If Texas Doesn't Expand Medicaid, Two Million Will Be Without Options

[cali]

Abby Rapoport

June 29, 2012


It's no secret there's a health-care crisis in Texas. The state has the biggest uninsured population in the country with around 6.2 million—or a quarter of all residents—lacking insurance. As a Kaiser Health News report highlighted, poor and uninsured Texans must sometimes wait more than 24 hours in emergency rooms, where treatment is most expensive, while more cost-effective health-care options, like preventative care, are out of reach.

The Affordable Care Act was supposed to change all that. It offered new avenues for health-care coverage to people at all income levels by expanding Medicaid. But yesterday's Supreme Court decision made it optional for states to expand their Medicaid coverage. "There's going to be a donut hole in the middle if a state doesn't proceed," says Edwin Park, vice president for health policy at the D.C.-based Center on Budget and Policy Priorities. In Texas, if the state chooses not to expand its services, almost two million people may be stuck in limbo—without access to Medicaid, but too poor for the subsidies.

First, a little background about the Court's decision: A key element of the ACA was expanding Medicaid to provide insurance for those making up to 133 percent of the federal poverty line; those who make above that amount can receive subsidies to help pay for their insurance. Prior to the ruling, states had little choice but to expand their programs by January 2014; if they did not, they risked losing all their Medicaid dollars. Now, however, the Court has ruled that states can only lose the extra dollars they would get through expansion, meaning they'll keep the Medicaid dollars they're already getting.

As I wrote earlier, the expansion is a great deal for states. The federal government will pay 100 percent of the costs of the expanded coverage for the first three years, and overall, states will never pay more than 10 percent of the costs for the extra people served. Over the next decade, states will only pay an estimated 2.8 percent more. Meanwhile, they'll see huge savings as more people get insurance and can access preventative care, rather than relying on emergency rooms.

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http://prospect.org/article/if-texas-doesnt-expand-medicaid-two-million-will-be-without-options