Texas Fails to Expand Medicaid, Address Health Insurance Crisis

Medicaid Expansion Dies (1)

With seven days left until the sine die, the last day for the regular session of the Texas Legislature, lawmakers are poised to do nothing to help the state’s 5 million adults without health insurance – the largest in the U.S.

This session, over a dozen bills, joint resolutions and a budget amendment were filed to expand Medicaid in one form or another. Of those, only HB 565 received a committee hearing. A dozen bills and joint resolutions died in the House two weeks ago. Several Senate bills have yet to be heard in committee and are not scheduled for House consideration by the end-of-session deadline this Tuesday.

On the only vote by either chamber, the House rejected the policy in a near party-line vote with all but one Republican voting against Medicaid expansion and all Democrats voting in favor.

Advocates say Texas is ignoring the health care coverage crisis for another session. Dr. Laura Guerra-Cardus, Deputy Director of the Children’s Defense Fund-Texas and lead coordinator of a March rally at the capitol on this issue, claimed by refusing to expand Medicaid, “Texas will continue to leave over a million Texans who could have health care coverage uninsured for another two years until the session is upon us again.”

“What we are seeing in Texas is our failure to address our high rate of uninsured is causing health care crises throughout our system,” she added.

Dr. Jason Terk, a pediatrician from Keller and Chair of the Texas Medical Association’s (TMA) Council on Legislation, said the failure to pass Medicaid expansion will keep Texas remaining in its ignoble position as a “leader in uninsured.” He went onto say the only reason this policy has not yet passed the Legislature is because it is “politically not viable.”

“Those legislators have to protect themselves from the potential from being primaried,” Lance Lunsford, Senior VP for Strategic Communications for the Texas Hospital Association, said.

Guerra-Cardas warned of the repercussions of health care funding Texas gets from the federal government, the 1115 Medicaid Waiver, which is set to expire in a few years and to which many hospitals rely.

“If we don’t find a way to replace the diminishing Medicaid funds because of that waiver, it will start impacting our entire community at a different level,” Guerra-Cardas said.

Keeping Rural Hospitals Open and Saving Mothers

Without the extra federal funds from Medicaid expansion, “rural hospitals are going to continue to have difficulty in keeping their doors open in the long term… [and it will be] even harder to keep key service lines in narrow margin areas open in the short term,” said Lunsford.

Some of the services rural hospitals will have difficulty maintaining include “labor and delivery services,” the loss of which is reported to have increased in recent years. This has contributed to the maternal mortality crisis in Texas. With low Medicaid reimbursement rates and low uncompensated care reimbursements, rural hospitals are “being asked to do more with less,” said Lunsford.

Experts argue Medicaid expansion will be a “big boost” to the primary care supply, particularly in rural Texas. One issue still facing physicians will be the low Medicaid payment rates. TMA’s focus this session is on improving those rates. According to Dr. Terk, they hoped it would be resolved in the conference process of the budget, but a draft released today contained no added dollars for payments to physicians who see Texans on Medicaid.

In lieu of Medicaid expansion, there is one bill, currently in the Senate facing a Wednesday end-of-session deadline, HB 744, to cover more women to reduce the maternal mortality rate. HB 744 expands Medicaid coverage for low income mothers to 12 months postpartum. Under federal law, coverage ends after two months. This is the #1 recommendation by the Maternal Mortality and Morbidity Task Force.

Texas’ Children Uninsured Rate is Double the National Average

New data released by the University of Minnesota and the Robert Wood Johnson Foundation show Texas has over 800,000 uninsured children, at an uninsured rate of more than double the national average.

Guerra-Cardus says Medicaid expansion would improve children uninsured rates because “when parents do better, so do their children. When parents are enrolled, children are more likely to get enrolled and to stay enrolled in health care coverage.”

In lieu of Medicaid expansion, there are a few alternatives to cover more children proposed this session. One proposal seeks to remedy an issue of 50,000 kids being kicked off the Medicaid rolls every year due to bureaucratic red tape, according to the state’s own data. Bills to do this have stalled. HB 342 died in Calendars Committee last week and the SB 637 has yet to receive a committee hearing.

Guerra-Cardas says failing to act on this simple fix, which the fiscal note of the committee substitute of HB 342 showed had a zero cost, “should be something every Texan and every member of the Legislature should be embarrassed.” She is hopeful at least this policy can get added to an amendment to a bill already in motion.

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