The Poor in Texas Are on Their Own for Health Care

Texas Governor Rick Perry is staunchly defending the right of his fellow residents to access to the worst health care system in the country, despite the efforts of the federal government to make things better.

“Please relay this message to the president: I oppose both the expansion of Medicaid as provided in the Patient Protection and Affordable Care Act and the creation of a so-called ‘state’ insurance exchange, because both represent brazen intrusions into the sovereignty of our state,” wrote Perry in an open letter to HHS Secretary Kathleen Sebelius. He is the sixth GOP governor to declare an open mutiny against the Medicaid expansion envisioned under Obamacare, which, to the horror of the conservative right, was upheld by the Supreme Court.

In particular, the Court ruled that it is legal to require Americans who can afford it to purchase health insurance, or be forced to pay a fine equivalent to 2.5 percent of their annual income. Simultaneously, the law mandated an expansion of Medicaid. Thanks to these reforms, around 40 million previously uninsured Americans will have guaranteed health care by 2014.

Governor Perry has for years been an advocate for states’ rights, and has even threatened that Texas would secede from the Union. State autonomy has become a favorite topic for conservatives. They often argue that state governments know better than the central authority in Washington.

According to Perry and other conservatives, Obama’s reform is the prime example of the overreach of federal authority. Firstly, it forces the citizens to buy a product, in this case health insurance; secondly, it coerces the states to expand Medicaid, which is partly financed through the states. Obama’s bill mandated that states that refuse to expand Medicaid would lose federal funding all together. This was one of the provisions, however, that the Supreme Court saw as unconstitutional. However, states that do expand Medicaid can see a large increase in funding. For example, Texas would have their Medicaid program funded 100 percent by Washington for three years, between 2014 and 2016.

By rejecting the Medicaid expansion, Governor Perry forfeited many billions of dollars offered by the federal government. This is controversial, since Texas has one of the worst healthcare systems in the U.S. Around 27 percent of residents, or 6 million Texans, do not have health insurance or any kind. In Houston, Texas’ largest city, 30 percent of the population is uninsured; the percentages are much higher as you get closer to the Mexican border. The Texas Democratic Party criticized Perry, saying that “… Rick Perry’s Texas solution is to let Texans stay ill and uninsured.”

Even those Texans who are insured under the Medicaid program have problems. According to a recently published report, only 31 percent of Texan doctors take Medicaid patients, down from 42 percent in 2010 and 67 percent from 2000. Doctors do not want to treat Medicaid patients because Medicaid only covers a fraction of the expenses, and even that small amount of money is predicated on filling out extensive amounts of paperwork.

What’s most shocking is the number of children who don’t have access to health care. Only 46 percent of Texan doctors accept children under CHIP (the Children’s Health Insurance Program). In Dallas, this number hovers at about 32 percent.

The situation in Texas shows the inefficiencies of the social programs initiated in 1965 by President Lyndon Johnson, which many states see as federal overreach. Medicare, a program designed for the elderly, is doing slightly better because it is directly financed by Washington. Nationally, 58 percent of doctors accept Medicare patients (down from 78 percent in 2000).