Have Texas lawmakers “made the coronavirus fallout worse” by not expanding Medicaid? That’s what Gilberto Hinojosa, the chairman of the Texas Democratic Party claims in the Fort Worth Star-Telegram. His prescription is for the Legislature to expand Medicaid as soon as it convenes in January.
First, a little background. In the last decade, we have seen substantial changes to the American health care system due to the Patient Protection and Affordable Care Act (ACA) signed into law by President Obama. The ACA brought changes that have impacted all of our lives.
The ACA required states to expand their Medicaid programs to individuals at and below 138 percent of the federal poverty level. Challenged in the Supreme Court in NFIB v. Sebelius, the Court ruled that expansion had to be a voluntary program that states could opt into. As of May 2020, 36 states and Washington, D.C. have chosen to expand.
Texas has not expanded, which has allowed the state to save taxpayer money that would have gone into a program that is fraught with issues. Medicaid was created by President Johnson in 1965 to assist lower income individuals and pregnant women who otherwise could not access the health care system. But expansion has broadened the program to include a population that can access care through other avenues.
Starting in 2014, the federal government funded states’ expansion populations 100 percent, with their share decreasing to 90 percent as of this year. Texas policy makers who are not in favor of expansion have argued that this would cost the state more than the federal government predicted. They aren’t wrong—nationally, more people have enrolled than originally predicted, which has cost taxpayers 157 percent more than expected.
Health care spending is already one of the largest portions of both Texas’ budget and the federal government mandatory spending, largely due to Medicaid. But even with this amount of funding being allocated, only 70.8 percent of physicians nationally are willing to take in new Medicaid patients, compared to 85.3 percent and 90 percent of Medicare and private insurance patients.
What Texans do have access to are Federally Qualified Health Centers (FQHCs). These community-based health centers exist for the medically underserved populations and areas across the state, offering primary and preventative care, as well as oral care and mental health and substance abuse services not always covered under the Medicaid program. Clients pay based on a sliding fee scale based on ability to pay.
The health care system in Texas has also seen the liberalization of telemedicine in light of COVID-19. Telemedicine can be an accessible alternative for individuals who may not have reliable transportation to attend appointments. It can also be a cheaper mode of accessing care if there is no payment parity tied to in-person office visits.
As we all begin to anticipate what will happen in Texas’ next legislative session starting in January, expanding Medicaid should not be an option considered when it comes to addressing our states health care issues. There are established FQHCs that can improve access to health care for lower income communities. And maintaining some of the deregulations of telemedicine brought on by COVID-19 can improve health care access to considerably more.
Hinojosa, in that Star-Telegram piece, makes the common mistake of conflating coverage with care. The states hardest hit by the coronavirus are states that did expand Medicaid, including New York, New Jersey, Washington and California. Clearly, Medicaid expansion is no panacea for a pandemic.
In this time of uncertainty and disarray, Texans cannot allow political rhetoric—like Hinojosa’s finger-pointing—to cloud their judgement. It is as important as ever that we hold firm our values of personal freedoms and liberty, especially when choosing our health care.