Marchers rallying for Medicaid expansion in 2013. (©Marjorie Kamys Cotera)
It’s hard to evaluate the status of Texas health care without getting into the politics of abortion, birth control, the size of the fiscal debt, party polarization, and a host of other issues—and we have Rick Perry to thank for that. With our population soaring—including expensive young Texans and even more expensive old Texans—Perry has used the well-being of our populace to exploit partisan rage. And, not coincidentally, boost his own presidential ambitions. Needless to say, people who run public hospitals and charitable organizations, along with a statistician or two, do not think highly of his policies.
“Policies” is not actually the right word, since the governor really hasn’t had much of a public health plan since taking office—except to get the state out of as much federal oversight as possible. Oh, sure, at the beginning of his tenure Perry had some capable people in charge, but they melted away faster than an ice cream cone in August. Hence, public hospitals and clinics are currently strained to the max, and 25 percent of Texans—6 million people, just slightly less than the population of the Houston metropolitan area—lack any sort of safety net, which means that they have no insurance and go without physicals, mammograms, inoculations, and the like. When and if they finally get care, it is typically only because they have reached a crisis, the treatment for which is likely to be very expensive but not very effective.
Perry’s values reflect one hearty strain of Texas tradition, the one that has never been too sympathetic to the poor and downtrodden. The same could be true of his calls for fiscal responsibility on the part of the state and federal government—his assertion that we simply cannot afford to spend vast amounts on public health. Those notions might have sold well when Texas was an underpopulated rural state, but they’ve now brought modern, urban Texas to the brink. As former state demographer Steve H. Murdock and his co-authors note in Changing Texas: Implications of Addressing or Ignoring the Texas Challenge, “Texas’ population is projected to increase by more than 30.1 million people from 2010 to 2050, an increase of 119.5 percent to a total population of 55.2 million people. . . . The number of incidences of disease and disorders in Texas will increase even more rapidly, with the number of incidences increasing by 84.3 million, or 136.8 percent, from 2010 to 2050.”
While these numbers were bearing down on the state before Perry became governor, he has done little to address them while in office. Yes, we have a new medical school in Austin, and yes, we have a chance of getting new doctors to ameliorate the shortage here. Yes, in 2007 he mandated that Texas’s teenage girls be vaccinated against HPV, a virus that causes cervical cancer, though critics suggested this was due to Perry’s right-hand man, Mike Toomey, who went to work for Merck, the developer of the vaccine and a generous contributor to the governor’s campaigns. Meanwhile, he hasn’t supported improvements in workplace safety, such as a ban on indoor smoking. He did, however, favor a law to reduce taxes on chewing tobacco. The list goes on: He vetoed a law to ban texting while driving and has worked overtime to prevent the dissemination of birth control and sex education in the schools. Merciless cuts to programs for the neediest Texans started in the 2003 session and have continued apace for the rest of his term. Women and children situated well below the poverty line are his most frequent victims. There was, for instance, the devastation of the Children’s Health Insurance Plan eleven years ago, which left at least 150,000 children uninsured. Perry made Planned Parenthood public enemy number one, and as a result, access to safe and legal abortions in Texas—along with information and birth control that would prevent them—is becoming a thing of the past. At the same time, he has claimed that Texas has some of the finest health care in the country—meaning that we can find just what we need in emergency rooms all over the state. Ignoring the cost involved, Perry stated that Texans “for decades have decided that this is the way we’re going to deliver health care.”
But by far the worst move Perry made was turning down the expansion of Medicaid that is a part of the Affordable Care Act, otherwise known as Obamacare. In short, he has refused $100 billion over ten years in federal Medicaid funds to help the uninsured get the health care they need, with the federal government paying 90 percent of the costs going forward. As former lieutenant governor Bill Hobby said, “Of all Rick Perry’s inexplicable antics as governor, none is as puzzling and tragic as his refusal to allow Texans to benefit from the Affordable Care Act. Millions of needy Texans suffer because Perry has refused to participate.” Hobby goes on to say that, because of Perry’s refusal, Texans’ tax dollars will go toward funding the program in other states.
It would be one thing if Perry’s belief in fiscal conservatism could be supported—if it were true that, as he has claimed, the ACA was expanding “a broken system that is already financially unsustainable.” In fact, as the pro-expansion forces have noted, taking the money makes a lot more sense than refusing it. For example, a report by the economists at the Waco-based Perryman Group concluded, “The state actually makes money by participating in the Medicaid expansion.” Among other things, accepting the federal funds would create jobs and ensure healthier, more productive workers. Of course, taking the money will also save lives. Let’s hope those factors figure into the next governor’s agenda.
Texas’s ranking among the states in uninsured residents in 2003: 1
Texas’s ranking among the states in uninsured residents in 2014: 1