Political blame game over Healthcare for uninsured Texans


The political blame game promptly started last week following the Biden administration’s decision to rescind the so-called 1115 waiver from Medicaid expansion.

In simple terms, the waiver allows the state to spend on providing healthcare to the uninsured through its own programs, instead of expanding the federally-mandated Medicaid.

In other words, Democrats want to expand coverage for the uninsured as dictated by the Federal government and Republicans do not support a likely welfare program that would be inefficient and wasteful.

Instead, Texas would compensate the hospitals for providing care to the uninsured in emergency rooms and support rural health clinics.

Thus it is a matter of style over substance.

The Medicaid waiver provides funds to hospitals to offset their costs for treating uninsured patients.

Medicaid expansion provides health insurance so that patients have a means to pay their doctors, hospitals, and pharmacies.

Uncompensated emergency care funds would still be needed for hospitals even with Medicaid expansion in Texas.

Even if Texas expands Medicaid as desired by the Federal government, it won’t provide insurance for all the uninsured and a sizeable section will remain uninsured, meaning mere Medicaid expansion won’t cure the problem of uninsured Texans.

The following statements from Texas leaders should be read in this context.

Texas Comptroller Glenn Hegar issued a statement following the Biden administration’s decision to rescind Texas’ 1115 waiver extension.

The extension was granted by the previous administration and was set to run through 2030.

The initial waiver was approved by the Obama administration in 2011 and was renewed again in December 2017.

The extension provided an important economic foundation and the fiscal certainty needed by Texas to properly plan for its post-pandemic recovery.

“The state of Texas negotiated in good faith to secure this waiver, believing that the federal government would honor its commitments to the people of Texas,” Hegar said.

“At a time when the entire nation is trying to pull itself out of the worst economic crisis since the Great Depression, the Biden administration is recklessly working to undermine our fragile recovery by holding hostage the critical funding Texas needs to support its rural hospitals, nursing homes, mental health and other crucial care facilities.

“It is particularly irresponsible for President Biden to take this action while his administration continues to fail to meet its responsibilities along our southern border. Uncompensated care is a major contributor to the costs of Medicaid that this waiver helped to mitigate, and rescinding it now is particularly malicious given the costs rural hospitals face in providing that type of care.”

The Texas Democratic Party said:

“Republicans Block One Million Texans From Getting Health Insurance”

During Budget Day, after briefly indicating they would be supporting Democrats’ efforts to help Texans get health care, Republicans returned to their classic stance of “we’d rather let uninsured Texans die,” blocking budget amendments meant to expand Medicaid to nearly one million currently uninsured Texans.

Medicaid expansion is not only common decency, it’s common sense. Texas leads the nation in the number of uninsured residents. Democrats have fought for years to get Texas to expand Medicaid eligibility and help the most vulnerable Texans get access to health care.

By unlocking billions of federal dollars to help with health care costs, the change would be a boon for the state’s economy -- helping to keep premiums down for everyone, keep rural hospitals open, address racial injustice in the health care system, and keep families across the state healthy.

Republicans’ longtime refusal to extend health care to Texans who need it is pure political posturing -- an obstinate unwillingness to share the benefits of the Obama-Biden administration’s flagship achievement.

Because of Republican posturing, the state has said no to at least $9 billion in federal funds to help insure more Texans. Nearly one million Texans who could have been eligible under Medicaid expansion are instead left without health insurance.

Texas Democratic Party Chair Gilberto Hinojosa issued the following statement:

“Health care is a human right. But Texas Republicans continue to block people from getting the care they need -- even though expanding Medicaid would bring in billions of federal dollars to our state’s economy.”

Governor Greg Abbott issued a statement: “This extension, which was scheduled to run through 2030, would have provided critical healthcare funding, including funds for uncompensated care.

“By rescinding this waiver extension, the Biden administration is obstructing healthcare access for vulnerable Texans and taking away crucial resources for rural hospitals in Texas,” said Governor Abbott.

“The State of Texas spent months negotiating this agreement with the federal government to ensure vital funds for hospitals, nursing homes, and mental health resources for Texans who are uninsured. With this action, the Biden administration is deliberately betraying Texans who depend on the resources made possible through this waiver.”

This means the Legislature will need to figure out how to spend more state funds on Medicaid to keep providers afloat. This is where things get even more difficult, according to experts.

As DJ Wilson, writes in Stateofreform.com, “Generally speaking, the easiest way to make up a big shortfall is for Texas to cover all of the costs to uphold these new benefits. However, that is the most expensive option. And, for a state like Texas that has consistently relied upon federal dollars to offset state investment, that’s an unlikely scenario.”

That leaves one other option — have the feds pay for almost all of the shortfall in uncompensated care the way 38 other states do: expand the Medicaid program to draw down over 90% of the cost from the feds.

That is not politically palatable among Republican legislators, either.

But those are the three primary options on the table:

Let the safety net collapse

Fund shortfalls with primarily state-only funds

Fund shortfalls with primarily federal-only funds (ie: expand Medicaid)

There are 47 days left in the Texas legislative session.