Time for Texas to expand Medicaid or face consequences
The jig is up: Texas will have to expand Medicaid, reduce the number of uninsured and embrace Obamacare or suffer the consequences.
Probably not this year, possibly after the Republican primary next year, but definitely before October 2022. Some in the GOP may even try to avoid calling it Medicaid expansion, but it will be in essence.
By the next time the Legislature meets in 2023, Texas may no longer have the highest uninsured rate in the nation, and the state’s health care industry will thrive.
The Biden administration is done with the Legislature’s games around health care for the poor. If Texas does not act, the resulting economic chaos will gut the safety-net system for the rest of us. To understand why this is not federal overreach, consider the history.
Medicaid is a joint program between the federal and state governments to provide health
care for the needy. Historically, the Centers for Medicare and Medicaid Services provide most of the funding, and therefore, set most of the rules.
The Affordable Care Act was designed to ensure every American has coverage, either from their employer, the Obamacare exchange, Medicare for the elderly, or Medicaid for the poor and disabled.
In 2011, Obamacare offered subsidies to working people above a certain income level while ordering states to expand Medicaid to include the working poor who could not afford the lowest premiums.
Republican leaders in the states sued because their base loved hating on Obamacare, even though studies show the program pays for itself in lower health care costs. Some GOP leaders decided that denying people coverage is a conservative value, even when the feds pay 90 percent of the costs.
The Supreme Court ultimately sided with the states, and Gov. Greg Abbott and Lt. Gov. Dan Patrick started wearing their rejection of Medicaid expansion as a conservative emblem.
The only problem is uninsured people still get sick and injured, and they still don’t have any money to pay their bills.
The Legislature ordered the Texas Department of Health and Human Services to ask the feds for a few billion dollars, not to expand Medicaid, but to cover unpaid emergency room bills and experiment with community care.
The Obama administration agreed, granting what’s called an 1115 waiver.
The Obama administration hoped that in time Texas lawmakers would figure out that expanding Medicaid made economic sense. Emergency departments are expensive, and they are not the correct setting for treating the flu or minor injuries.
Giving people coverage so they can see a primary care doctor would save billions. Surely, Texas would expand Medicaid, just as Louisiana, Arkansas and Kentucky did, President Barack Obama reasoned.
Some Republicans did see the light, and over the years they’ve proposed a dozen ways to expand Medicaid and save the state money. They even came up with fancy names to avoid mentioning Medicaid, Obamacare or the Affordable Care Act.
As recently as February, San Antonio Republican state Rep. Lyle Larson declared in an op-ed: “Refusing to expand Medicaid is a bad business decision for Texas. We have an opportunity this legislative session to fix this.”
Some Texas politicians, though, like to fetishize policy positions to the point where they would rather ruin lives and waste taxpayer money than compromise. Abbott and Patrick remain vehemently opposed, and new House Speaker Dade Phelan is not picking any fights.
The Biden administration is not playing around. Texas has had a decade to develop an alternative to Medicaid expansion but still has the highest uninsured rate in the nation. Texas must expand Medicaid by October 2022 or lose the money.
Without a waiver, hospitals will have no way to recoup from the federal government the cost of treating the sick and injured who cannot afford insurance or their bills. Many of these are hardworking people at low-wage jobs with employers too cheap to provide health insurance.
ER bills are among the highest in health care, and hospitals have few choices. They can raise rates on those with insurance, so hip replacements for Medicare patients will cost more. Or they can shut down the ER.
They can also lay off doctors and hospital workers, reduce capacity, and create long lines for emergency care. Once the ER is full, they can start sending ambulances to other facilities. People who could have survived will die because the Texas Legislature did not want to help the poor.
Larson explains that Medicaid expansion would bring in $5.4 billion in new federal funds every year. Comprehensive coverage would generate $45.3 billion in additional economic activity. Financially, it’s a nobrainer.
The sooner our leaders find a fig leaf so they can expand Medicaid, the better Texas workers, businesses and the economy will perform.
“Refusing to expand Medicaid is a bad business decision for Texas.”
State Rep. Lyle Larson, R-San Antonio