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New Data Reveals Impact of Medicaid Expansion in Texas

August 30, 2012

HOUSTON - Gov. Perry has said he'll oppose expanded Medicaid in Texas, but the next legislature will also have a say. Meanwhile, a growing chorus of social service advocates, health care providers and local officials are making it clear: They want to tap the billions of new federal dollars that would enable more low-income Texans to get health coverage under the Affordable Care Act.

Physician Laura Guerra-Cardus, associate director of the Children's Defense Fund of Texas, says accepting the money would go a long way toward improving the state's worst-in-the-nation uninsured rate - largely by increasing coverage among low-income 19- to 64-year-olds.

"There are 3.6 million in that group, and 2 million of them are uninsured. That's 57 percent. That's the very group we are potentially denying affordable health care coverage."

The figures are based on data released Wednesday by the U.S. Census Bureau, which has posted an online tool for tracking county-by-county coverage. Under the new health care legislation, adults who earn below 138 percent of the federal poverty level would be covered by expanded Medicaid. State health officials have estimated that Texas would cut its uninsured rate in half - from 24 percent to 12 percent - if the state embraces the plan.

Opponents argue that the federal aid comes with too many federal strings, and that state contribution levels might rise in the future. However, some of the largest Texas counties are exploring alternative ways to participate in the Medicaid expansion, even though it is not yet clear if the federal government would approve of local plans without state buy-in.

Guerra-Cardus says it's the counties that most bear the burden of the costs associated with the uninsured.

"They are being passed on to all taxpayers through hidden taxes on health insurance premiums and higher hospital district taxes."

A recent study published in the New England Journal of Medicine shows a significant decline in the adult death rate in states that have already expanded Medicaid on their own. Guerra-Cardus thinks that's the kind of statistic that will eventually lead states like Texas to reverse their opposition. She points out that the current Medicaid program, which is also optional, was eventually embraced by every state.

"There is good reason to hope that, in time, every state will adopt the new options. And the deal we're getting for this expanded Medicaid for adults is far better than the deal we got with original Medicaid."

States now pick up about 40 percent of their Medicaid expenses. The federal government would pay 100 percent of the expansion for the first three years, after which states would have to contribute up to 10 percent. The expansion was a key component of the Affordable Care Act, but the Supreme Court ruled that states had the right to reject it.

U.S. Census coverage estimates are at The NEJM study is available at

Peter Malof, Public News Service - TX