Howdy Y’all, it’s the TEXAS EPISODE

Everything is bigger in Texas, including medical bills and the uninsured population. The Lone Star state has the second-largest population in the country, and is among the fastest-growing as well, but all those people are stuck with THE worst healthcare system and very poor health outcomes as well. The uninsured rate is more than twice the national average.

Our guest today is Sofia Sepulveda, an activist based in San Antonio, Texas, organizing for healthcare justice, environmental justice, and trans rights. She is co-chair of San Antonio’s Healthcare-NOW coalition. In 2021, she was part of a successful campaign to pass legislation that expanded Medicaid for new mothers in Texas from two months to six months. She is also the co-founder of Trans Power San Antonio and sits on the board of the Transgender Education Network of Texas and the Community Advisory Board for Centro Med in San Antonio. Most importantly, she is on the board of Healthcare-NOW, the organization that hosts your favorite podcast!

Show Notes

What’s the Lone Star version of our crappy American healthcare system? First, they are one of only 12 states that haven’t expanded Medicaid. That means that the only the neediest people qualify for Medicaid.

Texas has the highest uninsured rate in the country at 18%, more than twice the national average of 8.6%. That rises to 30% uninsured among Hispanic Texans and 17% among African Americans. 11% of children in Texas are uninsured. Only 5 other states have more than 12% of their population uninsured (AK, FL, GA, MI, OK)

Texas also has the largest number of residents who said they skipped healthcare they needed because of costs and fewer residents who report having a regular source of healthcare. In Texas, health insurance costs comprise a larger portion of the median income in Texas than in other states. Premium contributions were 8 percent of median income or more.

Mortality rates in Texas are higher for treatable conditions, and is 74% higher among the Black population. A friend of Gillian’s once said “in Texas we don’t go to the doctor; we just die.”

Texas is ranked dead last in access to mental health care. 

Why won’t Texas expand Medicaid???

Around 750,000 Texans fall into the Medicaid “coverage gap” – too poor to qualify for ACA marketplace assistance, yet ineligible for Medicaid because Texas is one of only 12 states that have opted out of the expansion.

In some other states, voters have bypassed elected leaders via ballot measures to adopt Medicaid Expansion. Not a thing here. Even though 64% of Texans approve of Medicaid expansion (82% of Democrats).

Legislation to adopt Medicaid expansion has been introduced consistently in Texas state legislature with no success. Despite huge public support for Medicaid expansion, without support from the Governor, the bills are DOA.

One bill sought to give counties or cities the right to accept the funds allocated by the CMS 

Another (called the “Texas Solution”) would have set up a system where the state could receive block grants to enroll individuals in private plan using a sliding scale subsidy, rather than expanding Medicaid to cover them – this was also DOA.

Structural Racism

Racial health disparities exist across the US, but in Texas they are exacerbated by geography, distance, environmental factors, and a shortage of physicians.  

Texas ranks last in so many healthcare measures due to structural racism. In 2021, the size of the Latinx population in Texas surpassed the white population – 40.2% of the state is Latinx, while 39.4% is white. In every states, Latinos/as are the most likely to be uninsured, and have the worst healthcare coverage, so the combination of Texas’s healthcare policies, along with structural racism and a very large Latinx community, is really deadly.

Much of the economy is stacked against BIPOC, especially Latinx people. Historically, agriculture and domestic work have been excluded from social programs, the right to form unions, and from labor laws like minimum wage. In addition, these industries rarely provide health insurance to their employees. In many cases, these industries were originally made up of Black workers, but are now dominated by Latinx workers.

Texans are fighting back

Last year Texans managed to pass a law expanding postpartum Medicaid coverage from two to six months after giving birth. For a state with higher maternal mortality rates, it doesn’t go far enough, but it helps new parents continue to receive care

Some progessive, pro-Medicare for All candidates are running in 2022 including Greg Casar for Congress. (25th district), and Jessica Cisneros barely lost in a runoff against incumbent Henry Cuellar by less than 300 votes.

To support Texans fighting for healthcare justice:

Texas Organizing Project: organizes Black and Latino communities with the goal of transforming Texas into a state where working people of color have the power and representation they deserve. They work on issue campaigns – including Healthcare Justice – and electoral campaigns.

Equality Texas: works toward a vision of a Texas where lesbian, gay, bisexual, transgender, and queer Texans and their families have full equality in the hearts and minds of our fellow Texans and in all areas of the law.

Sofia credits Healthcare-NOW with her activation as a M4A supporter, so please donate to support our work, which includes providing infrastructure for local single payer groups like Healthcare for All Texas.

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This show is a project of the Healthcare NOW Education Fund! If you want to support our work, you can donate at our website,