Texas Medicaid Expansion

Over 2.4 million Texas residents had the Original Medicare insurance by 2015 while more than 675,000 had acquired Medigap insurance by 2014. The number has now increased over the years with Plan F gaining more popularity over the other plans. The Texas Department of Insurance standardizes the insurance plans, but the private companies are responsible for selling the insurance covers to the residents. This means that the insurance benefits across all plans sold by the companies in Texas are similar. However, TDI only regulates the plans meaning that the premiums vary from one company to another.

In support of Medicaid expansion in Texas, over 50 chambers of commerce across Texas have expressed strong interest in the expansion (8). Similarly, Texas Medical Association and Texas Hospital Association have also expressed their support (9). Laura Guerra-Cardus, Associate Director of the Children's Defense Fund, states "diverse groups from all across Texas support accepting federal funds to insure more Texans through Medicaid" (8). Finally, Texas Democratic officials also iterate their support by acknowledging that Texas stands alone with the highest percentage of uninsured people in the nation (10).

The federal part of Medicaid is known as the federal medical assistance percentage (FMAP) (Hegar). The FMAP annually reviews comparison of average state and U.S. per capita income. This means in Texas the federal government pays 60 percent of every dollar spent on Medicaid services (Hegar).

The Affordable Care Act (ACA) was signed into law by President Barack Obama on March 23, 2010, and on June 28, 2012 the Supreme Court decided to uphold the law.¹ Some of the most notable features that the ACA will provide for individuals are access to healthcare for everyone, new consumer protections such as pre-existing condition coverage, free preventative care, protection against healthcare fraud, small business tax credits, as well as many other features.¹

The following analysis will explore the current health insurance problem under the ACA. It will discuss the proposed policy of Medicaid Expansion and the impact of States not cooperating with the implementation of such provision. Moreover, a recommendation on strategies to alleviate the health

The Medicaid program is jointly funded by the federal government and each individual state. To offset costs for struggling state budgets, the federal government will fully finance new enrollees in 2014, gradually reducing its contribution over time (Sederstrom, 2012). The federal government pays each state for a particular percentage of program expenditures. These expenditures are call the Federal Medical Assistance Percentage (FMAP). Per capita income, from each state, is one of the criteria that FMAP is based on. FMAP can range from 50%-75% based on the per capita incomes. Every 3 years, FMAPs are adjusted for each state to account for variations in the economy. Each state must ensure that they can fund their share of Medicaid expenses for the services and care available under their state plan. Generally, each state pays for services through managed care arrangements or fee-for-service arrangements. Each state can establish their own Medicaid provider payment rates, as long as they are within federal requirements. Under the managed care arrangements, each state has a contract with organizations to deliver care through networks and pay providers. Providers are paid on a monthly payment rate. Under a fee-for-service arrangement, each state pays providers directly for services. Payment rates may be based on the cost of providing the services, a percentage of what Medicare pays for services, and/or an assessment of what commercial

Texas, which currently has a large uninsured population and limited Medicaid eligibility, forfeits billions of dollars from the federal government every year by not expanding its Medicaid program as implemented in the Affordable Care Act. In contrast, Medicaid expansion could benefit the state exponentially and give its citizens the fullest potential of what this country offers. A substantial amount of federal funding that could increase uninsured coverage, improve healthcare costs, and provide economic stimulus is left on the table. Additionally, the nation benefits when each state participates, contributing to the success of the healthcare reform.

Throughout the early 1980’s and 1990’s the Federal Medicaid program was challenged by rapidly rising Medicaid program costs and an increasing number of uninsured population. One of the primary reasons for the overall increase in healthcare costs is the

The Patient Protection and Affordable Care Act., a health reform, known as the “Obamacare” was signed into law by formal President Barack Obama on March 23, 2010.

The potential opportunity for the state to opt into the Medicaid expansion is the fact that low-income citizens will be insured. The decision of the state to opt into the Medicaid expansion will also impact the state’s budget, and this is the main challenge (Frakt, 2013). The government will cover majority of all the cost even as Medicaid expansion provides coverage for the low-income uninsured citizens. Expansion of the Medicaid is also a broken system that has poor outcomes, not severe federal strings, high inflation and no incentive for the personal responsibility of the citizens who

In Texas, the uninsured rate dropped from 37 percent to 27 percent due to many adults meeting the low poverty criteria to become insured. The adults that were eligible for the Medicaid program were adults who were eligible for a tax credit to buy the coverage on the federal health insurance programs. Texas decision not to expand Medicaid also made it hard for low income families to receive health care and pay for health medications. According to the study and observations of other states who have expanded Medicaid, it is proven that many low-income adults have less trouble paying for and obtaining health care while on the Medicaid program. In states with the Medicaid program in full effect compared to Texas where there is no expansion on Medicaid, many Americans are struggling with household responsibilities and finances due to having to pay for the private insurance and receive the health care that is needed for their condition.

President Obama signed the Affordable Care Act (ACA) into law on March 23rd of 2010, with hopes of helping make sure every American have access to quality and affordable health care. Having health care coverage is really a big deal, whether you are a parent with private insurance, a senior with Medicare or a single woman with a pre-existing condition, the Affordable Care Act (ACA) can save you money and help you get better coverage.

Medicaid initially established that each state is responsible for designing their medical costs to pay medical care for the poor. Also, Medicaid created as a voluntary program for each state; they have to have the choice to participate. For one thing, because of the rising costs of healthcare, it has been difficult to bring Medicaid recipients into the “mainstream” of United States (U.S.) medical care. Donald R. Barr notes, “between 1975 and 1989, the cost of the Medicaid program increased by an average of 11.9 percent per year before adjusting for inflation” (172). The rising costs of healthcare are necessary for each state to determine if it is beneficial for them to participate in the Medicaid program. As the government level of payment is determined by each state economic condition. For instance, a state with lower per capita income will receive more government funding. A state with higher per capita income receives less reimbursement for program costs. Therefore, on December 31, 2010, many states continued to experience budget cuts. As a result on August 2010, Congress increased reimbursement rates through June 2011.

The amount of money the state is leaving on the table over the next decade due to the lack of expansion is $5.3 billion. Medicaid is available for pregnant women with incomes 139% of FPL, children with incomes up to 200% of FPL, and parents with incomes up to 51% of

Ironically, Texas has the highest number of uninsured citizens in the nation, 6.2 million to be exact. The majority of these citizens are children. According to Goodwyn (2013), “by Texas refusing to participate in the Medicaid expansion, which is part of the ACA, the state will leave on the table an estimated 100 billion dollars over the next decade. It is sad to know many citizens in this state will be denied health care by those who already have the best insurance and will never have to worry about being uninsured. In addition, the Texas politicians fail to recognize the need for health care for neither its most vulnerable citizens nor the burden on the Emergency room as well as the rise in healthcare premiums for citizens who maintain health insurance. Landers (2013) reports, “whether they have a good income or a lower one, Texas lag behind much of the nation in access to and quality health care.” States who fail to expand Medicaid will see their funds distributed to states on board with expanding Medicaid.