Rick Perry’s refusal to cooperate with the Affordable Care Act and expand Medicaid has a heavy economic cost to the state of Texas, with $10 billion of GDP growth lost, $36 billion of Texas tax dollars that will go to other states’ Medicaid expansion, and even more that Texas hospitals will have to pay to cover the costs of the funding that Perry is giving up. But the cost of refusing to expand Medicaid isn’t just economic–it’s human too, and that comes in the form of the 2 million Texans who are losing health coverage because Medicaid is not being expanded.
The human cost of refusing to expand Medicaid was articulated powerfully in a piece by E. Tammy Kim at Al-Jazeera America this week. Kim told the story of Anissa Rangel, a 20-year old college student from Laredo, who has a chronic blood condition called “idiopathic thrombocytopenic purpura, a platelet deficiency that causes fatigue, bleeding and speckly bruises called petechiae.” When Rangel was a child, she was covered by Texas’ Children’s Health Insurance Program (CHIP), and was able to get treatment for her condition. She got kicked off CHIP at age 19, because Texas doesn’t cover poor adults “other than new moms or parents raising young children.”
Instead Anissa Rangel and her family members, who are almost all uninsured, use a combination of charity medical care and emergency room visits to manage a variety of chronic conditions. This can often lead to tough choices. Anissa’s mother, Alma Rangel, told Al-Jazeera, “Sometimes we don’t get tests done…Anissa needed this, [her father]needed that, and we choose. What is the priority?” When Anissa faced an acute episode of her idiopathic thrombocytopenic purpura, which left her with bleeding gums and mottled bruises on her body, her doctor had to advise her to go to the emergency room in San Antonio to get the tests she needed, because he knew they wouldn’t turn her away.
Al-Jazeera points out that one of the most insidious effects of the refusal to expand Medicaid is that poor Texans are blaming the Affordable Care Act for their difficulties, when it’s really Rick Perry’s fault. Texans like Anissa Rangel’s father, Jose Rangel, feel that “prior to the ACA, health providers were more attuned to those lacking coverage, whereas they now expect people to have insurance.” Many people who expected to be able to receive subsidized coverage through the ACA marketplaces have instead found themselves in the “coverage gap”, making too much to qualify for un-expanded Medicaid, but not enough to qualify for ACA insurance subsidies. For those who thought that “Obamacare” would help them, it feels like they are being wronged by the system.
As Andrea Guajardo, director of community health for the Christus Santa Rosa Health System, told Al-Jazeera, “The average customer did not understand Texas’ decision [not to expand Medicaid]. People were like, ‘I thought “Obamacare” was going to help me.'”
Of course, if the Affordable Care Act were implemented as it was intended to be, it would have helped them. But since Rick Perry thinks that Medicaid expansion is a “power grab” that’s like “a gun to the head,” vulnerable Texans are not seeing any of the benefits of the law. Implementing Medicaid expansion would have cost Texas nothing until 2017, and then only a dollar for every nine federal dollars–an incredibly good price to cover over a million Texans. Instead, individuals in the coverage gap have to increasingly have to rely on “emergency rooms and free clinics, pushing families, hospitals and state and local governments into debt,” meaning that these families are the ones who have to pay the price for Rick Perry’s actions, with both their health and their wallets.
Anissa Rangel’s case is a perfect example of this. Under CHIP, she used to receive free blood tests and paid only a $5 co-pay for the doctors’ visits she needed to manage her condition. Now, her co-pay is $25, and blood tests cost up to $75, which she has to pay out-of-pocket. The hospital bills from her ER visit to treat the acute episode of her condition earlier this year are adding an additional strain, and an allergic reaction to one of the treatments means she’s going to face even more bills. It is so bad that she has requested a leave of absence from Texas A&M International for the semester to save on tuition: “Tuition or medical bills — something would have to give.”
This is the sad truth of Texas’ refusal to expand Medicaid. As long as low-income Texans lack coverage, they will be forced to choose between their health and other vital expenses, like education–and that’s a choice they shouldn’t have to make. This is what it means when reports discuss Texas’ lost GDP from refusing to expand Medicaid. It means regular Texans who have to choose between paying for healthcare or paying for college, preventing them from academic achievements that lead to advanced jobs. It means families who have to go into debt to cover the cost of a life-saving ER visit and thus have less money to spend on clothes and shoes, cutting the consumer spending that is a key part of any economy. It means leaving Texans with the impossible choice between spending money on their health and spending money on anything else.
That’s why voting in this election matters so much. The future of Texas is at stake. Greg Abbott has promised to continue to deny Medicaid expansion, meaning Texans are going to continue to face unthinkable choices with their health. It’s not important to him that families are going into debt, and that students are dropping out of college to pay their medical bills. These problems affect all Texans, not just low-income ones. Local property taxes will have to rise in order to cover the added cost to hospitals to cover the uninsured. The entire state’s economic activity will suffer from the additional cost of healthcare. It’s up to you to make the right choice at the polls, so that Texans everywhere won’t have to face the impossible choice between their health and everything else.