Will legislators prescribe Medicaid expansion for Texas this year?

101,100 uninsured Bexar County residents could become eligible under expanded Medicaid

Local and state leader eye Medicaid expansion this legislative session

SAN ANTONIO – As a gig worker relying on the odd contract job, health insurance isn’t something Robert Laurence can rely on through work or anything he can afford on his own.

“The marketplace is usually like just so expensive, you know? And so I really —I feel like it’s almost a waste of my time,” the San Antonio man told KSAT.

Instead, Laurence’s version of health insurance amounts to drinking tea and taking tablets to boost his immune system in the hope that he’ll stay healthy. If he does, that’s a trip to the doctor that’s coming out of his pocket only.

“There’s really nothing else I can do in a lot of ways. It just seems like no matter what I do, you know, I’m never even able to break even,” he said.

His story isn’t unique. Texas has millions of uninsured residents, many of whom might at least be covered under Medicaid in other states. Now during a pandemic that has cost many people their jobs and possibly their healthcare or means to pay it, the issue is getting renewed focus.

Medicaid expansion was introduced in the 2010 Affordable Care Act and allows states to opt into expanded eligibility guidelines at a higher cost-sharing rate with the federal government than traditional Medicaid —with the federal government paying 90% to the state government’s 10%, instead of about 62%.

Anne Dunkelberg, the associate director for the policy institute “Every Texan,” says that, in its current form, Texas Medicaid mainly covers children.

“We cover seniors over 65 if they’re in poverty, and we cover people who are —adults who are fully disabled. But other than that, we cover almost no adults,” Dunkelberg said.

Medicaid is also available for Texas parents, but only if they earn less than a few hundred dollars a month.

A recent study by an associate professor and a student from the Bush School of Government and Public Service at Texas A&M University and funded by the Episcopal Health Foundation, estimated that 1.3 million Texans —most of whom are currently uninsured —would become eligible for Medicaid if the state adopted the expanded eligibility.

The study, which used pre-COVID-19 data, estimated there would be 101,100 residents in Bexar County alone who would find themselves eligible for Medicaid. The study authors estimated 76,000 of them would actually enroll in it.

With the pandemic squeezing the already limited budgets of many households, both the San Antonio City Council and Bexar County Commissioners Court have made expanded Medicaid part of their legislative priorities for the session in Austin.

“I think there is finally some momentum here in our state to expand Medicaid,” Mayor Ron Nirenberg told KSAT, “and there is not a better indication as to why than seeing the suffering in our state during this pandemic.”

As part of former President Barack Obama’s signature healthcare law, though, Medicaid expansion has been a partisan issue at the Republican-controlled state capitol. Texas remains one of 12 states that have not adopted the expanded eligibility criteria.

However, some think this could be the year that changes.

A separate study funded by the Episcopal Health Foundation, found that if the state spent $650 million on expanded Medicaid for 1 million new enrollees, it would still save $708 million through other health programs, current Medicaid groups, and extra tax revenue on insurance premiums.

With factors like those possible savings and the general strain on Texans caused by the COVID-19 pandemic, Dunkelberg thinks this could be the best shot Medicaid expansion has at passing since 2010.

“I do feel very comfortable saying that the level of interest in it is far higher than it’s ever been, that we’re hearing a lot more Republican members talk about it, about the need to consider it. I think a lot of them are persuaded by the fact that the state budget could actually save money,” Dunkelberg said.

Nirenberg was cautiously optimistic, too.

“If you’re asking me to forecast the Texas legislature, I don’t think there is a wizard or sorcerer in history that could do that,” Nirenberg said. What I will say is that if we are with level heads, looking logically at our situation in the state of Texas and the damage that this pandemic has done to our economy, it should be the top priority of everyone who is interested in saving the Texas economy or protecting the health of our communities to expand Medicaid. If we can’t do it in the wake of a pandemic, then we need new leadership.”

RELATED: Low-income Texans struggle to find new doctors as state officials boot Planned Parenthood off Medicaid:

About the Authors:

Garrett Brnger is a reporter with KSAT 12.

Luis Cienfuegos is a photographer at KSAT 12.