40,000 veterans in Texas won't get health care because Perry rejected Obamacare's Medicaid expansion.
Discussing the chances that state Sen. Leticia Van de Putte, D-San Antonio, might run for lieutenant governor, state Democratic chairman Gilberto Hinojosa said she has support among veterans who haven't been part of his party's base in the past. '(I)n the state of Texas, especially with Republicans, with Rick Perry refusing to accept the hundred billion dollars in expanded Medicaid, there's 40,000 veterans in the state of Texas that are not going to receive health care as a result of that decision,' Hinojosa said in a Sept. 25, 2013, interview on the YNN cable news channel's 'Capital Tonight' show. Gov. Rick Perry told the federal government that Texas would not expand its Medicaid eligibility to cover more low-income residents, a key Obamacare initiative, in a letter July 19, 2012. It's not clear that federal reimbursements for those new Medicaid enrollees would have reached $100 billion over 10 years; in an April 2013 fact-check, we found a $90 billion estimate wrongly included $11.6 billion that Texas would get whether it expanded Medicaid or not. Since then, Perry has altered his stance: In a Sept. 16, 2013, letter, he directed the state health commission to ask for a lump sum of money (instead of getting federal dollars for each patient) plus the flexibility to use Texas' own criteria to determine who qualifies. We wondered how Hinojosa concluded that rejecting expansion would deprive 40,000 Texas veterans of health care. Democratic Party spokeswoman Tanene Allison told us by email that Hinojosa's claim was based on a March 2013 study by the Washington-based Urban Institute that analyzed Census Bureau data to estimate how many U.S. military veterans aged 19 to 64 in the U.S. don't have insurance. (Veterans 65 and older qualify, like other Americans, for Medicare.) 'According to the analysis,' Allison said, 'the 48,900 uninsured veterans in Texas whose income is below 138 percent of the federal poverty level could qualify for Medicaid or new subsidies for coverage under the Affordable Care Act if the governor of Texas expands Medicaid.' On Aug. 6, 2013, our PolitiFact Georgia colleagues checked a statement based on the same study from the institute, which they said described itself as a nonpartisan research center although its leadership includes several former Clinton administration officials. That PolitiFact story rated as True a claim that by rejecting an expansion of Medicaid under the Obamacare law, Georgia was depriving 25,000 veterans of health care coverage. Medicaid is an insurance program operated by states in partnership with the federal government, aimed at reimbursing doctors who care for patients in low-income groups such as elderly and disabled people, children and pregnant women. Obamacare included a provision that federal money would cover all costs for the first three years for states to extend Medicaid to households earning up to 138 percent of the federal poverty level - which in 2013 is $15,865 for an individual, $32,499 for a family of four. In Texas, about 1 million adults were on Medicaid in January 2013, according to the website of the state Health and Human Services Commission, which administers Medicaid. Most were eligible because they were pregnant, disabled, older than 65 or raising children on a household income that was below the federal poverty line. If Texas went along with Obamacare's Medicaid expansion provisions, the state commission's most recent estimates, from 2012, predict another 341,000 Texas adults would get on Medicaid in 2014 -- reflecting people who earn less than $15,800 a year (for a one-person household) but weren't already qualified to get Medicaid for another reason. In a May 2012 report, the Urban Institute said 130,000 non-elderly veterans in Texas have no health insurance -- about 8 percent of the state's veterans and 13.1 percent of its non-elderly veterans. The institute based its estimate on the U.S. Census Bureau's 2009 and 2010 American Community Surveys, adjusted to correct for suspected errors such as high reports of private coverage among low-income families. To describe income groups, the researchers used modified adjusted gross income, the measure that will be used under the Obamacare law. Of those 130,000 non-elderly Texas veterans, the institute's March 2013 study said, 48,900 earned less than 138 percent of the federal poverty guideline. State health commission spokeswoman Stephanie Goodman emailed us a lower number: 42,771, based on the 2011 American Community Survey. So it looks like more than 40,000 non-elderly veterans would be eligible, total, if Texas expanded Medicaid to all adults earning less than 138 percent of the poverty guideline. Hinojosa said those veterans 'are not going to receive health care.' Experts told us, however, that some might already be eligible for Medicaid or for health care through the federal Department of Veterans Affairs. Under Texas' current Medicaid rules, Goodman said, some of the veterans could be eligible because they are pregnant, have a disability or are raising children on a below-poverty income. 'But we don't have a good way to estimate what that number would be,' she said. Jennifer Haley, an author of the Urban Institute study, told us by email, 'It's definitely the case that some of these veterans are eligible for VA care ... While our data can't tell us which of these uninsured veterans could qualify, many low-income veterans likely would.' Nationwide, about 40 percent of veterans get health care through the U.S. Department of Veterans Affairs and its network of VA hospitals, clinics and other facilities, according to a September 2012 report from the Center for Innovation and Research on Veterans and Military Families at the University of Southern California. According to the VA's website, its full health care plan is generally available free to veterans who have an injury or condition related to their military combat service, to veterans coming back from Iraq or Afghanistan for the first five years after they return and to veterans below certain income thresholds. Others may qualify for part or all of the services at varying costs. Jessica Jacobsen, a spokeswoman at the VA's Dallas office, told us that as of August 2013, 665,000 Texas veterans were enrolled in VA care and 440,000 were eligible but unenrolled. Many of those unenrolled, however, could have private or other government coverage, as more than half of veterans nationwide do according to the veterans center report. Among Texas' low-income veterans, Haley said, 'There are a number of factors that could keep these eligible veterans from enrolling' in VA care - lack of information about VA coverage, for example. 'It's also possible that some may live too far from VA facilities and they are therefore not convenient options.'
Our ruling Hinojosa said there are '40,000 veterans in the state of Texas that are not going to receive health care as a result of' the decision to reject expanding Medicaid. Two calculations based on Census data suggest 42,771 or 48,900 uninsured Texas veterans earn less than what would be the poverty threshold for adults qualifying for Medicaid if Texas had embraced that part of the Obamacare law. That's not the same thing as saying they won't 'receive health care'; in fact, some likely qualify now for Medicaid or VA care, but aren't signed up. Hinojosa had a reasonable basis for his figure, but his statement lacked this clarification. We rate it as Mostly True. MOSTLY TRUE - The statement is accurate but needs clarification or additional information. Click here for more on the six PolitiFact ratings and how we select facts to check.