Randy Osban’s job selling ribs and brisket from a yellow trailer on Texas’s state road 71 offers a sweeping view of the hill country beyond Austin. One benefit his business doesn’t provide is health insurance.
Osban, 55, could use it now, as his wife Kathy, 59, has a heart condition and the money he makes barely covers current expenses, much less a hospital bill. While he’s heard of Obamacare, he doesn’t know if it can help him or how to enroll.
“I’m in the dark; total darkness,” Osban said.
In 18 days, Americans will start signing up for medical coverage through the Affordable Care Act’s online exchanges. The law, targeting most of the 50 million uninsured, promises to change the way health care is provided in the U.S. It forces most Americans to buy coverage, offers subsidies to pay for it, mandates insurer outlays for disease prevention and guarantees a pre-existing condition won’t get you turned down.
You wouldn’t know it in Texas.
Distrustful of the U.S. government, with a defiant and independent heritage, Texans are largely unsupportive of a law they little understand. While no state has a higher proportion of uninsured, the Republican governor, Rick Perry, has refused to help build or promote an insurance exchange in the state and he won’t expand Medicaid, the joint state-federal health plan for the poor, to care for more people.
“It’s still Texas and it’s still, ‘pull yourself up by your own bootstraps,’” said Jim Young, who runs a private health program for the uninsured in San Antonio. The attitude is “if someone can’t do that, it’s their own problem. It’s a holdover from the Old West.”
More than 6 million Texans who now lack insurance coverage may be eligible to purchase it through a U.S.-run exchange that will open on Oct. 1, according to the nonprofit Kaiser Family Foundation. Yet Texas has provided no help to groups working to educate residents on the exchange, said Keilah Jacque, a policy coordinator at City Square, a social service agency in Dallas.
Instead, the state’s top officials and representatives are focused on getting the law overturned. U.S. Senator Ted Cruz, a Republican pushing a plan to defund Obamacare in Congress, appeared Aug. 20 at a rally against the law in Dallas.
Organized by Heritage Action for America, the “Defund Obamacare” event drew more than 1,500 people to a hotel ballroom, a crowd that leaned elderly and white and treated Cruz like a folk hero.
Cruz’s speech largely focused on politics, until a woman stood up and challenged him, asking what he would do for the 6 million Texans “that can’t afford health care.”
“We can take care of ourselves!” a man in the crowd shouted at her, to applause.
Cruz thanked the woman.
“I think we need to reform our health care to make health care more accessible, reduce the cost of health care and empower patients,” he said. “I’ve gotta tell you, Obamacare is making it worse.”
Perry, meanwhile, has swatted away efforts by U.S. Health and Human Services Secretary Kathleen Sebelius to publicize the law in trips she’s made this year to Dallas, Austin, San Antonio and Houston. The governor has greeted Sebelius’s arrival with critical press releases.
“Texans are already subject to too much costly and burdensome federal regulation, and Obamacare only makes the problem worse,” Perry wrote in statement released while Sebelius was visiting Houston.
Combating this are activists such as Luis Veloz, a 19-year-old who works with the Texas Organizing Project, part of a nationwide informational drive being organized and run by Enroll America, a Washington-based nonprofit whose president previously worked on behalf of the Obama campaign and later held a position as an aide in the White House.
The Texas group, a network of 20,000 volunteers, had contacted more than 100,000 people with a month to go before signups begin, Allison Brim, organizing director for the Texas Organizing Project, said in an interview.
For Veloz, the effort is personal.
His own family is uninsured and facing about $200,000 in medical bills after his father suffered a heart attack in November, Veloz said in an interview over lunch at a Dallas Tex-Mex restaurant. He spends his evenings knocking on doors in neighborhoods with high numbers of uninsured and accosting Texans on the street to educate them on the law, he said.
“It’s my fight,” he said. “The more people sign up, the better it’s going to work out for my family.”
Veloz said he measures his progress through the telephone numbers he collects from people who want more information on the law and those he will check in with later to see if they’re enrolled through the exchanges and offer them his help. He was escorted out of Cruz’s event after heckling the senator.
“While there may be some in Texas who want to make it more difficult for Americans to access affordable health insurance, we are fortunate to have a strong network of partners throughout the state who are committed to this effort,” said Joanne Peters, a spokeswoman for Sebelius, in an e-mail. “We have a broad coalition of stakeholders who are working every day to provide Texans with accurate information about how they can get the coverage their family needs.”
Lucy Nashed, a spokeswoman for Perry, said the governor didn’t have time for an interview the week of Aug. 19.
The federal government is building an insurance exchange for Texas, a marketplace where people can choose plans on the Internet or by phone, or work with insurance brokers who will purchase coverage for them.
Federally supported health clinics in Texas have received about $10 million from the Obama administration to hire 193 workers who will educate patients about the health law. The federal government is spending $11 million more on navigators who will help people enroll in insurance plans. That’s about 80 cents per Texan, and the lack of resources is evident across the state, where there’s little recognition the law exists.
The Obama administration’s work is made more difficult by some Texas doctors, who aren’t shy about sharing their dislike of the law with patients. The Texas Medical Association, the state’s professional society for physicians, broke with the American Medical Association in 2009 and opposed the Affordable Care Act while it was under consideration in Congress.
That’s because the law favors large hospitals and integrated care systems like California’s Kaiser Permanente over the independent medicine prevalent in Texas, said Edward Buckingham, a facial plastic surgeon who owns a practice in Austin.
Care will increasingly move from doctors’ offices into more expensive hospital settings under the law, he said.
His wife, Dawn, a surgical ophtalmologist who is part owner of a six-doctor practice, said over dinner at a restaurant overlooking Lake Travis that she advises patients who ask about the Affordable Care Act to get elective procedures done now, before the law is fully in effect.
“I tell them that I personally think it’s going to bring the downfall of the whole medical system,” she said. “I think there are going to be people without any medical experience determining what they can and cannot have done.”
Both Buckinghams described themselves as Republicans.
Only the most intrepid and motivated Texans seek out information about the law on their own.
Meggan Marasek, 28, of the city of Burnet, said she was diagnosed with ocular melanoma -- a cancer of the eye -- in September 2010. She learned of a program under the law called the Pre-Existing Condition Insurance Plan when an aunt showed her an AARP Magazine article. Marasek joined, and the plan paid for most of her care at the M.D. Anderson Cancer Center in Houston.
Her PCIP coverage costs her about $210 a month and expires on Dec. 31, when Marasek will have to enroll in an exchange plan instead.
She is concerned that the new insurance won’t cover as much of her care, which has cost $500,000. She has told her doctors that if they must remove her eye to do it before Jan. 1, in case she faces higher out-of-pocket costs next year.
Like Osban, Marasek said she had heard nothing about the law or its programs from her doctors, authorities or media sources, beyond AARP Magazine and her own research at the government’s website, healthcare.gov.
Both of them worry what the new exchange plans will cost. Osban, in an interview outside his trailer, said an insurance broker whose name he couldn’t remember had come by a few weeks earlier, trying to sell him a health plan before the Texas exchange opens.
The woman told him rates would probably double under Obamacare, Osban said. She didn’t mention subsidies that would bring down the cost.
“I’m definitely interested if it’s going to bring it down to the level that everybody should be able to pay,” he said.
He figures about $200 a month would be affordable, after subsidies. The Obama administration plans to announce rates later this month.