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The online federal insurance marketplace opened for business Sunday. It’s the third year of open enrollment for these subsidized plans, established by the Affordable Care Act. Many Texans still oppose the law, even though the state is home to the most uninsured people in the country, 4.4 million residents.
The uninsured rate in Texas is 19 percent. There are multiple reasons: the number of low-wage jobs in Texas that don’t offer benefits, cultural and language barriers, and political opposition to health reform. Another reason is that Republican leaders have not expanded Medicaid to more poor people, as 30 other states have done. That part of the law is optional, but by declining the expansion, Texas loses out on billions of dollars in federal funds every year.
There is growing pressure for Texas to expand Medicaid, and supporters are now looking for the right political message that could bring the parties together.
For the moment, Republicans still consider the Affordable Care Act to be political kryptonite. Senator Ted Cruz continues to criticize it. Attorney General Ken Paxton just filed another lawsuit attacking part of it. Governor Greg Abbott has said he won’t consider the Medicaid expansion, because he considers Medicaid a dysfunctional entitlement program that should not be allowed to expand.
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In Houston, local leaders want the expansion. Harris County Judge Ed Emmett, a moderate Republican, has supported it for years. The CEO of the taxpayer-supported Harris Health System, George Masi, says he needs the revenue that Medicaid expansion would bring. He’s had to lay off more than 100 employees, and cut back on charity care.
“What is even more profound is that money is going to other states that expanded Medicaid, like New York, California, Connecticut,” Masi said. “And so the taxpayer of Texas is being penalized, if you will, for not taking advantage of that option.”
By emphasizing the impact on taxpayers, Masi and others are framing the issue in terms of economics rather than humanitarian concerns.
“We call it a paradigm shift,” Masi added. “It’s a different way of thinking.”
Government leaders and health advocates from across Houston point out that the costs of caring for the uninsured fall heavily on local institutions. Those patients strain the budgets of hospitals, first responders, and even jails.
Last week, Masi welcomed the the U.S. Secretary of Health and Human Services to Houston, where she toured a Harris Health clinic.
Secretary Sylvia Burwell said she is willing to work with state leaders to craft a unique Medicaid plan for Texas. She’s done that with other Republican governors.
She, too, dangled the economic benefits of accepting more federal money under the law. She pointed to Kentucky, which did expand Medicaid .
“In Kentucky alone, which is obviously a much smaller state than the state I’m now visiting, the expectation is we will see an increase of 40,000 jobs by 2021 and $30 billion into the state’s coffers. So that’s something,” Burwell said.
In 2013, the Texas legislature took no action on Medicaid expansion. The same thing happened this year.
But more voices are starting to push for change, according to Ken Janda, who runs Community Health Choice, a not-for-profit insurance company in Houston.
Janda said the Texas Medical Association and the Texas Hospital Association are both being more vocal on the issue, as is the Texas Association of Business. The federal Medicaid funds would help the state budget, and inject revenue into the medical sector of the economy.
“Doctors’ offices are able to hire more people. Pharmacies are able to hire more people. That becomes an economic multiplier,” Janda said.
County budgets would benefit as well, because they support safety-net clinics and public hospitals such as Ben Taub, part of the Harris Health system.
“If Texas expanded Medicaid, we would be able to look at reducing local property taxes across the board in all counties, or use those dollars for something besides healthcare,” said Janda.
Janda says the new emphasis on economics could eventually bring the parties together.
“There is some interest now by some Republican state senators because of the potential to reduce local property taxes,” he added.
Janda isn’t naming names yet. He also says don’t expect to see any movement on this issue until after the 2016 presidential election. But he says he is “guardedly optimistic” that Republicans will be willing to discuss a possible Medicaid expansion after that.