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As Mississippi Nears Medicaid Expansion, Could Texas Be Next?

An Episcopal Health Foundation study found that Texas loses $7 billion in healthcare and lost productivity costs each year due to health disparities.
Courtesy: iStock

After a decade of resistance to expanding Medicaid in Mississippi, Medicaid expansion bills have passed both houses with two-thirds majorities, where Magnolia State Republicans have a supermajority in the legislature. While some wrangling about work requirements remains, the state is set to take advantage of $1 billion in federal funds and add coverage for 200,000 in the country’s poorest state.

If there is a state with more conservative bonafides than Texas, it might be Mississippi. Yet, Republican lawmakers there have changed their tune on the legislation as more states take advantage of federal funds to help pay for mounting healthcare costs. Mississippi House Speaker Jason White told Mississippi Today that fiscal impact is responsible for the shift in opinion over the years. “My Republicans think that is the smart, common sense, business-minded thing to do. I’ll admit this. Most of my Republicans don’t get there because of compassion. They get there when they look at dollars and cents.”

Will Mississippi’s movement on Medicaid expansion impact Texas legislators when public opinion and research haven’t? A 2020 poll found that 69 percent of Texans support Medicaid expansion, which would include $5 billion in federal money to pick up 90 percent of the cost of providing insurance to 1.2 million Texas in a state with the highest uninsured rate in the country at 18 percent (the national average is around 8 percent).

State leaders have resisted expansion on principle as part of Obama-era federal government expansion, and other thought leaders have argued that it would bust the state’s budget. However, Waco-based The Perryman Group research says that expanding Medicaid could save the state money. It would allow Texans to address their health issues before they become more expensive and require hospitalization. The study found that every $1 spent by the state to expand Medicaid coverage under the Affordable Care Act (ACA) would provide a $1.78 return in state government revenue over the first 10 years. An Episcopal Health Foundation report says the state would save $704 million yearly if the expansion occurred. 

The coverage gap worsened last year. As the public health emergency ended last year, Texas removed 1.7 million people from its Medicaid rolls. The coverage had expanded to 5 million Texans during the pandemic when states couldn’t remove anyone from Medicaid coverage. Texas Medicaid requirements are so restrictive that it is difficult for anyone but children, poor pregnant and postpartum mothers, and the disabled to get coverage. However, individual plans are often out of reach for the working poor.

With public opinion and fiscal responsibility arguing for expansion, why has there been no movement? The Texas Tribune reported that in Austin, it is an open secret that most Republican lawmakers believe that Medicaid expansion is a good deal for the state, but they are afraid to cross state leaders like Governor Greg Abbott and Lieutenant Governor Dan Patrick, for whom the issue is a non-starter.

North Texas lawmaker Nathan Johnson has written numerous bills to expand Medicaid in Texas, but they are usually stuck in committee and rarely make it to a vote on the house floor, despite having nine Republican signatories to a recent bill. When Houston Democrat Garnet Coleman’s amendment to a budget bill directed lawmakers to take advantage of the federal money to ensure poor Texans made it to the House floor, there was a glimmer of hope. But the amendment failed 80-68, with only one Republican joining the Democrats.

Advocates aren’t giving up hope. Last year, Texas expanded Medicaid coverage to new moms from six months to one year. DFW Hospital Council President and CEO wrote about the need to expand Medicaid, noting its impact on individuals and hospitals throughout the state, especially rural facilities that serve higher rates of Medicaid and Medicare patients and have thinner margins.

“Is there more we can do to improve the health of our Texas residents? Of course there is, and it’s time we improved the health of more than 1.5 million people. Simply put, Texas needs to expand Medicaid. It will reduce the number of uninsured, decrease emergency room visits, make a healthier workforce, and improve business productivity,” Love wrote. “Most importantly, it will help low-income individuals with healthcare expenses so personal funds can be used for food, clothing, and family needs.”


Will Maddox

Will Maddox

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Will is the senior writer for D CEO magazine and the editor of D CEO Healthcare. He's written about healthcare…