Gilberto Hinojosa, chairman of the Texas Democratic Party, claims that “Texas Republicans have made coronavirus fallout worse by fighting Medicaid expansion.”
“They didn’t create the global health crisis, but they’ve undoubtedly exacerbated its effects,” he writes.
But is that true? Had Texas expanded Medicaid when the Affordable Care Act was passed a decade ago, would we be in better shape now? The data — and logic — dispute this.
Hinojosa and other supporters of Medicaid expansion make three specific claims. First, that not expanding Medicaid has contributed to a lack of access to health care for the uninsured; second, that states with expanded Medicaid programs have seen an improvement in health outcomes; and third, that COVID-19 has amplified the need for expansion in Texas.
The truth, of course, is more complicated than that.
Texas does, indeed, have a large number of uninsured residents. But the Medicaid program was never intended to be a low-cost alternative to expensive commercial insurance. It was meant to provide coverage to the most vulnerable of our citizens — the disabled and the poor. It’s not designed to scale up, as other states have learned.
A very limited number of physicians and other health care providers accept Medicaid. Its reimbursement rates are often below what it costs to provide care. And patients and providers alike face burdensome rules that make it harder to get medications and see specialists, raising the question of whether patients are gaining value.
The vast majority of people considered uninsured in Texas (and across the nation) are eligible for some sort of coverage — yet they have chosen to forego that coverage. According to a 2018 study by the nonprofit Kaiser Family Foundation, about 582,000 people were eligible for Medicaid or other public programs in Texas and yet did not enroll.
Expanding Medicaid will further strain a system already bursting at the seams.
Next, Hinojosa assumes that expanding Medicaid will mean more care and better health outcomes. We can’t confuse health coverage with healthcare. The fact is, the uninsured already receive healthcare — one study found that they receive about 80% as much care as similar insured people.
The indirect effect of expanding Medicaid should be considered, too. Large expansions of coverage can lead to people with more pressing medical needs being crowded out because of the surge of demand. Overall, mortality worsened in Medicaid expansion states relative to non-expansion states after 2013 — a trend some have attributed to the opioid epidemic being more severe in expansion states.
But the key to Hinojosa’s argument is the assumption that COVID-19 makes Medicaid expansion an urgent necessity. If that’s so, it’s logical to assume that Medicaid-expansion states are handling the pandemic better than non-expansion states.
Yet as of April 11, nearly two-thirds of all confirmed COVID-19 cases and nearly three-quarters of all COVID-19 deaths have presented in just seven states, all of which expanded Medicaid.
We can launch targeted initiatives to increase health care access to those most in need. And we can provide direct government funding for clinics that provide care for vulnerable populations. These measures would almost certainly be a better use of resources because they’re laser-focused on providing care, rather than just providing coverage. Medicaid is a flawed program. So instead of expanding it — and amplifying those flaws — let’s fix health care in Texas.
Expanding Medicaid won’t solve the COVID-19 problem — or the many problems that have plagued the program in Texas for years.