But the strategy by Reps. Garnet Coleman (D-Houston), Bobby Guerra (D-McAllen), and Julie Johnson (D-Carrollton) — author of House Bill (HB) 3871, the expansion bill — is to tack the expansion on to the state budget during the amendment process.
At a press conference Thursday morning, the trio stated they were hopeful it could be done. “Texas has the highest number and highest percentage of uninsured people, and COVID-19 caused 659,000 more to lose their health insurance,” Coleman emphasized.
Texas’ uninsured rate is 18.9 percent, twice the national average.
Should that fail, Coleman stated he has two other amendments that would direct the state to apply for certain waivers. The first would be to reapply for the Section 1115 transformation waiver renewal that was rejected by the Biden administration last week.
“The transformation waiver was never meant to be a permanent strategy for health care,” Johnson stated, adding that the designers of Obamacare did not intend for the Supreme Court to decide Medicaid expansion was optional.
Governor Greg Abbott decried the waiver’s recission, which had already been approved by the Trump administration back in January, and many opposed to expansion see the move as an effort to strong-arm Texas into expanding Medicaid.
Coleman rejected this framing.
The second amendment is geared toward a similarly named, but substantively different Section 1115 demonstration waiver that, according to Coleman, would give the state leeway to develop its own structure to insure as many uninsured Texans as possible.
Coleman concluded by saying the package of Medicaid-related initiatives is “All carrots, no sticks.”
But one thing supporters of Medicaid expansion must contend with is that large portions of the uninsured in Texas are so by choice.
According to the left-leaning Kaiser Family Foundation’s latest numbers, 662,000 uninsured Texas already qualify for Medicaid or other public programs. That’s about 100,000 less than the number of people in the coverage gap who’d become eligible if Medicaid is expanded.
The total uninsured population in Texas is 5.1 million as of 2019 — approximately 15 percent of which fall in the Medicaid gap. About the same percentage are ineligible because they’re not citizens.
Currently, the federal match rate through Medicaid with the state is 60-40, meaning the federal government pays 60 percent of the state’s costs under Medicaid. Expansion would bring that up to 90-10, and Johnson indicated two years after that it’d move up to 95-5.
Johnson said her expansion bill, HB 3871, is not only revenue-neutral — a condition Speaker Dade Phelan (R-Beaumont) said earlier this year had to be met for the discussion — but that it is revenue-positive for the state. The trio estimated the expansion would bring in $15 billion more to the state, though the funds are still taxpayer dollars.
Additionally, some states faced cost overruns when they expanded due to higher-than-projected enrollment. When Texas’ neighbor, Louisiana, expanded Medicaid in 2015, it cost between double and triple the original projection.
There will undoubtedly be a big fight on the House floor over Medicaid and its related amendments. Republicans opposed to expansion have indicated their intention to fight those efforts and Democrats are bullish about their opportunity to slide expansion through.
But with a governor and lt. governor adamantly opposed, and a skeptical speaker, any successful effort would likely be symbolic.
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Brad Johnson is an Ohio native who graduated from the University of Cincinnati in 2017. He is an avid sports fan who most enjoys watching his favorite teams continue their title drought throughout his cognizant lifetime. In his free time, you may find Brad quoting Monty Python productions and trying to calculate the airspeed velocity of an unladen swallow.