In 2012, Tanya Walker took the $200 her father loaned her to see a doctor. She was in the aftermath of a divorce and needed a prescription for antidepressants, she said. But her doctor in Texarkana found signs of hypertension and prediabetes — problems Walker knew she could not afford to have.
Although her five kids were covered under Medicaid, Walker was ineligible for the state program and had no health insurance.
Walker fell into the uncertain terrain of the health care coverage gap — she earned too much from her part-time job at a local Walmart to qualify for Medicaid, but too little to qualify for tax credits for private insurance under the Affordable Care Act, better known as Obamacare.
Under Obamacare, Medicaid — the joint state-federal program that provides health care to low-income individuals — was intended to fill that gap by expanding to cover individuals who earn up to about 138 percent of the federal poverty level, or about $34,638 a year for a family of four. A recent ruling from a federal judge in Texas invalidated Obamacare, throwing the whole program into question; for now, the sweeping law remains in effect.
First, individual states had to agree to expand their Medicaid program, and the federal government offered to pay for 100 percent of states’ Medicaid expansion from 2014 to 2016 — aid that decreased to 90 percent by 2020.
But a number of states, including Texas, fought the Obama administration’s mandate to expand Medicaid, and in 2012 the Supreme Court ruled states were not required to comply with the mandate. That left about 638,000 non-elderly Texans in the Medicaid gap as of 2016 — the most among the states that didn’t expand Medicaid, according to the Kaiser Family Foundation.
“When the Supreme Court decision came down, people who were in that kind of middle-income band, they still had access to the subsidies through the marketplace,” said Rachel Garfield, associate director of the foundation’s Program on Medicaid and the Uninsured. “It was people at the lower end of the spectrum who were left without that coverage option.”
People like Walker.
Even after she got a job as a substitute teacher that paid around $800 per month — and offered health insurance through the school district — she still didn’t earn enough to pay the almost $1,000 a month for coverage. In Texas, substitute teachers don’t receive the same level of state contribution for health insurance as full-time teachers, said Amy Nix, director of human resources for Texarkana Independent School District.
Walker, 51, said Texas’ decision not to expand Medicaid under Obamacare left vulnerable Texans with few options for health care.
“It felt like in Charles Dickens’ Christmas Carol when Scrooge says, ‘Let them die and reduce the surplus population,’ ” Walker said. “That’s how I felt other Texans and my legislators felt about the working poor, ‘If you can’t afford insurance then we don’t care about you.’”
Many states, including Virginia and Louisiana, have since changed course and expanded Medicaid, while in other states — like Idaho, Nebraska and Utah — voters have bypassed their elected leaders to approve Medicaid expansion in recent elections. But Texas leaders haven’t budged on the issue and the state remains one of 14 with a coverage gap.
“Medicaid expansion is wrong for Texas,” Gov. Greg Abbott said during a 2015 press conference in which he called Obamacare a “massive expansion of an already broken and bloated Medicaid program.”