Medicaid Expansion Pressure Intensifies
as State Seeks Green Light for Long Stall

Mike Hailey
Capitol Inside
January 14, 2021

The state faces the prospect of throwing $5 billion or more away over the next decade if it receives permission from the federal government this week to delay an expansion of Medicaid under the Affordable Care Act as long as health officials who answer to Governor Greg Abbott have proposed.

The Texas Health and Human Services Commission expects to learn in the next day or two whether officials in Washington D.C. will grant the state a waiver that it's seeking in a move that would make it possible to put off a Medicaid expansion for 10 years.

Based on projections at Texas A&M University and other health public and private health care experts, the state stands to lose as much as $1 billion for every biennium that GOP leaders and lawmakers refuse to expand the program for the poor and elderly under the terms of Obamacare.

But the HHSC that's an agency in Texas executive branch has pushed forward with the bid for the extended waiver nonetheless in an apparent attempt by the ruling Republicans to reaffirm their opposition to a Medicaid expansion as a political statement regardless of the cost to taxpayers here.

Lobbyists for health care interests and advocates for the downtrodden thought they would have a substantially better chance in attempts to expand Medicaid in Texas as a consequence of the way that the coronavirus crisis has exposed the vast disparities in health care across the state.

The wages of the Republican's roadblock on the broadening of Medicaid in Texas have been especially evident in death toll from the pandemic have been dramatically higher in border cities and other areas that are heavily Hispanic, relatively poor and predominantly Democratic.

Abbott and the Republicans who are running the show in Austin might finding it disconcerting to learn that the COVID-19 fatality rates have been even higher in a significant sum of rural counties that are deeply red with substantial numbers of residents who can't afford health insurance and more likely targets of the virus as a result.

The Republicans don't seem to have the math to reinforce their resistance to an expansion of health coverage to their most vulnerable constituents. The state as an example currently foots the bill for 40 percent of the Medicaid program costs in Texas.

But advocates say that Texas would only be forced to cover 10 percent of the price tag for Medicaid here if Abbott and the Republicans agreed to end their resistance to an expansion of the program in the face of pressure that's intensified in the midst of the covid crisis.