication or further treatment by a doctor, these people are unable to restore their health.
Twenty four percent of Texas residents (6.1 million) currently have no health insurance. This is the highest rate of uninsured in the U.S. As many as 1.8 million Texans would benefit from the expansion of Medicare under Obamacare.
As Molly Ivins once said of Texas:
"It's a low-tax, low-service state - so shoot us. The only depressing part is that, unlike Mississippi, we can afford to do better. We just don't."
Texas can, indeed, afford to do better.
I hope that my story will encourage readers to contact their state representatives and ask them to support the expansion of Medicaid in Texas.