House rejects Medicaid proposal

The Texas House on Thursday defeated an amendment to expand Medicaid-funded health coverage for hundreds of thousands of low-income Texans, likely closing off any viable path for Democrats to move the decadelong effort forward this session.

The vote was 68-80, with Rep. Lyle Larson of San Antonio the lone Republican in support. Eight other Republicans who were being closely watched, given their earlier support for a separate Medicaid expansion bill, ultimately sided in opposition.

“Unfortunately we are stuck in a decade-old narrative that has forced the closing of many rural hospitals and less access to physician care,” Larson tweeted after the vote. “Fiscal conservatism

was denied today.”

Thursday’s defeat sets up an uncertain year ahead for state health officials, who must now begin renegotiating a deal with the Biden administration for billions of dollars to cover the cost of emergency care for uninsured Texans. Federal health officials last week threw out an eleventh-hour approval by the Trump administration for that funding — money that does not promote routine care but has long given Republicans cover to forgo Medicaid expansion.

Texas has long had both the highest rate and the highest overall number of uninsured people in the country, and has among the worst and least equitable health outcomes.

The amendment, brought by Rep. Garnet Coleman, D-Houston, would have directed the governor and state health officials to expand coverage for low-income Texans using mostly federal Medicaid dollars. The legislation was left intentionally vague, giving Republican state leaders authority to craft the coverage expansion as they saw fit.

Passage in the House would have been a mostly symbolic victory for Democrats. The amendment would have then headed to the more conservative Senate, where lawmakers have killed much smaller expansion efforts in the past. Gov. Greg Abbott, a Republican facing a heated primary next year, has also long opposed Medicaid expansion.

Opponents of the effort, including Abbott, have warned over the years that Medicaid is a costly, inefficient program, and that expanding it could drive up the state budget over several years. The only issue voiced Thursday was that Coleman’s amendment had not been properly vetted.

“This amendment is relatively brief,” said Rep. Giovanni Capriglione, R-Southlake. “It doesn’t even mention the cost of probably the most massive expense that we would be bringing on to this state. And it has not had a public debate.”

Meanwhile, Republican House leaders continue to block discussion on other Medicaid expansion bills, including the measure that Larson and other Republicans have supported. That legislation, HB 3871, would be modeled after an Indiana program, with work and health incentives for recipients, better physician reimbursement rates and a commitment to end the project if federal matching dollars decline.

The health coverage issue has taken on special urgency amid the pandemic, with more than 650,000 Texans having lost their employer-sponsored insurance. The Biden administration is also offering $3.5 billion in additional Medicaid funding over the next two years if the state expands its coverage.

Health policy experts estimate that about 1 million low-income Texans would sign up for expanded Medicaid if it was enacted in Texas, out of an uninsured pool of about 4.5 million, according to the most recent estimate.

Anyone making up to 138 percent of the federal poverty line — which is $26,500 for a family of four — would be eligible.

“Texas needs big solutions,” Ted Shaw, president of the Texas Hospital Association, wrote in a letter Thursday to the governor, House Speaker Dade Phelan and Lt. Gov. Dan Patrick. “Expand coverage for the 1 million low wage working Texans and support a strong uncompensated care pool to ensure care for the nearly 4 million Texans who still would not qualify even with expanded Medicaid eligibility.”

Democrats including Coleman had been careful not to describe Thursday’s effort as expansion per se, but rather a directive to draw down those dollars and expand coverage through a special waiver that would need to be approved by the Biden administration. Several Republican-led states have pursued similar paths.

Coleman told colleagues his aim was to allow Abbott to create a program that is cost neutral, that prioritizes “personal responsibility” and that is flexible.

“In other words, what we have as members of the legislature, they would have,” he said.