Texas Cities are Falling Behind Because Rick Perry Won't Expand Medicaid

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We already know that Rick Perry's refusal to expand Medicaid has left 1 million Texans in a Medicaid coverage gap. But a new study from the Urban Institute and the Robert Wood Johnson Foundation shows how cities around the country are impacted by their states choosing to expand (or not expand) Medicaid. Though Houston was the only Texas city included in the study, it gives us an idea of what other Texas cities have lost.  

“Cities stood to be among the biggest beneficiaries of a provision of the Affordable Care Act expanding access to Medicaid,” according to the Washington Post. “The low-income are disproportionately concentrated in urban America. So are major regional medical centers like Grady Memorial Hospital in Atlanta that provide care for and attract the uninsured from far outside of cities. Urban residents also frequently foot the bill for local taxing districts that help pay for this care.”

So what happens to cities without a Medicaid expansion? Find out after the jump.Overall, among the cities expanding Medicaid, the number of uninsured will decrease by an average of 57 percent. In the cities not expanding Medicaid, that figure is only 30 percent.

In Houston alone, there are 165,000 people who would have been insured at minimal cost to the state, but who will instead remain uninsured. The federal government would have spent around $17 billion more on health care in Houston, but as a result is only spending $10 billion more.

The graph at left shows what the decline in uninsured rate could have been with a Medicaid expansion, versus what the impact will actually be. Whereas Houston could have had almost a 45 percent decline in the ranks of the uninsured by 2016, that figure is only expected to reach roughly 28 percent.

It's easy to get an idea for what the impacts are in the other major Texas cities, which contribute the most to Texas's highest uninsured rate in the nation.

In fact, the lack of health care options has led to an increase in the number of families enrolling in Temporary Assistance for Needy Families (TANF, also known as welfare) because it allows them to become eligible for Medicaid. Since January, Medicaid enrollment among TANF-eligible adults has jumped by close to 5,000 people.

“They don't have to take the TANF, and some families don't actually want to get the TANF because it has a lot of strings attached and it's not a lot of money,” said Stephanie Goodman, spokesperson for the Texas Health and Human Services Commission. “But you can get the Medicaid coverage if you qualify.”

It goes to show how desperately Texas needs more access to health insurance, and how egregious it is that our state still doesn't have a Medicaid expansion.  


About Author

Emily Cadik

Emily is a Texas ex-pat and proud Longhorn living in Washington, DC, where she remains connected to the Lone Star State through her work on BOR and her enthusiasm for breakfast tacos. She works on affordable housing policy, and writes about health care, poverty and other social justice issues.

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