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Texas Refused To Expand Medicaid Coverage To More Poor Adults. Groups Ask Congress To Do It Instead.

A health care canvasser holds some pamphlets in her arm.
Julia Reihs
A group of health care advocates knock on doors on Nov. 9, 2019, in an effort to rally support to demand lawmakers address the high rate of uninsured people in Texas.

Hundreds of organizations from mostly southern parts of the United States are pleading with Congress to expand Medicaid in the 12 states that have refused to do so. Among those states is Texas, which has the highest uninsured rate in the country.

In a recent letter, roughly 400 organizations urged U.S. senators to prioritize closing the Medicaid coverage gap as they finalize a federal budget. The coverage gap refers to the people who make too much money to qualify for Medicaid but too little to quality for the Affordable Care Act’s individual marketplace.

“Closing the coverage gap would mean that over two million uninsured Americans — most of them Black, Latino, Indigenous, and Asian, all of whom live below the poverty line — could finally get health coverage,” groups wrote.

In Texas, people of color — mostly Latinos — have been drastically more likely to be uninsured. So have their children.

Laura Guerra-Cardus, the deputy director of Children’s Defense Fund-Texas, told KUT that closing the Medicaid gap is “the most significant single thing” lawmakers can do to create more equity and address the structural racism within our health care system.

“This about correcting a system that has allowed some bad actors — predominately in southern former slave-holding states — to continue to deny access to health care to people of color,” she said.

Former U.S. Housing and Urban Development Secretary Julian Castro said in a statement that Texas lawmakers have been “exploiting the Medicaid gap to deny people basic health care.”

“With the highest uninsured rate in the country, our state has blocked millions of low-income, working class, and disabled Texans from accessing coverage, and Texas is just the tip of the iceberg," he said. "Now more than ever, we need Congress to step up, close the coverage gap, and ensure every single American can get quality health care."

For years, health care access advocates have been pleading with Texas lawmakers to address the state’s uninsured rate. Advocates and health care organizations were hoping ahead of this year’s legislative session that the pandemic would inspire Republican leaders in Texas to tackle the issue.

However, Medicaid expansion bills — some of which had bipartisan support in the legislature — did not even get a committee hearing.

As Medicaid expansion efforts have completely stalled in states like Texas, Congress has been looking for ways to expand access in a way that doesn’t require action from the states.

This policy effort would extend coverage benefits to people in the coverage gap through the Affordable Care Act for a few years and then switch them over to a new Medicaid program created for this population. This is a plan that has support from Democratic leadership in the U.S. House, which includes U.S. Rep. Lloyd Doggett of Austin.

“As the Health Subcommittee Chairman, my focus is on the health care progress in this strong legislation,” Doggett said in a statement earlier this month. “Because Governors Perry and Abbott were so opposed to taking 100% initial federal funding to ensure Medicaid expansion in Texas, two million of our neighbors have been left behind — uninsured, and in the ‘coverage gap.’”

According to The New York Times, though, there is tension among Democrats about whether expanding coverage to states like Texas should be a priority.

Guerra-Cardus said she hopes federal lawmakers eventually understand the urgency and importance of making sure people of color are not left behind in the country’s healthcare system.

She said she’s worried the current negotiations over the budget reconciliation bill could be one of the few shots Congress has to finally address this issue.

“We do think this is the moment,” Guerra-Cardus told KUT. “We are worried we could be looking at another decade of over a million Texans… not having access to this basic human right.”

Ashley Lopez covers politics and health care. Got a tip? Email her at Follow her on Twitter @AshLopezRadio.
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