COMMENTARY: Help Texas: Expand Medicaid

By Lyle Larson, Special to the Herald

Say you were told that every dollar you contribute toward a cause would be matched with $9. Sounds like a pretty good deal, doesn’t it?

This is the deal that Texas is forgoing by refusing to expand Medicaid. If we elected to expand Medicaid, the federal government would provide $9 for every $1 of state funding we put in. As it stands, we are forgoing 90% of federal matching funds — this is money Texans have already paid to the federal government that we are not accessing. According to a study by the Bush School at Texas A& M University, expanding Medicaid would result in an increase of $5.4 billion in new federal funds into state coffers annually, while providing health insurance to 1 million low-income Texans.

When folks who don’t quite qualify for Medicaid need routine medical care, they are often left with visiting an emergency room as their only option. Using an emergency room for primary care is the most expensive way to obtain health care. When they have no way to pay for the services they receive, local taxpayers pick up the tab. Medicaid expansion would significantly reduce this uncompensated hospital care cost.

According to economist Ray Perryman, Medicaid expansion would have a massive positive economic impact on our state. Due to an increase in health-related spending, reduced uncompensated care costs and productivity increases, Texas would experience gains of $45.3 billion in gross product and $29.4 billion in personal income for the 2022-23 biennium.

Medicaid expansion would benefit more than just urban areas in Texas. The percentage of populations that lack health care coverage are higher in rural parts of the state than in urban areas. This has resulted in the closure of more than 20 rural hospitals throughout Texas in the past 10 years.

The COVID-19 pandemic has taken a terrible financial toll across industries. Many folks who lost their jobs as a result of the pandemic also found themselves without healthcare coverage at a time when a vicious virus is coursing through our state. According to an Urban Institute study, Texas’ uninsured rate could have decreased nearly 25% had Medicaid been expanded, helping folks who need coverage at this critical time.

Texas is one of just 12 states that have not expanded Medicaid, though we have the highest number of uninsured folks in the nation. In recent years, voters in red states (Idaho, Utah, Nebraska, Oklahoma and Missouri) have elected to expand Medicaid. A recent poll conducted statewide found that 64% of Texans favor expanding Medicaid.

The Legislature can develop a Medicaid expansion plan that is custom fit to Texas. It could include work requirements and cost-sharing through premiums and co-payments. It also could come with reforms to prevent fraud. Several of the red states that have expanded Medicaid in recent years offer templates and ideas for Texas to use to customize the terms of Medicaid expansion.

Refusing to expand Medicaid is a bad business decision for Texas. We have an opportunity this legislative session to fix this. If the Legislature approves, we can allow Texans to decide whether to expand Medicaid in a ballot initiative.

We recapture the taxes Texans pay to the federal government for education, highways and public safety. We transformed education for future generations last session. We must change the future in health care this session for the same future generations.

Lyle Larson, R-San Antonio, represents part of San Antonio in the Texas House of Representatives. His email address is