Inside the Rail Texas

Governor doubles down on no Medicaid expansion

The most noteworthy element of the Governor’s just-completed State of the State address was the refusal to expand Medicaid.  

As a refresher, here’s the value proposition presented to Texas by the Affordable Care Act:  states expand Medicaid to serve a larger share of their low-income population, and the federal government covers 100% of the cost of expanded eligibility for the first three years, and 90% in all the years after that.  

Or, since the Supreme Court ruled that states cannot be compelled to expand Medicaid eligibility, Texans can send their federal income taxes to pay for other states to provide health insurance to their low-income populations, while we maintain the highest percentage of children without health insurance of any state in the country.  And we can continue to absorb the cost of uncompensated care in our local hospital district taxes and in our private health insurance premiums.

I understand the Governor’s philosophical opposition to the ACA.  But once it became law and was largely upheld by the Supreme Court, this refusal to participate in Medicaid expansion is incredibly harmful.  The harm is not just to our uninsured population but also to our hospitals, our doctors, and our overall healthcare infrastructure - even as it causes Texans to become the biggest losers in the country in terms of the amount we pay to the federal government in taxes relative to the amount we get back from it.

I thought it was asinine when Texas made a similar decision to forego federal funding for the Women’s Health Program, which also had a 9:1 federal match (and saved the state millions of dollars in Medicaid costs by providing affordable contraception to low-income women).  But this takes the stakes from the hundreds of millions to the tens of billions.  

I’m really surprised the Governor would draw such an uncompromising line in the ground on this issue at this time.