This story examines the repercussions of the decision to reject the Obamacare Medicaid expansion in Texas, the state with the highest uninsured rate in the nation at the time (today it’s tied with Nevada). Traveling from Dallas to Galveston, I interviewed several uninsured people who exemplify how having either too high–or too low–of an income can preclude one from joining Texas’ extremely limited Medicaid program and lead to a worsening of health outcomes. Among others, I interviewed an uninsured homeless man named Mark Oswald who had a year elapse between his initial ER visit for mouth pain and his eventual diagnosis of tongue cancer. According to cancer specialists, head and neck cancers are most treatable when addressed within 100 days of the onset of symptoms. Oswald’s condition got much more severe because he was uninsured. The story also shows how Texas’ existing patchwork system of indigent-care charities and low-income clinics fails poor Texans far more frequently than Medicaid coverage would, particularly when it comes to specialty care. I discuss how other states that rejected the Medicaid expansion will fare similarly.
