The state's political leaders appear to be striving for a status quo wherein a large number of citizens lack health insurance or the means to obtain it. Will that spark a shift among voters during the upcoming November elections?
It can be easy to stereotype Texas. The Lone Star State -- which votes, at long last, in its much-delayed primary on Tuesday -- is big. It's brash. It's rock-ribbed conservative.
But a state that big necessarily contains multitudes. And those stereotypes aren't always as so cut-and-dried as one might think. First of all, Texas is not quite as Republican as popular lore would have it. Sure, it's ostensibly about as red as a red state can be. But Democrats have always had strong footholds in cities such as Austin and El Paso. Moreover, its demographics are shifting.
Earlier this spring, Austinist.com posited a plausible scenario by which the state might even "go blue" in the 2012 presidential election – with healthcare concerns being a big reason why.
[See also: Texas need for HIT workers estimated at 10,000; 8 healthcare spending trends by state]
Polls show President Barack Obama leading Mitt Romney 53 percent to 40 percent among Texas' women voters, irrespective of party. This is due, in part, "to the recent spate of bills proposed or passed by Republican legislatures in states across the nation that attempt to limit women's access to contraception or restrict access to reproductive health care," the site points out.
Texas was no exception, of course, having passed its own bill mandating invasive sonograms for women seeking abortions. Moreover, the state's Republicans supported a refusal to include Planned Parenthood in Medicaid contracts – resulting in more than 130,000 low-income women losing access to cancer screenings and other potentially life-saving medical services.
Women represent 53 percent of all voters in Texas – and they chose John McCain over Obama by more than five percentage points in 2008. "If that number flips as current polling indicates," according to Austinist, "that would move more than 210,000 votes to the Democrats."
Still, Texas awarding its electoral votes to Obama seems exceedingly unlikely. One thing that is indisputable, however, is that when it comes to healthcare, the former independent republic is a land of contrasts.
On one hand, it's home to some of the best care in the country – filled with world-class hospitals and research institutions. The Texas Medical Center, in Houston, is the largest and densest collection of healthcare facilities in the world; more heart transplants are performed there than anywhere else. The M.D. Anderson Cancer Center is one of the most renowned academic organizations devoted to oncology on the planet.
But in most other respects, the state is badly lacking. Everything is bigger in Texas, the saying goes; nowadays that includes the percentage of uninsured residents.
Texas holds the dubious distinction of having the most people without health insurance in the country. It's home to some 6.2 million uninsured people, according to Kaiser State Health Facts. That's more than 25 percent of its population. For the United States at large, by comparison, that number is just 16 percent. Seventeen percent of Texas children lack healthcare coverage, compared to 10 percent nationwide.
Still, the state's political leaders seem to be doing all they can to maintain that status quo. One of the Affordable Care Act's most vociferous opponents, Texas Governor Rick Perry, the presidential also-ran, has led his state to file suit against "Obamacare," and railed that he would "protect our families, taxpayers and medical providers" from the law's purported depredations.
But as the
Los Angeles Times reported in late 2011
, back when Perry was still a GOP front-runner, "in the 11 years the Republican presidential hopeful has been in office, working Texans increasingly have been priced out of private healthcare while the state's safety net has withered, leaving millions of state residents without medical care."
About the same time last year, The Washington Post enumerated some of the reasons why the percentage of uninsured people in Texas is so dismal. Among them: too many service and retail jobs in the state don't offer health insurance; Texas' Medicaid program is paltry compared to other states'; and private insurance companies are left largely free from regulation.
A high percentage of immigrants also skews the numbers: "Of the 1.2 million foreign-born, naturalized U.S. citizens in Texas, for example, 31 percent are uninsured, compared to 22 percent of U.S.-born Texans," writes the Post's Sarah Kliff.
Those poor rates of coverage have translated to bad news for those who do have insurance, the L.A. Times points out: The past decade has seen premiums going up faster in Texas than in the rest of the U.S.
Indeed, that article finds observers choosing some alarming words to describe the state's healthcare system: "eroding" is one; "at the breaking point" is another.
"Texas just hasn't proven it can run a health system," C. Bruce Malone, MD, president of the Texas Medical Association, told the Times.
If Texas' GOP leadership has been slow to find ways to address these serious problems, some grassroots activists are trying to find a way forward – however unlikely it may seem.
Vermont has made news in the past year or so for being the first state in the nation to begin laying the groundwork for a single-payer healthcare system. The Green Mountain State and the Lone Star State may be about as far apart on the political spectrum as two states can be, but some in Texas are trying to lead the state along a similar path.
The all-volunteer Health Care for All Texas (HCAT) was founded by physicians in 2002 with the conviction that, every person in Texas "deserves access to high quality health care at an affordable cost."
HCAT's goals, according to its website:
- Guaranteed health care for all
- Comprehensive coverage and emphasis on prevention
- Public accountability and public input
- Freedom to choose and change one's physician or other health care practitioner
- Portable coverage not affected by changing jobs, losing jobs, or moving
- Fair financing through employer and employee contributions based on income
- Cost containment
- Guaranteed accessibility based on community need
- Optimal transition to a system established and implemented by consumer, legislative, business, hospital, and provider interests
Pointing out that more than 45,000 Americans die each year because they lack health insurance and that 31 percent of every healthcare dollar is spent on costs that are unrelated to care, Health Care for All Texas' founders put it plainly: "We strongly believe that it is morally wrong to allow other Americans to suffer or die because they cannot afford to pay for health care."