The Texas Health and Human Services Commission recently negotiated a 15-month extension of a Medicaid waiver that will finally allow Texans to enjoy a benefit of the federal taxes they pay.

Michele Rountree
Michele Rountree

The extension will supply more than $4 billion for health care coverage for uninsured Texans. Texas taxpayers have already contributed to Medicaid expansion in other states through federal taxes — now Texas should have its turn and expand Medicaid.

Medicaid expansion under the Affordable Care Act is funded 100 percent by the federal government. These dollars would provide health care to the estimated 5 million uninsured Texans. This is especially an important concern because the U.S. Census Bureau reports the state has the largest number of uninsured Americans in the country.

Many Texans are facing a new reality. They are fully employed yet still unable to afford health insurance. Even with the government-subsidized health insurance offered under the Affordable Care Act, a large population falls into the “coverage gap.” Their salaries are too high for traditional, unexpanded Medicaid, yet they can’t afford private insurance.

It is a reasonable assumption that having health care insurance has significant effects on chronic disease identification and management. When Texans can’t afford insurance and are not eligible for ACA subsidies, their best option for health care is from hospitals, community-based providers such as clinics and health centers and office-based physicians. Without Medicaid reimbursements, it is inevitable that these health care providers will end up with unrecoverable debt.

Who pays the debt? Because Texas has refused Medicaid funds beyond the 15-month extension period, the state’s businesses and its residents absorb these costs in the form of property taxes and higher insurance premiums. Texas ranks third in the nation for the highest property taxes and second for the highest paid insurance premiums.

The reality is the money Texas gets from the 15-month Medicaid waiver comes from the taxes Texans have been paying to the federal government already. If Texas declines to participate, Texas residents will lose a benefit of their federal taxes, and will still have to pay that unrecoverable debt.

The financial strain of health care costs will only worsen if Texas refuses to participate. Our elected lawmakers might look to our neighbors to the north for advice. Oklahoma’s governor and state legislators are considering Medicaid expansion to prevent cutting doctor reimbursements by 25 percent and to otherwise address the rising costs of health care. After 2020, the federal government will cover 90 percent of the Medicaid allocation, and states will have to cover the remaining 10 percent. Oklahoma lawmakers are consider a $1.50-per-pack tax on cigarettes to pay the 10 percent.

The cost to Texans to refuse $6 billion annually until 2020 to extend Medicaid go beyond covering that bill. The economic and social costs of this decision are dire.


Michele A. Rountree is an associate professor of social work at The University of Texas at Austin. Tonia Wu is a public health and pre-med student in the College of Natural Sciences at The University of Texas at Austin. This opinion piece was published on the Dallas Morning News, June 1, 2016. It represents the views of the author, not of The University of Texas at Austin or the Steve Hicks School of Social Work.