Proponents of Medicaid expansion are predictable, though it’s not completely their fault. For more than a decade they’ve had to rely on a single talking point—one statistic—to make their case. Expanding eligibility for Medicaid would increase the number of Texans who have insurance.
That’s it. That’s the whole argument. A million formerly uninsured Texans would now have insurance. Problem solved.
Implicit in their talking point is that just because someone has insurance, they can get the timely, affordable care they need. As many of us know all too well, that is hardly the case with any insurance—and it is particularly false when it comes to government-run insurance like Medicaid.
Medicaid is designed to fail. The most existential problem—and there are many—is that reimbursement rates to doctors are low. Medical providers have no incentive to take Medicaid patients over those with other types of insurance, so many don’t.
And even if they do take Medicaid patients, they encounter far more billing problems and get stiffed at a much higher rate than with private insurance or even Medicare.
Providers are fleeing so wait times are growing. It now takes the average Medicaid patient two to four weeks just to get an appointment with a primary care provider.
Sounds like a program you’d want to dump a million more people into, right?
It gets worse.
A recent study by the Mercatus Center that found, “Medicaid expansion may well have had the unintended side effect of causing the perceived needs of adults to be prioritized over those of low-income children.”
Maybe that’s why Texas has over 600,000 people—the vast majority of them children—who are currently eligible for Medicaid but aren’t enrolled.
For supporters of Medicaid expansion, signing up all those kids and then adding a million more able-bodied childless adults is enough—completely ignoring that won’t be getting timely care. But It means they can keep trotting out their one statistic showing more people with insurance.
There are alternatives. Texas started making reforms in 2021 and is looking to keep that going in the legislative session this year. The state is proposing fixes to Medicaid so it betters serves the people for whom it was intended. New affordable choices for the uninsured, like direct primary care, are becoming more popular. And there are still options like federally qualified health centers and charity care at non-profit facilities available that better serve low-income patients than Medicaid.
Coverage isn’t care. The ones who ignore this reality aren’t serious about helping Texas patients.