SAN JUAN, RGV – An official in the Obama Administration says that with Texas’ budget bulging due to oil and gas revenues it can afford to expand Medicaid to help the working poor.

Tammy Treviño, Region 6 administrator for the Department of Housing and Urban Development, was in San Juan on Saturday to promote participation in the new Affordable Care Act (ACA) health insurance exchange. Her visit was part of a 15-city nationwide series designed to insure the population with the most to gain from ACA: Latinos.

Treviño noted that because Gov. Rick Perry prevented the state legislature from accepting billions of federal dollars to expand Medicaid, tens of thousands of residents in South Texas remain without health insurance. These working poor residents fall in what is called the “coverage gap” or the “black hole.” They earn too much to for Medicaid but not enough to qualify for a discount under ACA.

“The constituents of South Texas need to think about who is making those decisions at the state level and what advocacy can be done to convince the state that expanding Medicaid is important and that everyone needs to be covered,” Treviño said.

Martha Sanchez, a community organizer for LUPE, and Tammy Treviño, a regional administrator for HUD, are pictured at an Affordable Care Act event in San Juan.
Martha Sanchez, a community organizer for LUPE, and Tammy Treviño, a regional administrator for HUD, are pictured at an Affordable Care Act event in San Juan.

Asked how everybody could be covered given that Texas said “no” to Medicaid expansion, Treviño said: “I believe we are in a time of great economic prosperity in the State of Texas. I believe that the oil and gas shale that we are seeing popping up all over the State of Texas are bringing unprecedented income and wealth to the State of Texas.

“I believe there are ways we can all work together and hopefully figure out how to insure that segment of the population that is falling in between the gap. There are ways to fill that gap. I am not an expert on the Texas budget but I do believe it is necessary to close that gap. Whatever we can do as a state, we need to figure out how to do it. It is the right thing to do.”

Treviño is a native of South Texas. She was born and raised in the small town of Pearsall, which is situated on I-35, between San Antonio and Laredo. She has worked in the Mid Rio Grande region most of her life, starting out with around 15 years in the healthcare field. She then moved over to community and economic development, with housing a specialty. She has worked for the Obama Administration since 2009, first with USDA Rural Development and then at HUD. Region 6, which Treviño oversees, includes five states: Arkansas, Louisiana, Oklahoma, Texas and New Mexico.
According to researchers Sherry Glied and Stephanie Ma of New York University, Texas could forfeit as much as $9.6 billion of federal Medicaid matching funds by 2022. “No state that declines to expand the program is going to be fiscally better off because of it,” Glied told the Dallas Morning News reporter Robert T. Garrett. Glied is a former Obama administration health planning official and dean of NYU’s Robert F. Wagner Graduate School of Public Service.

The ACA event in San Juan was hosted by La Unión del Pueblo Entero, a non-profit that helps colonia and low-income families in Hidalgo County. LUPE has joined a campaign called Texas Left Me Out, which seeks to persuade legislators to expand Medicaid. Earlier this month, Texas Left Me Out sent a letter to legislators. It said:

“Texas has the highest rate of uninsured people in the United States – over six million Texans are uninsured. And consistent with the nation’s new health law’s purposes to improve health outcomes and reduce costs, every person is to have a way to access affordable and quality health care. But Texas’ decision that resulted in the loss of billions of federal dollars that could have expanded health coverage left more than one million Texans in a coverage gap. Texas adults above the poverty line will get publicly funded financial assistance for their health coverage, while those Texans below the poverty line will qualify for nothing.

“Hundreds of thousands of Texans currently trying to sign up for health coverage are being denied the financial assistance that is available to millions of Americans in other states. This includes veterans and their spouses, as well as workers in construction, child care, health care, and service industries. Many of the people taking newly created jobs in Texas won’t qualify.”

The letter offered an example of the inequity of the situation. “Imagine two uninsured parents, each with two children. The first uninsured parent, earning $17,000 a year, will receive no financial assistance for health coverage, while the second uninsured parent, earning $20,000 a year, will qualify for full health coverage on a sliding scale for $33-per-month or less.”

The San Juan event saw 25 navigators attempt to sign up those residents who could register for coverage under the health insurance exchange. In addition to Treviño, San Juan Mayor San Juanita Sanchez spoke at the event.

Asked to comment on those in the “coverage gap” or the “black hole,” Sanchez told the Guardian: “If we can get the community engaged we will get the attention of the politicians and we will get the funds. We as community leaders need to get the people behind us. Our challenge along the border is different. We have to continue to come together to inform people. We have to keep fighting for the money and the programs that help the majority of our community. A public hospital would be good. We need to support it and fill those gaps.”

Sanchez added: “It is important to vote. If we can get the people to understand the issues and vote that will grab the attention of the politicians. We cannot stay at home. We have to tell our state leaders we want the expansion of Medicaid. We want medical coverage for the working poor.”

Asked what message she would like to leave with Rio Grande Valley residents, HUD’s Treviño said: “Get registered. We need to register as many people as possible. Depending on your income and size of family, that will determine what you will pay but our message is get out here and get registered. The more people we sign up the less of a financial impact it will be on the government.”

Asked if the insurance rates were good, Treviño said: “Yes, they are good rates and it will give people peace of mind. It will allow them not to put off visits to the doctor when they need to be seen. It will not put them in grave health situations because they put off those types of visits. I myself know people who will say, ‘I just cannot go to the doctor, I don’t have any money.’ We cannot afford that. As a society, we cannot afford that and we cannot allow that. We need everybody to be registered, for peace of mind and for economic security.”

Treviño said that from her travels promoting ACA she is finding an eagerness to learn more. “People are not sure how to access the marketplace and they think this will be one more payment they will have to make each month. I think it is incumbent on us to give them reassurance and security. We need to tell the people that this health insurance is an investment in their life. In the long run they are going to be better off health-wise and wealth-wise.”

Treviño concluded her interview with the Guardian by thanking the media for helping to get the word out about ACA. “For many people, the masses in the United States, the Affordable Care Act is affordable,” she said.

Mayor Sanchez praised LUPE for hosting the health fair and for providing 25 navigators. “This gives us the opportunity to help people sign up for coverage. Many of our folks do not have the luxury of getting on a computer to get it done. We have to take advantage of this.”

Sanchez said her city was trying to encourage healthy living and exercise as a way of preventing poor health. “On April 12 we are holding a Walk ‘n Roll, otherwise known as San Juan on the Move. I got this idea when I visited Guadalajara. Every Sunday afternoon they close downtown Guadalajara and allow you to ride freely. We are shutting down a mile and half in downtown San Juan so that people can use their skateboards, their rollers, their bicycles. We will also hold a health fair and a farmer’s market. And, for the first 100 participants, the young kids, we will provide helmets for free.”