DALLAS — Texas is leaving $79 billion of federal money on the table by refusing to expand its Medicaid program, Health and Human Services Secretary Kathleen Sebelius told Dallas officials on Thursday.Sebelius was in North Texas to promote the upcoming Oct. 1 launch of the state’s federally run Health Insurance Marketplace, a key component of the Affordable Care Act, also called Obamacare. The marketplace, or exchange, is an online site where consumers can shop for private health insurance coverage and also see if they qualify for federal tax credits to offset the cost of premiums.While Gov. Rick Perry and Texas lawmakers have steadfastly refused to expand Medicaid, the federal-state health program for the poor, Sebelius said Texas leaders can revisit the issue at any time. The Medicaid expansion is “fully paid for” with federal funds, she said, noting that “without Medicaid expansion, there are 2.5 million Texans that really won’t have access to affordable medical care.”By a quirk in the healthcare law passed in 2010, legal residents who earn less than the federal poverty level aren’t eligible for tax credits on the exchange. The ACA originally required states to enroll citizens making less than 138 percent of the federal poverty level in Medicaid, the joint state-federal health care program for the poor and disabled.But the U.S. Supreme Court last year ruled that the federal government could not force the states to expand Medicaid, which Perry has described as already broken. Dallas County Judge Clay Jenkins and Dallas Mayor Mike Rawlings both seconded Sebelius’ suggestion that Texas expand Medicaid.Jenkins noted that Dallas and Tarrant counties together will spend more than $1 billion this year on their tax-supported hospital districts and other health services for uninsured residents.“I think we’ll continue to see states who chose” not to expand Medicaid rethink that decision, Jenkins said.“These are not numbers. These are people,” said Rawlings, saying there are about 500,000 uninsured in Dallas County. “This is a serious issue we’ve all got to understand,” he said.One of those people, Evelyn Hernandez, was at the event held in West Dallas at Los Barrios Unidos Community Clinic. Hernandez said her son, now 4, had a birth defect that required surgery the day after he was born.The community clinic is her primary source of medical care, said Hernandez, who currently is not insured.“It’s not that I don’t want to [have insurance], but the options out there are just too expensive. I just can’t put it on my budget, and I’ve been denied for pre-existing conditions,” Hernandez said. “So I am looking forward to Oct. 1.”Leonor Marquez, CEO of Los Barrios Unidos Community Clinic, said the facility would probably see about 300 patients Thursday, of whom about two-thirds will be uninsured. And that’s after years of work finding alternative state and federal programs, she said, that has slowly reduced the clinic’s percentage of uninsured patients from 90 percent.The Health Insurance Marketplace should allow more of those patients to afford their own coverage and not have to choose between paying for even the clinic’s discounted rates and paying for other necessities. The federal government will offer tax credits on a sliding scale, based on income and household size, for consumers who buy insurance on the exchange.Under the healthcare reform law, all individuals must have health insurance starting on Jan. 1 or face a small penalty that will grow in later years.Open enrollment on the federal exchanges, which offer a variety of policies offered by private insurers, will run from Oct. 1 to March 31, 2014.Sebelius said that as the Oct. 1 rollout approaches, “we are testing and re-testing and kicking the tires” to get the online exchange ready. “We have backups to the backups in place,” she said, although it’s still likely the exchange will have technical glitches in the early days.
Jim Fuquay, 817-390-7552 Twitter: @jimfuquay