Medicaid Expansion: A total governance failure.
It hasn’t always been this way and it doesn’t have to continue.
In the late 1990s, the Children’s Health Insurance Program (CHIP) passed the Texas House with virtually unanimous support. If the bill were coming before the Texas Legislature for the first time in the current environment I’m not sure it could pass and if President Obama’s name
were connected to it I’m pretty sure it wouldn’t.
Disagreements are not new to the legislature be they ideological, partisan or geographical—Texas is rarely a one size fits all state. We have however seen a time when the idea was more important than the author, not every motive was suspect and when advocacy for a cause and respect for the opinions of others were not mutually exclusive concepts. A time when it was occasionally possible to work together on issues for the benefit of Texas and Texans. That time is not today.
Expanding Medicaid under the Affordable Care Act is about as close to a no-brainer as any legislative body is likely to consider. The first three years would be funded by 100% federal dollars phasing out to a 90% federal 10% state match after 2020. The state, counties, and tax-supported medical providers already spend more than the potential state match on qualifying programs so no additional state funds would be needed. Over a million currently uninsured Texans would be covered, Somewhere north of 5,000 premature deaths per year would be
prevented, over 200 thousand good paying jobs would be created. Texas would be a healthier more prosperous state. No brainer. Except we said no and not even no thank you–every following result is bad.
Eighteen rural hospitals have closed, some have reduced services and others are struggling. Many of these institutions were hit by Medicare reductions under the ACA that would be more than compensated for by the Medicaid expansion but because Texas didn’t expand Medicaid
the compensations never came and rural communities suffer.
If you have a tax-supported hospital your taxes go up because the hospital is covering uncompensated care that would have been covered under expanded Medicaid.
If you have insurance your premiums are higher because uninsured that would have been covered under the expansion are driving costs and that drive premium.
If you should have to visit your local hospital your out of pocket cost will likely be higher because the hospital is trying to survive.
If you live in Texas Medicaid expansion would have added 100 billion to our state economy over 10 years, at virtually no cost to the state, causing in excess of 300 billion in economic stir.
Some have argued that a possible reason to not expand Medicaid is the possibility that the federal program might end but the state could have easily built in a trigger tying the state participation to the federal match. That’s not an argument it’s an excuse. If the funds are
removed they’re removed but as long as you have them it’s the obligation of any elected official the use of tools available to best serve your constituents. This was a total failure of governance.
It hasn’t always been that way. It doesn’t have to be that way tomorrow. We can do better.