A Realistic Positive Vision for Medicaid in Texas

This commentary originally appeared in the Austin American-Statesman.

ADunkelberg_webTexas could bring home $7 billion annually in federal dollars and cover more than a million uninsured U.S. adults today. Instead, Texans are stuck in the health care “coverage gap” — lacking the uninsured’s access to health insurance because they earn too much to qualify for Medicaid but earn too little to get federal financial assistance in the health insurance marketplace. Texas has already lost more than $9.3 billion in federal funds that could be providing health care to low-income Texans right now, with billions more on the line.

Texas is among 19 states currently refusing to expand Medicaid or to seek a coverage expansion alternative. Several conservative states have expanded health care coverage while adding features like premiums and wellness incentives for adults. The overwhelming budgetary benefits — and unprecedented opportunity to expand Medicaid under flexible parameters — are why “red states” like Arizona, Indiana, and Montana have expanded coverage. Texas is missing the boat.

Opponents of expanding health coverage to those in the coverage gap offer no plans to cover Texas’ uninsured U.S. adults, while proposing changes to the Medicaid program that target vulnerable populations and would violate federal Medicaid rules. Some ideas include moving most Texas children and pregnant women out of the commercial Medicaid Managed Care health plans (HMOs) they are enrolled in today and into managed care plans in the Affordable Care Act Marketplace. This would negatively affect about 3 million children and around 140,000 expectant mothers in any given month.

Some have compared Texas’ Medicaid costs to Marketplace premiums, and suggest that Texas could spend less on care for children and pregnant women. The proposed spending reduction would come largely from imposing new out-of-pocket costs on Texans once they transitioned to Marketplace health plans. Premiums and co-pays for maternity patients or children are not allowed under federal Medicaid, because research shows low-income consumers will go without care if they can’t afford the new charges.

The same proposal would move parents receiving Temporary Assistance for Needy Families (TANF) cash assistance off Medicaid and into the Marketplace, but this does nothing to close the coverage gap. In August, less than 9,300 Texas parents received TANF with Medicaid, and only 140,000 other parents got Medicaid alone. Texas’ astonishingly low income limits for parents in Medicaid — $247 per month for a parent with two children — are why Texas Medicaid covers nearly 3 million children but fewer than one in 20 of their parents. Most other parents of Medicaid kids are in the coverage gap. Texas needs a plan to close the gap because our kids do better when their parents can access health care.

Texas could actually save money on Medicaid for pregnant women by providing coverage for low-income women in the coverage gap. Today, Medicaid pays to deliver more than half of Texas babies, costing the state 42 cents on the dollar, and new mothers lose their coverage two months after the baby is born. But, if we provide real coverage to women, Texas’ share for their health care will drop to just 10 cents on the dollar — even less, if we do it before 2020.

Federal and state Medicaid maternity spending in Texas exceeds $1 billion each year, but enrolling women in the new coverage would save several hundred million annually. We could help women be as healthy as possible before they get pregnant, begin prenatal care earlier once they are pregnant, and have access to birth control, so they can space their children to ensure the healthiest babies.

Those who believe Texas should eliminate Medicaid or CHIP are counting on you to ignore the facts. “Red states” are making coverage expansion work – in terms of health care and for their budgets. Arkansas and New Mexico have closed their coverage gaps, and all four candidates – Republicans and Democrats – for Louisiana governor support Medicaid expansion. It’s time for Texans to demand a real plan from our elected leaders to close the gap.

Dunkelberg is associate director of the Center for Public Policy Priorities in Austin. Follow her at @adunkCPPP.

 

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