Texas Republicans are Warming to Medicaid Expansion

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Rick Perry’s indictment isn’t the only story about Texas Republicans realizing the error of the governor’s ways. They’re also starting to realize that we need to expand Medicaid in Texas.

According to Forbes, “Last week, while a grand jury indictment against Gov. Rick Perry grabbed much of the nation’s political attention in Austin, Texas lawmakers in the capital were making headlines of their own in an unrelated, but highly publicized hearing on how to expand Medicaid and deal with a nation-leading number of uninsured.”

Recognizing (better late than never) that something must be done to address Texas’s astronomical uninsured rate, the Senate Health and Human Services Committee met this month to “start a conversation that will give us an accurate picture of who the uninsured are, what services are available to them and what we can do to help them.” While there was not necessarily an interest in embracing Obamacare with open arms, there does seem to be openness to “market-based alternatives” like Medicaid block grants and waivers.

Though nothing conclusive emerged from the seven-hour hearing, it’s a sign that Republican lawmakers are starting to realize how bad Texas looks – and is – by not expanding Medicaid.

Prior to the hearing, county judges from Texas’ six largest counties urged members of the state Senate Health and Human Services Committee to find a “Texas way” to expand coverage to the Texans left behind without a Medicaid expansion. In their letter, the judges said that the coverage gap places a high cost burden on the urban counties that end up paying the most for emergency room visits.

The letter cites the Texas Impact study, “Smart, Affordable and Fair: Why Texas Should Expand Medicaid Coverage to Low-Income Adults,” which estimated how much Texas’s largest counties are spending on emergency care for people who should be covered by Medicaid but aren’t:

  • $422 million for Bexar County,
  • $690 million for Dallas County,
  • $158 million for El Paso County,
  • $920 million for Harris County,
  • $419 million for Tarrant County,
  • $270 million for Travis County.

In addition to incurring all of these costs, Texas is leaving over 1 million people uninsured and over $65 billion on the table by refusing to expand Medicaid. According to a recent report, Latinos are disproportionately represented in this group, making up over 600,000 of the 1 million. That’s over 60 percent of the people in the Medicaid coverage gap, despite that fact that Latinos make up only 38 percent of the state population.

Other red states have accepted Medicaid on their own terms so as not to be seen as supporting Obamacare. Arkansas, Iowa and Michigan have already expanded Medicaid through waivers, and the government is currently reviewing waivers for Pennsylvania and Indiana. The Center on Budget and Policy Priorities has a useful overview of state waiver programs and what sorts of boundaries they have to operate within. The bottom line is that they have to meet the purpose of Medicaid and be approved by the federal government. While the more obvious solution is to just expand Medicaid, expanding Medicaid under an alternative plan is at least a first step to getting 1 million people insured.


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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