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organizations, nonprofit health service plan corporations, and community integrated servicenetworks. 417Other Health Insurance Reforms/InitiativesMinnesota is a national leader in efforts to cover low-income uninsured people. BesidesMedicaid (called Medical Assistance) and SCHIP, the state has MinnesotaCare, which extendsinsurance to low-income working individuals without access to affordable employer-sponsoredinsurance and their families, and General Assistance Medical Care (GAMC), a free program forvery low-income adults between the ages of 21 and 64 with no children under age 19 who arenot eligible for any other state or federal programs and meet other criteria. The program isadministered by counties and is totally funded with state funds; $245.6 million was spent onGAMC in FY 2004. 418 There are two program options: full coverage GAMC for adults withincomes under 75 percent FPL, and catastrophic GAMC for adults at 75 to 175 percent FPL.Full coverage GAMC offers similar benefits to Medicaid, while catastrophic GAMC covers onlyinpatient hospitalizations, with a $1,000 deductible per stay and no monthly premiums. 419Conclusions and Recommendations for TexasMany models and strategies used to increase the number of people with health insurance inother states are unlikely to work in Texas due to the political climate, economy, types ofindustries, and large population in Texas. Since Texas has the highest percentage of uninsuredresidents in the nation, it will take more than one strategy to solve the problem, and there are avariety of steps that Texas could take to better address the issue. Regarding covering morepeople through Medicaid and SCHIP, see our list of expansion options for Texas on pages 36-38 of “Medicaid and the State Children’s Health Insurance Program in Texas: History, CurrentArrangements, and Options” by Warner, Jahnke, and Kimbell (April 2005). One of theserecommendations is using Section 1931 to cover more low-income people under Medicaid, likea majority of other states do. This option is relatively straightforward and does not require afederal waiver to implement.Lessening Hardship and Bankruptcy from Medical BillsAn issue related to the unaffordability of health insurance is the rate of personal bankruptciesstemming from unpaid medical bills. Mitigating these bankruptcies should be a related goal ofany reform effort. Reasons for bankruptcies are not tracked, but the only in-depth study ofbankruptcies from medical reasons, published by Harvard researchers in 2005 from 2001 data,estimated that half of the almost 1.5 million personal bankruptcies filed in the U.S. in 2001 weredue to illness and unpaid medical bills. About 75 percent of filers were found to have healthinsurance when filing (though some coverage was inadequate, and some people subsequentlylost coverage), but as the sample was taken in federal judicial districts in states other thanTexas (which has the highest rate of uninsurance), and Texas no longer has the MedicallyNeedy spend-down program in Medicaid, we can assume that the proportion of bankruptcy filersin Texas without insurance would be greater than the national estimate of 25 percent. Also, asthis study points out, most people filing for bankruptcy owned homes and were consideredmiddle class by occupation and education levels. Medical bills cause hardship or financial ruinto many other people besides those who formally file for bankruptcy, since poorer people do notneed to file if they have no assets to protect from creditors. 420Providing health insurance alone will not stop the bankruptcy problem, if the insurance is notadequate for some medical conditions or has higher deductibles and out-of-pocket costs thanpeople can afford. Many people lose income and even their jobs when they or a family memberhave a serious illness, when this is precisely the time that they need more money for bills andC-33