Texas Faces Hurdles For Medicaid Expansion In 2025

As the 2025 Texas legislative session approaches, Sen. Nathan Johnson is pushing for Medicaid expansion once again with his bill, Senate Bill 232, which would add 1 million low-income Texans to the Medicaid rolls. This marks his third attempt, despite a GOP-majority legislature that has been resistant to such efforts in the past.

Johnson’s proposal, the Live Well Texas program, includes conservative elements like health savings accounts and incentives for healthy behaviors. It also seeks to increase Medicaid reimbursement rates to attract more healthcare providers. Despite a few years of bipartisan support, Johnson’s previous efforts in 2021 and 2023 failed to gain significant traction, particularly in the Senate.

“I just want a million people to get health insurance, I want health insurance premiums to come down, and I want to do it without levying any new tax on the people,” Johnson said.

According to The Dallas Morning News, critics, including the Texas Public Policy Foundation, argue that Medicaid is financially unsustainable and needs reform before expansion. Caroline Welton, the foundation’s health policy expert, says expanding Medicaid would worsen the system’s existing problems.

Supporters, including Johnson, argue that expanding Medicaid would bring in billions of federal dollars, lower costs for hospitals, and provide coverage for the 1 million Texans who earn too much for Medicaid but too little for marketplace insurance.

“This is the single-largest change we could make, and we’re not doing it. And it’s free,” Johnson said.

Texas has the highest uninsured rate in the country, with around 20% of adults lacking coverage. Medicaid currently excludes low-income working adults without dependent children. Expanding Medicaid could fill this gap and provide coverage for those who need it most.

As Texas debates Medicaid in 2025, the issue remains contentious. Johnson’s bill faces tough odds, but the conversation around Medicaid reform is far from over.