NOEL KING, HOST:
Inside of that government spending bill that Congress is currently debating is a potential insurance lifeline for at least 2 million Americans. Now, these are people who have no health coverage because they live in one of the 12 states that have not expanded Medicaid. Texas is one of those states.
Here's Ashley Lopez of member station KUT in Austin.
ASHLEY LOPEZ, BYLINE: Lorraine Birabil lost one of the most important people in her life in 2019. It was her mother-in-law, Millicent McKinnon (ph).
LORRAINE BIRABIL: Oh, my gosh. She was such a vibrant woman - if I had to, like, sum it up (laughter) in one word. She was so vibrant, just always full of energy and joy.
LOPEZ: Birabil says McKinnon was a descendant of runaway slaves who settled in Chicago. As an adult, McKinnon moved to Dallas and worked as a nurse her entire career. Her very last job was as a home health aide, taking care of elderly and disabled people. Birabil says she didn't make a lot of money, though, and didn't get health insurance. And that's why when McKinnon started feeling sick, she put off going to the doctor.
BIRABIL: And so when she realized that something was wrong and she went to find out what it was, it turned out that it was stage 4 breast cancer.
LOPEZ: In the year after her diagnosis, she bounced around hospitals. Doctors would stabilize her and send her home. Without coverage, consistent treatment was hard to find. Her family looked for insurance but found nothing. All they could do in the end was be there as she slowly died.
BIRABIL: You know, and at the time that we found out, you know, we were also pregnant. And she kept saying, you know, (crying) I just want to meet my grandbaby. And she didn't make it.
LOPEZ: A month before her granddaughter was born, Millicent McKinnon died. She was 64 years old, months away from getting Medicare. Birabil says the health care system her mother-in-law spent her life working in ultimately failed her. Birabil says what makes her most angry, though, is that McKinnon might still be alive if she just lived in a different state. Texas is one of 12 states where lawmakers have declined to expand Medicaid under the Affordable Care Act. That affects people like McKinnon. They aren't quite poor enough to qualify for Medicaid, but can't afford to buy their own insurance in the individual marketplace.
Advocates, like Laura Guerra-Cardus with the Children's Defense Fund in Texas, have been pleading with state lawmakers to cover these uninsured Texans, which is about a million people.
LAURA GUERRA-CARDUS: But, you know, purely political opposition from our highest leaders is enough to block progress on an issue that is a basic human right.
LOPEZ: Guerra-Cardus is now looking to President Biden and Congress. Democratic leaders want this covered in the upcoming spending bill. Most of the people who would benefit are in the South and are people of color.
GUERRA-CARDUS: We are asking them to choose to make America a country that does not block health care from anybody.
LOPEZ: The racial disparity is even starker in Texas, where about 70% of folks in the coverage gap are Latino or Black.
Jesse Cross-Call with the Center for Budget and Policy Priorities says this is the first time since the Affordable Care Act went into effect that Congress may have enough votes to address this issue.
JESSE CROSS-CALL: This really is the unfinished work of the ACA to really ensure that everybody in this country who is poor or have moderate incomes has access to affordable health care coverage.
LOPEZ: But this insurance lifeline is competing for money and attention with other priorities.
For NPR News, I'm Ashley Lopez in Austin. Transcript provided by NPR, Copyright NPR.