Point Austin: Premature Deaths

We're in the midst of a health care emergency. People are dying under extreme circumstances, while the government stands idly by and either twiddles its thumbs or makes things worse.

No, I'm not talking about Ebola in Dallas. While the media (especially the hysterical redoubts of cable TV) have been obsessing about a few deadly U.S. cases of Ebola – and still largely ignoring the West African epidemic – the steady and persistent results of health care negligence in Texas have become so routine that they are seldom mentioned. The continual refusal of the state government under Gov. Rick Perry to enable millions of Texans to gain access to health insurance is most certainly a state scandal, but the situation is simultaneously so politicized and so persistent that it seldom gets attention, except passingly, when the Legis­lature is in session.

Yet the results produced by that ideological, institutional, willful negligence are far more deadly than the periodic eruption of a random virus. That's no exaggeration; as summarized by the Center for Public Policy Priorities, "Uninsured people are sicker and die prematurely compared to those with insurance. Families USA estimates that annually, almost 2,150 working-age Texans die prematurely due to a lack of health coverage."

More than 2,000 preventable deaths per year sounds like news – perhaps even a headline or two – but the drip-drip-drip of everyday disaster doesn't meet the sensationalism test of our hungry 24-hour news cycle. Nor do more mundane statistics about the state of Texas health care, recently ranked among the states: 27th in hospital beds, 39th in EMTs and paramedics, 44th in registered nurses, 45th in dentists, 40th in physicians. (Source: "The Texas Health Care Primer," Rev. 2011, CPPP.org.)

Death by Veto

The statistical summations are numbing after a while. But the plain fact is that many, many more people die as a consequence of an ideological refusal to expand the Texas health care system – primarily by accepting the expansion of Medicaid offered under the federal Affordable Care Act – than will ever die because of a temporary outbreak of a viral disease. Texas has long endured the highest state rate of uninsured residents – 24%, or 6.4 million people, as of 2013 – and among people of working age (19-64), it's 32%, or roughly 5.1 million people. And despite much popular (and politically promoted) mythology, most of those people are not noncitizens; removing noncitizens from the count only drops the percentage to 19.8%, and yes, Texas remains No. 1.

The CPPP reports that 734,000 Texans have enrolled in insurance plans through the ACA Marketplace (i.e., "Obamacare"), including those eligible for subsidies, but that still leaves millions of people without insurance. The Center's Anne Dunkelberg estimates about 1 million U.S. citizen adults fall into the "Coverage Gap" – ineligible for Medicaid under current state limits, but too poor either to qualify for or afford private insurance with the ACA ­markets.

Dunkelberg goes on to note that in the 2013 Legislature, there was in fact bipartisan support (even by the Texas Associa­tion of Business) for an expansion of Medicaid, under a Republican-sponsored plan. "There was more than sufficient support by House and Senate members," she wrote, for a bill sponsored by Rep. John Zerwas, R-Simonton. "But the governor's office began to communicate a veto threat," Dunkelberg concludes. "The bill was never allowed on the House floor for a vote."

Denial = Death

When our longest-serving governor steps down, come January, he will be able to brag that he stood in the Capitol doorway, refusing to allow the neediest Texans access to adequate health care (not to mention rejecting billions in federal dollars for the Texas economy). He doesn't see it that way, of course; as the Dallas Morning News' Lori Stahl reported in 2012, he told Fox News that he's drawing the line against the evils of collectivization: "We're just not going to be part of socializing health care in the state of Texas."

Moreover, as the governor sees it, the feds are just lying ("fake and false") about Texas health care. "Every Texan has health care in this state," he told Fox. "From the standpoint of having access to health care, every Texan has that."

Of course, it's easier to indulge in that bold-faced lie if you're not among those denied regular access to a physician, or dental care, or vision care, and are trying to decide whether this bout of asthma or dizziness or angina is worth another trip to the emergency room, because you have no other recourse. On this score, Gov. Perry's legacy will be one of staggering, willful neglect of his duty to provide for and protect the welfare of Texans – with the result of thousands of unnecessary deaths. No demands for more border guards, or calculated hysteria about Central American immigrants and African travelers, or fulminations against the federal government for attempting to do what Perry and his several administrations have arrogantly refused to do, can ever atone for that fundamental moral failure.