More than 700,000 Texans have signed up for a health plan through the online insurance marketplace. For that group, the Affordable Care Act appears to be working.
But an even larger number of Texans — one million or more — still have no access to affordable coverage because Texas officials opted out of a federal plan to expand Medicaid for the poorest adults.
From the Here & Now Contributors Network, Carrie Feibel of KUHF explains.
ROBIN YOUNG, HOST:
From NPR and WBUR Boston, I'm Robin Young. It's HERE AND NOW.
And we want to take an occasional look at health care. In Texas, more than 700,000 people signed up for a health plan through Obamacare, the federal online insurance marketplace. For that group, the Affordable Care Act seems to be working. But an even larger number of Texans, one million, had no access to a health plan they could afford.
From the HERE AND NOW Contributors Network, KUHF's Carrie Feibel explains from Houston.
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CARRIE FEIBEL, BYLINE: Terry Jordan spent many years working for the Harris County Appraisal District and he had good benefits there. But when the Houston resident decided to start his own landscaping business, he left behind the health coverage.
TERRY JORDAN: I've done great. I've worked all these years. I've accomplished a lot, I have a lot. And everything is paid for. But if something was happen to me, and I would have something like an eye injury or a broken leg or something or other, I would have to sell my place to pay for the medical bills.
FEIBEL: Jordan is 56 and healthy but a private health plan always costs too much. After paying for subcontractors and equipment - like a new trailer last year - his gross income fell below the federal poverty level. For a single person, that's just under $12,000 a year. So when the Affordable Care Act marketplace opened for business, Jordan couldn't wait to check out the health plans and government subsidies.
At first, he thought he would qualify for a plan costing just $79 a month.
JORDAN: I was very excited, very happy, got on the phone, called around. I told y'all Obamacare was great. Obamacare was great.
FEIBEL: But then Jordan learned he was actually too poor to get a subsidized plan. The subsidies were for people above the poverty line.
JORDAN: I knew it was going to help me but then I was real surprised when I found out, 'cause I've done good. I was real surprised to find out, whoa, I didn't qualify for it 'cause I didn't make enough money. I was very shocked at that.
FEIBEL: Originally, poor working adults like Jordan were supposed to be added to the Medicaid program. Anne Dunkelberg is with the left-leaning Texas think tank, the Center for Public Policy Priorities.
ANNE DUNKELBERG: It was an accidental outcome when Congress wrote the Affordable Care Act. They never anticipated that the Supreme Court's decision would make the Medicaid piece of it optional.
FEIBEL: But Texas and about half the other states opted out. That left people like Jordan without Medicaid. Dunkelberg and other advocates want the Texas legislature to reconsider next year. A coalition of Democrats, hospitals and chambers of commerce across Texas is pushing a compromise called the Texas Solution.
DUNKELBERG: Several other states have gotten 1115 Waivers, which is a wonky term. But its basically it's a formal sort of contract with the feds to break some of the usual rules of Medicaid.
FEIBEL: For example, some states did expand Medicaid to more poor adults but required them to pay a small fee for doctor visits. Ideas like that, where patients contribute more to the cost of their care, appeal to some Texas Republicans. But others are skeptical.
John Davidson is with the conservative think-tank, the Texas Public Policy Foundation.
JOHN DAVIDSON: If a Texas Solution, you know, is just sort of window dressing for expanding Medicaid, according to the dictates of Washington, D.C., then we're not for that because that will exacerbate problems that are already in the system.
FEIBEL: Davidson wants the federal government to give Texas a block grant of Medicaid money with no strings or rules attached. But the federal government has never given a block grant like that to any state.
For now, if Terry Jordan gets sick he'll go to Legacy, a federal qualified health clinic in Houston. But it's not comprehensive coverage and he's still disappointed with the Republicans in Texas.
JORDAN: The poor working class is really getting left behind. Way behind.
FEIBEL: If Jordan can earn just $5,000 more this year, that will push him back over the poverty line. That means next year, he can buy a subsidized plan online.
For HERE AND NOW, I'm Carrie Feibel in Houston. Transcript provided by NPR, Copyright NPR.