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Texas Medicaid Debate Complicated By Politics And Poverty

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When the sun rises over the Rio Grande Valley, the cries of the urracas — blackbirds — perched on the tops of palm trees swell to a noisy, unavoidable cacophony. That is also the strategy, it could be said, that local officials, health care providers and frustrated valley residents are trying to use to persuade Gov. Rick Perry and state Republican lawmakers to set aside their opposition and expand Medicaid, a key provision of the federal health law.

The Rio Grande Valley has a load of troubles: high unemployment, low-paying jobs, warring Mexican cartels, a meager tax base and legions of people without health insurance. While many of those woes seem incurable, expanding Medicaid to the region's uninsured is, to Paula Gomez, who runs several local health clinics, a no-brainer.

"I think if we're not ready, if Texas doesn't buy in in the next three months, shame on us," she says.

Texas has the highest rate of uninsured residents in the nation — 1 in 4 Texans has no health coverage — and the rate in the Rio Grande Valley is even higher. Medicaid is closed to anyone earning more than $196 a month, leaving many working adults ineligible and without coverage.

Under the health law, the federal government would pay the entire cost of the expansion for the first three years, then 90 percent in subsequent years. As it stands, Texas would have to spend about $1 billion a year over the next three years, say Democrats, to receive $27 billion in federal matching funds.

But Gov. Perry says Texas can ill afford to expand Medicaid, and he doesn't trust that the federal government will pay its promised share. At a news conference last month, he blasted Obamacare's Medicaid provisions:

"Seems to me an appropriate April Fool's Day event, makes it perfect to discuss something as foolish as Medicaid expansion, and to remind everyone that Texas will not be held hostage by the Obama administration's attempt to force us into the fool's errand of adding more than a million Texans to a broken system."

For now, uninsured patients in the Rio Grande Valley pay what they can for basic medical care, but specialty care — to follow up on a lump in the breast, for example — is almost always out of reach without some type of insurance, including Medicaid, according to Dr. Henry Imperial, the Brownsville Community Health Center's medical director. "Once you diagnose a cancer, then what? How are you going to give me chemotherapy or surgery or radiation therapy?" he asks.

Hospitals in Texas end up with millions in unpaid bills, and the counties, by state law, have to provide basic medical care to destitute residents. That has led a number of counties in the Rio Grande Valley — and elsewhere — to pass resolutions supporting the Medicaid expansion.

For local Republicans, that mild act of defiance against a powerful governor — who is opposed to every provision in the federal health law — can seem like political suicide. It's not something they're eager to draw attention to.

"It's contrary to what the [GOP] leadership in Austin is recommending, but we thought it was important enough to take a position," says Republican Carlos Cascos, the county's top elected official.

State Rep. Eddie Lucio III, a Democrat from Brownsville, faces daunting odds in trying to persuade the conservative Republicans who control the Legislature to buck Perry and approve a bill to expand Medicaid in Texas.

Lucio says he's not sure what effect, if any, the resolutions by county officials, including Republicans like Cascos, are having. There is ample pessimism here in Brownsville that lawmakers 350 miles away in Austin will ever understand life in the Valley.

But because there is no hard deadline for when Texas or any other state has to sign up for the Medicaid expansion, health clinic director Paula Gomez is pressing on. She says she still remembers fighting the state to get drinkable water in the Rio Grande Valley, and she'll patiently fight this war too.

Copyright 2013 Kaiser Health News. To see more, visit

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