Governor Perry’s decision not to accept federal expansion of Medicaid in Texas means 687,000 women will be left in a "coverage gap," according to a report by the National Women’s Law Center. Those women are too poor to qualify for Medicaid, but don’t make enough money to be eligible for subsidies on the federal health insurance exchange.
Medicaid eligibility standards in Texas are among the strictest in the nation. A parent in a family of three must make less than $3,737 annually to qualify (19 percent of the federal poverty level), according to the Kaiser Family Foundation. Adults without dependent children are not eligible for Medicaid in Texas.
To qualify for subsidies on the federal health insurance exchange, a person must earn at least 100 percent of the federal poverty level. Under the Affordable Care Act, Medicaid eligibility was intended to be expanded to cover all people making up to 138 percent of the federal poverty level, but a U.S. Supreme Court ruling in June 2012 effectively made that expansion optional.
“There are actual real costs that are associated with not having those women on insurance, including when they show up at the emergency room because they haven’t been able to get something taken care of on time," said Karen Davenport, health policy director with the National Women’s Law Center. "County tax payers are picking up the costs of uncompensated care.”
But opponents of Medicaid expansion, like the Texas Public Policy Foundation, say more Medicaid coverage won't do much to help that.
"Uncompensated care costs are not driven primarily by the uninsured," writes TPPF health care policy analyst John Davidson, "but by Medicaid patients, who tend to have a drastically higher rate of emergency room use than every other group, including the uninsured."
Governor Perry has said accepting Medicaid expansion would be “like putting 1,000 more people on the Titanic when you knew what was going to happen.” Gov. Perry has requested the federal government's Medicaid dollars be handed to Texas in a block grant, one big chunk of money that could be used to overhaul the program in this state.
But an increasing number of his fellow Republican governors see no better option than Medicaid expansion under Obamacare. This week, Utah's Republican governor Gary Herbert changed course and agreed his state would accept the expansion of Medicaid, making Utah the 26th state to do so.
"Doing nothing is not an option," Gov. Herbert said, according to the Salt Lake Tribune.