This is not a rhetorical question. For health care providers in Texas and over twenty other states this is now a fact of life. As middle and upper middle income workers sign up for their new, federally subsidized health insurance, many lower middle class and unemployed Americans are shocked to discover that they still can not get health insurance---because they are too poor and sick.
The so called "invincible" young people in the 20s may not care that their minimum wage job does not qualify them for federally subsidized health insurance. But to people in their 40s and 50s who are unemployed or underemployed because bad health caused them to lose their job and health insurance, this is a big slap in the face.
Where I live, in a major urban area of Texas, we have a public health program in place for the indigent uninsured. However, since it is not real insurance, it limits what it covers. So, for instance, you can not get a transplant. You can not get a sleep study or sleep disorder treatment. You can not get infertility treatment. You may wait and wait for orthopedic surgery. Your spouse won't be able to get home health care meaning you may have to cut back your work hours or quit your job altogether to take care of him yourself.
If you are a middle aged American who has lost your job due to chronic liver disease from Hepatitis C, and you are on a limited county funded public health program, you could die for lack of a liver transplant while waiting two years for your Medicare to kick in once you qualify for disability. This is the nightmare that real people are living right now.
For those who do not happen to live in one of the large, urban areas of Texas, it is even worse. They have no public health program to fall back upon. All they can do is seek care in rural emergency rooms which are already over-utilized and under reimbursed. When the rural hospitals fold, they will have no health care.
Since sickness is the major cause of adult poverty in this country, denying health insurance to those who are poor is the same as saying "Sorry, you are too sick to get health care." In what universe is this fair? In what world does this make sense?
When the Affordable Care Act was written, its authors did not intend to exclude the poor. They were not saying "The healthy middle and upper middle class deserves health insurance irregardless of pre-existing conditions, but those who are REALLY sick and poor, the ones too sick to work---they can go die on an ice floe for all we care." That's what the Supreme Court and the Tea Party affiliated governors of over 20 of our states have said when they blocked the Medicaid expansion that was supposed to provide health care to those who needed it the most but who could afford to pay for it the least. In Texas, Gov. Rick Perry is under the delusion that he will be our next Vice President, as long as he toadies to the Koch Brothers by denying poor and sick people the health care that could lift them out of sickness and out of poverty by putting them back to work.
There is only one way to set this right. If the Democrats regain control of the House this fall, they can amend the Affordable Care Act to close the loophole that allows states to put their neediest citizens out to pasture. This may seem like an almost impossible goal, but it should not be. Middle income tax payers need to learn how much their urban area property tax could be lowered if billions of dollars of federal money were to flow into their community, relieving them of the obligation to pay for care for the indigent from local tax coffers . Rural middle income tax payers need to know that their own access to health care at local doctors' offices and hospitals is being jeopardized, because their county poor will not receive the insurance benefits that poor rural citizens of Kentucky will receive. Knowledge really will set America free, but only if we spread the word.