Let Me Be Brief: Medicaid Expansion in Texas

A series of briefs by Texas Medical Students

By: Ryan Sorensen, Aaron Pathak, Aishani Khosia

What is Medicaid?

Medicaid is a program established by the federal government in 1965 as a solution to the coverage gap that many marginalized groups faced due to the inaccessibility of private health insurance.^¹ Funded jointly by the federal and state government, Medicaid became an option for health insurance for low-income, older, and disabled members of society. While partly federally funded, the program criteria, benefits, eligibility, etc all falls under the ruling of each state.²

In 2010, passage of the Affordable Care Act developed an even more comprehensive reform, with the goal of making insurance coverage and healthcare access accessible to a greater population. The ACA called for Medicaid expansion,³ which if adopted by each state would allow for more flexible eligibility- addressing the existing coverage gap that continues to remain an issue. Expansion of Medicaid would allow for individuals to be eligible to receive benefits through Medicaid on an income-basis, as long as household income did not exceed 138% of the established Federal Poverty level.⁴

How would Medicaid Expansion help Texans?

Texas leads the nation in the number of uninsured individuals in the state, with a reported rate of 18% according to data collected in the 2021 Census.⁵ For many who do not qualify for Medicaid or receive employer-sponsored health insurance, the barrier to insurance lies in the high cost of marketplace plans. With over 5 million uninsured individuals in Texas, Medicaid expansion would allow for increased access to care and improved health outcomes by expanding eligibility to include underserved and vulnerable populations above the poverty line.⁶

The pivotal 2002 report: Care without Coverage released by the Institute of Medicine has since been strengthened by findings that continue to show a direct relationship between mortality risk and the lack of health insurance.⁷ A literature review by the Kaiser Family Foundation showed that ACA expansion was correlated with better health outcomes and was specifically related to improvements in areas of cancer diagnosis and treatment, transplants, smoking cessation, behavioral health, and treatment of opioid disorders.⁸ Health insurance and health outcomes are undeniably interconnected, making Medicaid expansion a necessary legislative agenda to improve the health of Texans and address existing health inequities.⁹

A current bill to specifically advocate for is: Bill SB 343- Relating to the expansion of eligibility for Medicaid to all individuals for whom federal matching money is available. This bill was introduced by Nathan Johnson in January, and it was read in April and referred to the Health and Human Service Senate Committee for review.

How has the TMA advocated in the past?

The TMA for many years has advocated for the expansion of medicaid through the promotion of articles that show the health benefits of medicaid expansion in Texas. In 2019, 2020, and 2021 the TMA published articles showing public support, public health benefits, and fiscal benefits of allowing medicaid expansion in Texas.¹⁰ Furthermore, former TMA President Dr. Doug Curran testified in support of HB 565 introduced by Representative Coleman in the 2019 legislative session, although the bill did not make it past committee.¹¹ TMA Policies 190.032 (Medicaid Coverage and Reform) and 190.036 show the TMA’s support in accepting additional funds from the federal government for increasing Medicaid access while also urging the government to develop new, more sustainable systems than the current Medicaid expansion plan.^12,13 TMA Policy 190.037 (Medicaid Work Requirements) also states that the TMA opposed any lifetime
limits or reduction in access for Medicaid enrollees.¹⁴ Through medical student advocacy, it is important to support these lobbying efforts by the TMA in passing Medicaid expansion. It is important for the MSS to increase knowledge about the coverage gap between Texas’ current Medicaid system and the income needed to afford health insurance from the Affordable Care Act marketplace to decrease our state’s uninsured population.The federal government is slated to pay 90% of the total costs of Medicaid expansion,¹⁵ greater than the normal 50-78% that the federal government pays for current enrollees. This expansion will not only make healthcare more accessible for low-income Texans who fall in the coverage gap, but also increase the fiscal stability of safety-net hospitals that currently have to pay for people in this coverage gap through increased local property taxes.

Fast Facts

• Medicaid expansion in Texas would provide health insurance coverage to approximately 2 million low-income Texans who are currently uninsured.¹⁶
• States that have expanded Medicaid have seen improvements in health outcomes, including lower rates of mortality, better access to preventive care, and improved management of chronic conditions.¹⁷
• Expanding Medicaid in Texas could help address health disparities by providing access to healthcare for low-income and minority populations who are disproportionately
  uninsured. ¹⁸
• Medicaid expansion in Texas would also save taxpayers money by reducing the amount of uncompensated care provided by hospitals and other healthcare providers.¹⁹
• Expanding Medicaid in Texas would result in significant net fiscal benefits for the state. According to a report by the Urban Institute, the federal government would cover 90% of the costs of expansion, and the state would save money on healthcare and other programs that currently serve uninsured individuals.²⁰
• The Texas Hospital Association has estimated that Texas hospitals would see a $34 billion reduction in uncompensated care costs over a 10-year period if Medicaid were expanded.²¹
• Expanding Medicaid in Texas would generate more than $100 billion in economic activity and create 200,000 jobs over 10 years, according to a study by the Perryman Group.²²

References

1. Center on Budget and Policy Priorities. (n.d.). Introduction to Medicaid. https://www.cbpp.org/research/health/introduction-to-medicaid.
2. Medicaid.gov. (n.d.). Home. https://www.medicaid.gov/medicaid/index.html.
3. HealthCare.gov. (n.d.). Affordable Care Act (ACA) – Glossary.
   https://www.healthcare.gov/glossary/affordable-care-act/.
4. Kaiser Family Foundation. (2023). Status of State Medicaid Expansion Decisions: Interactive Map.
   https://www.kff.org/medicaid/issue-brief/status-of-state-medicaid-expansion-decisions-interactive-map/#:~:text=The%20Affordable%20Care%20Act’s%20(ACA,FMAP)%20for%20their%20expansion%20populations.
5. Mykyta DCand L. (2022). Decline in share of people without health insurance driven by increase in public coverage in 36 states. Census.gov. https://www.census.gov/library/stories/2022/09/uninsured-rate-declined-in-28-states.html
6. Rachel Garfield, K.O. (2021). The Coverage Gap: Uninsured Poor Adults in States That Do Not Expand Medicaid – Issue Brief – 8659-10. KFF. https://www.kff.org/report-section/the-coverage-gap-uninsured-poor-adults-in-states-that-do-not-expand-medicaid-issue-brief-8659-10/#endnote_link_508791-3.
7. Kilbourne AM. (2005). Care without Coverage: Too Little, Too Late. J Natl Med Assoc. 97(11), 1578.
8. Guth, M. (2023). The Effects of Medicaid Expansion under the ACA: Studies from January 2014 to January 2020 – Report. KFF. https://www.kff.org/report-section/the-effects-of-medicaid-expansion-under-the-aca-updated-findings-from-a-literature-review-report/.
9. Sommers BD, Baicker K, Epstein AM. (2012). Mortality and access to care among adults after state Medicaid expansions. New England Journal of Medicine. 367(11), 1025-1034. doi:10.1056/nejmsa1202099.
10. Texmed. (n.d.). Medicaid Expansion. https://www.texmed.org/Search/Keywords/?Keyword=Medicaid+expansion.
11. Doolittle, D. (n.d.). More than 1 million more Texans could be covered, report shows. Texmed. https://www.texmed.org/Template.aspx?id=50436.
12. Texmed. (n.d.). Medicaid Expansion: Why It Matters to Texas. https://www.texmed.org/Template.aspx?id=43009&terms=medicaid%20expansion.
13. Texmed. (n.d.). Medicaid Expansion: FAQs. https://www.texmed.org/Template.aspx?id=46586&terms=medicaid%20expansion.
14. Texmed. (n.d.). Medicaid Expansion: Economic Impact. https://www.texmed.org/Template.aspx?id=48322&terms=medicaid%20expansion.
15. Center on Budget and Policy Priorities. (n.d.). Medicaid Expansion: Frequently Asked Questions. https://www.cbpp.org/research/health/medicaid-expansion-frequently-asked-questions.
16. Kaiser Family Foundation. Medicaid in Texas. Retrieved from https://www.kff.org/medicaid/state-indicator/texas/
17. Kaiser Family Foundation. The Effects of Medicaid Expansion under the ACA: Updated Findings from a Literature Review. Retrieved from https://www.kff.org/medicaid/report/the-effects-of-medicaid-expansion-under-the-aca-updated-findings-from-a-literature-review/
18. National Academies of Sciences, Engineering, and Medicine. Accounting for Social Risk Factors in Medicare Payment: Identifying Social Risk Factors. Retrieved from https://www.nap.edu/catalog/23635/accounting-for-social-risk-factors-in-medicare-payment-identifying-social
19. The Commonwealth Fund. The Cost of Not Expanding Medicaid in Texas. Retrieved from https://www.commonwealthfund.org/blog/2019/cost-not-expanding-medicaid-texas
20. Urban Institute. The Cost and Coverage Implications of the ACA Medicaid Expansion: National and State-by-State Analysis. Retrieved from https://www.urban.org/sites/default/files/publication/32696/413136-The-Cost-and-Coverage-Implications-of-the-ACA-Medicaid-Expansion-National-and-State-by-State-Analysis.PDF
21. Texas Hospital Association. The Economic Benefit of Expanding Medicaid in Texas. Retrieved from https://www.tha.org/Public-Policy/State-Federal Issues/Medicaid-Expansion
22. The Perryman Group. Economic and Fiscal Benefits of Medicaid Expansion in Texas. Retrieved from https://www.texmed.org/Template.aspx?id=47027