New Study: States that Expanded Medicaid are Improving While Texas Falls Behind

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Ever since the Affordable Care Act’s Medicaid expansion became optional for states, Texas governors have been fighting tooth and nail to stop it from coming to Texas. They’ve done so in the face of an increasing body of evidence about the financial benefits Medicaid expansion would bring to Texas, and have continued to resist even as other Republican governors have acquiesced for the benefit of their states.

This week, the body of evidence against Rick Perry and Greg Abbott’s decision to forgo Medicaid expansion became a little larger, as a new study was published in the journal Health Affairs comparing Texas to two states that did expand Medicaid. The study compared Texas to Kentucky and Arkansas, two states that did expand Medicaid, and found that expanding Medicaid dramatically improved access to health care for low-income populations. Or, as lead author Benjamin Sommers of the Harvard T. H. Chan School of Public Health put it, “The big message we found is an expansion — any expansion — makes a big difference compared with no expansion.”

The study found several specific improvements in Kentucky and Arkansas that didn’t happen in Texas:

    “In Kentucky and Arkansas, the number of adults reporting not filling a prescription because of cost fell by nearly 10 percentage points more than in Texas; the share of people struggling to pay medical bills fell by nearly 9 percentage points more than in Texas; and the share of adults with chronic conditions such as high blood pressure and diabetes receiving regular care climbed by nearly 12 percentage points more than in Texas.”

The fact that Texas is missing out on these improvements is of course terrible for the low-income Texans who could have had access to better care and gotten healthier had Greg Abbott been looking out for their best interests.

But even if you don’t care about low-income Texans getting access to health care, the results of this study are relevant — and should be troubling — to you. We’re starting to see the predictions about the harmful effects of skipping Medicaid expansion come true, as more and more Texans are left behind without care. And that lack of care means a sicker population, which has significant economic effects on the entire state. Healthier people would have meant a healthier economy, but we won’t see that happen because of Greg Abbott.

Over the past couple years, we’ve written so much about how skipping Medicaid expansion is hurting Texas that it almost seems cliche. Go through the BOR archive and you’ll see countless headlines about $98 million lost here, $10 billion lost there, and millions of Texans left uninsured. As new data emerges about the effects of Medicaid expansion, we’ll probably write plenty more. But despite the multitude of posts already out there, this is a story we must continue to tell — and to share as loudly as possible. By refusing to expand Medicaid, Greg Abbott is refusing to accept the facts about what is best for Texas. Each time Republican leadership puts their pandering politics above reality, they should be held accountable. Every new study that comes out about Medicaid expansion reinforces that Greg Abbott only cares about what’s best for his image, and not what’s best for Texans. And that’s making our state sicker, in more ways than one.


About Author

Katie Singh

Katie grew up in Austin and has been involved in Texas politics since 2004. She has been a part of several campaigns, from state house races to working at President Obama's campaign headquarters in 2012. She loves public policy, public health, and tacos. Katie tweets from @kasingh19.


  1. A state or a nation that fails to care for the basic needs of its citizens is a failed state..
    Texas is a failed state..sick people are lined up in the ERs across all large cities in Texas…who do you think is paying for this…you and me..we pay hospital district taxes on top of income taxes and school district taxes…if we had accepted the monies to cover healthcare funding we wouldnt be paying hospital dist taxes …..Abbott is crazy and the voters in Texas are stupid. Abbott is a sign that most voters are ignorant….they vote against their own best interests.

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