Even with the Supreme Court ruling that the Patient Protection and Affordable Care Act, or "Obamacare," is largely constitutional, the contentious piece of legislation may not be fully implemented in more conservative states such as Texas.
In a public statement on Monday, Governor Rick Perry said, "I stand proudly with the growing chorus of governors who reject the Obamacare power grab. Neither a 'state' exchange nor the expansion of Medicaid under this program would result in better 'patient protection' or in more 'affordable care.' They would only make Texas a mere appendage of the federal government when it comes to health care."
The Texas Democratic Party responded shortly after, with spokeswoman Rebecca Acuña stating, "No person with a speck of intelligence would turn down billions in federal dollars that would be a boon to our economy and help Texans. [...] Rick Perry’s Texas solution is to let Texans stay ill and uninsured. That is not a health care plan."
Perry's announcement came more than one week after the Supreme Court ruled that the central provisions of the act were constitutional under the Taxing and Spending Clause. This decision came as a victory for the Obama administration, as the legislation has the potential to provide affordable health care coverage to a projected 17 million Americans by requiring nearly all American citizens and legal residents to purchase health insurance. However, opponents of the act -- such as Perry -- claim that, in addition to current health reform being a violation of limited government, the requirement will bankrupt the state. If implemented in Texas, the state will have to dish out about $6 billion. Although not a small amount, the federal government will provide the state with about $100 billion between 2014 and 2019 to enact the provisions such as setting up a state exchange and expanding Medicaid.
The story of health care in Texas is one of inadequate coverage and inefficient health care delivery for the poor and uninsured. Although this is the case for many states, Texas certainly stands out, since approximately one out of four Texans is uninsured. In a study released by the federal government's Agency for Health Care Research and Quality, Texas ranked 51st behind all the states and Washington, D.C., as the worst health care provider in the nation.
The state's Medicaid program does not cover "childless adults unless they are pregnant, disabled or elderly," and "parents of children [...] only if they make no more than $188 a month for a family of three." So those who are slightly above this threshold may find themselves unable to afford insurance with little to no governmental assistance.
Interestingly, many uninsured Texans are employed. Dr. G. Bobby Kapur, associate chief of the emergency room at Ben Taub General Hospital in Houston, observes that many of them are "hourly-wage earners, nannies, [people] working in lawn care services or dry cleaning or real estate, or people working two part-time jobs and neither will pay for health care. Many are small business owners who are well-educated and well-dressed." Emily Ramshaw of The Texas Tribune argues that the main problem is not the lack of health care providers in Texas, as Houston has world-renowned hospitals such as MD Anderson Cancer Center and Dallas has UT Southwestern, but the lack of access to high-quality care for the average person. When serious problems and illnesses arise, the uninsured will go to the emergency room because they cannot afford to see primary health care providers for preventive care. This puts a huge financial burden on the state. For those who are covered by Medicaid, they may have to wait months before they can schedule an appointment with their doctors because of the diminishing number of health care providers who are willing to accept Medicaid.
The act would increase Medicaid eligibility to adults with incomes up to 133% of the Federal Poverty Level (FPL) and cover about 1.8 million more Texans. However, even with the reform, there is concern that the number of Medicaid providers will not increase, resulting in even longer waiting times for patients.
Ramshaw predicts that Texas's dire need for funding will cause them to accept some of the funding from the federal government, but "under the auspices of a Texas-designed program."
For the time being, Perry seems resolute. "I look forward to implementing health care solutions that are right for the people of Texas. I urge you to support me in that effort. In the meantime, [health reform's] unsound encroachments will find no foothold here."