MP Lloyd Doggett (D-TX) introduced the Cover Now Act outside of the US Capitol on June 17, 2021. The bill aims to close the health coverage gap in Texas and 11 other states that Medicaid did not expand to uninsured adults. A similar solution is part of the spending bill debated in Congress this week and would provide affordable coverage for more than 2.2 million Americans. Win McNamee / Getty Images Hide caption
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Win McNamee / Getty Images
MP Lloyd Doggett (D-TX) introduced the Cover Now Act outside of the US Capitol on June 17, 2021. The bill aims to fill the health coverage gap in Texas and 11 other states that Medicaid did not expand to uninsured adults. A similar solution is part of the spending bill debated in Congress this week and would provide affordable coverage for more than 2.2 million Americans.
Win McNamee / Getty Images
Millicent McKinnon of Dallas was without health insurance for years. She was one of roughly 1 million Texans who made too much to qualify for Medicaid in the state but too little to get their own insurance. This was the situation until her death in 2019. She was 64 years old and had not been able to find consistent care for her breast cancer.
McKinnon’s daughter-in-law Lorraine Birabil says she is still mourning the loss.
“She was such a lively woman,” she says. “Just always full of energy and joy.”
Health insurance for about two million Americans is on the table as Congress considers a $ 3.5 trillion spending bill.
This plan would extend health coverage to people living in the 12 states that have not yet extended Medicaid to their working poor through the Affordable Care Act. In these states, people who are not poor enough to qualify for traditional Medicaid – but cannot afford to take out their own insurance in the respective market – are left behind in the so-called “Medicaid void”. Like McKinnon, most of these people work but do not have affordable health insurance offered through their work.
If Congress approves the measure, these individuals would have access to a health plan through the federal government.
This could be a lifeline for the people of Texas, where 17.5% of the population is uninsured, most in the country.
A career in healthcare doesn’t always involve health benefits
McKinnon was a descendant of runaway slaves who settled in Chicago. As an adult, she moved to Dallas and worked in the healthcare sector her entire career. Her very last job was as a domestic help – she took care of the elderly and the disabled. But McKinnon didn’t make a lot of money and didn’t get health insurance, according to Birabil.
And that’s why she put off going to the doctor when McKinnon started feeling sick.
“She had no coverage,” says Birabil, an attorney who briefly served in the Texas House of Representatives. “She did everything she could to lead a healthy lifestyle. When she realized something was wrong and she went to find out what it was, it turned out to be stage 4 breast cancer . “
The year after she was diagnosed, she hopped around hospitals. Doctors would stabilize her and send her home. Without coverage, consistent treatment was difficult to find. Her family looked for insurance but found nothing.
All they could do in the end was be there as she slowly died.
“When we found out, we were also pregnant,” says Birabil. “And she kept saying, ‘I just want to get to know my grandchild.’ And she didn’t make it. “
McKinnon died a month before her granddaughter was born. She was months away from getting Medicare.
Birabil says the health system her mother-in-law worked in all her life ultimately failed her.
Health insurance could help reduce inequalities among people of color
Patients and health care advocates have been asking state lawmakers for years to insure these uninsured Texans.
“But purely political opposition from our top leaders, the governor and lieutenant governor, is enough to block progress on an issue that is a fundamental right,” says Dr. Laura Guerra Cardus, associate director of the Children’s Defense Fund in Texas.
It is for this reason that Guerra Cardus and other advocates across the country are now turning to President Biden and Congress to resolve this issue. The Democrats’ $ 3.5 trillion spending bill – called Biden’s “Human Infrastructure” bill – includes money to expand health coverage to the uninsured through both the online health market and government Medicaid programs.
“We are asking them to choose to make America a country that will not block health care to anyone,” says Guerra Cardus.
When it first went into effect in 2010, the Affordable Care Act intended for every state to expand Medicaid coverage and provide access to uninsured adults with incomes up to 138 percent of the poverty line. (Those with higher incomes can purchase subsidized coverage on the online insurance marketplaces.)
However, in its 2012 ruling on the ACA, the Supreme Court allowed states to decide whether or not to expand Medicaid. Many countries implemented the change immediately, while others took longer. Some Republican-led states were forced to expand Medicaid following voter-led voting initiatives – most recently in Oklahoma and Missouri.
Texas is the most populous of the 12 states that have not yet expanded Medicaid. The remainder includes the 7 states of the southeast (Alabama, Florida, Georgia, Mississippi, North Carolina, South Carolina, and Tennessee) as well as the states of Kansas, South Dakota, Wisconsin, and Wyoming.
This is the first time since the Affordable Care Act went into effect that Congress has enough votes to address this issue, says Jesse Cross-Call, director of state Medicaid strategy for the Center for Budget and Policy Priorities.
“This is really the ACA’s unfinished job of ensuring that everyone in this country who is poor or on a moderate income has access to affordable health care,” says Cross-Call.
Most of the uninsured people who would benefit from the Congressional fix are people of color who live in the south.
The racial disparity is even greater in Texas – where roughly 70% of the people in the health insurance gap are Latinos or Blacks.
But this insurance lifeline competes with other priorities for money and attention.
POLITICO reported Tuesday that this plan could be curtailed as the Democrats negotiate an abridged version of the spending bill.
For example, some lawmakers have proposed reducing health coverage to just five years for those in the Medicaid void.
US MP Lloyd Doggett, D-TX, chairman of the House Ways and Means Health Subcommittee, said in a statement Tuesday that Congress “must permanently fill this gap” in order for people to live in these Republican-controlled states , never again be denied access to health care.
“Closing the coverage gap means access to a family doctor, essential medication and other medical care for [millions of people] who have been excluded and left behind for more than a decade, “he said.
Some Democrats have also raised political concerns – namely that extending coverage to non-enlarging states would reward Republican leaders in states that have blocked Medicaid’s expansion for years.
Guerra Cardus says the argument “is so far off” when it comes to why Congress should address the funding gap.
“This is about people dying in our rich country in the 21st century with preventable, treatable diseases,” she says.
This story is from NPR’s health coverage with KUT and KHN (Kaiser Health News).
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