It's still January, a couple of months away from the meat of the 2019 Texas legislative session, and it's already easy to see the difference in the way Dallas state representatives and senators are representing their city. Wednesday afternoon, Nathan Johnson, the Park Cities and North Dallas state senator who knocked off tea party conservative Don Huffines in November, introduced two bills that would allow Texas voters to decide in November whether the state would expand Medicaid in 2020.
Johnson campaigned against Huffines, in part, on promising to expand the federal heath program, which provides coverage to low-income Americans who would otherwise be unable to afford insurance coverage. The Affordable Care Act, President Barack Obama's signature achievement, allowed states to expand the program to cover more of their residents. Many states with Republican leadership initially refused, but by the end of 2018, 36 states had accepted or were prepared to accept federal Medicaid expansion cash.
"Medicaid expansion is, at this point, a conservative action. Over the last several years, the 36 states that have expanded Medicaid — including those led by Republican majorities — have benefited from improved health and net economic benefit," Johnson said Wednesday. "The data is in. Medicaid expansion conforms to principles of fiscal responsibility while immediately addressing critical health needs of millions of Texans."
According to research from the Kaiser Family Foundation, if Texas were to expand Medicaid, the state would see about 1 million more residents have health insurance than presently have coverage. That's about 22 percent of the state's 4.5 million uninsured residents.
Data show that the state would reap a significant savings from a decline in uninsured visits to public hospitals and other uncompensated care from the expansion, too. According to a report cited by the Kaiser Family Foundation, Medicaid expansion cut 41 cents from every dollar that hospitals in expansion states spent on uncompensated care from 2013 to '15, leading to a cumulative estimated savings of $6.2 billion.
Texas has the highest uninsured rate in the United States at 16.6 percent. Many of those uninsured, about 638,000, are in the so-called "coverage gap." They don't make enough money to qualify for the insurance subsidies guaranteed by the ACA, but they make too much cash to qualify for Texas' Medicaid statute. In addition to those in the gap, the expansion would also cover more than 400,000 Texas residents with incomes just above the poverty line, according to the foundation's research. Both groups are made up of people the ACA's Medicaid expansion was designed to cover, but Texas' lawmakers have left them out.
Texans' federal income taxes already pay for the expansion of Medicaid in other states, Johnson said, so Texas might as well begin reaping the benefits.
"In addition to increasing access to health care, Medicaid expansion reduces the rate of uncompensated care, lowers insurance premiums and provides a substantial economic stimulus to local economies. Currently, Texans pay billions of dollars in federal taxes to support Medicaid in other states. It is time we bring more of our tax dollars back to Texas," Johnson said.
Texas Republicans should look to states that have already expanded coverage and give their constituents a chance to decide whether they are for the expansion, Johnson said.
"I recognize and respect that many of my colleagues may have serious concerns about going down this path. Indeed, it has been debated in prior sessions. Today, however, as we proceed in this 86th session, the experience of other states should give us the confidence to proceed. This bill calls upon legislators to engage the citizens of Texas in a critical dialogue and to give them the right to make an informed decision through a public referendum," Johnson said.
Despite the fact that any money the state put into Medicaid after an expansion would be matched 9-to-1 by federal funds, Texas Republicans led by Gov. Greg Abbott and Lt. Gov. Dan Patrick have fought against the insurance program.
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After receiving a federal waiver allowing the state to continue receiving funds to support managed care programs without signing up for the expansion in 2017, Abbott celebrated.
“I committed to the people of Texas that we would focus on preserving access to care without expanding a broken Medicaid system under Obamacare,” Abbott said in December.
Patrick, who controls the state Senate's agenda as lieutenant governor, has said that the idea of Medicaid expansion "is not even worth discussing."
Despite their elected officials' positions, the majority of Texans support Medicaid expansion, according to a June 2018 poll included with the Kaiser Family Foundation's report. Sixty-four percent of Texans, according to the poll, believe that the state should accept federal cash to expand the low-income insurance program, with the same percentage agreeing that the state is "not doing enough to help low-income Texas adults get health care."