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Poor and Uninsured in Texas

• digitalengineer 10y ago
  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 10y ago
    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.
  • joesmo 10y ago
    I don't think you really understand the amount and magnitude of hate and cruelty in this country, especially hate for the poor and nonwhite, especially in the south. Rejection of Medicaid expansion is just one of many ways this hate and cruelty manifest themselves here.
  • Broken_Hippo 10y ago
    > The ROW (Rest of world) simply can't wrap their head around it... I am keenly aware of this. I moved to Norway, which by all means has a lot of social programs. Most of which I am covered by due to my immigration status (marriage). Part of my requirements was to take Norwegian language classes and civics, along with many other immigrants. More than once, medical care was discussed, as it is outside the classroom mostly because folks hear the rumors and get curious if the healthcare system is like they hear. Looks of shock for not having paid parental leave, which is pretty common in most of the world. And then the shock just seems to keep growing. For the average person with insurance, however, there are a few perks, so I try to include such things. (Less with the waiting times, for example, and the quality of care if you can access it is fairly good). Still a dire sitution.
• joesmo 10y ago
  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 10y ago
    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 10y ago
      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."
• grecy 10y ago
  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
• dzdt 10y ago
  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!]
  • dkarl 10y ago
    No accident that it comes out to "yourself, you're fucked" for a lot of people. Forcing people into dependency on family and the church is the point. Or another way it's been put to me by someone who thinks government welfare usurps the role of churches: you shouldn't be able to get charity without looking someone in the eye, asking for help, and listening to what they have to say about it. (Definitely not my view on the matter.)
  • fgandiya 10y ago
    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 10y ago
      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 10y ago
        Fair enough... But I still find it strange.
    • gozur88 10y ago
      There is a lot of disagreement on this point. Personally, I don't have a problem with these kinds of programs, but it's charity. Nobody should expect it.
      • toomuchtodo 10y ago
• kayla210 10y ago
  "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.
  • deleted 10y ago
    [deleted]
• jrnichols 10y ago
  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.
• phonon 10y ago
  Why didn't he move to a different state that had expanded Medicaid, like New Mexico? He would have easily qualified there.
  • shabble 10y ago
    because he was busy dying from liver failure?
  • Broken_Hippo 10y ago
    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 10y ago
      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/program-information/eligibility-verification-policies/downloads/new-mexico-verification-plan-template-final.pdf https://www.medicaid.gov/medicaid-chip-program-information/p... He could afford moving from Mexico to Texas when he was 20...
• zaroth 10y ago
  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.