Interactive: Which Health Care Costs Could be Offset by a Medicaid Expansion?

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.

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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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