San Antonio Express-News (Sunday)
Texas Dems pitch Medicaid proposal
Plan would give money to local governments to cover thousands of underinsured Texans
Texas Democrats have tried for years to persuade Republican state leaders to increase access to Medicaid. Now they think they have found a way to do it with or without their help.
U.S. Rep. Lloyd Doggett and lawmakers from 11 other GOP-led states introduced a measure last week that would give money directly to local governments that want to provide coverage for hundreds of thousands of low-income Texans who currently fall into what is known as the “coverage gap.”
The Cover Outstanding Vulnerable
Expansion-eligible Residents (COVER) Now Act would allow counties to apply for the money directly with the federal government, and it would prohibit state leaders from retaliating against them if they do.
Doggett said his aim is to avoid conflict with Republicans.
“You have your ideological objections to Medicaid expansion — I don’t agree, but I accept your position,” he said. “At least let those local leaders who want to take advantage of this and who recognize both the health and economic advantages of doing it, at least let them do that, and walk away and see how it works.”
Republican leaders in Texas declined again this year to hear legislation that would have increased Medicaid access under a model similar to that passed in GOP-controlled Indiana. They declined to take it up even though a bipartisan majority had signed onto the bill in the House, and Congress had offered billions in a one-time incentive through its pandemic relief.
Gov. Greg Abbott and others have been virtually silent on their reasoning, but have said in the past that they believe the safety-net program to be bloated and inefficient. The Republican resistance is also related to the party’s decadelong fight against the Affordable Care Act, which calls for states to expand Medicaid coverage to more of the working poor, and of
fers them funding to do so.
A spokeswoman for Abbott did not respond to a request for comment.
Doggett estimated that if San Antonio, Houston and Dallas alone signed on to the proposal, half of the state’s eligible uninsured population would gain access. All three cities are led by Democrats and have pushed for Medicaid expansion.
Statewide, more than 1.2 million Texans would be eligible for Medicaid if state officials were to expand the program, according to a study by the The Bush School of Government and Public Service at Texas A&M University
More than 2 million people are thought to be in the coverage gap today, meaning they make too much to qualify for traditional Medicaid
but not enough to qualify for subsidized insurance under the Affordable Care Act. Most are people of color, and the biggest group is in Texas, a state that has long had the highest uninsured rate in the country.
Anne Dunkelberg, a policy analyst for the left-leaning think tank Every Texan, said the new legislation would also increase funding to state health officials for any added administrative costs.
“Congressman Doggett’s bill really recognizes how
entrenched the ultra conservative opposition to expansion is in Texas and the need to really connect the dots about what it’s going to take for us to get possibly a million and a half uninsured adults — the vast majority of them working — coverage,” she said.
Doggett hopes to pass the measure through a process called reconciliation, which requires only a simple majority to pass in the U.S. Senate. Without that, Republicans would likely filibuster to block it from being voted on.
In a letter last week, members of the Congressional Black Caucus, the Congressional Hispanic Caucus and the Asian Pacific American Caucus urged the Biden administration to find a way to extend coverage to low-income adults in states that have so far refused.
“It is unacceptable for the federal government to continue to allow some states to deny basic health coverage to these uninsured and underinsured Americans,” they wrote. They noted that states with expanded Medicaid have lowered racial disparities in coverage rates, affordability of care and some health outcomes including maternal and infant mortality.
“The coronavirus pandemic has only illuminated the far-reaching, fatal consequences of inadequate access to health care,” they wrote. “Addressing the Medicaid coverage gap is critical both in correcting decades of unacceptable and unjust denial of health care coverage to underserved and minority populations throughout the United States and in protecting our nation from future pandemics.”