Red States are passing Medicaid expansion, why can’t Texas?

by | Aug 6, 2020 | Health Care, Policy

On Tuesday, Missouri became the 38th state to expand Medicaid, opening healthcare to over 230,000 Missourians. It joins a lengthy list of GOP-led states in expanding healthcare, including Nebraska, Utah, and Oklahoma. Meanwhile in Texas we still lead the country in the number of uninsured and, since the COVID-19, pandemic another 650,000 have lost their health insurance.

The ballot initiative to expand Medicaid passed in Missouri by 53 percent, with several suburban counties in St. Louis and Kansas City voting overwhelmingly for the measure. The governor of Missouri, a staunch conservative, actually added the ballot initiative to the August primary ballot instead of November’s presidential ballot, hoping a smaller turnout would defeat the measure.

Clearly, the voters of Missouri felt expanding Medicaid was important for their state. The vote also comes as the Trump administration continues its effort to dismantle the Affordable Care Act, potentially kicking 20 million Americans off their health care and denying preexisting conditions coverage to over 120 million. Both Gov. Greg Abbott and Texas Attorney General Ken Paxton support ending the ACA.

Texas has been in a health crisis for a long time, well after the state decided not to expand Medicaid through the ACA. According to a report from 2018, over 17 percent of Texas residents lacked health coverage. That’s about 5 million Texans without access to health care.

With COVID-19, that health crisis has only exacerbated. While cases and hospitalizations from COVID-19 have gone down in parts of the state, those numbers will likely rise precipitously as schools open. Over 7,000 Texans have died from the coronavirus. Many hospitals, particularly rural ones, are overwhelmed. The health care status quo has never felt so dangerous and untenable.

So will Texas ever get a chance to vote on expanding Medicaid? According to Republican lawmakers in the state, that would be a “no.” Rep. Celia Israel commented on Twitter that she and Rep. John Bucy sponsored a bill in the last legislative session that would allow voters to “weigh in and expand Medicaid,” but that it never got a hearing.

After Gilberto Hinojosa, Chairman of the Texas Democratic Party, published an op-ed decrying Republicans for opposing Medicaid expansion, the Texas Public Policy Foundation responded with their counter argument. The conservative think tank argued that Federally Qualified Health Centers and telemedicine were enough for health care parity in the state.

The TPPF also noted that states that did expand Medicaid, like New York or New Jersey, were hit hardest by COVID-19 (this was published in May). “Clearly, Medicaid expansion is no panacea for a pandemic,” wrote the TPPF author. Now, however, Texas has officially surpassed New York in the number of COVID-19 cases.

If the state of Texas expanded Medicaid like Missouri did, over 1.5 million Texans would have affordable health insurance. That should be reason enough to support expanding Medicaid, but it also makes economic sense. According to the Commonwealth Fund, if Texas adopted an expansion of Medicaid, the state would “bring an estimated $100 billion of federal funding over the next decade.” In addition to increasing care for Texans, it would also help stabilize both hospitals and providers, a net boon for the Texas economy.

Several Chambers of Commerce in the state support expanding Medicaid. Many of those chambers lobbied in 2013 for the state to expand Medicaid under the Affordable Care Act. Medicaid expansion is also supported by the Texas Association of Business, hardly a left-wing or progressive entity.  

Since he took office in 2018, State Sen. Nathan Johnson has forcefully argued for expanding Medicaid in Texas. Many candidates for the Texas state house have called for expanding Medicaid, including Ann Johnson, Elizabeth Beck and Brandy Chambers.

Gina Ortiz Jones, running for congress in TX-23, has seen how her community is being impacted by COVID-19 and a health care system that is failing too many in south Texas. Before the pandemic, Jones spoke on the campaign trail about returning home from Iraq and being confronted with her mother’s cancer diagnosis. Though her mother was able to receive care, too many Texans don’t have the option.

Now campaigning virtually, Jones recently hosted an online town hall about the importance of expanding Medicaid. In a statement to the Texas Signal, Jones reiterated her commitment. “It’s unacceptable that during a pandemic, our leaders continue to block Medicaid expansion – this failure has denied care to 1.6 million Texans, stretched rural health care providers in this district to their breaking point, and left Texans vulnerable to our current public health crisis.” 

If Texans do get a chance to vote on expanding Medicaid, it will surely be opposed by Republicans statewide and in the legislature. If history is any guide, however, improving health care will transcend partisan lines. 

Photo: Carl Court/Getty Images


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A longtime writer and journalist, Jessica was thrilled to join the Texas Signal where she could utilize her unique perspective on politics and culture. As the Features and Opinion Editor, she is responsible for coordinating editorials and segments from diverse authors. She is also the host of the podcast the Tex Mix, as well as the co-host for the weekly SignalCast. Jessica attended Harvard College, is a onetime fitness blogger, and has now transitioned to recreational runner (for which her joints are thankful).

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