Democrats still holding out hope for Medicaid expansion, even as budget amendment fails on House floor

Texas Politics

AUSTIN (Nexstar) — Lawmakers at the Capitol are sifting through hundreds of amendments to the state’s $246 billion biennial budget on the House floor Thursday, a process expected to go well into the night.

That included a proposal to expand Medicaid in Texas, which was ultimately shut down by Republicans.

“The amendment that I’m going to do empowers [Health and Human Services Commission] and Gov. Abbott to work with our federal partners to find a Texas solution to solve the uninsured crisis,” Democrat State Rep. Garnet Coleman explained before members gaveled in Thursday morning.

It would help Texans like Lauren Rangel’s 19-year-old sister, Sorayah.

“She, thanks to Medicaid, has been able to access medicine and therapy for some mental health conditions that she lives with,” Lauren explained, saying Sorayah technically aged out of the Medicaid system during the pandemic.

“Texas did not disenroll children who were eligible for coverage at the beginning of the public health emergency when they aged out, and so my sister has been able to stay on her coverage,” Rangel said, explaining Sorayah would lose her coverage as soon as the public health emergency ended.

“Right now, she, we are terrified,” Rangel said. “She is preparing to go to college in the fall. She’s working part time. And so it is impossible for her to access coverage.”

Sorayah does not meet the 138% of the federal poverty line to qualify for Medicaid coverage, but also doesn’t make too little to qualify for the Affordable Care Act’s subsidies and credits. Once the pandemic ends, she’ll join the 1.4 million Texans in the coverage gap.

“She may be one of 1.4 million, but she is my baby sister. She has her whole life ahead of her. She is going to be going to college in the fall, and she wants to be a dentist. But she is living in fear right now,” Rangel said.

“It’s about time for us to cover the rest of the people who are not part of the ACA above 138% of the poverty level. So what this amendment seeks to do is just that, is to add those individuals to a uniquely nontraditional Medicaid program, like other states have done,” Rep. Coleman said Thursday morning, but his amendment ended up failing.

It’s something the Children’s Defense Fund of Texas said is long overdue.

“Texas is one of the few places left in the country where low wage workers do not have access to affordable health insurance. And that is the primary reason that Texas has the highest uninsured rate in the country, doubling the national average, and our high uninsured rate is high for almost every category — adults, children, women, kind of the list goes on,” deputy director Laura Guerra-Cardus said.

Republicans have traditionally been against expansion, citing concerns it could end up costing the state more in the long run.

“I respectfully request you vote against this amendment,” Republican lawmaker Rep. Giovanni Capriglione pleaded with the House Thursday after Rep. Coleman laid out his proposal.

So far, however, nine Republicans have signed onto a separate Medicaid expansion bill. It would maximize federal dollars already available to the state with precautions in place so the state wouldn’t end up footing the bill.

“The Livable Texas plan addresses a lot of concerns that people have had to expanding health care coverage, it has a stopgap measure if the funding ever ceases at the federal level,” author of the House Bill 3871 Rep. Julie Johnson (D-Dallas) said Thursday morning.

“Right now, Texas is participating in a 60/40 match with the federal government, meaning that the federal government pays 60% of this care, and the state pays 40%. The match that the federal government is offering to the state is 90/10. But with an additional two years, it goes to 95/5,” Rep. Johnson said. It also aims to increase provider participation across Texas.

Republicans are also giving Medicaid a serious look this session due to the Biden administration rescinding the state’s 1115 Waiver, which began a decade ago, and was only meant as a safety net while states transitioned to expanded Medicaid coverage after the Affordable Care Act passed in 2010.

“The current 1115 waiver was never meant to be a long term solution,” Rep. Johnson said.

“We have 76 co-authors on our bill, enough to pass this to the legislature,” Rep. Johnson said, but explained it hasn’t been assigned to committee yet.

Guerra-Cardus said bipartisan support for any Medicaid expansion is a step in the right direction.

“[It] shows us what the polls have been telling us all along, that a growing and majority of Texans inside the Capitol and across every corner of the state want health care coverage for Texas,” she added.

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