GOP lawmaker files legislation to expand Medicaid
Rep. Lyle Larson filed legislation this week to expand Medicaid, becoming the first Texas Republican in years to actively push the Obama-era measure that would bring billions of dollars in federal aid to combat the state’s booming uninsured rate.
“I think we should have a discussion,” the
San Antonio lawmaker said. “We should have a discussion, and everybody should bring their ideas.”
Texas is one of only a dozen states that have declined to expand the public safety net program under the Affordable Care Act. House Republicans last tried in 2013 and faced a blockade by then-Gov. Rick Perry, who argued there were too many problems in the state’s existing Medicaid program to add even more people to it.
Pressure is building again as the uninsured rate climbs amid the pandemic, and Larson is hoping to avoid the threat of a governor’s veto this time by putting the idea directly to voters through a constitutional amendment. The approach still comes with risk: To get on the ballot, it will need twothirds support in both chambers, rather than a simple majority.
“A lot of members would rather have the voters make the decision on something this critical,” Larson said in an interview, noting that the same path has been used in other red states, including Oklahoma and Missouri. He expects more Republicans to come forward in support in the next several days.
A small-business owner who has at times drawn fire from fellow Republicans, including Gov. Greg Abbott, Larson urged his colleagues to move past their party loyalties and instead look at what makes the most fiscal sense.
“You take all the politics out of it, it’s really a bad business decision not to access the federal dollars,” he said.
In Texas, Medicaid is currently limited mostly to children, pregnant women, people with disabilities and low-income seniors. Under an expansion, it would extend to adults making up to 138 percent of the poverty line, or about $17,600 for an individual and $36,200 for a family of four.
That could add about 1.3 million people to the state’s Medicaid rolls, according to a study published in September from the Bush School of Government and Public Service at Texas A&M University.
The federal government would pay 90 percent of the cost, a more generous match than it offers for the rest of Medicaid but one that would still require a state contribution. Some other states have funded that 10 percent by taxing tobacco products or sales of medical marijuana. In 2013, then-state Rep. John Zerwas proposed leveraging tax revenue from premiums on health care plans.
House Speaker Dade Phelan, R-Beaumont, said last month that he does not believe that there is enough support in the GOP-controlled House to back Medicaid expansion outright. A spokesman said the speaker was still reviewing Larson’s proposal but has said any idea must be “revenue neutral.”
Phelan and others have speculated that a conservative alternative could pass in the chamber, though none has been filed and its fate in a more staunchly conservative Senate would be less certain.
Proponents also lost leverage this year when the outgoing Trump administration extended a waiver that helps defray the cost of uncompensated care in hospitals. The move does not expand health coverage but does help hospital systems cover the cost of treating uninsured patients.
That’s not all the costs, however, and local hospital districts are often left paying what’s left. Larson said that results in higher tax burdens, and he pointed to San Antonio as a prime example.
“Our county tax is the same as your hospital district tax, like $450 million of tax dollars to pay for uncompensated care,” he said. “So I think the state’s culpable in a lot of that.”
“If you’re paying into a system in D.C.,” he added, “and you’re not pulling the money back in, but you’re raising taxes at the local level to offset for that money you’re paying in, I think that’s fiscally irresponsible. The fiscally responsible thing to do is trying to maximize, like we do in every other revenue stream in the state budget.”
For years, Texas has had the highest uninsured rate in the country. It was 18.4 percent before the pandemic, or about 5.2 million people. That does not include the 1.6 million more
who lost work-related health care in the economic fallout from the health crisis.
Critics of expansion warn that Medicaid is outdated and inefficient, with too many administrative burdens and too few providers that accept the state’s low reimbursement rate. Some conservatives instead support targeted approaches to increasing access to low-cost options including regional health clinics and primary care doctors.
“Just because someone has government-issued insurance doesn’t mean they’ll get the health care they need,” James Quintero, a policy director at the right-leaning Texas Public Policy Foundation, has noted.
Rep. Tom Oliverson, RCypress, who chairs the House Insurance Committee, said he has concerns with Larson’s approach and specifically pointed to problems in Oklahoma after voters there approved Medicaid expansion last year.
“I have talked extensively with the insurance department folks in OK and they are having real problems with implementation because the ballot language was not written as well as a statute would have been,” he said in a text.
Democrats, meanwhile, are eager to pass an expansion bill and welcomed Larson’s support.
“Expanding Medicaid improves the state’s bottom line, increases our economic productivity and keeps our fellow Texans healthy,” Rep. Donna Howard, D-Austin, said in a statement. She added, “Between the pandemic and mounting rural hospital closures, I don’t think Rep. Larson will be such an outlier on this issue come May.”