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87TH LEGISLATIVE WRAP-UP 87TH LEGISLATIVE WRAP-UP

viding incentives for adults to work and manage their own health care 2. Kaiser Family Foundation. (2021, July 1). Status of State Medicaid
responsibly. This legislation had sufficient support to pass the House Expansion Decisions. https://www.kff.org/medicaid/issue-brief/sta-
Floor – as well as backing from nearly 200 business groups, health care tus-of-state-medicaid-expansion-decisions-interactive-map/.
organizations and local government entities – though it did not have 3. Dague, L., & Hughes, C. (2020, September 14). County-Level Pro-
the chance to be heard on the House Floor. jections of Medicaid Expansion’s Impact in Texas. Episcopal Health
In our opinion, Texas needs to do more for its uninsured population Foundation.
to bring them the health coverage they need. Whether that be through 4. Hoadley, J., Alker, J., Holmes, M., Schneider, A., & Whitener, K.
Medicaid expansion or through the creation of an alternative system, (2018, September 25). Health Insurance Coverage in Small Towns
we believe the legislature should hold a serious discourse on this topic and Rural America: The Role of Medicaid Expansion.
and consider expanding health coverage in the 2023 Legislative Session. https://ccf.georgetown.edu/2018/09/25/health-insurance-cover-
Medicaid Expansion Over one million Texans could possibly have their lives improved by age-in-small-towns-and-rural-america-the-role-of-medicaid-expan-
such a policy. Texas is one of the leaders in the nation when it comes to
sion/.
innovation and economic opportunity. We believe it is time for Texas
Medicaid expansion by ballot. Will Texas do the same? The Texas
to show that it is also a leader in taking care of the health and well-being 5. Evans, M. (2019, February 12). Voters in four states have approved
By Cameron Holguin and Ida Vaziri
of its citizens. We think the legislature should act in 2023 to possibly Tribune. https://www.texastribune.org/2019/02/12/texas-legisla-
expand health coverage for those who are uninsured. tors-filed-bills-put-medicaid-expansion-decision-ballot/.

When it comes to hot topics in both politics and medicine, nothing icaid could save Texas $110 million over the course of just two years. References: Cameron Holguin and Ida Vaziri are med-
turns more heads than the topic of Medicaid. One cannot simply bring Additionally, states that expanded Medicaid were shown to have fewer 1. Medicaid and CHIP Payment and Access Commission. (2021, June ical students at the UT Health San Antonio Long
up this topic without a debate ensuing. Yet, despite the complexity of closures of rural hospitals and higher patient volumes and quality of 30). Medicaid expansion to the new adult group. MACPAC. School of Medicine.
this topic and the discourse that comes with it, Medicaid expansion and care in rural hospitals that remained open. Texas has experienced the https://www.macpac.gov/subtopic/medicaid-expansion/.
the large uninsured population in this country are topics that health highest rate of rural hospital closure in the nation, with 15 hospital clo-
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care providers must address. Let's take a look at the complex and ongo- sures between 2010 and 2018.
ing story of Medicaid expansion here in Texas. Texas has opted to continue denying Medicaid expansion, although
The debate regarding Medicaid expansion began over a decade ago recent polls have shown that approximately 70% of Texans support it.
with the passage of the Affordable Care Act. As a part of that original Additionally, 59% of Texans feel that the state isn’t doing enough to
legislation, states were mandated to expand Medicaid eligibility to all help low-income individuals receive the health services and coverage
adults under the age of 65 whose incomes were lower than 133% of the that they need. A few bills to expand Medicaid have been proposed in
Federal Poverty Level. This provision was eventually made optional in the legislative sessions since Texas opted not to expand, but they have
2012 following the Supreme Court ruling in National Federation of In- not received the approval of some lawmakers. In 2019, Texas State Sen-
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dependent Business (NFIB) v. Sebelius. Following this ruling, over a ator Nathan Johnson proposed Senate Joint Resolution 34, proposing
dozen states, Texas included, opted to decline federal funds for Medi- an amendment to the state constitution to require the state to expand
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caid expansion once the policy went into effect on January 1, 2014. Medicaid eligibility per the ACA guidelines. This bill did not survive
Since then, 13 states have chosen to opt back into Medicaid expansion, to the 2019 Legislative Session.
with the most recent state being Oklahoma, which will implement its Lawmakers who oppose Medicaid expansion argue that the state
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expansion on July 1 of this year. Texas remains one of 12 states who could develop its own system to provide health coverage to the unin-
have yet to accept funding provided by the ACA. sured that is both cheaper and more efficient than Medicaid. Attempts
A 2020 report by Bush School Public Health estimated that $5.4 bil- to build this system have caused buzz in the legislature along with the
lion dollars are being left on the table by the Texas Government’s deci- direct expansion of Medicaid. The first attempt to develop this system
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sion to not expand Medicaid. Bexar County could have received over came in 2013. This by far would have been the most opportune time to
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$430 million if Texas had opted to expand Medicaid this year. It is es- create an alternative system, as it would have gone live just as the ma-
timated that these funds, along with the matching provided by the state, jority of the nation was expanding Medicaid through the ACA. This
would allow for nearly 1.3 million Texans (101,000 in Bexar County) attempt, however, failed and Texas became one of the 19 states to not
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to become eligible for Medicaid. Texas has the highest uninsured pop- expand health coverage. Another attempt to create an alternative system
ulation in the country, with 5.2 million Texans without insurance. This came in the most recent legislative session when lawmakers proposed
is over 18% of the population, more than double the national rate of SB 117 and HB 3871. These bills received bipartisan support and would
Contact BCMS today to join the 100% Membership Program! *100% member practice participation as of July 26, 2021.
uninsured individuals, which is 9%. It is estimated that expanding Med- have provided Texas with a unique way to expand Medicaid while pro-

32 SAN ANTONIO MEDICINE • August 2021 Visit us at www.bcms.org 33