Texas, again, slams the door on uninsured
The beginning of the 87th Texas legislative session in January offered the slim possibility for Medicaid expansion.
It was always the smallest of chances. Republican opposition to expansion has long been tethered to an ideological tenet rather than moral or economic calculations. But Texas’ dubious distinction of leading the nation in uninsured people, compounded by a pandemic, opened the possibility of action. Then came the Biden administration’s decision to rescind the extension of a federal funding agreement known as the 1115 waiver. Perhaps this would move some Republican legislators toward supporting a measure that would reduce those uninsured numbers.
But last week’s failure of an amendment in the House, and its inability to get more than one Republican vote, dims the possibility of any form of expansion.
The waiver the Biden administration rescinded is given to states that haven’t expanded Medicaid. It provides billions of dollars a year in reimbursement for care for uninsured patients — and will stay in effect through September 2022.
The amendment offered by Rep. Garnet Coleman, D-houston, would have had the state apply for another waiver under Section 1115 — a discovery waiver — to create its own Medicaid-type program for low-income, uninsured Texans. The only Republican voting for it was San Antonio Rep. Lyle Larson, the strongest Republican voice in favor of Medicaid expansion.
Another Republican representative from San Antonio who has said he is receptive to some form of expansion is Steve Allison. But in this instance, Allison failed to rise to the occasion. In an Express-news op-ed, he recently explained he voted against the amendment because, “It focused purely on Medicaid expansion, without the increase in reimbursement rates for health care providers that are so important to increasing access to care. It also lacked wellness, workforce assistance, and copay and medical savings account provisions that would help bring down the cost of care.” Instead, Allison wrote, he supported House Bill 3871 because, “It reflects a number of conservative concerns and priorities: It uses already-available federal funds to pay for additional health care coverage in a way that does not cost the state, but instead could lower health care costs for all Texans.”
But this is exactly the purpose of Medicaid expansion. The benefits of expansion for the state haven’t changed. It would be a boon to the economy, create jobs, increase revenue flowing into Texas, allow up to 1 million people to receive health insurance and all with the federal government funding 90 percent of the cost.
Also, as we noted in a recent editorial, the American Relief Plan signed into law last month by President Joe Biden increases the financial incentives for Medicaid expansion by adding extra federal aid to the states holding out. This extra funding would more than cover the state’s 10 percent share of expanding Medicaid.
Allison has praised HB 3871 as a bipartisan bill that has the support of 76 of the House’s 150 members. That number includes all 67 Democrats and nine Republicans, including Allison and Larson. While enough to squeak through passage, what’s discouraging is that while the bill was referred to the House Human Services Committee in late March, it has yet to be assigned a hearing. The legislative session concludes on May 31, but there is no sense of urgency, moral or economic, to move the bill along. Allison could have supported both efforts. We’re extremely disappointed. We may be able to calculate the amount of money Texas has forfeited by refusing to expand Medicaid, but we can never measure the lives that could have been saved or the increased quality of life that could have been purchased had more people been insured.
To fail to do the right thing is unexplainable and unforgivable.