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Rick Perry’s Refusal to Expand Texas’ Medicaid Program Could Result In Thousands of Deaths

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Members of the Texas Chapter of ADAPT celebrate the United States Supreme Court’s upholding of the Affordable Care Act, also known as Obamacare, in front of the Texas Capitol.
Jeff Newman/Globe Photos/ZUMAPRESS.com
Members of the Texas Chapter of ADAPT celebrate the United States Supreme Court’s upholding of the Affordable Care Act, also known as Obamacare, in front of the Texas Capitol.

You could say that the idea for Medicaid began in Texas. In the late 1920s, a middle-school teacher named Lyndon B. Johnson saw the crushing poverty and inequality his Mexican-American students faced in the small South Texas town of Cotulla. Nearly 40 years later, then-President Johnson declared a War on Poverty and, in 1965, signed the bill that created Medicaid—a program funded jointly by the states and the federal government to provide health insurance to low-income Americans. It was part of his vision for a “Great Society,” which he boldly defined as “a society where no child will go unfed, and no youngster will go unschooled.”

Johnson probably couldn’t have imagined the program’s impact. In the past 47 years, Medicaid has provided medical care to hundreds of millions of Americans—including low-income children, the elderly, disabled, and pregnant women—and has saved millions of lives. More than 50 million are currently enrolled.

In Johnson’s home state, however, the commitment to Medicaid has always been lackluster at best. Texas’ Medicaid program spends less than the national average per enrollee, and reimburses doctors, hospitals and other providers less than the national average. In many areas, the Texas program pays for only the minimum standards required by the federal government. One in four Texans—6.1 million people—lack health insurance, the highest percentage in the country.

Now another Democratic president wants to expand Medicaid, under the Patient Protection and Affordable Care Act, or “Obamacare.” Even a modest expansion would mean that an estimated 1.5 million working adults who earn 133 percent of the federal poverty level or less (about $14,856 a year for an individual) could have health insurance starting in 2014.

But there’s one big snag. The U.S. Supreme Court ruled in June that states have the right to refuse to expand Medicaid. Texas Gov. Rick Perry is among several governors, mostly southern and Republican, who are resisting. To make the expansion more palatable, the federal government will pay for all the people added to Medicaid rolls until 2017; after that, it will reimburse 90 percent of the costs. In effect, Americans around the country would help pay for the health insurance of more than a million Texans.

If Texas doesn’t expand Medicaid, it will reject more than $100 billion in federal money the first decade, according to the state’s own figures. To get that sizeable federal reimbursement, the state would have to spend about $16 billion over 10 years. The governor’s refusal to take the federal government’s billions puts him in an awkward position opposite some of the state’s most powerful economic players: hospital chains, local governments and chambers of commerce. Given that political pressure, Perry might strike a deal with the Obama administration, or the Texas Legislature could push for a Medicaid expansion.

Beyond the economics and politics, lives are at stake. Lack of insurance will certainly mean more deaths. How many more? Approximately 9,000 a year, according to Dr. Howard Brody, director of the Institute for Medical Humanities at the University of Texas Medical Branch in Galveston. Brody calculated that figure by extrapolating from a recent Harvard University study published in The New England Journal of Medicine that found that states that expanded Medicaid saw a 6.1 percent reduction in the death rate among adults below 65 who qualified for the program. In a recent op-ed in the Galveston Daily News Brody wrote, “This means that we can predict, with reasonable confidence, if we fail to expand Medicaid . . . 9,000 Texans will die each year for the next several years as a result.”

Too often the political debate around Medicaid expansion is about dollars and cents, Brody told me recently. “It’s presented as if it weren’t about life and death,” he said. Brody teaches ethics to medical students at UTMB, so for him, the issue of Medicaid expansion, when you cut through the rhetoric and endless policy discussions, is a deeply moral question: Should Texas allow people to die simply because they can’t afford health insurance? “Whose life and death are we talking about?” said Brody, who treated Medicaid patients for decades before becoming a professor at UTMB. “Politically, the Medicaid population are simply invisible folks. Most Americans may not care very much, because they think, ‘I’m not in that group of people and that’s somebody else and so it’s somebody else’s problem.’”

Perry has contributed to this attitude by arguing that uninsured Texans can receive health care in emergency rooms. “Everyone in the state of Texas has access to health care, everyone in America has access to health care,” Perry said at a New Hampshire campaign event in November 2011, according to the liberal website ThinkProgress. “From the standpoint of all people in this country, our government requires that everyone is covered.” Perry is correct that anyone can get treated in an emergency room—but it’s expensive. And not everyone in Texas has access to health care. People with chronic conditions—especially those with cancer—face a bleak future without health insurance. They are among the thousands of Texans whose lives could be saved by Medicaid expansion.

The Reyes family in front of the Methodist Healthcare Ministries clinic in San Antonio.
Jen Reel
The Reyes family in front of the Methodist Healthcare Ministries clinic in San Antonio.

For 15 years, Mario Reyes, a diabetic, bounced from one emergency room in San Antonio to the next. On some days his blood sugar was so high he feared he might black out while driving to the hospital.

A commercial painter by trade, he’d worked his entire life, but had never been able to afford health insurance. For years, like nearly 400,000 other uninsured residents in Bexar County, he’d relied on the local emergency room for treatment. Most months he would visit the ER at least twice for his diabetes. Then, two years ago, at the age of 52, he developed a constant, debilitating pain in his lower back. After a few excruciating weeks, Reyes finally went to the hospital. He felt numb when the doctor gave him his diagnosis. Reyes had kidney cancer.

For Reyes, the diagnosis felt like a death sentence. “I couldn’t work and I had no money and no health insurance,” he says. For Reyes, uninsured and living in Texas, a diagnosis like cancer meant he was at the mercy of a charity organization, or possibly a county indigent program. Reyes was more fortunate than most. He found Methodist Healthcare Ministries, a church-based charity health-care system, which referred him to a specialist who removed his cancerous kidney. Methodist Healthcare Ministries underwrote almost all of the costs of Reyes’ surgery and care.

“My husband wouldn’t be here today if it wasn’t for them,” his wife Mary said. But Reyes and his wife believe that he wouldn’t have gotten so sick to begin with if he’d had health insurance all those years. “I’m surprised he’s still here, because his sugars were always so high,” Mary says. “I feel blessed he’s here next to me.”

Reyes received life-saving treatment because he happened to live in a large metropolitan city with significant charity care for those without insurance. If he had lived in a rural county, we probably wouldn’t have had our recent conversation on a warm, sunny morning in San Antonio. The outcome had been very different for a 27-year-old East Texas man with the same diagnosis that I wrote about in a 2009 Texas Observer story (see “Sick + Tired,” Sept. 3, 2009). Sam, who was also uninsured, died because he couldn’t find anyone who would treat his cancer.

Reyes was lucky enough to find a charity program in his hometown. But even with the charity and indigent health-care programs that San Antonio offers, only a fraction of the county’s uninsured residents will get help, said Kevin Moriarty, CEO and president of Methodist Healthcare Ministries. “For every 2,000 or 3,000 that we cover, there are probably 20,000 or 30,000 that are not covered,” he said. “And they don’t get to us. And how unfair is that, that somebody’s tumor that could be removed, that someone’s life that could be extended, ends because we don’t have access to the resources to make that happen?”

Medicaid expansion would help people like Mario Reyes, said Moriarty, who is frustrated by Perry’s rejection of the program in Texas. “We’re talking 1.5 to 3 million people around the state who are going to get late care or no care,” he said. “They’re going to suffer, they’re going to be in pain because we can’t make a better policy decision.”

Patients check in at  the Brackenridge  Hospital emergency  room in Austin.
Jen Reel
Patients check in at the Brackenridge Hospital emergency room in Austin.

Perry has been a fierce opponent of the federal health-care reform bill since it passed. “Freedom was frontally attacked by passage of this monstrosity,” he told the media after the Affordable Care Act passed Congress in 2010. “Obamacare is bad for the economy, bad for health care, bad for freedom.” After the U.S. Supreme Court ruling in June upheld Obamacare but allowed states to opt out of the Medicaid expansion, Perry fired off a letter to Kathleen Sebelius, secretary of the U.S. Department of Health and Human Services, calling the notion of Medicaid expansion and the creation of a state-level insurance exchange—another element of Obamacare—a “brazen intrusion into the sovereignty of our state.”

“What they would do is make Texas a mere appendage of the federal government when it comes to healthcare,” he wrote Sebelius. “Neither a ‘state’ exchange nor the expansion of Medicaid under the Orwellian-named PPACA would result in better ‘patient protection’ or in more ‘affordable care.’”

Two hours after sending his letter, Perry was on Fox News comparing the Medicaid expansion to “adding 1,000 people to the Titanic.” Instead, Perry said, states like Texas should be given Medicaid block grants to create their own system for health-care coverage, without elaborating further on what that system might entail. Fox News correspondent Jenna Lee, much to Perry’s visible annoyance, began to press him for specifics. “According to a new federal government report—I know you’ve seen this—Texas has ranked last when it comes to health services provided by the state,” Lee pointed out. “The facts are one out of four Texans is without health insurance. One out of four Texans is on Medicare or Medicaid. The health crisis, the big crisis for the country and for your state, what is one solution you are offering to the citizens of Texas?”

Perry blinked for a moment. “The idea that this federal government, which doesn’t like Texas to begin with, to pick and choose and come up with some data and say somehow, Texas has, you know, the worst health-care system in the world is just fake and false on its face.

“The real issue here is about freedom,” Perry insisted. “Every Texan has health care in this state. From the standpoint of having access to health care, every Texan has that. How we pay for it and how we deliver it should be our decision.”

 

Health-care advocates could only shake their heads in dismay after Perry’s Fox News performance. The job of providing a health-care safety net has increasingly fallen on hospitals, counties and local taxpayers. To patch together a system of care, large metropolitan counties like Bexar have taxed themselves to create health districts and to fund public hospitals. Rural counties, with their limited pools of property taxpayers, don’t have that option, and provide fewer services to residents.

For at least 37 years, Kevin Moriarty has been involved in the debate over how to treat Texas’ uninsured. For decades he worked in San Antonio’s Department of Human Services. Then, in 1995, he became president and CEO of the nonprofit Methodist Healthcare Ministries, which funds its charity care from profits generated by hospitals it co-owns with HCA, a for-profit hospital chain.

In the past two decades, Methodist Healthcare Ministries’ charity care costs have grown from $200,000 to $72 million. Each year, Methodist Hospital and other Bexar County hospitals write off millions in unpaid emergency room charges. In 2010 alone, Methodist racked up $221 million in unpaid emergency room bills, according to a July 2012 report by the Kronkosky Charitable Foundation. Increasingly, the burden of underwriting charity care falls to the insured, who pay an average of $1,500 to $1,800 per year per family in extra costs, according to Anne Dunkelberg, associate director of the progressive Center for Public Policy Priorities.

Hospitals and physicians see the Medicaid expansion as a smart business decision, Moriarty said. “Every hospital system, every health-care provider, every physician in the state is suffering from a lack of revenue from health care,” he said. “Now, Medicaid is not their solution. However, it will take away what might be 10 to 20 percent of their charity care expenses. Every physician’s office, every dentist’s office that takes Medicaid, will see improvements to their bottom lines.”

Perry and other opponents of the expansion, such as the conservative think-tank Texas Public Policy Foundation, argue, however, that the expansion will cost the state too much. They contend that Texas will be on the hook if the federal government becomes less generous with reimbursements in the future. Or as Perry put it in a 2010 op-ed after the Affordable Care Act passed, “Staggering costs handed down to generations yet unborn.”

But the costs don’t seem so staggering when you look at a recent report by economist Ray Perryman, who estimated that Medicaid expansion would result in total cumulative gross benefits to the state economy of $270 billion in the first decade and a boost in employment. This, Perryman wrote, would come from health-care spending provided through expansion, reduction of uncompensated care (and thus the local government and private funds needed to pay for it), and reduction of chronic illness and death through better health care, and thus more productivity.

Whether Texas expands Medicaid or not, Perryman emphasized, taxpayers will still be paying for it. If Texas passes up the Medicaid expansion, it will forfeit an estimated $100 billion in federal reimbursements in the first decade. Some of this money will come from Texas taxpayers and be redistributed to other states for their own Medicaid expansion programs. “The relevant question at present is not philosophical, but practical,” Perryman said. The expansion “represents one of those rare occasions where Texas can both provide significant services for many of its least-advantaged citizens while simultaneously stimulating the economy and taking the most fiscally responsible course. Whether Texas opts in to this program or not, our citizens and businesses will pay the federal taxes that support it.”

It would be foolish to reject billions, especially if we’re paying for it anyway, Moriarty said. “Here you’ve got these very conservative individuals arguing that we shouldn’t accept this money because of the burden to the Texas taxpayer. But an important fact about what’s being proposed is, by not accepting these funds, we’d be taxed twice. First of all, we won’t get our state monies back from the federal government. And secondarily, as a property owner, I pay hospital district taxes, and so I’m paying and subsidizing these costs at a local level.”

The prospect of rejecting so many billions is giving county officials heartburn. Some of the state’s biggest metropolitan counties are looking for a way around Perry and other state leaders if they continue to block Medicaid expansion. In August, George Hernandez, president and CEO of University Health System in San Antonio, which runs the indigent program in Bexar County, made national headlines after he proposed that Texas’ six most populous counties band together to circumvent the state and apply for the federal Medicaid expansion money on their own.

Most counties are already tapped out, having formed local taxing districts to fund public hospitals and indigent programs. Hernandez’s University Health System has 55,000 uninsured county residents enrolled in its indigent program. Each person in the program costs county taxpayers $2,000 a year, he said.

At least 26,000 of those patients could be covered under the Medicaid expansion. “That’s a $53 million savings every year to Bexar County taxpayers.”

When I spoke to Hernandez recently, he wanted to de-emphasize the county-led effort and focus instead on a statewide solution. “It could reform the inequities in the existing system,” he said. “Right now we have a county-based approach under the Texas Constitution—254 counties provide health care in 254 different ways. Rural counties are only putting 8 percent into their indigent health-care programs because that’s all they’re required to do under state law. While the urban counties, including Bexar, Tarrant and Harris, are putting 40 to 50 percent of their budgets into health care.”

Urban counties are disproportionately carrying the load for the whole state. “When you have a health crisis and you’re in a rural county, what do you do?” Hernandez said. “You move into an urban county to get health care much the same way families move school districts to get into the right school.”

In his mind, one of the most powerful arguments for Medicaid expansion is to equalize that expense and lift some of the burden from urban areas and urban taxpayers. “This is what moved our chamber of commerce to support the Medicaid expansion,” he said. “The business community knows that there is an unequal burden that our taxpayers are paying.”

In politics as in health care, nothing is as easy as it should be. Despite the compelling economic figures and the moral question of saving lives, convincing some state leaders to adopt anything under the umbrella of “Obamacare” will be a difficult task this legislative session. Perry must be won over. Even if the Legislature passes a bill expanding Medicaid, Perry could veto it. If Texas is going to expand Medicaid, the governor will have to change his position.

Nearly 50 years after the birth of Medicaid, things are not as dire for low-income Texans as during Johnson’s time. But they’re not much better. In one of the wealthiest states in the nation, more than six million people lack access to health care. Without Medicaid expansion, thousands of Texans will continue to die from treatable conditions.

(Correction: The original version of this story said that Kevin Moriarty ran San Antonio’s Metropolitan Health District. It should have stated that Moriarty worked in San Antonio’s Department of Human Services. The Observer regrets the error).

Melissa del Bosque joined The Texas Observer staff in 2008. She specializes in reporting on immigration and the U.S.-Mexico border. Her work has been published in national and international publications including TIME magazine and the Mexico City-based Nexos magazine. Melissa is a 2014-15 Lannan Fellow at The Investigative Fund.

  • stormkite

    Those 9,000 people will be peasants, almost by definition….. so where’s the problem?

  • clr1390

    There is seriously something bad in the water down there. OMG…While the rest of the country moves on to better healthcare, the South is going to gain steam for evidence of why we need to cut them loose and wave by, by. Pro life??? Abortion should be mandatory in the South to save those idiots from a life of doom. And while the tax payers or uninsured down there pay for Rick Perry to live in a 10 thousand dollar a month mansion while treating people like that…

    • Joemunch

      If you want to pay for it, get your checkbook out.

      • clr1390

        Shows how stupid you people are. Defunding Planned Parenthood in Texas cost the state 300 million dollars..All because of spite…More unwanted babies you will have to pay for and feed. proven fact when poor women have no access to birth control more babies are born to pay for..Sucks to be you people. Abortions have never been paid for..there is a thing called the Hyde Amendment..Even women in the service raped have to pay out of their pocket. The Hyde Amendment was put in place when Roe V Wade was started..By the way, they do not ask me, but i do not want to pay for wars started on lies. Get your checkbook out, and pay away. Because they just do not seem to ask us what we want to pay for, But in Texas they like to waste millions to prove a point…i am laughing all the way to the bank on that one, because the cost will go on for years….LMFAO.

  • http://www.facebook.com/people/Sam-Davis/1109907684 Sam Davis

    Perry and his fellow TEA Partiers are the first to shout their militant “Christian” beliefs from the rooftop. Sadly, their actions never seem to back up their talk. I lay much of the blame at the feet of older white people (like me) who have theirs and don’t want anyone else to have the advantages they had. Take the Southern Baptist Church out of Texas politics and we would be much kinder and gentler. Those who should care about our most vulnerable don’t. When people like Ted Cruz and Greg Abbott are elected, Texas sends a message that it just doesn’t care about anyone except religious extremists. We hear cries about the evil of Planned Parenthood by the same ones who refuse comprehensive sex-ed in school, refuse to make birth control available, refuse prenatal care, and cut benefits to low income families with children.

    Is there a possibility that we could perform retroactive abortions on some of these righteous lunatics?

    • Joemunch

      They are some of the most charitable people I’ve met. They just don’t believe in forcing all taxpayers to agree with them. How much have you donated to your local free clinic?

  • ntjenz

    I hope Perry stands his ground… the plan IS NOT to take away the present Medicaid… the plan is to EXPAND and follow the federal way which is to surmount so much debt that we as a country can not pay it. I am not opposed to everyone having an affordable means to healthcare… the bigger picture that someone needs to stand up to… is the incredible costs of the Obamacare program… it is more expensive than this nation can afford … revise it … fix it… and I favor it…. but if more Governors like Perry don’t refute Obamacare at the state level… than reforming the spending to fund Obamacare doesn’t happen…. People its a nice idea… but we just braced ourselves for a fiscal cliff and another debt ceiling is looming in the months ahead… this government has GOT TO STOP SPENDING MONEY that we don’t have… Stand your ground Perry the smaller picture is for the small minded who want their cake and eat it too… the bigger picture is the status of your state and this nation financially. Wish more freebie lovers would and could understand the bigger picture… and no… I don’t represent the “wealthy” … I am the California middle class with a hefty mortgage… taxes greater than any other state, kids, and working 3 jobs between my husband and I to make ends meet. There is NOTHING free to us. The right thing… is certainly for everyone to have access to affordable healthcare… how do you do it …. financially without breaking everyone elses financial backs.

    • clr1390

      Too bad your state just spent another 300 million dollars because they defunded Planned Parenthood…You people are the dumbest, misinformed useless morons around. Defund Planned Parenthood, and another 40 thousand babies were born paying birthing costs, and not welfare costs included….So while the rest of the country sits back and enjoys obamacare, you people keep sending them to the emergency rooms…Going to cost ya big time in the long run…its called pay now or pay latter…

    • ghhshirley

      What you and the people of Texas don’t seem to grasp is one, Obamacare is not going anywhere, and two, even if Perry does not expand Medicaid, the people of Texas will be paying for it either way.
      The only difference is, instead of those tax dollars flowing back into Texas, that money will be going to other states that have decided to expand Medicaid. We are talking about billions of dollars in lost revenue for the state of Texas.

  • http://www.facebook.com/lee.schill.31 Lee Schill

    For the more dense audience, it’s like someone telling you that they will buy you a new car. The deal is they will pay the first 2years of payments at $1,000/month then you take over payments for the next 4 years.

    • john

      nope. Its like paying for it for the first three years at $1,000 and then you taking over $100 after that…..plus by the time those years where you have to start paying roll around the overall cost will have decreased because you have 1.) created jobs and 2.) have a healthier working population.

  • Dave

    Bleeding hearts never see the bigger picture. No one gets health care when our country collapses because of surmounting debt! Welfare, Social Security and Medicare already exceed tax revenue alone. If people are really worried about their healthcare then they’ll go to school and get a better job, if not don’t steal my American dream to pay for your life’s mistakes!!!

    • clr1390

      You idiot….The people that can’t afford healthcare are the one working you fool. The Republican party of Texas sure produces some misinformed people….Your Republican talking points of people who have no health insurance are the people not working…OMG how dumb you are. Wars and massive tax cuts are the reason the country is BROKE. And the cost of healthcare which has gone up so high even college educated people can’t afford it.

      • Dave

        You must posses an infinitesimal mental capacity, you are responding to a Mensa member and calling me an idiot? The problem with stupid people like yourself is they have lack the capacity to learn thus thwarting what I am about to advocate, but I will attempt a futile effort anyway! Obviously you have never looked at the Federal budget or know anything about economics otherwise you would know at the time of Obama’s inauguration there was $8 trillion in national debt and the deficit was $508 billion a year. In less than 4 years The Obama Administration managed to more than double both the deficit and national debt at $1.3 trillion per year and over 16 trillion. It certainly was not because of “wars and massive tax cuts” that caused us to be broke. Here is an example of how constipated you brain is with liberal ideals. The budget for the war in Afghanistan was just passed at $85 billion for fiscal year 13. Taxes were just increased for middle class when the payroll tax cuts expired and taxes raised on individuals making over $400k per year gaining a revenue estimated around $85 billion. You think wars and tax cuts are the problem yet how come they cancel each other out and we still have a deficit over a trillion dollars??? The reason why our country is broke is a separate lesson that dates back to 1907. The fact is Medicare and Medicaid is for individuals that work AND do not work. First HEALTHCARE is not RIGHT and second we can’t afford add any more debt since we are already teetering on the brink of economic disaster. If you are really interested making healthcare affordable then try strongly urging your representatives to reform healthcare instead throwing tax money at it. Try asking them to create competition in the health care industry and lowering the cost of drugs instead of bartering deals with hospitals and drug companies for campaign money. Good luck in life and if Darwinism existed, I would certainly be concerned for your safety….

        • clr1390

          Yes, wars and tax breaks are the problem….foreignassistance.gov….We give almost every country in the world foreign aid. Most of those civilized countries have universal health care for all…We pay for it fool…We give Israel hundreds of millions of dollars in foreign aid and in turn they have an individual mandate with healthcare for all with us funding most of it. Healthcare is a right,especially if you live in a civilized nation, which we don’t. That is why we are the laughing stock of the world. Your theory of the high cost of healthcare which has pretty much out paced the cost of earnings by about 100 to 1…LOL Obamacare is hated by Republicns because of Obama. It is working quite well in Mass…Romneycare, and if you Google Ronald Reagan in the 60′s on the evils of socialized medicine, you see the exact talking points today they used when they hated Medicare before it was here….Without it seniors would not have access to healthcare because for profit insurance companies would not insure sick old people because it cuts into profits…Your old theory of sending the poor and working people without insurance to emergencyrooms is why the cost of healthcare is so high, And it is why people working at Walmart for slave wages so the owners make billions continue to qualify for medicaid and the taxpayers pick up the tab.

          • Dave

            Your’e officially the biggest idiot I’ve ever talked to, you think our foreign aid pays for everyone’s universal healthcare? Do you own a calculator? Do you know how to use it? The entire US Foreign aid consists of 1% of the budget, just over $20 billion, that isn’t even enough to cover one countries healthcare cost retard! Israel has a population of 7,765,700 people, if the entire foreign aid was spent on Israel alone the money would equate to $2,575.42 per person. Last year the average healthcare cost per person was $8.160.00 so I don’t think hundreds of millions would cut it fella. Germany has 81,760,000 people, under half of their population works and to pay for their universal healthcare their taxes are 47% with a 16% VAT tax. If the US had universal healthcare the tax payers would bare the cost of 311 million people which would cost $2,537,760,000,000.00. That is over a 100% increase in taxes which would collapse the entire US economy. Show me where it is written that healthcare is a right, I want to see where it is listed in the Constitution or are you going to keep spewing liberal lies until you believe yourself?

          • clr1390

            You are a complete idiot. Quit watching FOX LIES. People are going to pay for healthcare..Many would have access to healthcare. It is not free. It is now..We pay a high price to send people to the emergency rooms…Don’t you people get it. We give Israel alone hundreds of millions of dollars in foreign aid….They have universal healthcare. Thanks to us……And by the way, the welfare in the budget is not even a blip on the screen. The bulk of the spending is Defense, Medicare, and Medicaid…We have the highest cost for healthcare than any other civilized country…WHY??????????????? Most of the others have universal healthcare….With an individual mandate. The countries who worry so much about the debt today are the ones in recession….The ones that have moved on and invested are doing good..

          • Dave
          • clr1390

            Read Behind Debt the New York times today on the Simpson Bowles. behind Debt Campaign. it talks about Republicans and Democrats who are in bed with the fix the debt commission. The same corporation whose corporations pay no taxes. You are a fool being played by politicians…LOL Wikipedia can be changed at any times….The Federal budget is driven by 3 things..defense, Medicaid, and Medicare…

          • Dave

            You cannot change Wikipedia, you can add your own line but you cannot change it. Welfare falls under the Department of Health and Human Services and is by far the largest part of our budget followed by Social Security then Department of Defense. There is a difference between mandatory and discretionary spending! This website and all .GOV websites correspond to every Federal Budget I’ve ever looked at to include Wikipedia. So again, your’e wrong!!!! http://www.federalbudget.com/

          • clr1390

            Understanding the Federal Budget…As Wiki reports..There is no part of the Federal Budget which is welfare only. Part of that includes Federal Employee retirement benefits, and numerous other things. Need to check a little farther. Welfare per say is a very small portion of the federal budget…

  • I Have a Voice

    I find it very hard to believe that the man featured in the story did not qualify for MAP or Medicaid. HHS has made it easier to apply, but you have to provide documentation to prove that you qualify. I believe that so many Texans are uninsured because they are paranoid about the State looking at their pay stubs and bank accounts. The application is easy to fill out and there are people to help if you are unable to read/write/understand.

  • Mike

    Melissa del Bosque is an example of what Benjamin Franklin said, ” When you give up freedom for a little security now, before long you neither have freedom or security,” Giving in to Obamacare for a few dollars now, will cost Texans a lot of dollars later – and the plan takes away my hard earned income to pay for someone else’s health problems. If I want to pay for someone else’s medical care, I’ll donate to a charity. If I don’t want to, the Government doesn’t have the right to steal money from me, thereby forcing me to do contribute to something against my will. It’s called legalized coercion and is unconstitutional! And if we had any politicians that actually wanted to do something for the citizens of this great country, they would band together and repeal Obamacare – and impeach the idiot sitting in the President’s chair. Johnson was an idiot as well – not only for the Great Society debacle, but for losing the Viet Nam war as well. A true idiot – Lyndon B. Johnson.

    • clr1390

      You fool, in foreign aid to almost every country in the world, we pay for universal healthcare is just about every other country but here….Google healthcare in Israel. They have universal healthcare…I do not want to pay for wars either……You people are GOING TO PAY. YOU HAVE BEEN PAYING FOR YEARS SENDING THE UNINSURED TO EMERGENCY ROOMS FOR THE MOST USELESS HEALTHCARE AVAILABLE….THAT IS WHY OUR HEALTHCARE IS THE LAUGHING STOCK OF THE WORLD. ONLY IN AMERICA DO WE PAY FOR THE REST OF THE WORLD TO BE HEALTHY EXCEPT FOR HERE..IT IS BECAUSE OF FOOLS LIKE YOU.

  • machattan

    this is where it stops being funny. you know, funny in that dark, cobwebby way that makes me itch.

  • http://www.facebook.com/lois.hamilton Lois Hamilton

    This could have been a good discussion if these commenters had not gone off on a name calling , hateful binge. It is no wonder that we cannot get anything done in this country. Grow up and speak respectfully to each other if you expect to make your point heard.

  • http://www.facebook.com/beverly.margoliskurtin Beverly Margolis-Kurtin

    Let’s stop this garbage now. If you happen to have a copy of the Constitution of the United States of America go to Article I, Section 8.

    Who is responsible for spending our money?

    For those of you who don’t have a copy of the Constitution, the ONLY part of our government that can put our country into debt is THE CONGRESS.

    Now let’s talk about health care. EVERY OTHER CIVILIZED COUNTRY IN THE WORLD HAS HEALTH INSURANCE FOR EVERYONE. Are you Republicans so negative that you think that the supposedly best country in the world cannot find a way to finance health insurance without breaking the budget?

    Keep in mind that the only way that we’re going to stop spending, spending, spending is to get CONGRESS to stop borrowing money. Yes. Article I, Section 8 of the Constitution of the United States says that ONLY Congress can borrow money…not the president, not the courts, CONGRESS controls the purse strings, folks, nobody else.

    Texas’ Governor God claims to be a wonderful Christian. His favorite part of the bible is “the poor will always be with us.”

  • radsenior

    Loss of federal funding and prestige across the nation are the fruits of the fruits runing Texas. It is going to take a concerted effort by everyone interested in taking our state back from the fringe elements who have turned the Republican party and Texas into a mockery. This once proud party of Lincoln and Reagan has free-failed into extreme radicalism. It is sad that outright bigotry has trumped this once sane segment of political power. Voter disenfranchisement is prevalent across the nation and Texas has become both lightening rod and laughing stock of the nation. Perry has proven his total disdain and contempt for the citizens of his state. Perry is truly a gross anomaly which has morphed into a failed faximile of pseudo-intelligence. Do not sit on the sidelines and allow the few with the most power and stroke to make decisions that will effect you directly without your input. We must remember that money and power in the hands of fewer and fewer people with stricter less compassion has taken hold in many states and Washington is their next target. Do not sit on the sidelines and allow others to make decisions that will effect you, or your family directly, without your input. Get active in local, state and national politics and keep yourselves informed. We can make a great change in the 2014 Mid-term election!

  • radsenior

    The saddest part of this posting is the first paragraph. LBJ was and still is the best of Texas! Rick Perry on the other hand is such a discredit to Texas, the Governorship and the Republican party. Rick Perry is turning his back on Texas residents and $100 billion the first ten years just because he doesn’t want to follow federal laws. Rick Perry and the entire TEA-Republican leadership and membership in Austin are playing to the bigots for local elections. 9,000 Texans will die due to Rick Perry’s position on non-implementation and enhancing Medicaid. That is blood on Perry’s hand. More than love, hate, food, water, sex, wealth or security it would seem that the strongest emotional need here is the overwhelming desire to find something to be offended by. And that one issue this crowd is against – President Barack Obama! How sad, pitiful and empty those lives must be, to hate a man just because of his skin color.

    • AbdullahtheButcher

      LBJ got us into Vietnam, and he refused to fight to win it.

  • damntexan

    Perry – I didnt vote for you, never will….but PLEASE do not give Medicaid anymore than they already have….Im sick of it. So a thousand some odd people are going to die…whats their total contribution anyway? Some need to go – we cant keep everyone alive and the ones that need to go are usually just being kept alive from selfish family members that want million dollar a year care for a child that WILL NEVER amount to anything but a ball of space v=confined to teh painful body in which it lives. Just saying.

    • Melinda Callahan

      So we measure our levels of compassion based on what other people have to offer us? One, that is psychopathic logic…a lack of empathy for others and only seeing the “benefit” of humans rather than caring for them (i.e. empathy) is a mental disorder. I really hope the anonymity of the internet is leading you to speak harshly rather than this being a true peek into your morals.

      Two, aside from being psychotic logic, it’s also nonsensical. We can’t keep everyone alive, so lets stop working on a cure for cancer. Or any disease. Shit, lets just stop treating sick people who may die altogether. I mean, they might die anyway and all of those resources and effort from doctors and nurses will have been wasted. Ask yourself, what is the goal in becoming a doctor or nurse? To HELP people, because that is a NORMAL urge and value in decent human beings.

      Lets say you were born into a poor family. Maybe your parents never went to college, maybe they had children young and worked minimum wage or close to it jobs to take care of you, their child. Maybe they didn’t have money for school, or maybe they didn’t have the time to sacrifice hours away to studying and going to class for putting food on the table for your tiny self who they love. If your hypothetical mother gets cancer, should we let her die in pain because and I quote “we can’t keep everyone alive”? Do you think if your mother had cancer, and no insurance or money to pay for treatment, this would be your thought process on the matter? Imagine saying that to someone YOU loved. Doesn’t seem quite as appropriate now, does it? Hopefully not, anyway.

      I’d like to touch on your last statement, you seem to be under the impression most people who will die because of a lack of treatment or money for it are just vegetables laying around drooling so family members can have them around. That is the most ignorant thing I’ve heard all month. On. The. Internet. Think about it. You literally have no reason to think this is most cases of people dying from lack of care. There is no statistic, no source of information that even slightly alludes to this being even fractionally true. Just saying.

  • Tony Terracina

    Fascism in North America – Wikipedia, the free encyclopedia
    en.wikipedia.org/wiki/Fascism_in_North_America‎

    In 1966 Republican Senator Thomas Kuchel said of the Conservative movement, “A fanatical neo-fascist political cult in the GOP, driven by a strange mixture o

  • LB

    This is just silly. Are you really saying that hospitals are refusing to treat people and just allowing them to die? Most hospitals have their own charity funds – you can boycott those that do not. Turning away the poor is something that would certainly not have happened back when virtually all hospitals in the USA were nonprofits. What changed the landscape and led to the surge in for-profit” hospitals was increased government reimbursement, which made hospitals – and particularly ERs – a source of net revenues for the first time in US history. This also led to the closure of small charity clinics, as people who are already being taxed heavily for a service are less likely to donate for that same service. The solution is less government, not more. Prices are vastly inflated because government “charity” involves passing money around in a very leaky bucket. Get rid of Medicaid completely and instead allow charity workers to do the job. They will provide life coaches and teach people to get off of aid, instead of just patching them up with a revolving door system that benefits only the bureaucrats.