|RAYMONDVILLE, August 20 - State Rep. Ryan Guillen believes the “biggest negative” about this year’s legislative sessions was Texas’ failure to expand Medicaid to help more adults get health insurance coverage.
“There are over six million people in Texas who do not have insurance. Half of those six million people would be covered under the Affordable Care Act, would be been covered under Medicaid,” Guillen said, in a speech at the Raymondville Community Economic Summit on Saturday.
“Texas is not going to accept it (expanded Medicaid) and so three million Texans will not have access to healthcare, will not have Medicaid, many of which are here in the Valley.”
An additional 50,509 people in Hidalgo County would have been covered if Medicaid had been expanded this year, according to analysis from Michael E. Cline and Steve H. Murdock of Rice University. Another 27,987 would have been covered in Cameron County and another 16,031 in Webb County. The Cline/Murdock analysis is based upon Health and Human Services Commission data.
Guillen, D-Rio Grande City, made his comments while giving a power point presentation on the highlights and lowlights of 83rd legislative session that wrapped up in May and the three special sessions that followed. He told those at the Raymondville summit that it would not have been right to focus only the positive things that happened in Austin.
“I wanted to make sure we did not just put up the positive things (on the power point). We wanted to let you know about the negative things as well,” Guillen said. He said the “non-expansion of Medicaid” was the “biggest negative” of the legislative session though also mentioned cuts in health care provider rates.
Guillen went on to say that expanding Medicaid would have been very attractive to the State of Texas financially.
“In first few years it does not cost the state anything. In the out years it costs a dollar to get nine dollars. It costs the state a dollar to get nine dollars. That is another big negative thing that will impact the economy. It is certainly something the vast majority of the states are taking advantage of simply by just accepting it and Texas is one that is not going to accept it,” Guillen said.
“In fact, we are going to have a situation where folks that make more money than those that would otherwise qualify for Medicaid would qualify for some kind of tax incentive to buy healthcare over people who make less money and don’t get anything, because Texas is not accepting it.”
Anne Dunkelberg, associate director of the Center for Public Policy Priorities, told the Guardian on Monday that Guillen is right to say some Texas families will be able to get insurance under the Affordable Care Act while those earning less will go without. She said this has happened because Texas chose not to expand Medicaid.
“It is completely accurate and tragic,” Dunkelberg said. “We have a situation where if I am at 105 percent of poverty in January I can apply for and qualify for sliding scale-help with my premiums and out of pocket costs thanks to the Affordable Care Act. But, if I am 95 percent of poverty there will not be anything for me because Texas hasn’t expanded Medicaid.”
Dunkelberg then provided an example. “Let us take a family of four earning say exactly $23,000 a year - that would put them just below the poverty line. The good news is the kids could get Medicaid coverage, but the parents would not qualify for anything because we did not do the Medicaid Expansion. However, if that same family were living on, say, $25,000, the parents could get sliding scale-help in the Health Insurance Exchange under the Affordable Care Act. It is a surprisingly generous help with the premium and the out of pocket costs.”
Dunkelberg said Guillen was also right to say Texas is missing out financially. The new Medicaid dollars would have brought in $404.7 million in the first year for Hidalgo County, $198.4 million for Cameron County and $92.0 million for Webb County, according to the Cline/Murdock analysis.
“It was a terrible negative for Texas because the 100 percent federal match that is available, our own Health and Human Services Commission has estimated, would bring more than $6 billion every year for the next four years in new federal healthcare funding to Texas. That 100 percent match is only available in calendar years 2014, 2015, and 2016. It is not three years from when Texas gets its act together. That money is just gone. We have not optimized things for the people who need healthcare and nor have we optimized things fiscally for Texas,” Dunkelberg said.
“However, the coverage for the expansion group is always a much better deal for the state than the current Medicaid program. For the basic Medicaid program that we have today for children, pregnant women, seniors and people with disabilities, basically, we are paying about 39 cents out of every dollar. The feds pay about 61 cents.
“Under this expanded Medicaid program, Texas will never have to pay more than ten cents on the dollar for this new adult group. So it is always a good deal, we are just losing the benefit of it being 100 percent federally funded by dragging our feet and leaving these people without coverage.”
Asked to sum up what the non-expansion of Medicaid means for South Texas, Dunkelberg said: “South Texas has some astonishingly high uninsured rates and the good news is that there will be some new options for lots of uninsured folks in South Texas with the opening of the Health Insurance Market Place. But it is a huge loss on a humanitarian and a fiscal basis for South Texas not to have the Medicaid Expansion because there so many working families with incomes below the poverty line there. Those dollars could be flowing through your economy and creating tens of thousands of healthcare jobs.”