Texas’ continued refusal to participate in the Medicaid expansion set up under the Affordable Care Act has been a constant source of frustration for health care advocates over the past decade as the state leaves billions of federal dollars on the table as more than a million Texans go without health insurance. While it looked like expansion might happen thanks to bipartisan support in the House, the bill has stalled in the Senate. That’s not unexpected, but what is more surprising is that attempts to formally study how badly off we are for not doing the expansion are failing to get off the ground, sometimes by the thinnest of margins.
The legislation in question is Senate Bill 1138 authored by State Sen. Bryan Hughes (R-Tyler). It would task the Legislative Budget Board with studying the various state and federal safety net programs that affect Texans to see how well they are performing in the last five years. The goal is to reduce cost and promote efficiency. These include, but are not limited to, various medical and healthcare assistance programs. More data is always a good thing.
The trouble began in the House after the upper chamber had already passed the bill. State Rep. Ann Johnson (D-Houston) forwarded an amendment that would have also included studying how Texans have been hurt by not participating in the expansion. Her amendment was championed by the Children’s Defense Fund-Texas on Twitter.
“Our heartfelt thanks to @VoteAnnJohnson for trying to study the cost of TX’s refusal to expand Medicaid,” the tweet reads. “It’s a mystery that all legislators aren’t talking abt #MedEx4TX (> 2/3 voters support). We deserve to know at what cost #txlege ignores their constituents.”
The most recent polls do show that 69 percent of Texans do support the Medicaid expansion.
Johnson’s amendment caused an immediate uproar. One of the bill’s sponsors, State Rep. Candy Noble (R-Lucas) immediately came out against the proposal. Republicans claimed it was not related to the aim of the bill, though it’s hard to argue with a straight face that any deep look at the safety nets that are used by Texans should not include one of the most prominent and successful federal programs of all time.
Nonetheless, the amendment was shot down 77-70. Only four Republicans joined the Democrats in supporting it: State Reps. Lyle Larson (R-San Antonio), Dan Huberty (R-Kingwood), Kyle Kacal (R-Bryan), and Phil Stephenson (R-Rosenberg). All four were also joint authors on Julie Johnson’s Medicaid expansion bill, HB 3871. Also notable were state Reps. Travis Clardy (R-Nacogdoches), Phil Stephenson (R-Wharton), and Stan Lambert (R-Abilene) who voted against the amendment despite signing up as co-authors to bipartisan Medicaid expansion bill. SB 1138 went on to pass the House without the amendment.
Should the Senate finally take up and pass the Medicaid expansion, the fight over Johnson’s call to study just how much Texans are being hurt by their stubborn refusal to join will be moot. There is some indication that the Biden Administration may be trying to force the issue on behalf of residents.
The Centers for Medicare & Medicaid Services sent a notice that it was revoking Texas’ Medicaid waiver, which has been in place since 2011. The waiver provides the state with $3.87 billion to offset free care. Part of the agreement for the waiver is that Texas take public input on the Medicaid expansion, which the federal government says that the state is failing to do. Attorney General Ken Paxton is now suing the Biden Administration, claiming that the move is a nudge to make Texas accept the Medicaid expansion. The waivers were supposed to be a temporary lifeline for states as they transition into the Medicaid expansion, not a permanent handout for stubborn conservatives who want the money but not the obligation to provide all impoverished adults with coverage.
The health of over a million Texans now hangs in the balance, and most Republicans in the House are reluctant to even acknowledge the damage a formal study of the refusal to expand Medicaid would likely show. There are less than two weeks left in the current legislative session.