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After A Decade Of Refusing Medicaid Expansion, Texas Lawmakers Might Be Forced To Reconsider

The Texas Capitol is seen reflected on a building.
Gabriel C. Pérez/KUT

Texas remains one of the few states in the country that has not expanded its Medicaid program to more low-income adults. The pandemic might compel state lawmakers to at least consider changing that during the upcoming legislative session, though.

Luis Figueroa, legislative and policy director for the public policy think tank Every Texan, said the pandemic has “changed the calculus” for lawmakers considering what to do about the state's coverage crisis.

“I am not guaranteeing that everybody has seen the light,” he said, “but I think there will be more robust discussions that have been previously closed.”

Texas has long had the highest uninsured rate in the country, but the pandemic has made a bad situation worse. Early this summer, Families USA, a consumer health advocacy group that supports the Affordable Care Act, found that 29% of Texas adults under 65 didn’t have health insurance at the time. The group also found that about 659,000 people in the state had lost their health coverage between February and May, as job losses soared.

Figueroa said addressing the state's uninsured rate is going to have to be a focus for lawmakers in January.

“We are doing an abysmal job at making sure that all Texans are covered through either public or private health [insurance],” he said.

Elena Marks, president and chief executive officer for the Episcopal Health Foundation in Houston, said Medicaid expansion remains the best way for lawmakers to tackle this issue.

“That is a cost-effective and already-established mechanism for covering millions of Texans who are going to otherwise remain uninsured,” she told KUT over the summer. “If there is some other plan, I’d love to see it.”

Texas is one of just 12 statesthat have not expanded Medicaid under the Affordable Care Act – largely for ideological reasons. In the past few years, a growing number of conservative states have begun to expand their programs. Some decided to do it for budget reasons, others were forced to by statewide ballot initiatives approved by voters.

As a result, uninsured rates have remained high in Texas, while other states have seen significant improvements.

“Texas has been resisting Medicaid expansion since the [Affordable Care Act] came out,” Marks said, “and yet Texas has not come up with anything else to replace it with.”

John Hawkins, senior vice president of government relations for the Texas Hospital Association, said state lawmakers should work with the federal government to come up with a plan that works for the state.

He said that could include outlining ways to use federal dollars to expand coverage that requires “some level of personal responsibility” without penalizing beneficiaries.

Hawkins said lawmakers are running out of time to tackle this issue because hospitals around the state – particularly in rural parts of Texas – are facing long-term financial problems.

“We have been able to cobble together a financing system to make it work up until this point,” he said, “but right now I think it is a lot more critical that we do something on a large scale to help stabilize the system.”

Figueroa said Medicaid expansion is becoming more palatable to some lawmakers because of the budget constraints the state will be facing in the coming years; expansion comes with an influx of federal dollars.

“We have seen members of both parties – candidates – talking about Medicaid expansion in ways that have never been talked about going into a legislative session,” Figueroa said. “Legislators are looking at it from the cost effectiveness of these are tax dollars that are going up to D.C. and not coming back to our state.”

Even though conversations around Medicaid expansion might sound different in 2021, Figueroa said, it's hard to say whether anything will actually change.

Texas Republicans – who have been opposed to expanding Medicaid – will have control of both the House and Senate.

“It might be a longer-term issue beyond one session,” Figueroa said.

Got a tip? Email Ashley Lopez at Follow her on Twitter @AshLopezRadio.

Ashley Lopez - KUT