Since the passage of the Affordable Care Act, Gov. Greg Abbott and the Texas Legislature have rejected Medicaid expansion even though Texas has the highest rate of uninsured residents in the nation. With the spread of COVID-19 and the threat of health care systems being overwhelmed by this pandemic, the governor should call a special session of the Legislature to expand Medicaid.
Medicaid expansion has been an overwhelmingly successful program. It has increased insurance coverage, expanded access to health care services and reduced costs. Medicaid expansion would cost Texas approximately $5.6 billion, but in return, Texas would receive $65.6 billion in federal funding and save $34.3 billion from reduced emergency room or hospital visits from the uninsured. Medicaid expansion is necessary for diminishing the devastating impact that COVID-19 will have on Texas population health.
COVID-19 has proved to be more deadly than the flu, with a death rate of approximately 1%, and more resource-intensive than the flu, with twice the length of hospital stay required for severe cases. There is also a serious concern about medical equipment shortages, from surgical masks to ventilators, because we are all dependent on the same supply chain globally.
It has also overwhelmed health care systems across the world. Some have used this as an argument against moving toward universal health care in America. But this argument does not consider how many Americans are at risk of losing their employer-based health insurance due to rising unemployment. Federal officials are predicting unemployment could hit an all-time high of 30%, and 3.3 million Americans have already filed for unemployment. While it may not be feasible to pass Medicare For All anytime soon, Medicaid expansion is something that state legislators could enact right now to expand access to the 1.6 million Texans who are uninsured.
In addition to practicing social distancing, it is imperative that as many Americans as possible are able to get tested. Although the Families First Coronavirus Response Act has guaranteed that testing will be free regardless of insurance status, there are no standardized eligibility criteria or payment procedures. Furthermore, this bill provides limited funding for people who are uninsured and does not cover treatment for COVID-19.
Currently, the cost of COVID treatment for someone who is uninsured is more than $34,000. This will lead Americans who are symptomatic to either skip testing or delay getting medical care until their symptoms have seriously progressed.
Medicaid in Texas is currently available only to children, pregnant women, people with disabilities, and people over age 65 who are at or below 75% of the Federal Poverty Level. With Medicaid expansion, Texas has the ability to expand these benefits to anyone at or below 133% of the Federal Poverty Level. Not only would this ensure that more than 1.6 million Texans have access to health care, it would also eliminate the current Medicaid gap that exists for people who are ineligible for ACA coverage due to limited income.
Health care is not a partisan issue. More than half of Texans reported difficulty affording health care, and almost 40% struggle to pay their medical bills. According to a 2018 poll conducted by the Kaiser Family Foundation and Episcopal Health Foundation, 60% of Texans support Medicaid expansion and 55% of Texans support Medicare for all.
The Kaiser Family Foundation also compiled a thorough policy brief on the benefits of expanding Medicaid in response to COVID-19. These benefits include providing comprehensive coverage for those who are most vulnerable, little to no out-of-pocket costs, and no cap on the services that can be provided to enrollees. This funding is critical at a time of increased need.
The COVID-19 pandemic underscores the need for Texas to expand Medicaid now. Ensuring that everyone has access to affordable testing and timely health care is essential to controlling the spread of COVID-19.
Considering that Texas consistently ranks at the bottom of health outcomes such as health care accessibility, and a majority of Texans support Medicaid expansion, it should be strongly considered. Medicaid will not only help address the long-term health and economic effects of COVID-19, it will also improve Texans’ health for the future. Texas legislators should listen.
Liana Petruzzi is a doctoral student at the Steve Hicks School of Social Work at The University of Texas at Austin.