Texas Leads Nation In Number & Percentage Of Uninsured

From the San Antonio Express-News: 

More Texans are getting health insurance, but the state still leads the nation in the percentage of residents without it, according to the Census Bureau. 

Data released Thursday as part of the American Community Survey shows that nearly 5 million Texans are without health insurance, or about 16.6 percent of the population, which is more than double the national percentage of 8. 

There are 4,899,000 Texans who are not insured, which is almost double the 2.49 million who are without insurance in California, the state with the second-most residents without health care coverage. Behind Texas in the percentage of uninsured residents are Georgia and Oklahoma, which are tied at 11.7 percent. 

According to the data, 3.98 million Texans between the ages of 19 and 64 do not have health insurance. Another 854,000 residents under the age of 19 and 69,000 over the age of 65 are also not insured. . . .

According to a 2019 study by the Texas Alliance for Health Care, a lack of health insurance creates issues for hospitals, physicians and Texas residents. The study found that while in 2016, unsubsidized and uncompensated care cost $3.5 billion, that number could rise to $12.4 billion by 2040 if no policy changes are made. Lost earnings and poor health due to those without insurance could be as high as $178.5 billion by 2040 without policy changes.

NOTE - About 10.9% of all Texas children are uninsured.

There Are Far Too Many In U.S. Without Health Insurance

 

There are about 29,349,300 people in the United States that do not have any kind of health insurance. That is inexcusable. The United States is the only country in the developed world that does not cover all its citizens with health insurance or government provided medical care. The charts above use numbers from the Kaiser Family Foundation. They show the number of uninsured citizens in each state.

Recession Has Cost Over 6 Million Their Health Insurance

More than 6 million Americans have lost their health insurance in the recession caused by the Coronavirus (and Trump's mishandling of it). As the chart above shows, over 9 million lost it initially and slightly over 2.8 million regained it when they returned to work -- leaving over 6.1 million still without insurance they had before the recession hit.

That didn't happen in other developed nations -- even those hit hard by the virus and its accompanying recession -- only in the United States. Why?

Because the other developed nations guarantee citizens health insurance through the government. That means a citizen losing their job does not lose their health insurance. It's different in the United States. In the U.S., a majority of people are covered by employer-sponsored health insurance (ESI), and when a worker loses his/her job, they also lose their health insurance (and probably the health insurance for their family).

The chart to the right shows the percentage in each industry covered by health insurance through their employer (ESI). These are all in danger of losing that insurance by losing their job.

This pandemic has revealed the serious flaw in the health insurance system in the United States -- the dependence on employers to provide that insurance. This needs to be fixed, and the best fix is to make the government responsible for providing health insurance for all citizens -- like other developed nations do.

Right-wingers (Republicans) will whine that this is "socialism". That's because they don't believe health insurance is a right of citizens. They see it only as a product to be sold to those lucky enough to afford it. They are wrong. Health insurance (assuring medical care) should be a right of every citizen -- and it should be the government's responsibility to see that every citizen is provided with insurance that allows them to receive decent medical care.

Josh Bivens and Ben Zipperer of the Economic Policy Institute (EPI) have written an excellent report of this issue -- and I recommend you read it.

Here is the conclusion from that report:

The inefficiencies and problems caused by the U.S. system of tying access to health insurance to specific jobs is well known. The downsides of employer-based health insurance access have been made spectacularly visible by the COVID-19 shock—a shock that has cost millions of Americans their jobs and their access to health care in the midst of a public health catastrophe.

Delinking access to health insurance from specific jobs should be a top policy priority for the long term. The most ambitious and transformational way to sever this link is to make the federal government the payer of first resort for all health care expenses—a “single-payer” plan. The federal government already is the primary insurer for all Americans over the age of 65 and for households with incomes low enough to qualify for Medicaid. The advantages of a single-payer system are large, both in ensuring consistent access to medical providers that households prefer and in restraining the often-rapid growth of health care costs.

Absent a once-and-for-all switch to a single-payer system, policymakers can take smaller steps to delink health insurance from specific jobs. They could lower the age of eligibility for Medicare, raise the income thresholds for Medicaid eligibility, and/or incorporate into the ACA marketplace exchanges a public option that enrolls all workers without job-based insurance—even those with access to ESI if they prefer the public option instead. Policymakers could also require that employers either provide comprehensive and affordable insurance or pay a fee to help cover the costs of enrolling their workers in the public option.

Finally, the lowest-hanging fruit in the current crisis is to have the federal government pay all expenses for COVID-19-related testing and treatment. Given the historically rapid increase in uninsurance in the first months of the COVID-19 shock, policymakers should also allow all those without insurance to enroll in Medicaid, regardless of income, for the duration of the crisis.

The COVID-19 shock has exposed just how incomplete and threadbare the U.S. safety net and social insurance system is. We should begin building a better set of systems that provide economic security to U.S. workers.

Nearly 27 Million Have Lost Their Health Insurance

One of the biggest obstacles to government-provided insurance in the United States has been employer-provided insurance. About 61% of Americans get their health insurance through their employer, and they generally like the insurance they get that way. They are afraid of changing, because they believe a government plan might not be as good as their employer-provided plan.

That system is fine most of the time. But the recession we are now experiencing has revealed a huge flaw in employer-provided insurance -- when someone loses their job (fired, laid-off, etc.), they also lose their insurance.

Note the chart above (from the Kaiser Family Foundation). It shows that of the millions who have lost their jobs, about 26.8 million have also lost their health insurance (because it was provided by their employer, and they cannot afford to pay for it themselves without a job).

We already had millions who didn't have any health insurance (because Obamacare didn't cover everyone and many states have refused to expand Medicaid). The addition of another 26.8 million dramatically rises that percentage.

How many other developed countries have had people lose their health insurance due to this recession? NONE! They don't provide insurance through an employer (although employers do help pay for the insurance). Their insurance is provided through the government -- either through a government single-payer system, or private insurance subsidized by the government.

We can discuss how we want to do a government insurance program. It could be by vastly expanding Obamacare to help everyone get private insurance, or it could be a single-payer system (like Medicare-For-All). But one thing is clear. We must get away from employer-provided insurance, and move to a system where a person keeps their health insurance even after losing their job.

Health insurance is not a "privilege" only provided to those who can afford it, or a "benefit" given to workers by their employer. It is a RIGHT of every citizen.

The Number Of Uninsured Children Is Rising Under Trump

The Georgetown University Health Policy Institute's Center for Children and Families has issued a new report. It's very disturbing. It shows that since Donald Trump took office the trend of children being insured has been reversed. While the number of uninsured children went down every year of the Obama administration, the opposite is happening under the Trump administration.

Below are the Key Findings of the report, some rather horrifying charts, and the report's conclusions.

Conclusion

The alarming increase in the number of uninsured children — up by more than 400,000 children between 2016 and 2018— reverses a longstanding, positive trend that was driven by

a bipartisan commitment to children’s health coverage and, more recently, implementation of the ACA. The state-by- state analysis found this reversal is widespread, with only one state showing improvement on this critical child health metric. This is particularly troubling as more children became uninsured during a period of economic growth when more people are working and earning more and children should be gaining coverage.

This serious erosion of child health coverage is likely due in large part to the Trump Administration’s actions that have made health coverage harder to access and have deterred families from enrolling their eligible children in Medicaid and CHIP. These actions include attempting to repeal the ACA and deeply cut Medicaid, cutting outreach and advertising funds, encouraging states to put up more red tape barriers that make it harder for families to enroll or renew their eligible children in Medicaid or CHIP (or ignoring it when they do), eliminating the ACA’s individual mandate penalty, and creating a pervasive climate of fear and confusion for immigrant families. That has left many of these families reluctant to enroll their (largely) citizen children in public coverage for fear of having this held against them.

Continuous health coverage is essential for children— improving their access to needed preventive and routine care, improving their health, educational and economic outcomes as adults, and protecting their families from medical debt and bankruptcy when a child breaks a bone, or worse, has cancer.

There are no signs that this disturbing trend in children’s health coverage will abate unless national and state leaders fully rededicate themselves on a bipartisan basis to the goal of ensuring that all children have access to affordable, comprehensive health insurance.

2.8% More Uninsured Americans Under Donald Trump

During his run for the presidency, Donald Trump promised to eliminate Obamacare and replace it with a system that would provide decent and affordable health care for all Americans. He was lying. All he, and his Republican congressional cohorts, did was to damage Obamacare. The result was that there are about 7 million (2.8%) more uninsured Americans than there were in the Obama administration. It was just another in a long line of lies and broken promises by Trump.

The charts above are from a recent Gallup Poll -- done of 115,929 nationwide adults throughout 2018. The margin of error for the survey is 0.5 points.

Number Of Uninsured Children Rose In 2017 Under Trump

Throughout the years of the Obama administration, the number of uninsured children steadily declined -- from 7.6 million in 2008 to 3.6 million in 2016. This was largely due to the passage of Obamacare, the expansion of Medicaid in many states, and the protection and funding of the CHIP program.

There was no reason why that decline shouldn't have continued. Unfortunately, it did not. In the first year of the Trump administration the number of uninsured children rose significantly -- from 3.6 million to 3.9 million (from 4.7% to 5% of this nation's children). No state had a decline in the number of uninsured children, and three quarters of the increase in uninsured children came in states that have not expanded Medicaid.

The state with the most uninsured children is Texas. Currently 10.7% of Texas children do not have health insurance -- growing by 83,000 in 2017 to a total of about 835,000 children. That's 21% of the nation's total uninsured children -- far more than any other state. Florida and California had 8% each, and Georgia had 5%.

These numbers are from a new report by the Georgetown University Health Policy Institute. Why the rise in uninsured children? here's what they said:

The most likely culprits, per the report: 

• The Republican pursuit of Obamacare repeal and their success in repealing the individual mandate.
• The Trump administration’s regulations that undermine the health care law.
• Congress allowed an unprecedented lapse in funding authorization for the Children’s Health Insurance Program.
• President Trump’s immigration crackdown: Nearly 1 in 4 children in the US have a parent who is an immigrant, and we have strong evidence that an unwelcoming environment for that population leads them to pull out of public programs similar to CHIP and Medicaid.

GOP Raised % Of Uninsured (And Is Doing Nothing To Fix It)

We don't hear much these days about the problem of Americans without any kind of health insurance (which prevents them from getting life-saving preventative care). That's doesn't mean the problem has gone away though. In fact, thanks to Republican efforts, the percentage of uninsured in the United States is once again growing. The charts above illustrate the problem.

The top chart shows the percentage range of uninsured people in each state. The darker the color, the higher the percentage of uninsured. The second chart shows the states that had their percentage of uninsured people rise in 2017. They are the states in black, and there are 17 of them.

The bottom chart shows the states with the highest percentage of uninsured people. Texas leads the list with 22.1% of its inhabitants uninsured. Note that all of the states with the highest percentage of the uninsured are red states (states controlled by Republicans).

Since the Republicans control Congress and the White House, it is up to them to do something to solve this problem. What are they doing? NOTHING!

This is just one more reason, among many, why we must vote them out of power in November. The lives of many of our fellow citizens depends on it.

The charts about reflect in formation in a newly-released Gallup Poll. The poll was done between January 2nd and December 30th of 2017 of a national sample of 160,498 adults, with a margin of error between 1 and 2 points.

Number Of Uninsured Americans Has Risen Under Trump

The chart above reflects the numbers in a newly released Gallup Poll. It was done between October 1 and December 31st of 2017 of a random national sample of 25,072 adults, with a margin of error of only 1 point. It compares the number of uninsured Americans in the 4th quarter of 2016 (Obama;s last year in office) with the 4th quarter of 2017 (Trump's first year in office).

Note that the percentage of uninsured Americans has risen since Trump took office by 1.3% (from 10.9% to 12.2%), reversing a trend of several years that had the percentage decreasing. And there was a rise in the percentage of uninsured in every income, racial, and age group but one -- those over 65 who are covered by Medicare (and Trump and the congressional GOP are laying plans to cut Medicare).

That 1.3% may not sound like much, but in a country with a population of over 323 million people, that translates to about 4 million people. That's a lot of people who no longer have any health insurance -- and Trump's policies are just beginning to disrupt the insurance market. I expect there will be millions more who've lost their insurance at this time next year.

Trump/GOP Efforts Already Causing Uninsured % To Rise

The efforts by the GOP to repeal Obamacare, and the threats to stop insurance subsidies to help cover the cost of insuring working and middle class people, have already had a negative effect on the percentage of uninsured Americans. Because of that insecurity about what will happen, insurance companies have raised premiums. That is causing some to be unable to afford insurance -- the the percentage of uninsured Americans has risen from 10.9% to 12.3%. That may not sound like much, but remember that each percentage point represents about 3 million people.

Now that Trump has stopped those insurance subsidies, and it is unsure what Congress will do about that, we can expect the number of uninsured to continue to rise. Trump is gloating over damaging Obamacare -- and that shows he really doesn't care about making insurance unaffordable for millions of Americans. He only cares about the rich (who don't need Obamacare).

The chart above is from the Gallup Poll, and it was done in the third quarter of this year (July-August-September) of a random national sample of 45,743 adults, with a 1 point margin of error.

U.S.'s Greatest Shame Is An Inadequate Health System

(This image is from the website All U Need.)

Most developed nations provide all their citizens with decent health care. They consider health care to be a right (instead of just a product sold to those who can afford it). They have chosen different ways to do this. Some have nationalized health care (with doctors and hospitals working for the government, some have opted for a single-payer health insurance system, and some do it through a mixture of government and private insurance -- but all of them have something in common. They all provide universal health care coverage (coverage for all citizens).

There is one nation that does not provide universal health care coverage -- the United States. The Democrats passed the Affordable Care Act in 2010. The ACA (commonly known as Obamacare) covered many millions more Americans with health insurance -- lowering the uninsured rate fro about 18% to under 10%. But it still left 28 million Americans with any health insurance. That was partly due to state GOP administrations refusing to expand Medicaid, and partly due to the fact the ACA simply wasn't designed to cover everyone.

The Republicans have promised to repeal the ACA and replace it with something better for the last seven years. Unfortunately, every plan they came up with would increase the number of uninsured Americans from 28 million to more than 50 million. Thankfully, none of those plans made it through Congress.

There is now a group of Republicans and Democrats in Congress working to "fix" the problems with the ACA. But they are just talking about fixing insurance availability and costs for a few million people who buy their own policies. They are NOT discussing any ways to cover the 28 million uninsured Americans with any kind of health insurance.

The sad fact is that neither of our political parties is ready to address America's greatest shame -- the fact that 28 million Americans have no real access to our health care system. There are those who claim the country cannot afford to provide decent health care to all its citizens. That is simply a lie -- for the following two reasons:

1. The United States is still the richest nation on the planet -- richer than any of the other developed nations (who all provide health care for all their citizens).

2. The United States currently spend far more for health care per capita than any of the other developed nations, and we get less for those dollars spent than other nations get.

It is simply shameful that so many millions of Americans have no health insurance, which means they have no access to life-saving preventative care. And neither party is addressing the issue. Until they do, they are failing the nation they claim to represent -- and that is inexcusable.

Uninsured % Continues To Drop Thanks To Obamacare

You may have noticed that there is one issue the Republicans have been complaining about for years that is conspicuously absent from the presidential campaign -- the Affordable Care Act (Obamacare). If the Republicans hate Obamacare so much, why aren't they campaigning on opposition to it?

The simple answer is that it is not a winning campaign issue. Too many people are now insured that weren't before Obamacare was passed -- millions of people. And the GOP knows it would be a huge mistake to promise those millions they would take their health insurance away from them.

They also know they are in a minority position in disliking Obamacare. Obamacare has worked. It has covered many people with insurance that could not afford it before, and it has cured other problems with health insurance -- like doing away with pre-existing conditions, removing caps on insurance payouts for medical care, and not allowing insurance companies to pay less than 80% of premiums for medical care.

Obamacare is not perfect, and most Americans would like to see it improved. But one thing most Americans don't want is to see it repealed. Only the stupidest teabaggers still want that.

The charts in this post reflect the dropping percentage of Americans without heal insurance. They are from a recent Gallup Poll -- done between January 2nd and March 31st of 2016 of a random national sample of 44,557 adults, with a 1 point margin of error. Note that the percentage of uninsured people is still dropping, and is below that recorded in the 4th quarter of 2015 (11.6%). It is now down to 11.0%.

Obamacare Has Insured 20 Million More Americans

The chart above was made from information provided by the Department of Health And Human Services. It shows that, while Obamacare (the Affordable Care Act) has not been perfect, it has been pretty effective in helping more Americans to get health insurance. The percentage of uninsured Americans has been cut from 20.3% in 2013 to 11.5% in 2016 (and the drop has been evident among all demographic groups). It could be cut even more if the Republican-controlled states would expand Medicaid. This is a good result, but not good enough.

Here is the conclusion of DHHS on Obamacare's effect:

We estimate that the provisions of the ACA have resulted in gains in health insurance coverage for 20.0 million nonelderly adults (ages 18 to 64). This estimate comprises 17.7 million nonelderly adults who gained coverage due to the coverage expansions that began in the fourth quarter of 2013 and 2.3 million young adults (ages 19 to 25) who gained coverage between 2010 and 2013 due to the ACA’s provision allowing young adults to stay on a parents’ plan until the age of 26. In total, 6.1 million previously uninsured young adults have gained coverage due to the ACA. This is especially important because this population were particularly likely to be uninsured prior to the enactment of the ACA. The gains in coverage have been shared widely across racial and ethnic groups, with the rate of being uninsured decreasing by 11.8 percentage points among Black non-Hispanics, by 11.3 percentage points among Hispanics, and by 7.3 among White non-Hispanics.

This is a good result, but not good enough. All Americans should be covered by good health insurance (as the other developed nations have done). Both Democratic presidential presidents have this as their goal. Hillary Clinton wants to improve on Obamacare -- something a clear majority of Americans also want (according to Kaiser Family Foundation health polls). Bernie Sanders wants to institute a "Medicare for all" single-payer system. I think that would be the best answer, but polls have shown that Americans are just not ready for that drastic a change.

All of the Republican presidential candidates have said they would do away with Obamacare, and replace it with a better plan (although none of them have come up with any kind of plan at all). According to the Kaiser polls, only about a third of Americans agree with this approach. That idea may appeal to the Republican base, but it would take health insurance away from 20 million Americans -- which seems to be a mistake in an election year.

Percentage Of Uninsured In U.S. Drops To A Record Low 9%

The chart above was made from information in a new report by the National Center for Health Statistics. It shows that the percentage of Americans with no health insurance has dropped to a record low of 9%. That shows that the Affordable Care Act (Obamacare) is working to reduce the number of uninsured Americans.

Some of that 9% is people who simply refuse to comply with the law -- either because they have bought into the Republican lies about Obamacare, or because they simply hate President Obama and don't want to see the program succeed. It is succeeding though, and if the 20 holdout states would expand Medicaid, then that 9% uninsured could be significantly reduced. That refusal (by Republican state governments) is a callous political ploy -- and condemns about 17,000 people to die each year (because they didn't have insurance that would provide them with preventative care).

That 9% uninsured is a much better percentage than we have ever had in the past -- but we must not forget that translates into about 28.7 million people without insurance. And even if every state expanded Medicaid, there would still be a few million people without health insurance. That's because Obamacare was not designed to provide every American with health insurance.

I think it would be a serious mistake to repeal Obamacare (because that would take insurance away from millions of people), but it is getting clearer all the time that Obamacare did not go far enough. Other developed nations cover all their citizens with health insurance (and at a lower per person cost) -- and there is no reason why the United States can't do the same thing.

We need to go farther. We need to institute a government-run, single-payer health insurance system. That's what Medicare is, and it's worked very well. We need to create a Medicare-like program that covers all American citizens. It is simply immoral to not do so.

Texas Is Number One (In The Number Of Uninsured Children)

Texas is number one in another statistic, but it is not one that any Texan should be proud of at all. Texas leads the nation in the number of children that have no health insurance coverage -- about 783,938 children. That's far more than any other state, and makes up about 17.8% of all uninsured children in the entire United States. Let me put that another way -- Texas has nearly one out of every five uninsured children in this country!

California is second with 497,090 (over a quarter of a million less uninsured children than Texas. And since California has a significantly larger population than Texas (about 12 million more people), it has an uninsured percentage of children at 5.4% -- while the percentage of uninsured children in Texas is a whopping 11% (or more than one out of every 10 children).

Those are shameful statistics, and in no way can they be justified. How can this be? It is because Texas is ruled by ultra-right-wing Republicans who care only for the rich (and are perfectly willing to throw poor children under the bus so the rich and the corporations won't have to pay taxes). Texas has no income tax, and the taxes they do have are very regressive (meaning the poor, working, and middle classes must pay a much larger percentage of their income in taxes than the rich and corporations pay).

The Republicans call this the Texas "miracle". I call it the Texas "shame" -- and I have never been more embarrassed to be a life-long Texan than I am right now, because it doesn't have to be this way.

These numbers on uninsured children are from the new report by the Georgetown University Health Policy Institute's Center for Children and Families. You can go to their website to see how your state measures up.

Obamacare Is Working - But We Need More

The chart above is from a recent survey by the Gallup Poll. Between July 1st and September 30th, they questioned a random national sample of 45,615 adults, and because of the huge sample the poll has a margin of error of only 1 point.

The chart shows that the Affordable Care Act (Obamacare) has been pretty successful in its primary goal -- to lower the number of uninsured Americans (thus assuring they can get the healthcare, especially preventative care, that they need). In the last seven quarters, the percentage of uninsured Americans has been reduced fro 17.1% to 11.6% (a reduction in the uninsured of about 32%).

That's good, and I applaud the law for that reduction. But we need to get that number much lower -- all the way down to 0%. Obamacare could be even more successful if the Republican state legislatures would stop playing politics, and expand Medicaid (which currently about half of the states are refusing to do). That 22.2% of uninsured making less than $36,000 could be significantly reduced by that.

But while Obamacare has significantly reduced the number of uninsured Americans, and with GOP cooperation could do even more, the truth is that Obamacare alone will never eliminate the uninsured citizens in the U.S. -- and was never designed to do that. Obamacare was a significant step forward in many ways, but it has not completely fixed the health care system in this country. More needs to be done.

While there is not the political will for it right now, if Americans are to accept that healthcare is a right (and not just a product to be sold), then we are eventually going to have to go to a better system. I believe what is necessary is a government-run, single-payer health insurance system -- like most other developed countries have done (including our neighbor to the north).

This would be something like a Medicare-for-all -- which would have the advantage of covering all citizens with health insurance, and would reduce the amount of money spent on health care in the U.S. (which is much higher than in any other developed nation). It has to come. The only question is how long it will take to finally do it.

Obamacare Works When The States Do Their Part

The chart above was made with information from a recent Gallup Poll. A random national sample of 178,068 adults was queried between January 2nd and December 29th of 2013. Another random national sample of 88,678 adults was questioned between January 2nd and June 30th of 2014. Because of the large sample, the margin of error is 1 to 2 points.

If there was any doubt in your mind as to whether Obamacare could actually work to reduce the number of uninsured people in the United States, the chart above should settle that. It shows ten states that have seen their number of uninsured citizens drop dramatically since Obamacare (the Affordable Care Act) was fully put into effect. This means Obamacare has been able to help millions of Americans get health insurance (which gives them access to medical care, including very important preventative care).

Meanwhile, many other states saw very little reduction in their number of uninsured citizens. A prime example is Texas -- which had 27% of its population uninsured before the establishment of Obamacare (about 7,051,939 people). Only a few hundred thousand were able to get coverage through the federal insurance exchange, which was a drop in the bucket compared to the state's uninsured population. That means Texas still has more than a quarter of its population without any kind of health insurance.

Why the big difference between the states in the chart above (which had a huge drop in the number of uninsured) and the states like Texas (who did not see much drop in the number of uninsured)? The main reason is the degree of cooperation of the state governments.

The states that saw a big drop in uninsured citizens were the states that created a state insurance exchange, expanded Medicaid to cover more of their poor citizens, and encouraged all citizens to get insurance coverage. The states with only a tiny drop in the number of uninsured citizens were those who refused to create their own state insurance exchange, refused to expand Medicaid, and tried to discourage people from signing up for health insurance (telling them they couldn't afford it and it would be bad for them). The latter states were those controlled by the Republicans.

Obamacare does work in reducing significantly the number of uninsured citizens -- but it's not magic. It works best when states cooperate and do their part., and works least when states refuse to cooperate.

Of course, Obamacare is not the complete solution to the broken medical system in the United States. It has significantly reduced the number of uninsured citizens, and probably will reduce that number even further in the future. And it has slowed the rising health care costs. But the United States still spends much more per capita for health care than other countries do, and Obamacare will never cover ALL American citizens with health insurance. It was a significant improvement, but only a partial solution to U.S. health care problems.

It is now time to fix Obamacare by taking it to the next level -- turning it into a government-run, single-payer system (like Medicare) that covers all Americans and reduces health care costs. This will have to be done someday -- and sooner would be better than later.

The "Red State" South Has Half Of All Uninsured Americans

This is a rather staggering statistic -- that nearly half of all Americans without health insurance live in one region of the country (the South). In September of 2013, before Obamacare was fully implemented, the South had 41.5% of uninsured Americans, but in June of 2014 that has risen to 48.9%.

While enough states in the three other regions of the country covered many of their poorer residents by expanding Medicaid, the solidly red states of the South did not -- and when you combine that with the fact that the South has a higher percentage of people living in poverty (or working for a very low wage), it means the South now has millions of people living without health insurance (or any chance of getting it anytime soon).

This should not surprise us. The Republican officials in the South, like the national GOP officials, run their GOP-controlled governments for the benefit of the rich and the corporations. They don't care about the poor (or even the middle class). They oppose the minimum wage (and refuse to raise it), believing employers should be able to pay as little as possible to workers (even if that is a poverty wage). They also believe health care is a product to be sold to those who can afford it, instead of a right of all citizens.

This prompts a question -- why do the people of the South (many of whom are poorly paid or in poverty, and have no health insurance) continue to elect Republicans to political office? Why do they keep voting against their own economic and health interests? There are two facets to the answer -- race and religion.

Regardless of what you may have been told (or just want to believe), there are still a lot of racists in the South. They abandoned the Democratic Party when President Johnson got the civil rights laws passed in the 1960s -- and the Republican Party welcomed them with open arms. And since that time the Republican Party in the South has championed policies that are anti-immigrant and anti-minority, giving those racist voters (who have morphed into the teabaggers) the illusion that a white-dominated America is still a possibility.

But the racists alone cannot control the Republican Party. They need the help of the religious fundamentalists, who control religion in the South. These fundamentalists are upset that their religious views are not elevated above those of other Americans. And the Republican Party has been effective in convincing them that they are the party of christianity, and fooled them into believing they can re-introduce teacher or administrator-led school prayers and force the teaching of creationism as science.

The teabaggers and the evangelicals together dream of replacing out democracy with a white fundamentalist christian theocracy -- and the Republican Party has convinced them that they can make that happen. The crazy part is that they could elect Republicans from now until doomsday, and that still would not happen. The First Amendment protects all religions (and those without religion) equally, and would prevent the establishment of any religion above all others. And the Fourteenth Amendment, along with the demographic population changes happening in the U.S., insures that the future of this country will be a multi-racial and multi-ethnic democracy -- and dominance by whites (even where it still exists) is going to be eliminated.

In other words, a majority in the South votes against its own economic and health interests for a pipe-dream -- an illusion kept alive by Republican propaganda. There is hope for the South though. Just like in other parts of this nation, each new generation in the South is less racist and less religious than the one that preceded it -- and someday the racism and religious bigotry that currently triumphs, will no longer make Southerners vote against their own best interests.

Obamacare Is Not Perfect - But It Is Working

Have you noticed that the Republicans have not been talking as much recently about Obamacare -- and the need to repeal it? For quite a while now the GOP has been telling us that Obamacare won't work -- that it will not reduce the number of Americans without insurance and would hurt those Americans who had insurance. Those assertions have now been exposed as lies.

The truth is that most people have seen a drop in their insurance rates (and many have gotten a premium refund for the overcharge). In some states, like New York, the premiums have almost been cut in half. And as the chart above shows, there has been a significant reduction in the percentage of uninsured Americans -- a drop from the 3rd quarter of 2013 to the 2nd quarter of 2014 of about 4.6 points.

Now I do believe that while that drop is significant, it is not nearly enough. I expect the next sign-up period will lower it even more. But as long as Republican-controlled states refuse to recognize health care as a right of all Americans and expand Medicaid, there will remain millions of Americans without health insurance coverage. This is not the fault of Obamacare, but of Republicans refusing to implement it fully.

Obamacare is not perfect. It has not riven down medical costs enough, and even if fully implemented in all states it would leave some Americans without coverage. But it is working, and has been shown to be a huge improvement over what we had before its passage. It is far from the disaster the Republicans predicted, and any effort to repeal it now would be ludicrous.

The chart above is made from information provided in the Gallup Poll. The latest information was gathered between April 1st and June 30th of a random national sample of 45,125 adults, and has only a 1 point margin of error.

Condemning The Poor To Death In Texas

(This image is from the website of The Brownsville Herald.)

The state of Texas has the highest rate of people without health insurance of any state in this nation -- somewhere between 25% and 27% of the state's population (more than one out of every four people). The 2010 census showed the state's population was about 25.2 million, meaning that more than 6.3 million Texans are uninsured.

Of that huge number of uninsured, the most vulnerable are the poor -- because they have no way to access the preventative care that could save their lives. And in fact, about 9,000 Texans die every year from treatable diseases -- diseases that could have been cured if they had been caught in time through adequate preventative care. They die because the GOP leadership in Austin has refused to expand Medicaid, even though the federal government would have paid for all of that expansion for ten years (and 90% after that ten year period).

For me, these numbers are shocking -- and the failure of state leaders to do something about it (for purely political reasons) is inexcusable. The Texas Observer has printed an essay from a young medical student named Rachel Pearson. This excellent essay puts a human face on the problem of the uninsured poor in Texas. I am posting the opening paragraphs of her essay below, but I urge you to read the whole thing. It will probably leave you feeling angry and frustrated (as it did me), but it is well worth your time. Ms. Pearson says:

The first patient who called me “doctor” died a few winters ago. I met him at the St. Vincent’s Student-Run Free Clinic on Galveston Island. I was a first-year medical student then, and the disease in his body baffled me. His belly was swollen, his eyes were yellow and his blood tests were all awry. It hurt when he swallowed and his urine stank.

I saw him every Thursday afternoon. I would do a physical exam, talk to him, and consult with the doctor. We ran blood counts and wrote a prescription for an antacid—not the best medication, but one you can get for $4 a month. His disease seemed serious, but we couldn’t diagnose him at the free clinic because the tests needed to do so—a CT scan, a biopsy of the liver, a test to look for cancer cells in the fluid in his belly—are beyond our financial reach.

He started calling me “Dr. Rachel.” When his pain got so bad that he couldn’t eat, we decided to send him to the emergency room. It was not an easy decision.

There’s a popular myth that the uninsured—in Texas, that’s 25 percent of us—can always get medical care through emergency rooms. Ted Cruz has argued that it is “much cheaper to provide emergency care than it is to expand Medicaid,” and Rick Perry has claimed that Texans prefer the ER system. The myth is based on a 1986 federal law called the Emergency Medical Treatment and Labor Act (EMTALA), which states that hospitals with emergency rooms have to accept and stabilize patients who are in labor or who have an acute medical condition that threatens life or limb. That word “stabilize” is key: Hospital ERs don’t have to treat you. They just have to patch you up to the point where you’re not actively dying. Also, hospitals charge for ER care, and usually send patients to collections when they cannot pay.

My patient went to the ER, but didn’t get treatment. Although he was obviously sick, it wasn’t an emergency that threatened life or limb. He came back to St. Vincent’s, where I went through my routine: conversation, vital signs, physical exam. We laughed a lot, even though we both knew it was a bad situation.

One night, a friend called to say that my patient was in the hospital. He’d finally gotten so anemic that he couldn’t catch his breath, and the University of Texas Medical Branch (UTMB), where I am a student, took him in. My friend emailed me the results of his CT scans: There was cancer in his kidney, his liver and his lungs. It must have been spreading over the weeks that he’d been coming into St. Vincent’s.

I went to visit him that night. “There’s my doctor!” he called out when he saw me. I sat next to him, and he explained that he was waiting to call his sister until they told him whether or not the cancer was “bad.”

“It might be one of those real treatable kinds of cancers,” he said. I nodded uncomfortably. We talked for a while, and when I left he said, “Well now you know where I am, so you can come visit me.”

I never came back. I was too ashamed, and too early in my training to even recognize why I felt that way. After all, I had done everything I could—what did I have to feel ashamed of?

UTMB sent him to hospice, and he died at home a few months later. I read his obituary in the Galveston County Daily News.

The shame has stuck with me through my medical training—not only from my first patient, but from many more. I am now a director of the free clinic. It’s a volunteer position. I love my patients, and I love being able to help many who need primary care: blood pressure control, pap smears, diabetes management. We even do some specialty care. But the free clinic is also where some people learn that there is no hope for the chemotherapy or surgery that they need but can’t afford. When UTMB refuses to treat them, it falls to us to tell them that they will die of diseases that are, in fact, treatable.