Surviving epilepsy in the Medicaid coverage gap

On April 1, 2013, then Texas Governor Rick Perry — flanked by senators John Cornyn and Ted Cruz — shared his thoughts about what had come to be known as Obamacare and its Medicaid expansion.

“Seems to me an appropriate April Fool’s Day event … 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 this fool’s errand of adding more than a million Texans to a broken system.”

Perry continued, “Medicaid expansion is, simply put, a misguided and ultimately doomed attempt to mask the shortcomings of Obamacare.”

Perry stressed that Texas was among the first states to reject the offer from the federal government to add uninsured low-income adults in every state to Medicaid.

With the expansion, people who made less than roughly $15,856 and families of four that brought in less than $32,499 would qualify for the federal health insurance program without also having to be pregnant, disabled, or elderly, and the feds would pay for it. The federal government planned to pay 100% of the cost of the Medicaid expansion until 2020. Then, its contribution would drop to 90%.

Perry called that April Fool’s news conference to reiterate that Texas wanted nothing to do with it. But why leave all that money on the table, and more than a million Texans uninsured?

“Our decision is based on what is in the best interest of Texans, all Texans, and is one definitive way that we can seek to minimize the damage done by the institution of Obamacare,” Perry said, over the din of protestors just outside his office doors.

Governor Greg Abbott would soon replace Perry in the governor’s office, and his stance would be the same. No Medicaid expansion, no how.

In 2022, Gov. Greg Abbott told Public Health Watch that he stood firm in his refusal to take the money on behalf of his constituents because, he said, expansion is “a tax increase waiting to happen” and that “Medicaid was created to serve the most vulnerable, not able-bodied adults who can and should get health care through an employer.”

But what if your health makes it difficult for you to get or keep a job? Those are the vulnerable people Abbott said Medicaid is for, but many people with chronic illnesses do not qualify for disability.

They’re caught in a frustrating catch-22. They find it challenging to get or keep a job, so they can’t get employer-sponsored health insurance, and without health insurance, they can’t get the medical care that would improve their health enough to allow them to get and keep a job.

That’s life for many Texans with epilepsy.

Public Health Watch reporter Kim Krisberg recently explored that part of the Medicaid expansion story. What happens if you have a chronic illness like epilepsy in Texas or another state that has rejected the Medicaid expansion? She spoke with TPR’s Bonnie Petrie about what it’s like to survive with epilepsy in the Medicaid coverage gap.