Last December, both of junior Rose Dotson’s parents lost their jobs, and with them, their family’s health insurance. It became a serious issue when her brother appeared to have walking pneumonia, costing them hundreds of dollars, and later when they could no longer afford their daily medications.

“Everyone in my family is on medication, and I take about four different medications from anxiety to headaches to Accutane, and one time we went to pick up one medication, and it was $600 for a one-month prescription,” she said. “And that’s when my family was like, ‘Yeah, we can’t pay for this.’ So none of us had any of our medications for that six-month timespan. And my brother [needed medication], and he didn’t have [it] when school started.”

Her parents tried to hide the severity of the situation from her, but she soon realized just how much of a financial impact a lack of coverage meant.

“I think my parents tried to shelter me from it at first for a little bit; it wasn’t until we started being really frugal with money that I was seeing that medical insurance is very important for everyone,” she said. “At first I was just kind of like, ‘Oh, it’s just whenever you need it; It’s not that expensive.’ But we learned that we couldn’t pay out-of-pocket, and it was a really eye-opening experience. Despite my parents trying to hide things from me and comforting me, saying that I shouldn’t be worried, it’s something to worry about. We were pretty much living off savings, and we couldn’t be dumping our savings into medication when we had a mortgage and car payments and everything else.

Her story is by no means rare; Texas is, according to a study by Georgetown University, ranked first in the country for rate of children without health insurance. Researchers found that 10.7 percent, or 835,000, children were uninsured, going up from 9.8 percent in 2016. The study also concluded that one in five uninsured children in America live in Texas.

“[Lack of insurance] makes it harder for children to get timely care, whether it’s vaccines to stay healthy, help for strep throat, detection and treatment of cancer before it spreads, eyeglasses to see better in the classroom, or therapy for a developmental delay or disability,” Peter Clark, communications director for Texans Care for Children, said.

This trend was not confined to the state level; legislative attempts to retrench public health programs, spearheaded by the GOP, led to 300,000 more uninsured children in America, a 0.3 percent increase over the course of one year.

“There are a number of reasons [Republicans oppose health care expansion]: resistance to spending money, opposition to policies that are associated with President Obama, an ideology that expects people to solve their problems on their own, and historically an opposition to public assistance programs in parts of the country where people of color are seen as significant beneficiaries of those programs,” Clark said.

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Policy experts say that more people became insured with the enactment of the Affordable Care Act and the streamlining of the enrollment process for Medicaid and Children’s Health Insurance Program, or CHIP, but recent efforts to scale back the scope of those programs have reversed that trend.

“The ACA and CHIP have certainly made a big change in Texas, reducing the uninsured from roughly 27 percent to roughly 17 percent,” Warner said. “Medicaid expansion would be an excellent initiative alone and help cover a large number of adults. Being more proactive in reducing barriers and outreach would help as well.”

Clark agrees the Medicaid expansion would greatly reduce uninsured rates.

“State leaders have not made health coverage a priority,” Clark said. “The biggest thing that state leaders should do is to accept Medicaid expansion funding to cover low-income adults, many of whom currently have no affordable insurance options.”

This issue has socioeconomic nuances; black, Hispanic and immigrant children are disproportionately more likely to be uninsured, and low-income families make up the majority of those who lack coverage.

“If children are in families with one or more adults who are recent immigrants, even though the kids may be citizens, the parents may be leery of signing them up for fear of exposing their situation or even threatening their green card status for fear of being identified as a public charge,” said David Warner, professor of health policy at UT Austin.

One solution would be to increase awareness of how the process to qualify for and enroll in government-provided health care works; many families that qualify simply don’t know how to sign up, or even that they’re eligible in the first place. According to the study, the Trump administration has cut navigators that guided people to sign up for public service, funding for marketing and outreach and reduced the open enrollment period in 2018 from three months to six weeks. More than half of uninsured children are eligible for programs in which they are not enrolled.

“We need to put greater effort into outreach and enrollment efforts, including efforts that focus on reaching out to [socioeconomically-disadvantaged] communities,” Clark said. “There are a number of limitations on immigrants’ access to Medicaid and other health insurance programs.”

Texan Republicans have said that they are dubious about the quality of Medicaid-provided health care and the promise from the federal government to reimburse 90 percent of any expansion of the program. Texas is one of 17 states that have opted out of Medicaid expansion. The Shield reached out to all of the Republican state representatives on the Texas House Public Health Committee; none responded to a request for comment.

“When the Affordable Care Act went into effect, we saw the uninsured rate in Texas decline,” Texas Senator Kirk Watson, D-Austin, said. “We can see further declines in the uninsured rate if Texas expands Medicaid, just like what has happened in the other 37 states (including D.C.). Such an action will have a significant impact on lower-income Texans, a group which is too heavily comprised of minority and immigrant communities.”

The Urban Institute released a report claiming that if Texas either chose to expand Medicaid or found another way to provide insurance for low-income families, then 1.2 million citizens would become eligible for free or reduced health coverage.

“While I am ever hopeful that this issue will be tackled this session, unfortunately the politics tied to it have gotten in the way of the help we can provide to those Texans who desperately need it,” Watson said.

In this year’s state legislative session, state Attorney General Ken Paxton has expressed his intent to reduce the effects of the ACA at the state level. However, multiple state representatives have proposed the Children’s Coverage Bill, which would allow children enrolled in Medicaid to only need to renew every year and would reach out to families eligible for Medicaid and CHIP but are not enrolled.

In a survey by the Kaiser Family Foundation, 64 percent of Texans said they supported accepting expanded funding for Medicaid at the state level, and 79 percent said they believed that “[e]xpanding Medicaid to cover more low-income Texans” is either “a top priority” or “important.”

Dotson’s family remained uninsured until both parents found a new job last September. She said that the experience changed the way she perceived the political discussion surrounding healthcare.

“I definitely was kind of skeptical of universal health care for everyone, that kind of ideal, but now I definitely do think that is something very important. … You know, it is something that everyone needs,” Dotson said. “[Increased] taxes will always be argued against and argued for. But I definitely think it is something worth sticking up for.”