RENEE MONTAGNE, HOST:
And people who buy insurance through the Affordable Care Act marketplace can now start shopping for 2016. It's the third year of the program people call Obamacare. But millions of people have resisted or simply ignored the law's mandate to get coverage. The federal government is encouraging enrollment in five urban areas, one being Houston, Texas, where Houston Public Media's Carrie Feibel has this update.
CARRIE FEIBEL, BYLINE: The Republicans who run Texas are still filing lawsuits against the Affordable Care Act. And they haven't expanded Medicaid to cover more uninsured adults. But at the local level, caring for the uninsured has put a strain on hospitals. George Masi is the CEO of Harris Health, the public health system for Houston and its suburbs.
GEORGE MASI: If you take a look at what it is costing Texas not to expand Medicaid for the three years that the Affordable Care Act has been in play, that would be $20 billion that Texas has let go.
FEIBEL: Earlier this year, Harris Health laid off more than 100 workers. Now it's tightening the rules for who can get to free medical care. Milena Rossum is one of 10,000 patients who have just learned they're probably eligible to enroll in a marketplace plan and they'll have to or else pay the full price at the county clinics.
MILENA ROSSUM: Yeah, they sent us a letter, so I have to look through that and call and find out.
FEIBEL: It's a tough-love strategy that has certainly gotten her attention. But why didn't she enroll before? She's been raising twins, job-hunting and had no idea there was financial assistance to buy a plan.
ROSSUM: No, I didn't know that, that they have subsidy. I didn't know.
FEIBEL: Leticia Tillman hears that a lot. She helps patients at Harris Health enroll in the plans.
LETICIA TILLMAN: They never went on the site. They just heard from family members it was too expensive. And so they just opted not. They thought it was cheaper to pay the penalty at the time.
FEIBEL: She says when people don't sign up, i's not really about the politics. They're just coping with other things.
PATRICIA EDMISSOM: I'm just extremely busy.
FEIBEL: Patricia Edmissom is 49 and lost her insurance four years ago when her marriage ended. I found her in a county clinic doing her algebra homework.
EDMISSOM: I go to school part-time, but it seems like it's full time 'cause it takes up all of my time and I work part-time.
FEIBEL: Edmissom has never checked out her insurance options under the law. There are almost 7 million Americans who are probably eligible for help but just haven't signed up yet. For NPR News, I'm Carrie Feibel in Houston.
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