Elections matter. They matter because they signal to policymakers the direction in which a community, state or nation wants to go. When it comes to Medicaid expansion and making our system of delivering care to the truly needy worse, the people of Texas have made their intentions very clear. By keeping Texas firmly in the hands of Republican majorities, they took a stand against it.

Those who would gain the most financially from the Medicaid expansion scheme (hospitals, insurance companies, trade associations) spent an enormous amount of money on lobbying and marketing to secure future revenue streams for their organizations. Their idea to ensure the gravy train keeps rolling is to add nearly a million more people to the rolls of a program that is already strained for resources and discourages the participation of medical professionals.

At the outset, Medicaid was intended to provide “health coverage to millions of Americans, including eligible low-income adults, children, pregnant women, elderly adults, and people with disabilities.” Texas has nearly 3.5 million people on Medicaid, most of whom are children in very low-income families.

When proponents say they want to “expand” Medicaid, what they mean is to allow able-bodied people with higher incomes to access the doctors and dollars meant for the truly poor and disabled. This would result in an obvious crowding-out effect as patients jockey for finite resources.

That’s because fewer than half of Texas physicians are enrolled as providers in the program and accept new Medicaid patients. The federal government imposes unworkable reimbursement rates and draconian regulatory burdens that require tremendous administrative work outside of the patient visit. Doctors have decided they would rather not become pencil-pushing bureaucrats and will gladly forgo Medicaid all together if it means they can focus on caring for their patients and practicing medicine.

Adding millions of patients while discouraging doctor participation is a recipe for longer wait times and increased use of emergency rooms, which drives the cost to taxpayers through the roof.

Nondisabled children and adults are roughly 31 percent of beneficiaries, yet they consume nearly 40 percent of the spending because they frequently use the emergency department as their source for basic primary care. This is both inefficient and expensive. According to the Graham Center, researchers found that “states that spend more on primary care get better results. Increased primary care spending was associated with lower rates of hospitalization and (emergency department) use.”

That’s not to say that those who want to expand Medicaid because of their concern for the uninsured don’t have their heart in the right place. But the difficulty of getting care despite having “insurance” is precisely why nearly 600,000 people who are eligible for Medicaid have chosen not to enroll. Even more tragic is the list of 166,416 disabled people, mostly children, who are awaiting an opportunity to benefit from the program.

And that is perhaps the most critical point: Medicaid is health insurance, not assurance of care.

Regardless of party affiliation, we want a properly functioning safety net that focuses on access to medical professionals and getting the care they need. Focusing on coverage alone as the end-all solution is letting our most vulnerable down.

How do we improve the current program? One of the solutions is called Direct Primary Care. If allowed to be part of Medicaid it would give beneficiaries 24/7 direct access to a physician with whom they can build an ongoing doctor-patient relationship. Direct primary care physicians and staff are typically available at all hours via text or telephone if patients need an issue addressed. Allowing a direct relationship with medical professionals without insurance companies as intermediaries for basic primary care is a commonsense and compassionate approach to improving care and reducing expenses that could better be used to help those that are medically fragile.

Ten years after Obamacare passed, two-thirds of Americans still say the health care system is broken, and it is routinely one of the top three issues that concern the country. If elections are about the future, health care is always on the ballot. Providing compassionate care — not merely expanded coverage — is what Texans want, and that is the way they voted.