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Texas' uninsured working poor could get health coverage under Congress' latest spending plan

An exam room at the CommUnity Care Health Center in East Austin.
Miguel Gutierrez Jr
The working poor in Texas are too poor to qualify for an insurance plan at, but make too much money to qualify for Medicaid.

The latest iteration of Congress’ Build Back Better spending bill would offer health care plans to low-income people in Texas who would be covered if the state didn't refuse to expand Medicaid.

An expected House vote on the spending bill was postponed Friday. If passed, it’s estimated hundreds of thousands of Texans could get health insurance starting next year.

The bill includes provisions that would allow low-income people to buy insurance on, the insurance marketplace created by the Affordable Care Act. Those individuals would qualify for plans with no out-of-pocket costs. The program would provide coverage for four years, and enrollment would be open all year.

Texas remains one of only a dozen states that have refused to expand Medicaid to more low-income people. Because of this refusal, it’s estimated somewhere between 700,000 to more than 1 million Texans have been shut out of the health insurance market.

Low-income people in these non-expansion states are often too poor to qualify for plans on, but they make too much money for their state’s Medicaid program. Experts have referred to this as the “Medicaid gap.” Advocates have been urging state lawmakers to close the gap for years.

Southerners for Medicaid Expansion, a coalition of organizations pushing for equity in health care, said it's essential for Congress to pass a solution to this problem.

"Closing the Medicaid gap is the single most important step Congress could take to tackle structural racism in our healthcare system,” it said in a statement.

Many of the states that have held out on expanding Medicaid are in the South and have large communities of color.

“It is no accident that 60 percent of the two million Americans in the coverage gap are people of color, and most live in the South,” it said. “Taking this simple step will help Americans access preventive care, mental health services, and cancer treatment. It will reduce our nation’s tragic maternal mortality rate, shore up struggling rural hospitals, and ensure our children, families, and communities can thrive.”

Laura Guerra-Cardus goes through canvassing talking points with health care advocates before they knock on doors as part of an effort to improve the state's uninsured rate.
Julia Reihs
Laura Guerra-Cardus goes through talking points with health care advocates before they knock on doors in 2019 as part of an effort to improve the state's uninsured rate.

Laura Guerra-Cardus, deputy director of the Children’s Defense Fund in Texas, said she has worked with many Texans in the Medicaid gap and it’s been heartbreaking.

“Some families have come to the [Affordable Care Act] marketplace to get enrolled only to find out they make too little to get financial assistance in the marketplace and have been quoted the full cost of the health plan,” she said. “People have cried at this news. Families have suffered. People have gotten sick. And Texans have died.”
Guerra-Cardus said she and other advocates have been pushing state lawmakers to extend Medicaid for a decade now.

“It has been painstaking work,” she said.

Despite bipartisan support in the Texas Legislature during the regular session, lawmakers did not make any serious efforts to expand the program to the working poor in the state.

Guerra-Cardus said if these measures make it out of Congress, it would be “huge for Texas,” which has the largest uninsured population in the country.

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Ashley Lopez covers politics and health care. Got a tip? Email her at Follow her on Twitter @AshLopezRadio.
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