Medicaid expansion a smart business move
It’s often said government should be run like a business. More to the point, it should be run like a successful business. But our state may no longer be making the right business decisions when it comes to health care.
Texas receives federal support for our health care system — specifically to provide care for children, pregnant women and disabled adults from our lowestincome families. But our state accepts those dollars in a rather inefficient way, with a patchwork system of waivers that have left us with the country’s highest uninsured rate, a sparse safety net of doctors in many communities, and property taxes that are driven higher and higher by the cost of providing basic care to uninsured Texans in emergency rooms.
A smarter business approach would be to accept federal assistance in a more straightforward and transparent way that maximizes value for all Texans, including taxpayers. For years, Texas has resisted calls to expand Medicaid health coverage to low-income, able-bodied adults through the terms and programs other states have accessed. Instead, Texas has suffered the consequences of an increasingly rickety — and, for those who pay property taxes, expensive — health care system across the state.
This is a missed opportunity. It is estimated more than 1.5 million Texans who lack health insurance would enroll if Texas sought federal funding to expand coverage. Many of these Texans are among the nearly 700,000 people in our state who have lost insurance during the pandemic. An eligible adult could be a 35-year-old single man who works in a meatpacking plant in the Texas Panhandle and cares for aging parents. Or she could be a single woman who provides home health care shift work and earns less than $13,000 per year.
Importantly, however, the state’s approach has not just affected Texans who lack coverage. When more funding comes into the state from Washington, it fortifies the state’s entire health care system. This means there would be more support for primary care, specialists and hospitals across Texas — something critical in a state that is both aging and seeing more of its hospitals close than any other.
The state’s current approach also contributes to higher property taxes. Counties and hospital districts expend local taxpayer funds each year on care for which they are only partially compensated. It is inefficient to use property taxes paid by Texas homeowners for this massive expense when there are smarter ways to pay for most of it. These existing expenses could be leveraged in a more efficient manner that would allow Texas to pull down federal dollars for its efforts.
Earlier this year, residents of Missouri and Oklahoma voted to draw down federal dollars to expand coverage. They are the latest among conservative states, including Nebraska, Idaho, Georgia and Utah, that have chosen to cover more of their population.
Texas could construct our own program that relies heavily on federal dollars but includes requirements that are important to Texas policymakers, such as copayments for recipients or other flexibility from usual Medicaid rules. The dollars would not flow to individuals but to doctors, hospitals and others providing care.
Texans take no pride in having the highest uninsured rate of any state in the country. And we are pragmatic enough to support a new approach — one that will be better for our residents, our economy and taxpayers’ wallets.