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Austin American-Statesman Op-Ed: Moorhead: Without Medicaid plan Texas is stuck

By: 
Executive Director

Note: this op-ed originally appeared in the Austin American-Statesman, Friday, April 15. Find the original story here.


Texas should accept billions of dollars in federal funds to secure vital infrastructure across our state, reduce bottlenecks and congestion in urban areas, improve accessibility in rural areas and ease pressure on local taxpayers.

No, it’s not highway funding; it’s Medicaid.

Texas is one of 19 states still rejecting federal Medicaid expansion — but according the Texas Legislative Budget Board, we are in a class by ourselves. Testifying at a legislative hearing last week, the board’s staff pointed out that, compared to other states rejecting Medicaid expansion, Texas is by far the largest. Compared to the five other large states rejecting the funds, we have the smallest population share currently on Medicaid/CHIP — and it’s not because Texans don’t need the help. We have the highest uninsured rate and largest number of uninsured people of any state in the country. If any state should want to increase health coverage, you’d think it would be us.

Our persistent refusal to accept our own taxes back to cover our own taxpayers could end up hurting health care for all Texans — even those who have insurance. In the same hearing last week, Health and Human Services Commissioner Chris Traylor testified that federal extension of Texas’ 1115 Medicaid waiver — an important source of hospital funding — is “not in the cards.”

The funds in jeopardy are a special stream of federal Medicaid funds to help support hospitals that serve a lot of uninsured patients. But now that states can use federal Medicaid funds to cover more people, theoretically there should be fewer uninsured patients in the system. Federal officials could be reluctant to continue propping up our hospitals with the waiver funds while we keep rejecting the much larger pool of insurance funds they are trying to give us.

When asked if the loss of the waiver funds could cause some Texas hospitals to close, the commissioner stated that he couldn’t say how many hospitals might close — but he didn’t suggest the number would be zero. At least 10 rural Texas hospitals have closed in Texas over the past three years, even with the 1115 waiver.

Hospital closures hits rural communities hard because they have limited provider options already, but losing the waiver funds would affect urban hospitals, too. One staff member in the governor’s office has been quoted as saying that without waiver funds, “some private hospitals may eventually be forced to make the business decision to stop serving poor people,” leading to overcrowding in public hospitals and making it harder for Texans to get timely, life-saving care in emergency rooms, no matter how good their insurance might be. Of course, this would be less of a problem if more of those poor people had health insurance — especially insurance paid for with the corporate and personal income taxes that Texans send to the feds every year.

State leaders say the Medicaid expansion funds are dangerous because they come with federal “strings” that advance a federal policy agenda: providing quality health insurance for all Americans. They say the federal deficit is already high, and they can’t in good conscience add to it — as though we could earmark Texans’ income taxes to pay down the principal on the federal debt.

What they haven’t said is how they intend to keep Texas hospital doors open, ease the strain of indigent care on local property taxes, or provide coverage for the nearly one million Texans who earn too little to qualify for subsidies on healthcare.gov.

If we were talking about highway funding, there would be a blue-ribbon commission and hearings around the state. Instead, Texans are left wondering: What’s the plan?

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