Texas Expanding Medicaid Coverage With Help From Republican Lawmakers

April 25, 2023
Jeramy Kitchen
88th Legislative Session, Dade Phelan, Medicaid Expansion

The state of Texas is one of only 10 states that have not expanded Medicaid after the passage of Obamacare. That is a good thing. Medicaid expansion is costly and does not provide timely access to quality care.

If you are someone who is new to the Texas legislative process or Texas politics, you might be under the impression that there is no way Texas would support expanding a government welfare program like Medicaid. Well, you might be half right.

There is the expansion in the Obamacare sense, which Texas has fortunately not done so far, and then there is the expansion in the sense of growing the pool of Texans who qualify for Medicaid coverage and lengthening the time they can benefit from the program.

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 expanding Medicaid.

These Democrats and liberal Republicans have then gradually advanced such policies through the Legislature but ultimately stopped short of the broader expansion within the legislative process.

Long a plank in their platform, the Republican Party of Texas explicitly opposes Medicaid expansion:

  1. 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.
  2. 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.

Why, then, do many Republican lawmakers continue to support efforts to expand Medicaid?

The Ongoing 88th Legislative Session

With the ongoing 88th Legislative Session in full swing, it appears that this session is no different when it comes to lawmakers, especially in the Texas House of Representatives, promoting and voting in favor of legislation expanding the pool of Texans who qualify to receive Medicaid benefits.

House Bill 12

Recently, the Texas House of Representatives passed legislation that extended Medicaid coverage to pregnant women for an additional 10 months after their pregnancy. On the surface, that might sound harmless, but in reality, it is projected to cost Texas taxpayers at least $147 million over the next biennium and at least $150 million every biennium thereafter, while expanding caseload and no promise of higher-quality care. Even those estimations are disingenuous at best. The legislation will be paid for out of general revenue or by Texas taxpayers. There is no federal match, as the program needs a waiver from the U.S. Health and Human Services. It is not the 60/40 match like under the current Medicaid program, and it will not be subject to the match at all because it takes the form of a waiver. The real cost would be almost $367.5 million through the upcoming biennium and at least $400 million every biennium thereafter.

The legislation, authored by Democrat State Rep. Toni Rose (Dallas) and a legislative priority of Republican House Speaker Dade Phelan, passed by a vote of 132-8. In fact, prior to its passage, House Bill 12 boasted 65 total authors.

Potentially Incentivizing Abortion

Some critics of the legislation highlight the additional potential, if implemented, for it to incentivize abortions. The legislation explicitly says the full 12 months of Medicaid coverage would “begin on the last day of the woman’s pregnancy.” It does not suggest that the woman has to carry the pregnancy to term. In fact, it appears as though a woman could have an abortion, a miscarriage, or other complications and still be eligible. This is counter to the GOP platform and the recent Dobbs decision by the Supreme Court of the United States.

Though HB 12 may be well intended, the results will not be consistent with the GOP platform or what is best for Texans. Instead, there should be efforts to help get people off of Medicaid and other welfare programs with a more prosperous economy and opportunities for people to connect in a flourishing civil society. If Texas expands Medicaid, this will send the message that Texas is willing to choose to put people on welfare instead of giving Texans paths to care for themselves and their children. 

Upcoming Efforts

On Wednesday, the Texas House is scheduled to consider even more legislation that would expand coverage under Medicaid services. 

House Bill 2727, authored by Republican State Rep. Four Price (Amarillo), would provide for telemonitoring services to be provided under Medicaid for certain high-risk pregnancies and other medical conditions. It is estimated to cost Texas taxpayers almost $13.4 million over the next two years and nearly $13.4 million every year thereafter. It currently has a bipartisan list of supporters.

Democrat State Rep. Ann Johnson (Houston) has authored House Bill 2638, which seeks to provide for Medicaid reimbursement services that are qualified as MST (multisystemic therapy) and requires the Texas Health and Human Services Commission (HHSC) to establish a separate provider type for MST providers. Johnson also authored House Bill 2404, which seeks to provide for Medicaid reimbursement for functional family therapy for delinquent youth who are at risk for involvement with the child welfare, criminal justice, or juvenile justice systems. Both of these bills would result in a negative fiscal impact on Texas taxpayers. Republican State Reps. Four Price (Amarillo) and J.M. Lozano (Kingsville) are joint authors on both bills.

Lastly, Republican State Rep. Tom Oliverson (Cypress) authored House Bill 2983, which seeks to create a pilot program for medical nutrition programs in coordination with community-based organizations and medical providers to provide services to women who are pregnant or in the postpartum period. Oliverson is also the vice chairman of the Texas House Republican Caucus.

All of these pieces of legislation expand who qualifies and benefits from Medicaid in Texas. Instead of expanding Medicaid services, the Texas Legislature should be focused on creating an environment where Texans are not driven to these social safety nets.

What is Next?

It is likely the aforementioned legislation will be voted out of the Texas House of Representatives, especially since much of it is prioritized by House Speaker Dade Phelan.

Concerned taxpayers may contact their lawmakers here.