Texas leaders decided during the Obama administration that they would fight the Affordable Care Act to the bitter end, including digging in against the expansion of Medicaid to provide health insurance coverage to more low-income residents.
Fast forward through two administrations. The bitter end is in the rearview mirror. The ACA has stood the test of time, and Texas is still refusing to accept federal funds for expanded Medicaid.
Give our state leaders credit. When they dig in, they really dig in, even if they take the rest of us to the bottom.
Texas has the worst rate of uninsured residents in the U.S., about 18% of our population, according to Census Bureau statistics. Among states that have expanded Medicaid, the uninsured rate on average is less than 7%.
Most states have expanded Medicaid enrollment under a provision of the ACA that went into effect in 2014. Texas is one of 11 holdouts.
That is disastrous for the uninsured. But it costs all of us.
It’s unlikely that the Republican majority in the Texas Legislature will finally vote in favor of expanding Medicaid this year. Gov. Greg Abbott and Lt. Gov. Dan Patrick have declared themselves sworn enemies of former President Barack Obama’s signature achievement, and GOP lawmakers are reluctant to break with their leaders.
They would be wise to eat a little crow and accept they were wrong. Expanding Medicaid would cover at least an additional 1 million low-income Texans. More than two-thirds of people in this red state support expanding enrollment, according to a 2021 poll. Health care and business leaders are begging lawmakers to do it not only because it’s the right thing to do but because they understand that it’s good for the bottom line.
Our governor and our Legislature have been willing to overlook all of this to stick it to a Democratic president who hasn’t been in office for six years. They may think they’re reinforcing their conservative bonafides, but rejecting Medicaid expansion is the opposite of good governance.
States that expand Medicaid pay 10% of the cost of enrolling new members while the federal government pays the rest. One study by Texas A&M University found that our state is turning down as much as $5.4 billion a year by refusing to expand Medicaid enrollment.
That’s to say nothing of the harshness of the current eligibility rules in Texas. To get Medicaid, an adult in a household of four would have to make $3,324 or less a year if there is only one parent, or $3,420 in a home with two parents. That’s about 13% of the federal poverty level. This standard leaves unprotected a large swath of Texas working families who still make less than the poverty threshold.
Those families suffer, and we all pay. Untreated illnesses can escalate to life-threatening emergencies that often land uninsured Texans in safety-net hospitals. We bear the costs through local taxes.
The ACA allows Texas to expand Medicaid eligibility to individuals and families earning up to a certain level above the federal poverty line. That would include a family of four making $38,000 or less.
Texas boasts about its jobs, but those jobs can be difficult if not impossible to hold down when workers are chronically or severely ill. Texas has more than 570,000 private employers, but fewer than half offer health insurance, according to federal data.
Most adult Medicaid enrollees in the U.S. — about 4 in 5 — have jobs, are caregivers or are students. This kind of data helped Phil Berger, a North Carolina Senate leader and one of the most powerful Republicans in that state, overcome his opposition to Medicaid expansion after years of resistance.
“There’s a deal in there somewhere,” he recently told Stateline, the Pew Charitable Trusts news service.
The Affordable Care Act has survived Supreme Court scrutiny and more than a decade of Republican attacks. Medicaid expansion is here to stay. If Berger can change his mind, why can’t Texas Republicans?
What will it take for them to budge so that uninsured Texans, and the rest of us, get a break on health care costs?
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