As GOP blocks Medicaid coverage for 1 million Texans, Democrats offer workaround

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Texas Democrats have been trying for years to convince Republican heads of state to expand access to Medicaid. Now they think they’ve found a way to do it with or without their help.

U.S. Representative Lloyd Doggett and lawmakers in 11 other GOP-led states this week introduced a measure that would give money directly to local governments who wish to cover the hundreds of thousands of low-income Texans who are currently falling into what this is called the “coverage gap”.

The Cover Outstanding Vulnerable Expansion-Eligible Residents (COVER) Now Act would allow counties to request money directly from the federal government, and it would prohibit heads of state from retaliating against them if they do.

Doggett said his goal was to avoid conflict with Republicans.

“You have your ideological objections to the expansion of Medicaid – I disagree, but I accept your position,” he said. “At least let the local leaders who want to take advantage of it and recognize both the health and economic benefits of doing so, at least let them go, and go and see how it works. “

Republican leaders in Texas again this year refused to hear legislation that would have increased access to Medicaid according to a model similar to that adopted in GOP-controlled Indiana. They refused to accept it even though a bipartisan majority signed the bill in the House and Congress offered billions in a one-time incentive through its pandemic relief.

4.1 million: Texans currently enrolled in Medicaid

1.27 million: Texans who would be eligible for coverage as part of the expansion

$ 5.4 billion: Additional federal dollars for Medicaid if the state expands

$ 600 million: Texas’ expected contribution expanding, or 10 percent of the federal counterpart

$ 66.5 billion: Current two-year budget for Medicaid, 60% of which is federally funded

Source: Bush School of Government and Public Service, Texas A&M University


Governor Greg Abbott and others have remained virtually silent on their reasoning, but have said in the past that they believe the safety net program to be bloated and ineffective. Republican resistance is also linked to the party’s decade-long struggle against the Affordable Care Act, which calls on states to extend Medicaid coverage to more of the working poor and offers them funding to do so.

An Abbott spokeswoman did not respond to a request for comment.

Doggett estimated that if Houston, San Antonio and Dallas signed the proposal alone, half of the state’s eligible uninsured population would have access. All three cities are run by Democrats and have pushed for the expansion of Medicaid.

Statewide, more than 1.2 million Texans would be eligible for Medicaid if state officials expanded the program, according to a study by the Bush School of Government and Public Service at Texas A&M University.

More … than two million people are considered to be in the coverage gap today, which means they earn too much to qualify for traditional Medicaid but not enough to qualify for subsidized insurance under the Affordable Care Act. Most are people of color, and the largest group is in Texas, a state that has long had the highest uninsured rate in the country.

Anne Dunkelberg, policy analyst for left-wing think tank Every Texan, said the new legislation would also increase funding to state health officials for any additional administrative costs.

“Congressman Doggett’s bill really recognizes how entrenched ultra-conservative opposition to expansion is in Texas and the need to really connect the dots on what it will take us to get maybe a million and half of uninsured adults – the vast majority of them working – coverage, ”she said.

Doggett hopes to pass the measure through a process called reconciliation, which only requires a simple majority to pass the U.S. Senate. Without it, Republicans would likely filibuster to prevent his vote.

In a letter this week, members of the Congressional Black Caucus, the Congressional Hispanic Caucus and the Asian Pacific American Caucus urged the Biden administration to find a way to extend coverage to low-income adults in states that have so far refused.

“It is unacceptable that the federal government continues to allow some states to deny basic health coverage to these uninsured and underinsured Americans,” they wrote. They noted that states with expanded Medicaid have reduced racial disparities in coverage rates, affordability of care, and some health outcomes, including maternal and infant mortality.

“The coronavirus pandemic has only highlighted the fatal and far-reaching consequences of inadequate access to health care,” they wrote. “Closing the Medicaid coverage gap is critical to correcting decades of unacceptable and unfair denial of health care coverage to underserved and minority populations across the United States and to protect our nation from future pandemics. “

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