Death in Dallas: One Family’s Experience in the Medicaid Gap
Millicent McKinnon of Dallas was without health insurance for years. She was one of roughly 1 million Texans in the state who earn too much to qualify for Medicaid but not enough to get their own insurance. That is, until her death in 2019. She was 64 years old and had been unable to find consistent care for her breast cancer.
McKinnon’s daughter-in-law Lorraine Birabil said she was still mourning the loss.
“She was such a lively woman,” she says. “Just always full of energy and joy.”
Health insurance for about 2.2 million Americans is on the table as Congress considers a spending bill that could go as high as $ 3.5 trillion over the next decade.
This plan would extend health coverage to residents of the 12 states that Medicaid has not yet extended to their working poor through the Affordable Care Act. In these states, people who earn too little to qualify for Medicaid, but who cannot afford to get insurance in that market, are left in what is known as the Medicaid void. Like McKinnon, most of these people work in jobs that don’t have affordable health insurance.
If Congress approves the measure, these individuals would have access to a health plan through the federal government.
This could be a lifeline for some of the 17.5% of Texans who are uninsured, the highest rate in the country.
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. Most recently she worked as a home nurse and took care of the elderly and people with disabilities. However, Birabil said she didn’t make a lot of money and didn’t get health insurance.
And that’s why she put off going to the doctor when McKinnon started feeling sick.
“She had no coverage,” said Birabil, an attorney who served briefly in the Texas House of Representatives. “She did everything she could to lead a healthy lifestyle. When she realized something was wrong and 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.
“At the time we found out about it, we were also pregnant,” said 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 said the health system her mother-in-law worked in all her life ultimately failed her.
Laura Guerra-Cardus, assistant director of the Children’s Defense Fund in Texas, said proponents like her had been asking state lawmakers for years to insure uninsured Texans.
“But purely political opposition from our highest leaders, the governor and lieutenant governor,” she said, “is enough to block progress on an issue that is a fundamental right.”
Because of this, Guerra-Cardus and other health care advocates across the country are now turning to President Joe Biden and Congress to resolve this issue. The Democrats’ $ 3.5 trillion spending bill – Biden’s “human infrastructure” bill – includes funds to cover the uninsured through the health insurance market and government Medicaid programs.
Most of those who would benefit from it are people of color in the south.
“We ask them to choose to make America a country that won’t block anyone’s health care,” said Guerra-Cardus.
Racial disparities are pronounced in Texas, where approximately 70% of the people in the gap are Latinos or Blacks.
Jesse Cross-Call from the Center for Budget and Policy Priorities said this was the first time since the Affordable Care Act went into effect that Congress has had enough votes to address this issue.
“This is really the ACA’s unfinished business in ensuring that everyone in this country who is poor or on a modest income has access to affordable health care,” he said.
But this insurance lifeline competes with other priorities for money and attention.
Politico reported 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 people in the Medicaid void.
United States MP Lloyd Doggett (D-Texas), chairman of the House Ways and Means Health Subcommittee, said in a statement Tuesday that Congress “must permanently close this gap in coverage” in order to allow people in the 12 Republican-controlled states never again will health care be denied.
“Closing the coverage gap means gaining access to a family doctor, essential medicines, and other healthcare [millions] that have been left behind and left behind for more than a decade, ”he said.
Some Democrats have also raised political concerns that extending coverage to non-enlargement states would reward Republican leaders in states that have blocked Medicaid’s expansion for years.
Guerra-Cardus said 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 said.
In every state where Medicaid’s expansion was put to the vote, it has been voted for by voters, most recently in Oklahoma and Missouri.
This story is part of a partnership that includes KUT, NPR, and KHN.
alopez@kut.org, @AshLopezRadio
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