Irma Aguilar, a 28-year-old San Antonio native and single mother of four, struggles to make ends meet. As an assistant manager at Pizza Hut burdened with health problems, Aguilar finds herself caught in an almost unbelievable circumstance; she makes too much to be enrolled in Medicaid and too little to afford the program under the Affordable Care Act’s marketplace.
“I have no idea what I’m going to do … if I’m forced to pay hundreds of dollars a month for health care, I’ll be completely broke,” she tells the Current. “It’s very stressful and it’s just not fair to those of us paying taxes and working hard.”
Unable to afford treatment, Aguilar suffers from ailments including anxiety, high blood pressure and an injured back. She says securing a second job is out of the question due to the expense she’d have to incur for childcare.
Aguilar is not alone. She and an estimated one million poor Texans fall into the “coverage gap”—those left out of the potential benefits that come along with expanded Medicaid coverage under the Affordable Care Act, legislation designed to grant all legal U.S. residents healthcare. While 26 states accepted the expansion (including ones with similarly conservative guvs like Arizona’s Jan Brewer), Gov. Rick Perry, in a move criticized as a largely political gesture, refused the billions in public assistance. Today, Texans account for more than 22 percent of U.S. residents whose leadership denied them the federal assistance.
Who else got left behind? With the exception of being pregnant, disabled or extremely poor and taking care of children, adults under 65 with incomes below the poverty line, meaning below $958 per month for one or $1,963 per month for a family of four, could be left out. That includes thousands of veterans as well as retail, construction and food service employees in San Antonio. Perry’s decision left 179,654 Bexar County residents from obtaining Medicaid coverage, totaling $503.5 million forgone dollars, according to figures compiled by the non-partisan Kaiser Family Foundation. And, in Texas, the denial of federal funds hits Latinos the hardest—with 60 percent of the population uninsured as it is, some 583,000 Texas Latinos fall into the gap, according to Kaiser, far surpassing any other racial or ethnic group.
The failure to expand has allowed for some ongoing counterintuitive circumstances for Texans.
Anne Dunkelberg, associate director at the Center for Public Policy Priorities (CPPP) points to the example of a single mother of two making $18,500 and a single male with no dependents earning the same amount. In this case, the man is considered above poverty (defined as $11,670 for one person) and can sign up for the ACA marketplace but the mother, considered below poverty (family of three: $19,790), won’t qualify for either Medicaid or subsidies.
The ACA Medicaid expansion was meant to swoop in and help those like the single mom with kids, but since that didn’t happen in Texas, we’re left with a gaping hole. “The Affordable Care Act was never, ever intended to have this Medicaid piece optional, so there is no way to have it make sense without it,” says Dunkelberg. “We’ve essentially adopted a policy that discriminates against parents.”
A report released last week by the Working Poor Families Project examined the barriers facing low-income working mothers like Aguilar. It found families headed by single mothers make up 39 percent of low-income working family households, and almost half of those working mothers are employed in retail and service industry jobs that typically pay low wages, limit hours and fail to provide benefits such as health coverage. The number of low-income female-headed working families is on the rise, too—growing from 54 percent of the share of low-income working families overall in 2007 to 58 percent in 2012. By refusing the health care boost, the state further complicates the tough economic situation for the growing pool of poor, working moms.
As residents like San Antonio’s Aguilar suffer the consequences, a new campaign, powered by a broad coalition of groups—like Consumers Union, the interfaith Texas Impact, Progress Texas and CPPP—hopes to bring attention to their situations by showcasing the lives of those negatively affected by the refusal. The Texas Left Me Out initiative rolled out last October but made its public debut this month. The mission is three-pronged: it seeks to collect and tell the stories of Texans stuck in the coverage gap; connect them with affordable health care options; and create an activist network that’ll do everything from protest at the Capitol to attend legislative committee hearings.
The groups involved plan to ramp up their campaign as the 2014 election nears and lobby during the 2015 legislative session. As a snapshot of their force, they collected 1,000 online petition signatures in their first week alone.
“We want to make sure the people most impacted have a voice and build the momentum to drive toward a solution with state lawmakers,” says Tiffany Hogue with the Texas Organizing Project, a campaign partner.
It remains to be seen if this action will move GOP lawmakers still staunchly opposed to the ACA and Medicaid expansion. But in a state with the largest percentage of uninsured residents—more than six million Texans go without health insurance—the campaign team has their work cut for them.
Living in the wake of Perry’s decision, which leaves an estimated $100 billion in federal funds on the table over the next 10 years according to a study prepared for Texas Impact and Methodist Healthcare Ministries of South Texas, Inc., Texans like Aguilar grapple with the reality that state leadership would impede access to affordable healthcare in order to score political points. Thus far, state GOP lawmakers have not proposed any workarounds.
“If he would have accepted the money it would have been a lot easier for everyone,” Aguilar says of Gov. Perry. “It’s destroying my life and it’s destroying other families who are busting their butts to do everything we can to survive.”