No more excuses

It’s time for the state Legislature to expand Medicaid to provide assistance Texans need.

We regret to say that Medicaid expansion, even if begrudgingly approved by the Texas Legislature, is unlikely to cover the self-administered nose jobs that Texas Republican lawmakers have been flaunting for the past decade.

Cutting off their noses to spite their faces, to quote the old proverb, the lawmakers have proudly rejected opportunities to provide health coverage to more of their fellow Texans, despite the fact that the federal government was offering to pay for nearly all of it and despite the fact that the Lone Star State is home to the largest number of uninsured Americans of any state in the country.

Now, we’re at a pivot point. A ruling last week by the Biden administration makes Medicaid expansion in Texas more of a possibility than it’s ever been since lawmakers mounted their resistance a decade ago. Billions of dollars are at stake, not to mention the health and well-being of more than 1 million Texans. We would be fools not to take the money and the opportunity it represents to make this state we love a better, healthier place to live and work.

To many, it’s been a mystery worthy of a trench-coated Columbo’s detecting skills to try to ascertain why Texas Republicans are so adamantly opposed to expansion — we’re one of only a dozen states still saying no — even though the federal government would have picked up 90 percent of the tab. Aren’t we all better off when every Texan can afford their medical bills, pay for needed prescription drugs and obtain coverage for chronic conditions?

The answer is obvious, so obvious that only another chronic malady can explain GOP obstinacy. Call it anti-Obamaitis. Medicaid expansion is affiliated with former President Barack Obama’s Democratic Party and the Affordable Care Act, aka the dreaded, supposedly socialist plot Obamacare, which now covers more than 20 million Americans and has been credited with saving thousands of lives.

But, better a mutilated nose than a healthy Texas face.

Gov. Greg Abbott, Lt. Gov. Dan Patrick and most of their GOP cohorts have always known they were on the short end of a losing argument. That’s why they were willing to tolerate a workaround — a facesaving workaround, so to speak — with the federal government to cover low-income Texans worth billions of dollars a year.

( Just don’t call it Medicaid expansion!)

Now, they have been unmasked. The Biden administration announced last week that it was rescinding a waiver renewed in the waning days of the Trump administration that would have reimbursed hospitals for the uncompensated care they provide to patients without health care. The socalled 1115 waiver, intended to be a temporary fix, would have continued hospital reimbursements until September 2030.

Federal officials explained they were rescinding the Trump agreement not because Biden is “deliberately betraying Texans” as Abbott claimed but because the latest renewal was granted without the usual period of public comment, an exception Texas asked for during the pandemic but which the Biden administration has determined was improperly granted. Most likely, it’s also a convenient excuse to push Texas once and for all into a permanent solution for low-income Texans: expanding Medicaid. However blatant the ploy, we welcome it.

Incidentally, we also welcome Attorney General Ken Paxton’s disingenuously righteous vow to “use every legal tool available to regain the assistance Texans need.” We know one! How about expanding Medicaid?

The waiver was only granted the first time back in 2011 to give Texas and other states time to comply with Obamacare, which required states to expand Medicaid. But when federal courts ruled that the expansion had to be voluntary, Texas seized the opportunity to say no. Instead, it continued to bet that the federal government would keep extending the 1115 waivers so it could be paid without having to lose face by complying with even the spirit of the new law.

Now the old excuses for not expanding don’t make sense anymore, most especially: “because Obama.” Gov. Rick Perry once warned of a bait-and-switch where the feds would yank matching funds after states agreed to expand. Never happened. And nothing is keeping Texas from pulling out of the arrangement later, although none of the 38 states that have expanded have seen fit to leave.

The state’s rate of uninsured is officially 18.4 percent, double the national average, although it’s probably higher than that in light of pandemic-induced unemployment. Medicaid in Texas covers mostly children, pregnant women and disabled Texans. Expanding it to other adults who earn 138 percent of the poverty line (about $36,200 for a family of four) would provide health coverage to some 1.3 million Texans. Roughly a quarter-million Harris County residents would gain insurance, experts have predicted.

No wonder a recent poll conducted by the University of Houston’s Hobby School of Public Affairs found that 69 percent of those polled supported expansion. No wonder that roughly 150 Texas organizations signed a letter last week urging state officials to provide a health insurance option for low-income adults. The signers included business leaders, doctors, local officials and health care advocates, as well as the Texas Medical Association and the Texas Nurses Association.

The Texas House just approved a bill expanding Medicaid for new mothers. Another bill still in play would expand telemedicine. Those are relatively small steps, but they represent progress. The next obvious step is full expansion.

With the legislative session winding down, Texas Republicans should hold their noses – if they still have one – and vote to expand Medicaid. For Texas.