Survey: Texans want more Medicaid

About two-thirds of residents think leaders aren’t doing enough for poor

About two-thirds of Texans think state lawmakers are not doing enough to help low-income adults get the health care they need, including tackling skyrocketing costs, reducing the number of maternal deaths and boosting access to health insurance, a new national survey found.

And by the exact same percentage, Texans think the solution is expanding Medicaid — a position current state leaders and conservative forces have steadfastly opposed.

The findings, released Thursday, come from a survey commissioned by the Houston-based Episcopal Health Foundation working in partnership with the national Kaiser Health Foundation to measure the attitudes in a state that leads the nation in the number of uninsured and has long struggled with access to care among its poor and near poor. Between March and May 1, 367 adults in the state were interviewed by land lines and cellphones, in both Spanish and English, about who they hold accountable.

The highest-ranked priority for lawmakers to tackle is the cost of health care, followed by reducing the number of women who die during pregnancy and childbirth. Lowering the cost of prescription drugs and increasing funding for mental health treatment were also flagged as priorities.

“The public is telling state leaders that they have an important role to play. People are saying: solve the problem,” said Elana Marks, president and CEO of Episcopal Health Foundation, a $1 billion foundation focused on improving access to health services access in Texas.

‘Really surprising’

In a state that prides itself on a less-is-more philosophy when it comes to government involvement in people’s lives, the revelation that 64 percent thought the state should expand its Medicaid program is seen as stunning.

Under the initial rendering of the Affordable Care Act, all states were to expand the federal safety net program to scoop up more lower-income people who were uninsured. But in 2012, the U.S. Supreme Court ruled that individual states could decide whether to expand Medicaid. Texas is one of 17 states that said no. In addition, the state has one of the toughest thresholds in the nation to qualify for the program.

“What is really surprising is it’s as high as it is in Texas,” Liz Hamel, director of public opinion and survey research at the Washington, D.C.-based Kaiser Family Foundation, said about Medicaid expansion.

Typically, the bright red politics of Texas come with an assumption that it will be an outlier to national attitudes that favor Medicaid expansion, she said. “We think of Texas as being very different, but the survey shows that it is not dissimilar.”

One clue to the support: The survey found that seven in 10 Texans reported a personal connection to Medicaid, either by being personally assisted or as someone who had a child, other family member or close friend who had been covered.

The latest two states to expand Medicaid are Maine and Virginia.

Still, opposition to expansion in Texas remains strong.

While Dr. Deane Waldman, director of the Center for Health Care Policy at the right-leaning Texas Public Policy Foundation, does not doubt the findings of the new survey, he believes those surveyed reached the wrong conclusion.

“I’m sure two-thirds of Texans believe those things. People who are medically needy should get the care they need. They think the solution to that is to spend more money, and expand Medicaid, get more people insured,” the retired pediatric cardiologist said.

But he argued that is precisely the wrong way to travel.

He said increased Medicaid actually decreases access to care because it becomes so expensive to administer that physician reimbursement rates decline and fewer doctors accept Medicaid patients.

“The answer is not to spend more, but to spend what we have more wisely, meaning spend more on patient care and less on government bureaucracy and insurance profits,” he said.

‘Not the only one’

Gov. Greg Abbott, who is a staunch opponent of Medicaid expansion, did not reply to a request for comment on the survey.

Marks, of the Episcopal Health Foundation, said the conversation surrounding Texas health care access has often been fixated on the yea or nay question of Medicaid expansion. “Medicaid expansion is one mechanism to increase access but not the only one,” she said.

The Trump administration has favored giving individual states wide leeway in crafting individual state solutions, she said, adding that the survey proves Texans are ready for state leaders to step up with a plan.

“We haven’t been having that conversation in this state,” she said.