Mary Lou Retton didn’t have insurance. Wait. What?! (Notice)

I felt immense sadness at Mrs. Rettons’ health and financial difficulties. I was relieved to learn that she is doing better on both fronts, that she has left the hospital and that she would have raised over $400,000 for her hospital bill.

But, because I’m a health policy enthusiast, I also thought: How can Americas Sweetheart not be insured?

The United States has an unusual and unusually complex health care delivery and financing system. For most Americans, the highest health care costs are financed by employer-sponsored (49%) or government (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. The publicly available sources I checked indicate that she is not currently employed and she is not currently married, so she would not have the option to qualify through the employer of his spouse.

It is also unlikely that Retton would have been eligible for government-funded insurance. This category includes Medicare, Medicaid and the military. She is not in the military, and because she is 55, 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 very low-income seniors. 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 has refused to expand Medicaid to this population. Therefore, even if Ms. Retton lived below the poverty line, she would not be eligible for Texas Medicaid.

That leaves individual insurance plans. Americans can purchase 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.

The Marketplace offered more than 120 plans, with monthly premiums ranging from $289 to $689. For Harris County residents with low to moderate incomes, the plans come with hundreds of dollars in subsidies, eliminating premiums for some plans. Marketplace plans include limits for out-of-pocket expenses above $18,200, which is far less than the cost of a long hospital stay. More than two million Texans purchased Marketplace plans in 2023.

So why wasn’t Retton insured? I only see two options.

If she lived below the poverty line, then she fell into the Medicaid coverage gap, a result of the state’s failure to expand Medicaid. If this is the case, we must ask ourselves how we can allow someone who has given so much to our country to slip through the cracks.

If Retton’s income was above the poverty line, she could have benefited from more than 100 plans that would have protected her from the very high cost of weeks of hospitalization. She is fortunate that her popularity has allowed her family to raise hundreds of thousands of dollars from strangers. Most people facing hospital bills aren’t so lucky.

I wonder if she’ll buy a plan for 2024. The time is now: open enrollment is underway and ends January 15.

Elena Marks is a senior health policy fellow at the Baker Institute for Public Policy at Rice University.