Democrat State Rep. Bobby Guerra (Mission), who “boasts” a career rating of an F on the Fiscal Responsibility Index and scored a dismal 17 out of 100 in the most recent legislative session, recently took to the Rio Grande Guardian to opine about why he believes “expanding Medicaid is wise fiscal policy.”
Notably, this comes at a time in which Texans are reeling from historic inflation and a bleak economic outlook due to things like runaway spending on both the federal and state levels, among other fiscal insanities.
In the column, Guerra uses an interim charge issued by Republican House Speaker Dade Phelan and an upcoming hearing of the newly created Select Committee on Health Care Reform as his reasoning to discuss the topic.
Guerra, who also serves as the current vice chairman of the House Public Health Committee, has long been a supporter of expanding Medicaid in Texas, having filed his own unsuccessful legislation to do just that in several different ways since first being elected.
Saving Texas Money?
In the column, Guerra alleges, “If Texas expanded Medicaid, the federal government would pay 90% of the cost, reducing Texans’ responsibility to just 10%. Expanding coverage for adults between the ages of 19-64 with incomes below 138% of the poverty level (a family of four that makes at or below $38,295 per year) is not only wise fiscal policy, but it is also a moral imperative.”
According to David Balat, the director of the Right on Healthcare Initiative at the Texas Public Policy Foundation, other states that have expanded Medicaid, like New York and California, have had to address budget shortfalls that resulted from expanding the program and enrollment exploding. Even states controlled by Republicans, like Ohio and Indiana, saw Medicaid expansion cause exponential increases in state spending, eating “into the budgets for other important priorities, such as public safety, schools, and roads.”
Balat goes on to say, “Largely as a result of expansion, Medicaid spending is now 50 percent higher than education spending nationwide, and 30 states spend more than a quarter of their budgets on Medicaid.” He notes that “if Texas were to expand Medicaid, state spending would increase by nearly $1.3 billion every single year. Another 2.8 million able-bodied adult Texans would be added to welfare. Texas hospitals would see roughly $720 million in new Medicaid shortfalls, the equivalent of nearly 12,000 lost hospital jobs.”
In April of 2020, Balat and Dr. Brian Blase produced a report that indicated “the bulk of evidence suggests targeted health programs, including those geared towards children, prove to be far better public investments than does a massive Medicaid expansion.”
Expanding Medicaid hardly seems like a “wise fiscal policy,” as Guerra suggests.
It should be noted that state spending is already increasing at an alarming rate, albeit as of recent legislative sessions it has grown more conservatively. Texas’ state spending is on track to grow 300% over the last two decades, even though the state’s population has only grown by 40% in that same period.
Moreover, in the next legislative session, set to begin in January of 2023, Texas lawmakers will also be faced with a historic budget surplus (i.e. they over-collected taxpayer money). It is absolutely within the realm of possibility that some lawmakers will be motivated to use some of this surplus to put Texas on a path to Medicaid expansion.
Efforts in the 87th Legislative Session
Democrats wanting to expand Medicaid in Texas is nothing new; an effort is made every legislative session to make this a reality.
Remarkably, in the most recent legislative session, several Republican House lawmakers signed on as joint authors of legislation that would do just that, despite their own party’s platform explicitly calling for no further expansion.
Legislation authored by Democrat State Rep. Julie Johnson (Carrollton) garnered enough support from a bipartisan group of lawmakers to put the Texas House of Representatives on the precipice of its passage, having 76 (a majority) total authors. Nine Republican lawmakers counted themselves among that list, which caused the author of several pre-filed budget amendments, Democrat State Rep. Garnet Coleman (Houston), to hold a press conference announcing his intent to offer an amendment to the state budget, which was being deliberated at the time, to expand Medicaid in Texas.
The vote on the budget amendment ultimately failed, with only 68 House lawmakers voting in favor. Though other Republican lawmakers originally signed on as supporters of Johnson’s legislation, only one—State Rep. Lyle Larson (San Antonio)—ultimately voted for the amendment.
The other Republican House lawmakers who signed on as supporters of Medicaid expansion in Texas were Steve Allison (San Antonio), Kyle Kacal (College Station), Dan Huberty (Humble), Ernest Bailes (Shepherd), Travis Clardy (Nacogdoches), Stan Lambert (Abilene), Phil Stephenson (Wharton), and John Raney (Bryan).
Perhaps unsurprisingly, they are all lawmakers who score near the bottom of their entire caucus on the Fiscal Responsibility Index, with scores ranging from 28 to 43 out of a possible 100.
Larson and Huberty chose not to seek re-election, and Stephenson lost his most recent party’s primary election. None of them will be returning for the 88th legislative session.
After efforts in the regular legislative session failed, a bipartisan group of lawmakers sent a letter to Texas Governor Greg Abbott in June of 2021, imploring him to add the topic of Medicaid expansion to the impending special legislative session agenda. A total of 56 House lawmakers signed the letter, including Guerra and Larson, one of the Republicans who supported the expansion in the regular legislative session.
The subject was never added to any of the three subsequent special legislative sessions’ agendas.
Republicans in Texas
Though Republicans have held the majority in the state Legislature for nearly two decades, they have also empowered—and often even aided—Democrats to promote policies such as Medicaid expansion.
These Democrats and liberal Republicans have then gradually advanced such policies through the Legislature but ultimately stop the broader expansion within the legislative process.
Long a plank in their platform, the Republican Party of Texas explicitly opposes the expansion of Medicaid in Texas:
Texas HSA: We recommend the creation of the State of Texas Health Savings Account, with funds in excess of those needed in the Rainy Day Fund, for the purpose of enabling the state to develop reserves sufficient to exit the federal Medicaid program, which will not expire nor be utilized for any other purpose.
Medicaid Reform: We support Medicaid block grants to the states and returning Medicaid to its original purpose to be a temporary assistance program. We oppose any further expansion of Medicaid.
A Brief and Consolidated Recent History
Shortly after the passage of the 2010 “Affordable Care Act” (ACA), which included provisions calling for every state to expand Medicaid, the U.S. Supreme Court ruled in NFIB v. Sebelius that states could not be subject to penalty for opting out of its expansion. This led Texas to decide to instead maintain the previously existing Medicaid rules.
In 2013, the Texas Legislature passed legislation requiring the Texas Health and Human Services Commission (HHSC) to first receive approval from the Legislature before deciding to expand Medicaid.
This prompted a series of “Texas Solutions” in the form of legislation every session to address the numbers of uninsured Texans in the states. Thus far, none have made it through the entirety of the legislative process.
What Does it All Mean?
While Americans—and more bluntly, Texans—are being forced to be guarded about their own spending due to record-high inflation and exploding spending habits at both the state and federal government levels, it is more apparent than ever that concerned citizens should implore their lawmakers to do the same.
Seeking to expand programs like Medicaid in Texas has never proven to be a fiscally responsible idea, nor would it be wise in the midst of the current economic turmoil. In a matter of months, the 88th legislative session will convene, and lawmakers will be faced with the decision of what to do with the historic budget surplus. It is important that taxpayers demand they return that money to them as opposed to letting lawmakers spend those surplus dollars on their pet projects.
Texans for Fiscal Responsibility (TFR) has long held that Texas does not have a revenue problem, it has a spending problem. To help address many of the economic challenges facing the state, TFR recently released the “Texas Prosperity Plan.”
Go read the Texas Prosperity Plan for yourself and voice your support for banning taxpayer-funded lobbying, eliminating the property tax, and freezing state spending by signing up to support the TPP. While you are there, sign up for The Fiscal Note to stay up to date on all fiscal issues that affect Texans, especially our broken property tax system. We CAN put Texas on a path to fiscal sanity and future prosperity if we amplify our voices loudly enough.