Texas’ Broken Medicaid System May Finally Be Fixed

Among the many different items in the $1.75 trillion social spending bill that is currently being debated in Congress would be a fix to the incredibly broken Medicaid system in Texas.

Even before the Affordable Care Act, Texas was well-known for being especially stingy with its medical insurance program for the poor. Like a dozen other states, most of which are in the Republican-dominated south, Texas has consistently refused to expand Medicaid coverage offered in the ACA, which pays for 90 percent of the expense.

 That means that Texas has lost out on hundreds of millions of dollars in funds for the poor and sick, often because of a few conservative minds. A patch in the new bill would close the gap between people who make too much to be eligible for Medicaid in Texas or who are otherwise prohibited for the next four years. This could extend coverage to 2.2 million Texans. 

 The new law, as it currently stands, would take effect in January and bring out-of-pocket expenses to zero by 2023. To placate the states that have already done the expansion, the federal reimbursement rate will be raised to 93 percent through 2025. The law would also punish states that refused to fully expand Medicaid to the prescribed ACA levels by withholding Medicare funds starting in 2023. If Texas refuses, it could be devastating to the medical industry and hospital system in the state.

 As it stands now, about 32 percent of Texans qualify as low-income, but only half of them are on Medicaid. This is largely because of the low-income cap for eligibility ($25,503 annually for a single individual versus $49,960 under the ACA plan) and the narrow definition of who is allowed to collect. Childless, abled adults who are not seniors are entirely prohibited from Medicaid. The program mostly serves to take care of children and their parents. 

 Contrary to popular conservative media, 50 percent of adults enrolled in Medicaid work at least part-time. The rest are disabled, elderly, or cannot make too much money without losing their coverage for their children. 

Since the ACA passed, more than 700,000 adult Texans who would otherwise be eligible for Medicaid have gone uninsured. The state by far has the most uninsured people in America.

Republicans in the legislature seemed more open to the idea of finally launching a Medicaid expansion this session. A bill to do so had bipartisan support in the Texas House but stalled in the Senate. The matter was not brought up during the special sessions called by Governor Greg Abbott. In the end, only small changes were made in the length of time that a pregnant person could receive post-natal care, an action that will indeed save many lives but not significantly put a dent in the state’s overall number of uninsured. It’s possible that President Joe Biden’s singular legislation might finally do what Texas Republicans have refused for more than a decade.