Texas Needs to Prepare for 2021 – Now

I recently read an interesting article by the Kaiser Family Foundation analyzing uninsured adults in states not expanding Medicaid coverage as part of the Affordable Care Act (ACA). The ACA expanded Medicaid coverage to nearly all adults with incomes up to 138 percent of the Federal Poverty Level (FPL).

In examining the Kaiser fact sheet, some interesting points stood out:

  • In the U.S., only 14 states have not expanded Medicaid;
  • If all states expanded Medicaid, 4.4 million uninsured non-elderly adults would be eligible for coverage (1.4 million live in Texas)
  • Of the Texans eligible under Medicaid expansion, 67 percent are childless adults historically excluded from the program;
  • In Texas, 80 percent of the uninsured who would become eligible are in a family with at least one person employed in the workplace;
  • In Texas, more than half (54 percent) are adults living below the FPL;
  • In Texas, 758,000 women (more than 50 percent), are uninsured adults who would be eligible if Texas expanded coverage; this is even with current pregnant women being covered.
  • Across the 14 non-expansion states, 50 percent of uninsured adults who would qualify are middle-aged and more likely to have substantial health needs.

Research shows states that expanded Medicaid provided increased coverage, improved affordability, reduced medical debt and decreased uncompensated care costs. One fact we should examine is our traditional Medicaid federal share payment is approximately 61 percent of the total and the ACA Medicaid expansion federal share payment is 90 percent. This is a significant difference in federal matching funds. With our 86th legislative session ended, we thank our leaders for their conscientious public service. Regardless of differing viewpoints, please remember Texas public health policy should benefit all Texans. When the 2021 session convenes, please give serious consideration to helping our vulnerable Texans by expanding our Medicaid coverage.

We need to enhance Medicaid coverage because the Delivery System Reform Incentive Payments (DSRIP) will be expiring under the current Medicaid 1115 Waiver, and many of the participants will not qualify for traditional Medicaid. In fact, over 50 percent of the current DSRIP beneficiaries would be negatively impacted.

Improving the public health of Texas is everyone’s responsibility and striving to help our fellow Texans is the right thing for all. We need serious planning beginning today.