Medicaid works

Texas is losing out by not expanding the program; more than 30 states have done it.

It’s a shame that Texas’ political leadership likes to cast shade on a signature achievement of a fellow Texan who became one of America’s most productive presidents. They should instead heed the words of Lyndon B. Johnson, who in signing Medicare and Medicaid into law quoted Deuteronomy’s command to show compassion for the poor: “Thou shalt open thine hand wide unto thy brother, to thy poor, and to thy needy, in thy land.”

That biblical directive applies particularly to Medicaid, which unlike Medicare, requires no buy-in by participants to receive benefits. Medicaid, created in 1965, pools state and federal funds to provide coverage for the poor. In Texas, Medicaid requirements are so stingy that most working adults don’t qualify. Recipients are overwhelmingly children, pregnant women, the elderly and disabled.

But former Gov. Rick Perry wasn’t thinking of the Bible when he refused to expand the Medicaid program under the Affordable Care Act. He wasn’t thinking of good fiscal policy, either. Perry passed up $100 billion in federal funds that Texas could have drawn down over a decade for making Medicaid available to more people who couldn’t afford private health insurance. His successor, Gov. Greg Abbott, has also resisted expansion. For both, politics seemed a stronger motivating force than the desire to rid Texas of the highest uninsured rate in the nation.

Perry tried to argue that, in the long run, Medicaid expansion would cost more than Texas gained. Folks with common sense, including some in Perry’s own Republican party, argued it was nonsensical to throw away federal money. Now there’s evidence — just in case we needed it — that the common sense folks were right.

A new report by the Henry J. Kaiser Family Foundation says the 32 states that have expanded Medicaid under the Affordable Care Act have realized budget savings, revenue gains, and overall economic growth. The report also says that states that didn’t expand their programs have seen bigger increases in Medicaid spending than those that did. Louisiana, for example, saved $199 million in fiscal 2017. That was in large part due to the increase in federal matching funds given to states that expanded Medicaid, but also because expanding Medicaid reduced what Louisiana was paying hospitals to provide indigent care.

One study cited in the Kaiser report said Medicaid expansion had reduced uncompensated hospital care costs by $6.2 billion nationally between 2013 and 2015. It said that was equivalent to cutting 41 cents out of every dollar being spent by states that expanded Medicaid before they took that step. You can connect the dots between those savings and another study cited by the Kaiser report that showed Medicaid expansion had helped improve many hospitals’ operating margins, especially small, financially challenged hospitals in rural areas.

Expanding Medicaid has also helped create jobs, according to the Kaiser report. It cited a Colorado study that linked Medicaid expansion to an increase of 31,074 jobs in that state in 2015 and 2016. Meanwhile, a Kentucky study estimates Medicaid’s expansion in that state will by 2021 create 40,000 jobs, with an average annual salary of $41,000.

It’s time for the madness to stop. Kentucky, under the leadership of a Democratic governor, saw its uninsured rate drop from 16.3 percent, the year before it expanded Medicaid, to 5.1 percent in 2016. Yet its current governor, a Republican, is decrying the state’s Medicaid expansion by suggesting it is rife with lazy participants who ought to get off their butts and get a job. A similiar inference, of which there is no evidence, is made by politicians in Texas.

But there is plenty of evidence that more people need health coverage. The percentage of Americans without it had decreased significantly since Obamacare was introduced, dropping from 18 percent in 2013 to 11 percent in 2016. But Trump administration efforts to thwart ACA enrollment have taken a toll, with the uninsured rate rising to 12.2 percent in 2017.

In Texas, the uninsured rate was 27 percent before Obamacare, decreased to 20.5 percent in 2016, but last year inched back up to 22 percent. Expanding Medicaid is the right tonic to reverse that trend. But it won’t happen so long as politicians ignore LBJ’s plea for those in power to “open thine hand wide … to thy needy.” And it won’t happen as long as the politicians ignore the facts.