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An alternate route to Medicaid expansion

I’m okay with this.

Texas Democrats have tried for years to convince Republican state leaders to increase access to Medicaid. Now they think they have found a way to do it with or without their help.

U.S. Rep. Lloyd Doggett and lawmakers from 11 other GOP-led states introduced a measure this week that would give money directly to local governments that want to provide coverage for hundreds of thousands of low-income Texans who currently fall into what is known as the “coverage gap.”

The Cover Outstanding Vulnerable Expansion-eligible Residents (COVER) Now Act would allow counties to apply for the money directly with the federal government, and it would prohibit state leaders from retaliating against them if they do.

Doggett said his aim is to avoid conflict with Republicans.

“You have your ideological objections to Medicaid expansion — I don’t agree, but I accept your position,” he said. “At least let those local leaders who want to take advantage of this and who recognize both the health and economic advantages of doing it, at least let them do that, and walk away and see how it works.”

[…]

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

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

More than two million people are thought to be in the coverage gap today, meaning they make 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 biggest group is in Texas, a state that has long had the highest uninsured rate in the country.

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

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

I don’t know if the reconciliation process that Rep. Doggett envisions for this would be part of the infrastructure package or as a later budget bill, but either way there will be opportunities. I think the odds of it avoiding conflict with Republicans is basically zero, so the more important consideration is how well-defended it will be from Republican attempts to screw with it or obstruct it. We have seen too many examples in recent times of the state having control over federal money intended for local governments that have resulted in all kinds of bad outcomes, from the delays in appropriating COVID relief to the GLO’s screw job against Houston and Harris County. Cut the state completely out of it, and then hope it’s too difficult for a future Republican Congress or President to mess with it.

Assuming this does go through, I would expect quite a few more counties than those three cited would jump at this. Travis, El Paso, Fort Bend, Cameron, Webb, some other South Texas counties, probably Hays, would certainly take advantage. Nueces, Tarrant, and Williamson would be interesting to watch, and I bet this would add some spice to county races in Collin and Denton and maybe Brazoria. It’s possible that some Republican counties, especially ones with hospitals teetering on the brink of financial disaster, might decide to put aside politics and grab the money, as several Republican states have done. I could definitely see this making a huge dent in the uninsured population, and providing some fodder for the 2022 elections as well. It’s mostly a question of how durable it is, and that’s something that Rep. Doggett can work on. Here’s hoping.

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