As the Texas House takes up the roughly $250 billion state budget on Thursday, Democrats will propose an amendment to expand Medicaid coverage under the Affordable Care Act — and they could have the votes for it to pass.
State leaders are facing heightened pressure to expand coverage through the joint state-federal program to more low-income Texans after the federal government this month rescinded approval for a waiver that delivers billions of dollars to a safety net program for uninsured Texans.
A bipartisan group of legislators urged their colleagues to consider bills that would expand Medicaid in a joint statement on Monday, the same day that 188 organizations and local governments from across the state submitted a letter to state leaders calling for the same.
“Texans cannot wait,” the letter reads. “Many continue to reel from the ongoing health, economic, and social impacts of the COVID-19 pandemic. Extending coverage to them will clearly demonstrate Texas’ commitment to economic freedom and security.”
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Currently, Medicaid eligibility in Texas is limited to pregnant women, children, the medically needy and people over 65. Parents can also qualify for coverage if their monthly income is $200 or less for a family or two, or $300 or less for a family of four.
Under Medicaid expansion, eligibility would broaden to include adults who earn up to 138% of the federal poverty level — roughly $1,500 per month for individuals, or $3,000 a month for a family of four.
Advocates say expansion would dramatically reduce the number of uninsured residents and deliver billions of dollars to the state through federal incentives.
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Lawmakers have filed 245 amendments ahead of Thursday’s budget debate in the House; included among them is language to expand Medicaid coverage.
Rep. Garnet Coleman, D-Houston, filed an amendment that would call for the “maximization of federal funds under Medicaid” and direct the state to broaden eligibility requirements for the state’s program to the maximum extent allowed under federal law (which is adults who earn up to 138% of the federal poverty level).
Given resistance to expand Medicaid coverage from the state’s Republican leaders, past bills to broaden eligibility have stalled, but lawmakers have made similar attempts to amend the state budget.
In 2019, a budget amendment to expand Medicaid was defeated 80-66 along party lines.
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But this year, there is bipartisan support for expansion in the House — enough that an amendment could be successful.
Nine Republicans and all 67 Democrats in the chamber have signed onto House Bill 3871 as co-authors, publicly expressing support for the Medicaid expansion plan. With 76 lawmakers on board, the bill would have enough support to pass through the 150-member chamber.
The Republican lawmakers are: Lyle Larson of San Antonio, Steve Allison of San Antonio, Kyle Kacal of College Station, Dan Huberty of Houston, Ernest Bailes of Shepherd, Travis Clardy of Nacogdoches, Stan Lambert of Abilene, John Raney of College Station and Phil Stephenson of Wharton.
Billions on the table
Texas is one of 12 states that has not expanded Medicaid.
Some holdout states with Republican leadership have opted to expand coverage through legislative action or ballot measures approved by voters in recent years, including Arkansas, Indiana, Ohio and Missouri.
Instead of expansion, Texas has used a federal funding agreement to secure federal dollars to help hospitals cover the cost of caring for uninsured people: the 1115 Medicaid waiver.
Supporters of Medicaid expansion have criticized state leaders for pursuing extensions of the waiver instead of considering expansion, as the waiver does not include the health care coverage that is available to people under Medicaid.
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The Trump administration in January extended the state's waiver for the next decade, but the Biden administration rescinded that approval last week and said Texas cut corners on its application and must re-submit its request after allowing for a public comment period.
“We need to have a serious conversation about a solution for coverage expansion,” said Patrick Bresette, executive director of the Children’s Defense Fund in Texas. “Lawmakers in the building are connecting the dots on this and trying to see it as an opportunity to have a serious conversation about a coverage solution.”
Should Texas opt to expand Medicaid instead of pursuing an extension of its 1115 waiver, it would be responsible for paying 10 cents on the dollar, or anywhere between $600 to $700 million a year.
The federal government would match the state’s investment and contribute close to $6 billion a year, according to Anne Dunkelberg, associate director of EveryTexan, previously the Center for Public Policy Priorities.
But Texas could benefit from a temporary expansion to the federal match rate under incentives included in the American Rescue Plan Act passed by Congress earlier this year.
Under the law, states that have yet to expand Medicaid would be eligible for a 5 percentage point increase in the traditional match rate for two years if they opt to expand coverage.
In Texas, that translates to roughly $3.5 million, according to Dunkelberg.
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This article originally appeared on Austin American-Statesman: Texas House eying a Thursday vote on Medicaid expansion; supporters say they have enough votes
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