It was with a mixture of disdain and gratitude that I read in this newspaper David Balat’s April 24 op-ed, in which he purports to beat the badly concussed Medicaid expansion horse a little closer to death with another round of … the same old arguments. Why gratitude? We’re back in the news!
It’s been a little over two years since I wrote an op-ed for this newspaper aiming to present, in an objective non-partisan way, the enormous benefits of Medicaid expansion for Texas: healthier people living better and more dignified lives, vast economic growth and job creation, and net revenue growth for state and local budgets (without new taxes). Theories and myths about the perils of Medicaid expansion, I explained, had long since been disproven and dispelled by empirical data from the 36 (now 38) states that had already expanded Medicaid.
Eight months later, on the eve of the 87th Legislative Session, I announced at a press conference the filing of my politically conservative Medicaid expansion waiver bill, SB 117. How the Legislature would handle the question of Medicaid expansion would be, I said, either “a bipartisan success, or a partisan failure.” Alas, it was decidedly the latter.
Under pressure from its GOP leadership and the sad inertia of a lack of understanding, the Texas Legislature again refused to expand Medicaid. We’ve lost another two years of revenue and health and job creation. Even worse, we rejected a $4 billion bonus incentive from the federal government to do what we should be doing anyway. Yes, $4 billion that would have flowed to Texas from Washington.
That same ideological inertia continues to drive resistance to the proven success of Medicaid expansion under the Affordable Care Act. That it persists despite mountains of empirical findings and analyses by esteemed economists and institutions, including several here in Texas, calls for closer scrutiny. And a broom.
The basic opposition argument asserts that Medicaid doesn’t work and therefore we shouldn’t expand it. Further, opponents say, better health care access models serve the same purpose. None of this is true.
Take, for example, the 662,000 Texans who, though eligible for Medicaid under our existing state law, supposedly “choose” not to enroll. Around 550,000 of them are children. They didn’t choose to not enroll.
So why aren’t they enrolled? Many of them were automatically disenrolled by a policy purportedly intended to combat fraud and abuse. In practice the policy proved useless, costly, and damaging. Fortunately the Legislature terminated it last session. Meanwhile the Trump administration, and Texas for all practical purposes, eliminated outreach to low-income families. Many families simply don’t know what to do. Or perhaps they’re dissuaded by all the false information out there.
In his Op-Ed, Balat also asserted that “most Medicaid patients” get their care in emergency rooms. The opposite is true. In fact, since 2011 Texas’ Medicaid program has dramatically decreased the incidence of unnecessary ER visits and improved access to basic primary care.
Next, while Medicaid expansion could insure close to a million people, it would not overwhelm the health system. Texas health plans, which currently cover more than 20 million people, have accommodated enrollment swings of even larger magnitude with no problem. State law requires network adequacy, and health plans have historically been quite successful at meeting network adequacy standards.
Expansion opponents and Medicaid detractors attribute to Medicaid problems that are endemic to our health care system. As anyone who has sought health care in the U.S. can attest, problems with wait times to see a physician and patient frustration with a confusing system are not unique to Medicaid.
Yes, the state Medicaid program, and our overall health care infrastructure, need to be improved. So here we have an opportunity: other states have used their Medicaid expansion programs to improve their existing Medicaid programs, in the process introducing elements that have both ideological appeal and genuine functionality. We should, too.
The fact is, the Texas Medicaid program — run by the state, not the federal government — is working. Recent studies from sources like the Kaiser Family Foundation show increased access to care (including increases in the number of physicians accepting Medicaid), improved health outcomes, reductions in preventable hospitalizations, higher patient satisfaction, and overall cost growth significantly below that of private health insurance.
Meanwhile alternative models of access to health care, like unregulated quasi-insurance products and so-called “direct primary care,” can’t serve as alternatives to Medicaid expansion. The expansion population, the majority of whom live in working households but are, by definition, living in poverty, can’t afford to buy them. Though perhaps useful to lower- and middle-income healthy populations in some contexts for some purposes, these other models simply don’t cover what health insurance covers, and they can’t replace Medicaid or Medicaid expansion. (Their overall usefulness in the health care space remains subject to debate.) As confirmed most recently by the rigorous, unbiased analysis by Dallas-based policy group Texas 2036, nothing comes close to Medicaid expansion.
That opponents continue to proffer the same misleading numbers, false statements and dubious and ultimately irrelevant alternatives, should tell us something. It’s time to sweep aside ideologically motivated and factually bereft arguments, and forge a bipartisan Medicaid expansion plan for Texas.
Nathan Johnson is a member of the Texas Senate. He wrote this for The Dallas Morning News.
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