Thank God for Texas (Having So Many Uninsured)

“Thank God for Texas.”

Unfortunately, that’s what the other 49 states will continue saying when looking at their own uninsured populations. They can always look down on Texas, the state with the most uninsured citizens. However, if we grasp the opportunity to expand Medicaid while putting it on the federal government’s dime, we can change that.

The federal government is offering billions of dollars to states to expand Medicaid coverage to cover all those earning up to 138 percent of the poverty level. As further enticement, the federal government will fund 100 percent of the expansion for the first three years (nothing lasts forever, as they say) and 90 percent thereafter. But it is up to each state to implement the expansion to receive these extra federal dollars. Thus far, it is unclear whether or not Texas leaders will approve the expansion.

Roughly 25 percent of all Texans are uninsured – that’s 6.3 million of our fellow Texans. Rice University estimates the Medicaid expansion would reduce the number of uninsured Texans by half by 2014. The expansion would streamline eligibility requirements by allowing families making below 138 percent of the poverty line ($30,675 for a family of four in 2012) to enroll in Medicaid. More important, it will prevent millions of Texans from having to go to a state or federally run health insurance exchange.

While reducing the number of families without insurance is obviously the main goal of the expansion, its byproducts provide even more incentives. It will protect large businesses from the penalties they will incur if their entire workforce isn’t covered when the Affordable Care Act fully takes effect. Hospitals currently forced to serve those without insurance for free will be reimbursed, cost-shifting onto other patients will decrease and local tax burdens relieved. A recent Vanderbilt study shows that without the expansion those same hospitals will likely face budget cuts due to reductions in Medicaid and Medicare reimbursements. Perhaps most important for the coming legislative session is the expansion’s ability to help legislators build a bridge to balanced budgets for the next biennium and beyond.

Make no mistake. This costs money. It would simultaneously require the Legislature to begin saving for the day when Texas will have to pick up ten percent of the expansion’s tab – a difficult task in these uncertain economic times. The expansion will cost Texas an estimated $5.7 billion from 2013 to 2022, with the federal government paying $65.6 billion over that same period.

Legislators already face tough decisions in budgeting for other necessary state services. A Medicaid expansion may be viewed as just adding yet another line to the appropriations bill. Fortunately, if the expansion proves too expensive or otherwise problematic, states have the option of dropping out at any time (even after the first three fully paid years).

Ultimately, without the Medicaid expansion, our state will lose billions in Texans’ taxpayer dollars to other states while remaining at the very bottom in the nation in health insurance coverage. The over six billion uninsured Texans and their families will watch as their federal income tax money is sent to help workers and families in other states gain coverage.

However, if Texas expands Medicaid coverage to those making 138 percent above the poverty line, we can put the other 49 states back in their place: in the shadow of Texas’ growing economy and compassion.

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