Red States Across The Country Are Rethinking Medicaid Expansion, But Will Texas?

Mar 30, 2017

After the failure of the GOP’s plan to replace the Affordable Care Act, there’s a new political landscape, and states across the country with Republican-led legislatures are weighing their options when it comes to Medicaid expansion. 

Conservative states – most recently Kansas — see an opening to extend health care to more low-income adults. But it’s unclear whether Texas – a state that has more uninsured people than any other state in the country – is willing to hop on the bandwagon.

Though, even under the Affordable Care Act, some Texans still haven’t been able to get insurance. Amber Keith, who lives in Texarkana, is one of those Texans.

Keith’s family earns a little over $47,000 a year, and they can’t afford private health insurance. She qualifies for a subsidy to help pay for her premiums, if she buys a plan through the federal marketplace, but she says the coverage isn’t enough.

Keith has a large family with seven people and she just can’t make that work. While they would qualify for Medicaid, Texas hasn’t expanded the program.

“I live in the northeast part of Texas, which is on the border with Arkansas,” Keith says. “If I lived just two miles from my current location and I lived in Arkansas, we would have qualified for Medicaid under Arkansas’ expansion.”

The number of states joining Arkansas – and other conservative states neighboring Texas – has been slowly growing.

That’s due, in part, to that new political landscape: There’s a Republican in the White House now, and attempts to repeal and replace Obamacare proved harder than congressional Republicans previously thought. That’s why a few more Republican states are toying with the idea of expanding their Medicaid programs to low-income adults like Keith. Anne Dunkelberg with the left-leaning Center for Public Policy Priorities argues Texas should be one of those states.

“There is absolutely an opportunity to do some kind of coverage program that would incorporate pieces that would probably never have been approved under the Obama administration,” Dunkelberg says.

She argues Texas could expand Medicaid now and officials could include things in the program like work requirements, higher premiums and copayments – conservative ideas that were less likely to get past the Obama administration.

Texas Rep. Garnet Coleman, who has tried to get Texas to expand Medicaid in the past, says he doesn’t think that will be enough.

“I see Texas sticking with our status quo," the Houston Democrat says. "That we don’t like Medicaid, we don’t like anything that has to do with Obamacare, we don’t like people getting health care on the government dollars."

Meanwhile, conservatives in Texas are hoping the federal government brokers a deal with the state.

Doctor Deane Waldman with the right-leaning Texas Public Policy Foundation says he envisions Texas getting billions of Medicaid dollars over the next few years – without any of the usual strings attached.

“We want and I think we will get a total release of all those mandates,” Waldman says.

That way, he says, Texas could control costs and access to care instead of fixating on expanding insurance coverage.