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SAN JUAN, Texas – Methodist Healthcare Ministries of South Texas has made Medicaid Expansion one of its top legislative agenda items.

Christine Yanas, MHM’s vice president of policy and advocacy, spoke about the issue during a webinar hosted by the Rio Grande Valley Health Working Group.

“We are going to do what we can for Medicaid Expansion,” Yanas said. 

Texas has more uninsured people than any other state. It is one of 12 states that has not expanded Medicaid under the Affordable Care Act. Texas lawmakers blocked the expansion envisaged under ACA. 

The ACA provided a 90-10 match, with the federal government paying 90 percent of the cost. As a result, Texas tax dollars are now going to other states. If Texas were to expand Medicaid, the state would recoup $6 billion of its tax dollars every year. 

Christine Yanas

According to an opinion poll conducted by the Kaiser Family Foundation, nearly two-two-thirds of Texans want Medicaid Expansion. 

Because COVID-19 has caused unemployment to rise, leaving more people without health insurance, calls for Medicaid to be expanded in Texas have grown louder.

“It is getting a lot of different momentum. Everybody is talking about it in different ways,” Yanas said. “Certainly our conservative lawmakers have their own idea on what expansion looks like.”

Yanas said that at last count there were 26 bills filed this legislative session dealing with Medicaid Expansion in some way.

Yanas said MHM is waiting to see which legislators take the lead on expanding Medicaid during the current session. She said in the Senate that looks like state Sen. Nathan Johnson, D-Dallas.

“So, we are working with him and anyone else who is going to be advancing this,” Yanas said. 

“We are also partnering with all the coalitions that are coming together, the hospitals, local mental health authorities, the rural hospitals, the community health plans, the managed care plans.”

Yanas said MHM is currently working out how to put together a legislative package that will gain widespread support. “And that is complex because you also have to make sure that providers do get reimbursed and they are taken care of as well.”

Yanas said she is aware of legislation about to be filed by state Rep. Lyle Larson, R-San Antonio, that would expand Medicaid through a block grant. “We just need to see how leadership, especially in the Senate, what they are going to be looking at. 

Yanas said MHM will be working with the Texas Tribune to amplify its message.

“We figured that MHM really needed to get its voice out there. This is what we should be doing. We need to amplify the discussion. So, we talked to Evan Smith at the Texas Tribune and said, we really want to get this started in January. Well, it is February now,” Yanas said. 

“We need to make sure that folks at least start talking about some of the options. We have a new administration in D.C. What does that mean as well?”

Yanas said MHM will be hosting a one-hour conversation with the Texas Tribune about Medicaid Expansion. “So, February 16, on Tuesday at 8 o’clock in the morning for an hour, we are bringing in Evan Smith to narrate, to moderate.”

Yanas said the panel for the Texas Tribune discussion would include economist Ray Perryman who, she said, has just put out a study on the economic impact of Medicaid Expansion. Also on the panel would be Sen. Johnson. She said he is “the Senate leader on expansion.”

MHM is also hoping that Texas 2036 is part of the MHM-Texas Tribune panel.

“Have you all heard of a group called Texas 2036 that was started by Tom Luce recently?” Yanas asked the RGV Health Working Group.

“This group has really been putting out a lot of information on big issues like broadband and education and, surprising to me, I didn’t think they were going to but now healthcare. So, they are rolling it out and yesterday they had their press release. If you Google them you will find what they put out.”

Yanas said Texas 2036 has done a forecast model on what expanding Medicaid might mean.

“Charles Miller and a lot of experts have come together and have put together a model of what would it look like with four or five different components of what we know. Different waivers, different groups that would be covered. They have an online software program that they created to tell you exactly how much it would cost, who would be covered, what the State would have to pay, how many federal dollars would come in.”

Yanas said she got a quick glimpse of the forecast model.

“It is getting a lot of press and recognition so we wanted to see if Charles Miller who sort of built it, would come and speak with us. So we have got him invited and hopefully we will hear back. We will be sending out invites to you all. You are all on our distribution list. So, you will definitely get invitations to come in and see this with the Trib, the Texas Tribune.”

Anne Dunkelberg

Also on the RGV Health Working Group webinar was Anne Dunkelberg, who oversees health policy for the nonprofit Every Texan. 

Dunkelberg highlighted information put out by the Kaiser Family Foundation.

“It shows Texas has the worst adult coverage of any Medicaid program and by a long shot. We are the worse even among the states that haven’t expanded,” Dunkelberg said.

“Every state is supposed to offer Medicaid to adults up to 138 percent of poverty. It still says that. All the Supreme Court said was, you can’t be penalized fiscally for not doing that. And unfortunately the law still says those subsidies start at the poverty line. So, if you are below poverty and you are a U.S. citizen you are not going to get them.”

Dunkelberg said Kaiser also looked at who was hit hardest by Texas not expanding Medicaid.

“It has the racial and ethnic breakout. It shows Texans of color are disproportionately affected. Of the percentage of folks that are in that uninsured group who could get Medicaid Expansion, the black percentage is pretty close to the actual percentage of black Texans. Maybe a little bit higher. But the Hispanic percentage is way higher than the incidence of Hispanics in the Texas population.”

Dunkelberg pointed to a map showing which regions are hit hardest.

“It shows the disproportionate affect. Almost all of the Rio Grande Valley and along the Texas-Mexico border being disproportionately affected.” 

Dunkelberg added that Texas would get 90 cents on the dollar if it expanded Medicaid. She said that for the standing Medicaid group Texas gets 62 cents on the dollar. “So, it is an extremely fiscal good deal for Texas,” Dunkelberg said.


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