'Political football': Texas among 10 states without expanded Medicaid

Wednesday, May 17, 2023
'Political football': Texas among 10 states without expanded Medicaid
Texas is one of 10 states without expanded Medicaid, but 1.4 million uninsured, non-elderly adults could get insurance if Texas expanded eligibility.

HOUSTON, Texas (KTRK) -- After Edilio Acosta moved to Texas, he said he didn't realize he wouldn't have the same access to free healthcare that he was used to in his home country of Cuba.

In his native Spanish, Acosta told 13 Investigates' Daniela Hurtado that he only makes about $1,600 a month working at a factory.

He said getting health insurance just isn't affordable right now, and he's not alone.

Statewide, 4 million people are uninsured, according to the Texas Medical Association.

"We have the dubious honor of being the least insured state of the United States, which is not a proud distinction," Joe Freudenberger, CEO of OakBend Medical Center in Richmond, said.

More than 1 million more people would be insured if Texas participated in expanded Medicaid.

In order to be currently eligible for Medicaid in Texas, you have to be pregnant, responsible for a child, 65 or older, or have a disability, or a family member with a disability, along with a certain household income, according to the government's website for benefits.

States with expanded Medicaid extend healthcare coverage to more low-income, working residents, even if they're not elderly or disabled.

State Sen. Nathan Johnson, D-Dallas, is one of the Texas politicians who have been trying to get expanded Medicaid for Texans for years.

"We are now one of only 10 states that have refused the benefits of Medicaid expansion. It dates back all the way to when the Affordable Care Act was first enacted, and Medicaid expansion was initially forced upon and then made optional to states through a Supreme Court ruling," Johnson said. "(It's) to essentially cover more people. We're talking about the working poor, by definition. We're not talking about people who don't work. We're largely talking about families where at least one person works."

David Balat, director of the Texas Public Policy Foundation's Right on Healthcare initiative, said expanding Medicaid would extend the benefits to "able-bodied adults beyond those for whom the program was intended."

"Medicaid expansion has become some kind of political football," Balat said.

Balat, who is against expanding Medicaid, said it isn't about dollar signs. Instead, he said, it's about the bottleneck he believes this will cause for an already saturated system without enough physicians to treat those who are on Medicaid.

"We have to take into consideration those people who are most vulnerable that would be crowded out by the added folks into the program with an already limited supply of physicians and facilities," Balat said.

Freudenberger countered the argument, saying Medicaid expansion could benefit rural hospitals.

"It can be the difference between the hospital surviving and not surviving," he said.

Right now, the federal government pays for 60% of Texas' Medicaid program, with the state picking up the rest of the cost. Under expanded Medicaid, more people would be eligible, but the federal government would pay for 90% of the program, with the state contributing the remaining 10%.

"What we're talking about is taking the tax dollars that we're all paying in federal income tax - that go off to Washington, that are currently being sent to 40 other states to cover healthcare costs, but not to Texas," Johnson said.

13 Investigates found 1.4 million uninsured, non-elderly adults could get insurance if Texas expanded its Medicaid eligibility requirements, according to the Kaiser Family Foundation. About 70% of those uninsured adults who aren't eligible now live below the poverty level, and 80% come from homes where at least one person works full or part-time.

"Expanded Medicaid gives people access to primary care, gives people the ability to get the care they need when they need it, instead of waiting until it's a death sentence," Freudenberger said.

Johnson proposed four bills this session that would seek ways to expand Medicaid either through a constitutional amendment or a waiver.

None of the bills have seen any movement this legislative session.

"It's pure politics," Johnson said. "We're stuck in the ideology of 2008. We're stuck in the narrative of 2008, and so many people have opposed it for so long that they have a political difficulty changing positions. But I have a solution to that, and it's to recognize that 10 years ago, this was a risky proposition for a lot of states...In Texas, we've made many improvements to our state-run Medicaid system, so whatever problems you might have been concerned about in expanding our state Medicaid program in 2008, 2010, we have fixed."

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