Gov. Rick Perry says Texas won’t expand Medicaid, but that hasn’t stopped health care advocates and some lawmakers from continuing to argue that expanding coverage to low-income adults would save the state money.
“Due largely to Texas’ high rate of uninsured individuals, local governments and the private sector must spend billions to provide uncoordinated and often inefficient health care services for specific populations,” wrote Billy Hamilton, the state's former deputy comptroller and former chief revenue estimator, in a report commissioned by Methodist Healthcare Ministries of South Texas and Texas Impact, a statewide interfaith network. “Extending Medicaid coverage to low-income adults would eliminate many of these costs, leaving cities, counties, hospital districts and hospitals with additional resources to meet other pressing needs.”
Using numbers from Hamilton's report, this map shows annual local spending on indigent health care, unreimbursed health care costs and charity spending by county in comparison to the federal dollars Texas would receive to expand Medicaid. Hover over the counties for specific details.
For an investment of $15 billion in the federally-mandated Medicaid expansion, Hamilton's report indicates, Texas could draw down $100 billion in federal funds and expand health care coverage to 2 million low-income Texans over 10 years. By 2016, the federal government would cover 100 percent of health care costs for Medicaid expansion enrollees at an estimated cost of $7.6 billion, Hamilton says, while the state would pay part of the administrative costs, an estimated $293 million.
The state’s health commissioner, Dr. Kyle Janek, offered lower estimates of federal funding for a Medicaid expansion — $78.9 billion over 10 years — at a Senate Finance Committee hearing on Wednesday. Janek's estimate only included additional federal funding for adults covered by the expansion, while Hamilton's estimate of $100 billion also included additional federal funding for children covered by the expansion.
“I see good and I see bad that can come of it, not necessarily bad, but problematic,” Janek said, after he was asked his personal opinion on whether Texas should expand Medicaid. He explained that the additional federal funding is like a coupon, and Texas will still be required to pay a lot of money, which may affect the state’s spending in other areas.
Hamilton’s report states that unreimbursed health care costs — paid by local taxes, mostly collected by public hospital districts — totaled $2.5 billion in 2011, while counties spent an additional $258 million on indigent care and unreimbursed jail health care costs. Public and private hospitals also spent $1.8 million on charity care in 2010, the most recent data, according to the report.
“If politics are set aside, the right decision is obvious,” wrote Hamilton.
Many of the Legislature's Republicans do not agree. “While some will couch the decision not to expand Medicaid as political, such an expansion is not good public policy,” said Sen. Bob Deuell, R-Greensville, in a statement responding to Hamilton’s report. He said expanding Medicaid could harm the private insurance market by encouraging poor adults with employer-covered insurance to switch to Medicaid.
Although Deuell said he did not dispute Hamilton's numbers, he questioned the report’s “conclusions of the positive benefits regarding savings, increased tax revenue, effects on the economy and job creation.”
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Comments (7)
Christine Carey via Texas Tribune on Facebook
I can't get it working, but does this take into account all of the children diagnosed with autism and autism-related disorders since 1990? There are Medicaid disability waivers that are critical to those families, and I imagine a lot of them are clustered in the cities.
Autism rate is skyrocketing. If you have never met a child with autism, I encourage you to do so. If you never spent significant time with a child with autism, just imagine.... The divorce rate is around 90% in autism families. Single parents with primary custody many times cannot work a regular full-time job (the kind with benefits like health insurance) due to their child's needs. Who is going to care for these kids when mom is gone?
The last time I checked, you cannot have more than $2K in assets to get Medicaid as an adult. That means these parents would need to be homeless and car-less to have access to basic healthcare.
Cynthia Casper Robertson via Texas Tribune on Facebook
Predicated upon this issue alone, it just gobsmacks me as to why Texans keep re-electing Rick Perry. He obviously is a student of Bush's fuzzy math.
Christine Carey via Texas Tribune on Facebook
You pay now, or you pay later, folks. Your friend, the independent.
Michelle James
So Sen. Deuell doesn't want to expand Medicaid because it could harm the private insurance market??? I think the insurance industry is doing fine and their loss ratios would probably improve if poor adults moved onto Medicaid because typically, lower income workers aren't as healthy. I guess we know who is paying him and Perry.
Brian Ortego via Texas Tribune on Facebook
Something is fuzzy about these unreimbursed healthcare cost projections. If accurate, it doesn't matter if Medicaid is expanded or not, both state and federal budgets will be overwhelmed beyond capability, and unable to provide any other service beside indigent healthcare. We'll all be indigent...
S S
This interactive feature is really excellent!
Jeff Funkhouser
Maybe I'm missing something here ...
"For an investment of $15 billion in the federally-mandated Medicaid expansion, Hamilton's report indicates, Texas could draw down $100 billion in federal funds and expand health care coverage to 2 million low-income Texans over 10 years. By 2016, the federal government would cover 100 percent of health care costs for Medicaid expansion enrollees at an estimated cost of $7.6 billion, Hamilton says, while the state would pay part of the administrative costs, an estimated $293 million."
That says to me that the State government will make a payment of $15B over 10 years (none over the first three years) and receive Federal tax $$ totaling almost $100B. In the meantime city/county/charity savings estimates for this past year alone would have totaled $1.2B (expenditure amount of $3.6B reduced to $2.4B).
In the next 3 years local taxing authorities would save expenditures approaching $4B (assuming medical inflation of 10%). The state would spend NOTHING in the first three years. The Feds send approx $25B our way?!? That's a $30B NET GAIN in the near term!!! Even in the out years as the state must kick in 10% of the cost of the additional insured, the savings to local authorities would at least equal that amount. It's ONLY A WIN!! How do you fold a hand that you've WON when you KNOW you've got the other person beat?? There's nothing to be gained by mucking here other than some political hay for Gubner Goodhair and cronies.
This is the line that I love:
"Although Deuell said he did not dispute Hamilton's numbers, he questioned the reports 'conclusions of the positive benefits regarding savings, increased tax revenue, effects on the economy and job creation.' "
So, Rep Duell thinks that savings, increased tax revenue, economic effects, and job creation are not necessarily positive benefits?!?
WTF have the Repubs been bloviating about for a decade now other than ALL OF THOSE THINGS!?! Oh, right, it's resulting from Federal policy initiated by Obama and passed by Dems ... that's the problem!