Maybe there was a brief moment, when the budget situation looked dire, when the forbidden topic could have been quietly whispered about. But come on, we know the score.
It’s constitutional – deal with it
Texas Republicans have long resisted expanding Medicaid under the Affordable Care Act, unswayed by the promise of billions in new federal aid for a state perennially ranked last in health coverage. But last fall, with their state House majority on the line and the uninsured rate climbing again amid the pandemic, conservative support seemed to be building.
On the campaign trail, Rep. Angie Chen Button, R-Richardson, said she was newly open to expanding the public insurance program under limited conditions. Rep. Morgan Meyer, R-Dallas, expressed support for a broader expansion than he had previously. Rep. Lyle Larson, R-San Antonio, tweeted that lawmakers should “seriously consider accessing federal Medicaid funding” in the next legislative session.
“This is money we’re sending to the federal government and not getting back,” he wrote.
With the session now underway, the party is facing a reckoning on the issue. All but a dozen states including Texas have expanded Medicaid since President Barack Obama’s signature health care law passed in 2010. It is broadly popular in Texas, according to polls. And Republicans in swing districts have come under increasing pressure from voters to address the state’s ballooning uninsured rate, which was at 18.4 percent before the pandemic, or about 5.2 million people.
House Republicans have yet to file any bills, though lawmakers said work is happening behind the scenes on a measure that could satisfy the GOP majority. Staffers for Button, Meyer and Larson either did not respond to messages or said they were unavailable to comment.
Finding widespread approval will be tough, and proponents lost a key leverage point this month when the outgoing Trump administration extended part of a waiver that helps Texas hospitals cover uncompensated care. While the move does not expand health coverage, it does ensure that emergency care is reimbursed for struggling hospital systems that treat low-income patients.
“The 1115 waiver was never meant to be a permanent fix,” said Sarah Davis, a former Republican state representative who favors expansion. “It was really supposed to be kind of like a bridge, because we were assuming — or the government was assuming — that the state would be expanding Medicaid.”
In the Senate, Republicans are likely to oppose any expansion bills. The upper chamber has blocked past attempts and killed legislation last session that sought even a narrow expansion, for new moms. A Senate committee omitted the option entirely in a report last year on ways to lower the state’s uninsured rate.
See here for more on the 1115 waiver. As the story notes, Greg Abbott has no interest in expanding Medicaid, either. I can believe there are some Republican State Reps, especially in tight-margin urban/suburban districts, who’d vote for some form of Medicaid expansion if a bill came up, but that’s a long way away from convincing Greg Abbott and Dan Patrick. You want to expand Medicaid, you need to vote for the candidates from the party that wants to expand Medicaid. It ain’t happening otherwise. This is our sixth regular session post-Obamacare, the track record should be perfectly clear by now.