
Poor and Uninsured in Texas - anthotny
http://www.newyorker.com/news/news-desk/poor-and-uninsured-in-texas
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kayla210
_" After he was discharged from the hospital, Oregón went to the disability
office, filed the appropriate paperwork, and, in September of 2014, acquired
his Medicaid card. Two months later, however, he received notice that his
health-care benefits had been terminated. S.S.D.I. payments are calculated
according to a person’s average lifetime earnings before he became disabled.
When Oregón’s started coming in, they amounted to nine hundred and twelve
dollars per month, which put him over the Texas income threshold. The fact
that he had paid into Social Security, in other words, made him ineligible for
social health care."_

This is insane. Just plain insane. All because he earned almost $200 in
disability money above the already low threshold.

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jrnichols
Having been involved in health care in both California and Texas, it's still
so surprising to me how they can get it both right and wrong at the same time.

But there's one thing that I wish would change - this attitude that a single
payer system is the death knell for healthcare. Handing it over to shareholder
owned corporations like the ACA did sure hasn't worked out very well. This is
one of the areas that I agree with Trump, oddly enough - no more cuts to
Medicare, and if we simply can't manage to get a single payer program going,
allow existing insurance companies to compete across state lines.

We could start with dental. Appropriate dental care can help prevent a whole
bunch of other problems. But the shareholders making decisions? No. That needs
to stop.

Random side note: "When they inserted a needle into Oregón’s arm to draw
blood, a procedure that, even in a heavily sedated patient, would cause a
flinch, he didn’t move"

I'm a Paramedic, and can tell you that the number of people that flinch when
I'm starting an IV on them or doing a blood draw is actually pretty low.
Sedated or not.

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digitalengineer
Damnit America. For all the power you hold how could you f*ck up medical aid
for your own people by this magnitude? The ROW (rest of world) simply can't
wrap their head around it...

~~~
lbhnact
It's frustrating to a lot of us. We are a big country made of states that have
a degree of autonomy often surprising to outside observers. The result is
surges of progress, and pockets of injustice, all over.

 _And even in other states that didn’t adopt the expansion, like North
Carolina and Missouri, patients like Oregón still have hope of a transplant in
a life-or-death situation. That’s because these states allow for a “medically
needy” pathway, or a “spend-down” program, whereby patients can meet the
Medicaid limit by deducting certain items, including unpaid medical bills,
from their income._

In NC at least, these mostly happen not because of the spend-down rule. They
happen because we have a public university, with a public hospital, that is
supported through the state by the public to provide care for the poor.

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grecy
It's so sad to see so many people struggling in what is ostensibly the
wealthiest country in the world.

All this talk about "disruption". Someone needs to fix _this_

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joesmo
I wonder what goes on in the minds of politicians and people alike when they
campaign against something like Medicaid expansion. I'd like to think they
don't realize they are campaigning for the deaths of many of their neighbors,
but I cannot. I can only imagine extreme cruelty and indifference to life and
suffering. I assume this is what drives this kind of hate in America,
especially in the south. Otherwise why would anyone turn down an almost fully
federally funded health program that helps the poor? Other than hate for the
poor, hate for foreigners, hate of other peoples' enjoyment of life, there do
not seem to be other logical explanations for such viewpoints.

The people that campaigned for and ultimately defeated the Medicaid expansion
in many states should have to spend the rest of their lives without health
insurance or proper health care. They are the ones who should be slowly dying
and watching as existing cures pass them on by. _They are the ones who deserve
to suffer for their hate and cruelty._

~~~
grecy
I spent my summer with a staunch Republican, and I think I understand now.

My friend explained (over many arguments over many months) he simply does not
want to pay for anyone's healthcare. He goes to work, and pays his own. He
expects others will go to work, and pay their own. End of story. It's that
simple for him.

He doesn't even care if paying a little more tax would result in better
healthcare for _him_. He'd rather have shittier healthcare himself than accept
paying even a tiny bit for another persons healthcare.

It's completely unacceptable to him that he should have to go to work more
(i.e. pay more taxes) to fund someone's healthcare.

I get it. He doesn't care about a "we" society where we all look out for each
other and share the wealth and do well, he wants a "me" society, where me does
well.

NOTE: Not my views, don't shoot the messenger.

~~~
miles7
Disappointing how many Republicans hold this view and simultaneously claim to
be the party of Christianity. How does refusing to support people worse off
than you square with this: "from one who takes away your cloak do not withhold
your tunic either. Give to everyone who begs from you, and from one who takes
away your goods do not demand them back. And as you wish that others would do
to you, do so to them."

~~~
fgandiya
From my Republican friends, it'd that they believe that it's there
churches/Christian's responsibility to take care of the poor, not the
government.

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dzdt
The mindset against medicaid is it isn't the government's job. The circles of
responsibility are yourself, your family, your church, you're fucked. That is
just life.

[Not necessarily my own view!]

~~~
fgandiya
I don't quite get this view. Why shouldn't they expect the government to help
them out? That's why we pay taxes and reject them isn't it?

~~~
dzdt
They don't want to pay taxes for that. Given the choice, most evangelical
Christians in America will pick lower taxes and reduced or eliminated
government role in providing social services.

~~~
fgandiya
Fair enough... But I still find it strange.

------
zaroth
I really appreciated the depth of detail into what programs Oregon did and did
not qualify for, how Medicaid expansion was supposed to work, and how opting
out of it effects poor Texans.

There's just one data point that it would have been good to see... For people
who don't qualify for Medicaid, the next step is a heavily subsidized
marketplace plan through ACA. Now it isn't an option for people like Oregon
_after the fact_ / in this case because getting sick is not a qualifying life
event. You would have to do something like move to another state to qualify
for special enrollment. But if he had had an ACA plan, the transplant would
have been covered, with some very small deductible. I would really liked to
have seen the article address how much this would have cost, in monthly
premiums and out-of-pocket expenses, because it's a another very "interesting"
minefield.

Now, in order to qualify for federal subsidies in the marketplace, you need to
make 100%-400% of FPL. If you make less than 100% of FPL you do not get any
subsidy whatsoever because the Feds expect you to get Medicaid. This is where
states that don't cover people who are making less than 100% FPL can truly
fuck someone over.

In this case Oregon was declaring $10,944 of income, or 93% of FPL. An
unsubsidized silver plan would then cost ~$252 per month with significant
annual out-of-pocket expenses. However if Oregon reported income of $11,800
($856 more) then he suddenly would have been eligible for a subsidized silver
plan for $20 / month with virtual no out-of-pocket expenses. (numbers are from
Kaiser's cost calculator for Dallas, Texas)

This income would be so minimal that it would not have disqualiied him for
SSDI. You need SGA (Substantial Gainful Activity) of $1,130 per month for
that. In other words, he needed to "rent" a room of his house for a few days
and report Schedule E income, or have a garage sale and report Schedule D
income, or just report $900 of "Other Income" on Line 21 of the 1040 in order
to declare the extra income, and thereby qualify for an ACA subsidy.

The ACA was written so as not to expose the Fed to states dumping their
Medicaid patients into the marketplace. That's why they have the 100% FPL
minimum in order to get any subsidies at all. That makes sense from a Federal
policy standpoint, but really drives the point of how badly a state is
behaving to not cover people who are under 100% on Medicaid. The "answer" in
cases where the number is so close is to make up the necessary income on the
tax forms as needed to get the ACA subsidy. And really, at least by my moral
compass and theory of civility, you can read _make up_ however you like in
this case.

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phonon
Why didn't he move to a different state that had expanded Medicaid, like New
Mexico? He would have easily qualified there.

~~~
Broken_Hippo
He was already sick. And poor. And on disability.

Moving costs money, which he obviously couldn't afford. In addition, not all
states will immediately put you on their medicaid because it takes time to
establish residency.

~~~
phonon
Well, maybe instead of "For nearly the next two years, Oregón received
frequent checkups from his physicians at Harris Health" they would have told
him to take a bus to NM and establish residency there? Not to mention that in
NM residency for Medicaid can be established with "Self Attestation Accepted
without Additional Verification" so not a huge hurdle
[https://www.medicaid.gov/medicaid-chip-program-
information/p...](https://www.medicaid.gov/medicaid-chip-program-
information/program-information/eligibility-verification-
policies/downloads/new-mexico-verification-plan-template-final.pdf)

He could afford moving from Mexico to Texas when he was 20...

