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Stuck In The Doughnut Hole: Living Without Insurance, Subsidies Or Medicaid

Lauren Silverman
Sheila Anderson (right) with her mom Martha, in Watauga, TX. Anderson, who has multiple sclerosis, is uninsured and doesn't make enough money to qualify for subsidies on the health insurance marketplace.

Even with Obamacare, more than one million people in Texas are in health care limbo. Since the state didn't expand Medicaid, low-income people people like Sheila Anderson won’t have access to government assistance or health insurance subsidies on the marketplace.

After a decade of working with the same company, Sheila Anderson was laid off in 2012. As painful as it was to lose her job, she was excited to go back to school and finally get her nursing degree.

After Sheila Anderson, 46, lost her job and health insurance she decided to go back to school to get her nursing degree. She would have qualified for Medicaid if Texas had expanded the program for low-income people in the state.
Credit Lauren Silverman / KERA News

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  “I’ve done so many different things in the medical industry,” Anderson says, “Except for a nurse and a doctor it seems like.”

The classes Anderson’s taking at Tarrant County College aren’t the challenge. It’s living without health insurance and knowing the Affordable Care Act won’t help. That’s because Anderson falls into the so-called coverage gap, or doughnut hole of Obamacare. She doesn’t make enough to qualify for health insurance subsidies on the marketplace, but also isn’t eligible for Medicaid in Texas because the state hasn’t expanded the program.

For Anderson, this doughnut hole is anything but sweet. She has multiple sclerosis, a chronic medical condition. 

Drugs to treat multiple sclerosis cost thousands of dollars a month, and appointments with a neurologist only add to the bill.  Anderson has already sold her car, and doesn’t want to give up the three-bedroom in Keller she saved up for. Right now, she says she’s relying on grants from a local nonprofit, her mom Martha who lives down the street, and her faith.

“It’s frustrating because you want to do the right thing. I’m trying to do the right thing, but it’s like I’m hanging on by a string.”

The Texas Debate Over Medicaid Expansion 

Earlier in the year, Anderson traveled to the Capitol with a group of people fromAlliedCommunities of Tarrant and Dallas Area Interfaith to rally in support for expanding Medicaid.  the deal Texas legislators were looking at would have covered those making up to 138 percent of the federal poverty level, or about $15,860 for an individual.

This graph, created by the Texas Tribune, shows the potential change in Medicaid enrollment spurred by the Affordable Care Act, according to estimates by the Texas Health and Human Services Commission.
Credit Texas Tribune

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  Willie Bennett is lead organizer for Dallas Area Interfaith. He’s still in disbelief that Governor Rick Perry would refuse to expand Medicaid even if it meant turning down about $100 billion dollars from the Federal government over the next ten years.

“I think it absolutely makes no sense to provide tax credits for health care to people who make $100,000 or more,” Bennet says, “but tell people who make less than $10,000 sorry you get nothing. That makes no sense at all.”

Perry and other Republicans argue the expansion would still be too costly.

Arlene Wohlgemuth is executive of Texas Public Policy Foundation and director of the Foundation’s Center for Health Care Policy. She says as generous as the offer from the federal government sounds, accepting the money would be a mistake.

“We feel that that decision was absolutely the right thing to do,” she says, “Why double down on a broken program?”

Broken, she says, because it doesn’t allow for innovation, is rife with fraud, and worsens the cycle of dependence.

“The bottom line is we need to reform Medicaid," Wohlgemuth says, “rather than expanding it.”

Still Searching For A Texas-Style Solution

Medicaid may be imperfect, Bennett says, but for people like Sheila Anderson, it’s the only health coverage there is.

“We would say is let’s make it better, let’s not ditch it,” Bennett says.

Groups like Dallas Area Interfaith are still fighting for a “Texas Solution” on Medicaid, and they’re gaining support from chambers ofcommerceacross the state. The Governor, though is holding his ground.

So what’s that mean for Sheila Anderson? That nursing degree is looking more important than ever.

Lauren Silverman was the Health, Science & Technology reporter/blogger at KERA News. She was also the primary backup host for KERA’s Think and the statewide newsmagazine  Texas Standard. In 2016, Lauren was recognized as Texas Health Journalist of the Year by the Texas Medical Association. She was part of the Peabody Award-winning team that covered Ebola for NPR in 2014. She also hosted "Surviving Ebola," a special that won Best Long Documentary honors from the Public Radio News Directors Inc. (PRNDI). And she's won a number of regional awards, including an honorable mention for Edward R. Murrow award (for her project “The Broken Hip”), as well as the Texas Veterans Commission’s Excellence in Media Awards in the radio category.