I’m old enough to remember the 1984 Summer Olympics and how gymnast Mary Lou Retton showed the world what a West Virginia girl trained in Houston could do. Her amazing talent and million dollar smile were on display. After Retton retired from gymnastics, I occasionally saw her on TV. I hadn’t thought about her until a few weeks ago. But this time the picture was completely different.
I read on the news what Retton’s daughter had posted on Instagram: that Retton was hospitalized in Houston with a rare form of pneumonia, fighting for her life and uninsured. Her daughter asked people to pray for Retton and help pay the hospital bill by donating money through a crowdfunding website.
I felt great sadness at Mrs. Retton’s difficulties, both health and financial. I was relieved to hear that she is doing better on both fronts, leaving the hospital and reportedly raising over $400,000 for her hospital bill.
But since I’m a health policy, I also thought: How could “America’s Darling” not be insured?
The US has an unusual and unusually complex health care delivery and financing system. Most Americans’ highest health care costs are paid by employer-sponsored (49%) or government-sponsored (37%) insurance plans or self-purchased plans (6%). In Texas, the numbers are slightly different: employers (47%), government (30%) and individuals (7%). Eight percent of Americans and 17 percent of Texans are uninsured, including Ms. Retton.
Retton may not have had access to employer-sponsored insurance. Publicly available sources I checked indicate that she is not currently employed – and also that she is not currently married, so she would not be able to qualify through the husband’s employer.
Retton is also unlikely to qualify for government-sponsored insurance. This category includes Medicare, Medicaid, and the military. She is not in the military and since she is 55 years old, she is not yet eligible for Medicare. Currently, Medicaid in Texas only covers low-income children and some of their parents; , pregnant women; , Texans with Disabilities; and a small percentage of elderly people with very low incomes. In the 40 states that have expanded Medicaid, adults with incomes up to 138 percent of the federal poverty level ($20,120) are also covered, but Texas declined to expand Medicaid to that population. Therefore, even if Ms. Retton lived below the poverty line, she would not be eligible for Texas Medicaid.
Individual insurance plans remain. Americans can buy private plans directly from insurance companies or through the ACA Marketplace on healthcare.gov. Many wealthier Texans buy through private companies. When I checked the Texas Department of Insurance website, I found over 100 comprehensive plans available in Harris County in 2023 with monthly premiums ranging from $544 to $1,258.
Marketplace offers over 120 plans, with monthly premiums ranging from $289 to $689. For low- to moderate-income Harris County residents, the plans come with hundreds of dollars in subsidies, eliminating premiums for some plans. Marketplace plans include out-of-pocket limits above $18,200, which is much less than the cost of a long hospital stay. More than two million Texans purchased plans on the Marketplace in 2023.
So why wasn’t Retton insured? I see only two options.
If she lived below the poverty line, then she fell outside Medicaid coverage as a result of the state’s failure to expand Medicaid. If that is the case, we must ask ourselves how we allow someone who has given so much to our country to fall through the cracks.
If Retton’s income was above the poverty line, she had more than 100 plans that would have protected her from the very high costs of weeks of hospitalization. She is happy that her popularity has allowed her family to collect hundreds of thousands of dollars from strangers. Most people faced with hospital bills are not so lucky.
I wonder if he will buy a plan for 2024. Now is the time: Open Enrollment is ongoing and ends January 15th.
Elena Marks is a senior fellow in health policy at the Baker Institute for Public Policy at Rice University.