Pandemic fuels some ‘what if ’ questions

There’s nothing like a pandemic to make Texans reflect on the wisdom of our collective failure to provide for those who lack access to reliable health care.

The state notoriously has the highest uninsured rate in the country, at nearly 18 percent of the population — roughly double the national average. That figure has come down a bit since passage of the Affordable Care Act in 2010, but not as much as it might have. Texas is one of the states that has opted against expanding Medicaid, and its Republican leaders have brooked little debate on that subject. Indeed, Attorney General Ken Paxton is leading a push to overturn the ACA — or “Obamacare” — at the Supreme Court.

With nearly 42,000 confirmed COVID-19 cases in the state and 1,153 deaths, Democratic lawmakers believe it’s time revisit the question of expanding health care access.

Last month, the 12 members of the Texas Senate Democratic Caucus, chaired by Sen. Carol Alvarado of Houston, called on Gov. Greg Abbott to expand Medicaid via executive action, as governors in several states have done. All told, 36 states — including Republican-led states such as Ohio — have opted into the expansion.

“As governor, you have the power to break the political inertia that presently blocks successful implementation,” they write.

That’s true, but there’s no indication that Abbott, a Republican who frequently sued the Obama administration when he was attorney general, is inclined to use that power. So the Democratic senators have also taken their case to the public, in an op-ed that reflects a hard-won understanding of how arguments are won or lost in the Texas Legislature.

The dozen Democrats point to the state’s high uninsured rate, as well as the financial toll that this takes on hospitals and families, particularly in rural areas. They argue that absent Medicaid expansion, Texas taxpayers are missing out on an opportunity to recapture billions of the dollars that we send to Washington, D.C., each year. Under the ACA, the federal government covers 90 percent of the costs of Medicaid expansion, with states covering the rest.

That being the case, Democrats say expanding Medicaid would provide the state with an economic stimulus of sorts as well as improve public health.

“As we contend with the troubles of the oil industry, coupled with those caused by the pandemic, it doesn’t make sense for state leaders to refuse billions of our own federal tax dollars,” they write.

They continue, “The double whammy significantly will reduce the state’s ability to pay for other essential obligations and ultimately reduce our ability to afford any tax cuts.”

There’s something poignant about this argument, isn’t there?

The bit about the tax cuts would seem like a non sequitur, unless you’ve spent some time around the Republicans who have controlled both chambers of the Legislature for over a decade.

Some of the more rowdy members of the GOP caucus may even push for tax cuts during the next regular session, in 2021, although their more experienced colleagues are anticipating the kind of session that will see lawmakers looking for loose change in a desperate bid to blunt the impact of likely budget cuts.

The grim revenue forecasts they’re receiving from Comptroller Glenn Hegar explain why it’s unlikely the Legislature will have a serious discussion about expanding Medicaid next year even if Democrats retake the Texas House. Sales tax receipts — which make up more than half of the state’s tax collections — have plunged as a result of the shutdown necessitated by the new coronavirus. And though Abbott has initiated a phased re-opening, Hegar is warning, rightly, that we shouldn’t expect the economy to swiftly bounce back.

“We don’t think the recovery in the economy will be a V-shaped recovery — in other words, a very rapid recovery,” he said Monday in an appearance in Temple, explaining that the globalization

of the state’s economy means we’re bound to experience adverse impacts until the pandemic subsides around the world. “It’s going to be more of a U-shaped recovery — a long recovery.”

Under those circumstances, the state’s budget-writers are going to have precious little latitude for expanding state spending in any area — even if Republicans such as Abbott and Paxton suddenly have a change of heart about expanding health care access. Which they probably won’t. Republican leaders in some states have been pragmatic rather than ideological in considering the question. But as it stands, state Rep. Sarah Davis of Houston, is the only Republican serving in Austin who supports Medicaid expansion.

Still, Democrats are right to raise the issue. According to the Kaiser Family Foundation, Medicaid expansion would extend health care coverage to an additional 1.5 million adults in Texas. The state’s share of the tab would be roughly $10 billion over the next decade, with the federal government supplying an estimated $100 billion in funds. And a majority of Texans would like to take this step: In a 2019 poll from the Episcopal Health Foundation, 64 percent of respondents expressed support for the idea of Medicaid expansion.

That was before the pandemic itself offered a powerful reminder that the health of our neighbors affects all of us.