McALLEN, RGV – On the eve of its annual summer conference, the Border Health Caucus has reaffirmed its support for the expansion of Medicaid.

“There is no question about our support for Medicaid expansion,” said Dr. Manuel Acosta, an El Paso physician who chairs the BHC.

“I know the state government does not want to expand Medicaid but we have so many people that need help. We really need to push for Medicaid expansion. We need the federal government’s help but for some reason the state government will not allow us to tap into all those federal dollars.”

Dr. Manuel Acosta
Dr. Manuel Acosta

Dr. Tom Garcia, president of the Texas Medical Association, said he agrees with Dr. Acosta. Like Acosta, Garcia will give opening remarks at the BHC conference.

“The dollars are already there to expand Medicaid. The state leadership refuses to allow those federal dollars to cross the Red River into Texas. Unfortunately, it all comes down to politics,” Garcia told the Rio Grande Guardian. “Those dollars are meant to help our doctors render care for the indigent and the question is who gets the credit for that. The minute you start having that conversation, of who gets the credit, that’s when the rub comes in and at the state level, they just don’t want to work with the federal government. It is different for physicians. Our principle concern is with our patients.”

The BHC summer conference is now in its tenth year. This year’s conference takes at the El Paso Natural Gas Conference Center on the University of Texas at El Paso campus on Thursday, August 6. It is only the second time the conference has been held outside of Washington, D.C. Two years ago it was held in Laredo.

Medicaid is the government health-coverage program for the poor. In Texas, Medicaid covers 4.1 million people, mostly poor, disabled and elderly. It costs roughly $30 billion per year. The federal government pays about 60 percent of this. Texas leads the nation in the rate of people without health insurance — roughly one in four Texans. Along the border the figure is roughly one in three.

State leaders in Texas, such as former Gov. Rick Perry and current Gov. Greg Abbott have resisted calls from the medical community to expand Medicaid. “Medicaid expansion is wrong for Texas,” Abbott said in a news release issued in April. He said the Affordable Care Act was “massive expansion of an already broken and bloated Medicaid program.”

Perry’s and then Abbott’s decision to leave additional Medicaid dollars on the table left a “coverage gap” of about one million Texans. This segment of the population earns too little to receive federal subsidies for private health insurance under the Affordable Care Act but too much to qualify for coverage under Texas’ current Medicaid requirements. It means an uninsured parent with two children earning $17,000 a year will receive no financial assistance for health coverage, while an uninsured parent with two children earning $20,000 a year will qualify for health coverage.

The decision to forgo Medicaid expansion prevents Texas from receiving an estimated $100 billion in federal cash over the next decade. Meanwhile, it is costing Texas hospitals $5.5 billion in annual costs for treating uninsured people.

According to an analysis by The Perryman Group, every $1 spent by the state of Texas to expand Medicaid coverage under the Affordable Care Act would return $1.29 in dynamic state government revenue over the first ten years of the expansion. Medicaid expenditures lead to substantial economic activity, federal funds inflow, reduction in costs for uncompensated care and insurance, and enhanced productivity from a healthier population, the Perryman Group study showed. When these outcomes and the related multiplier effects are considered, the program pays for itself and provides a notable economic stimulus, said economist Ray Perryman.

“Neither the Affordable Care Act nor the Medicaid program is perfect, and there are many opportunities to provide needed health services in a more efficient and cost effective manner,” Perryman said, when his group’s study was released. “But, if we don’t expand Medicaid coverage as envisioned under the Affordable Care Act, Texas loses an opportunity to enhance access to health care for about 1.5 million Texans and foregoes almost $90 billion in federal health care funds over the first 10 years.”

Dr. Garcia said he hopes this year’s BHC conference will send a strong message that border physicians are big supporters of Medicaid expansion. “We are going to try to influence the state leadership, please reconsider what we believe is the wrong decision, of not accepting those Medicaid dollars,” Garcia said.

Garcia said the BHC conference will be invaluable for doctors wishing to articulate the challenges of practicing medicine on the border.

“We have a huge population that is indigent and extremely poor. Our doctors are facing extreme challenges, caring for patients with declining reimbursement. Some of our doctors are getting so stressed out, economically stressed, that is creating huge challenges for them to continue to practice medicine. These kinds of meetings help us air out our problems. These conferences make a big difference,” Garcia said.

Garcia paid tribute to the leaders of the BHC, physicians like Acosta, Luis Benavides of Laredo, Linda Villarreal of Edinburg, and Carlos Cardenas of McAllen.

Dr. Luis Benavides
Dr. Luis Benavides

“These are great leaders on the border who are addressing the extreme challenge of rendering care to our indigent. Those same problems are in the poorer areas of our metroplex areas, such as south and southeast Houston. The issues raised at the border conference will resonate in the big cities,” Garcia said.

Garcia also thanked media outlets for publicizing the work of border physicians. “Sometimes it is not verbalized to the public the caring and hardworking doctors we have and how they are trying to address the healthcare needs of border residents. Good folks like you are getting the story out,” Garcia told the Rio Grande Guardian.

Dr. Acosta said he hopes the BHC conference will lead to more border physicians get involved in the politics of medicine. “It is very frustrating to see our doctors relying on the words of politicians. We have issues people do not see elsewhere. We need to tell the politicians of our problems,” Acosta said.

Acosta added: “I am very proud of everyone who has worked on this conference. We have a very strong line up of speakers. The conference is important because we feel totally neglected on the border. We are like a lost child. We have to communicate with the powers that be in Austin and Washington and remind them that the border region is part of the United States. We need to help the millions of people that live on the border. Diabetes is rampant. We used to have members of Congress and U.S. senators come and tour our area so they could see the reality. We need this to happen again. We need to make an imprint on their minds. We have the feeling they do not know we exist. We have to keep pushing.”

Editor’s Note: Dr. Tom Garcia, president of the Texas Medical Association, is pictured in the main image accompanying this story.

Editor’s Note: Click here to see the full agenda for the Border Health Caucus’ 10th Annual Border Health Conference.