On Jan. 13, the doors to the Texas Capitol reopened as the state legislature began its 87th regular session. There has been no shortage of issues requiring immediate attention following the return of state politicians to Austin, such as the vaccine rollout, energy winterization, and redistricting, to name a few. With a May 31 deadline and over 7,500 bills and resolutions filed, politicians need to scramble to get legislation onto the floor and then to the governor’s desk. But amidst the commotion, one bill, House Bill 389, should not get left behind.
HB 389, authored by four House Democrats, would expand Medicaid in Texas, providing health care coverage to an estimated 1.5 million more currently uninsured Texans. Right now, Medicaid only covers adult Texans earning an income above 18% of the federal poverty line. By passing HB 389, the Medicaid eligibility limit would increase to 138% of the federal poverty line, amounting to a consequential shift for Texas, which has the greatest number of uninsured people in the nation.
The Affordable Care Act (ACA) originally provided for the expansion of Medicaid by raising the eligibility limit, but the Supreme Court ruled in 2012 that states could not be required to implement the change. By the time President Obama left office, most states had taken the federal government up on its offer, as they would receive aid covering 100% of the operating cost. Texas, however, along with many other mostly Republican states, refused. Since then, even some of the reddest states in the nation have chosen to forgo their initial resistance as study after study has shown that there are clear benefits to expansion. In 2020, for example, Utah, Nebraska, and Idaho all initiated their expanded Medicaid programs, and Arkansas did the same in 2021. Now, it’s Texas’s turn.
There are several hurdles that stand in the way of HB 389 passing. A Medicaid expansion bill has been introduced every session since the ACA went into effect, each time being blocked. The Texas legislature remains in the hands of Republican politicians, most of whom openly oppose Medicaid expansion. Even if HB 389 were to make it out of the House and Senate, the bill would still need a signature from Governor Abbott who is on the record saying “Medicaid expansion is wrong for Texas.”
There are, however, some reasons to be optimistic about the future. For the first time, a slate of moderate Republicans, such as Rep. Button of Dallas, signaled an openness to Medicaid expansion during the last campaign season, proving that the position is popular enough for some Republicans to support.
This year, the added pressure of the pandemic has put more emphasis on the importance of health care nationwide. The latest federal pandemic relief bill includes an extra five billion dollars in funds for states that decide to expand Medicaid. A press release from Rep. Israel’s office, one of the bill’s authors, cited COVID-19 related issues as an impetus for reform. “Expanding Medicaid would bring relief to those who are currently in the coverage gap — many of whom are our essential workers,” the office spokesperson said.
The combination of these factors has led health care advocates to make a big push for expansion during this legislative session. It remains to be seen whether this effort will bring about policy results, but what is clear is that the arguments against expansion are becoming harder to make. If Texas politicians are serious about wanting what’s best for the state, Medicaid expansion needs to be embraced.