New Campaign Focuses on Texans in "Coverage Gap"

More than 40 statewide health care and religious organizations working to educate Texans on health plan options available through the Affordable Care Act are embarking on a grassroots political campaign to mobilize those who have been left in the state’s “coverage gap.” 

The groups’ new coalition, Cover Texas Now, launched its Texas Left Me Out campaign on Wednesday to educate uninsured Texans who do not make enough money to qualify for tax credits on health insurance and don’t qualify for Medicaid.  

With websites in English and Spanish, the campaign is collecting stories from Texans who fall in the coverage gap, and it hopes to motivate them to become more politically engaged. The coalition has also presented the Legislature with a letter alerting it to the campaign and its mission to close the coverage gap.

"The hope is that Texas finds a way to close the coverage gap for the more than 1 million Texans left without a way to get affordable health care coverage," said Laura Guerra-Cardus, associate director of the Texas branch of the Children's Defense Fund, a member of the coalition. 

Texas is one of 25 states that have not expanded Medicaid for low-income adults living below 138 percent of the federal poverty threshold. Gov. Rick Perry and other Republican leaders have argued that Medicaid is a “broken” program, and that adding more people to the program would cripple the state’s economy.

Members of the coalition are volunteering their time to operate the campaign’s websites and contact people in the coverage gap to ask them to share their stories and help put enough pressure on lawmakers to reconsider the issue in the 2015 session. 

While people with incomes between 100 to 400 percent of the federal poverty threshold qualify for tax credits to purchase private coverage through the federal health insurance marketplace, Guerra-Cardus said that for people in the coverage gap, “there is no product out there that they can afford.” She said that Cover Texas Now would continue the Texas Left Me Out Campaign until this is no longer the case.  

Although Republican lawmakers considered an alternative “Texas solution” to Medicaid expansion during the 2013 legislative session, they ultimately passed a measure requiring the Health and Human Services Commission to receive legislative approval before expanding Medicaid eligibility. That means the earliest that Medicaid expansion could again be addressed is in the 2015 legislative session, unless a special session is called to discuss this issue.

Meanwhile, more than 1 million Texans living in the coverage gap — under $11,490 for an individual, and $23,550 for a family of four — don’t qualify for any type of assistance under the Affordable Care Act.

Linda Berman, who owns a business in Denton County, is one of those Texans. As a diabetic, Berman has struggled to pay for health insurance and has not had coverage since 2009. In 2012, she racked up a $70,000 hospital bill while spending four days at the hospital. She had to file Chapter 7 bankruptcy and almost lost her home. 

"What I don't understand is that it seems like the people who are telling us we can’t have insurance all do,” Berman said.

Medicaid consumes one-third of Texas’ biennial budget, and conservative lawmakers and policy groups have argued the program should be heavily reformed to help eliminate the coverage gap, rather than expand the program.

Perry has pushed the Health and Human Services Commission to pursue a block grant — a fixed amount of money, rather than matching dollars for Medicaid services — from the federal government to fundamentally reform Medicaid. Specifically, Perry requested that the agency seek a waiver that allows the state to make changes to the program without receiving federal approval, and initiate cost-sharing initiatives, such as co-payments, premiums and deductibles, among other reforms.

The waiver “should give Texas the flexibility to transform our program into one that encourages personal responsibility, reduces dependence on the government, reins in program cost growth and efficiently improves coordination of care,” Perry wrote in a letter to HHSC in September.

Currently, “these federal dollars come with strings attached,” said John Davidson, senior health care policy analyst for the Texas Public Policy Foundation, which has laid out a similar block grant proposal. A block grant would allow the state to use the money for poor individuals to buy private insurance, he said, rather than expand Medicaid, "the worst kind of insurance that more and more doctors are not accepting." 

However, Guerra-Cardus said that the  Cover Texas Now coalition does not support block grants because they would reduce federal matching funds and cut services. 

State Rep. John Zerwas, R-Richmond, who led efforts to craft “a Texas solution,” said he hoped that the period between legislative sessions would give lawmakers a chance to work on a road for reform. However, he said he wasn’t sure that this particular coalition would have a significant impact, and he said a coalition of businesses concerned with health care issues would have a stronger impact. He said a business-focused coalition would “resonate especially with the conservative Legislature.”  

Texas has declined billions of dollars from the federal government to assist with Medicaid expansion and will lose $100 billion in federal funds over a 10-year span, according to a report by Billy Hamilton, a tax consultant and former deputy comptroller, for Texas Impact and Methodist Healthcare Ministries of South Texas Inc. The federal government would cover 100 percent of the Medicaid expansion enrollees’ health care costs from 2014 to 2016, then gradually lower its share of the costs to 90 percent over 10 years, resulting in 10 percent of financial responsibility for the state by 2020.

The Texas Association of Business, local government officials, and the state's largest medical associations, including the Texas Hospital Association, and Texas Medical Association, pushed lawmakers to expand Medicaid during the 2013 session, but the issue still failed to gain traction among Texas' conservative leadership.

This story was produced in partnership with Kaiser Health News, an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente.