Since the Senate failed to repeal the Affordable Care Act, attention has focused on stabilizing the individual insurance market. Rightly so, because premiums are rising, many areas have too few insurers, and President Donald Trump threatened to cut subsidies. With fall enrollment approaching, there’s a need to act.
But health care problems are evident elsewhere, too, and some of the blame goes beyond Washington. Austin, we’re talking about you.
Texas is one of 19 states where lawmakers chose to not expand Medicaid, a key plank of the Affordable Care Act. Every year, the consequences are clearer as expansion states reap more health gains. That’s one reason the Affordable Care Act has survived a GOP Congress.
More than 1 million Texans stand to gain coverage under Medicaid expansion, and the federal government would cover at least 90 percent of the costs. Critics like to say that’s taxpayer money, which is true enough. What’s more relevant is whether it comes back to Texas or goes elsewhere.
What are we giving up?
A recent study by Harvard researchers compared Texas with Arkansas and Kentucky, two southern states that expanded Medicaid. Prior to the ACA, all had roughly the same share of low-income adults without insurance.
Arkansas and Kentucky cut that rate by more than 25 percentage points, more than twice the reduction in Texas, the study estimated. As a result, a much higher share of those residents had a personal doctor, annual checkups and regular treatment for chronic conditions. Many fewer went to the emergency room, skipped medication or reported trouble paying medical bills.
In Arkansas and Kentucky, states with Republican governors and GOP-controlled legislatures like Texas, there was a 23-percentage point increase in people reporting “excellent” health. These states also reduced consumer out-of-pocket spending by $337 a year.
According to another study, hospitals in expansion states cut uncompensated care by 40 percent. In contrast, three of our largest hospital systems had sharp increases. In 2016, bad debt and charity care topped a combined $1 billion for Baylor Scott & White, Texas Health Resources and Methodist Health.
These numbers point to opportunity. Health care changes are coming in Washington and Republicans want states to shape the future. With that political cover, leaders in Austin should revisit Medicaid expansion and make it their own.
In Arkansas, Medicaid money buys insurance on the exchange, a so-called private option that stokes competition. Indiana residents can be locked out of Medicaid for six months if they fail to pay premiums. Michigan requires co-pays and offers discounts for healthy behaviors.
In March, federal officials urged governors to propose Medicaid reforms. Their letter mentioned incentives to reduce emergency room visits and encourage health savings accounts.
In sum, the door is wide open to improve health care — with no political excuses this time.
It’s bad policy to leave billions of federal dollars on the table, and it’s even worse to let some of our neediest go without.
Austin, are you listening?
What’s your view?
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