Health care coverage in Texas looks like an umbrella with a giant hole in it. That hole is the Medicaid coverage gap and it is costing more than 1.5 million Texans their livelihoods or lives. Knowing Texas has the highest uninsured rate in the U.S. and more than a half a million more losing insurance as a result of the COVID-19 pandemic, Medicaid expansion must be prioritized as a movement of social justice, economic feasibility, and crisis response. 

The coverage gap exists because there is no viable health care option for working adults making 100-138 percent of the federal poverty level. This population is making too much to qualify for Medicaid (less than $20,200 annually for a family of three) but not enough to afford private insurance. Medicaid expansion would provide affordable health insurance to this population and would immediately aid more than 1.5 million Texans struggling to choose between their health and a roof over their head

Research shows the uninsured population uses non-ER medical services substantially less than their insured and Medicaid-covered counterparts, resulting in poorer clinical and overall health outcomes for this population. These poorer health outcomes, primarily premature death, disproportionately affect people of color in Texas, where they are uninsured at a rate three times that of their white counterparts. Given that 75.2 percent of the San Antonio population are people of color, our gap in racial health disparities is stark.  

The solution to this problem already exists and is funded in part by Texan federal tax dollars currently bettering the lives of those in 39 other states. These states have seen significant decreases in mortality rates, food insecurity, poverty, and home evictions as a result of Medicaid expansion. Studies show Medicaid expansion in direct correlation with significant increases in coverage, access rates, and health status/outcomes in states like Louisiana, New Mexico, and Ohio. Additionally, expansion states have seen the gap in uninsured rates between white and Black and white and Hispanic adults shrink by 51 percent and 45 percent respectively

While individuals are paying with their lives, communities with their livelihoods, and rural hospitals with their facilities, the federal funds that offer a safety net for uncompensated care costs in hospitals is set to run out entirely by the end of 2021. The weight of these costs is already too burdensome, totaling a growing 6.6 billion dollar burden on public hospitals annually and causing the Lone Star State to lead the nation in rural hospital closures. This crisis is the result of our state refusing the estimated $100 billion in federal funding for Medicaid expansion. 

The federal government covers 90 percent of Medicaid expansion costs with states covering the remaining 10 percent. Comparatively, in 2015 Texas health care spending accounted for nearly half of the state budget, with Medicaid and CHIP accounting for 70 percent of all state government health care spending.  

Texas would spend approximately $5.6 billion on Medicaid expansion to receive $65.6 billion in federal funding, with an expected $34.3 billion in savings from reduced emergency room and hospital visits. Because the San Antonio metropolitan area has the highest poverty rate in the country and up to a 20-year gap in life expectancy by varying zip codes we have the most to gain from Medicaid expansion. Increasing access to preventative and necessary health care through Medicaid expansion improves health equity outcomes, economic productivity, and ensures the future of our dedicated and tireless medical center. 

Despite the clear benefits, Gov. Greg Abbott, Lt. Gov. Dan Patrick, and former Gov. Rick Perry have adamantly vetoed access to affordable health care for those living in poverty, cautioning that Medicaid expansion would be “bad for freedom.” These leaders claim that Texans already have the freedom to access health care via emergency rooms – a trip with an average price tag of $1,265, plus $400-1,200 via ambulance. They also worry about what would happen if the government stops paying its share. While expansion has been successfully funded since 2014, leading to a 6.1 percent reduction in the death rate among qualifying adults, the political narrative insists that Medicaid is a broken system not worth investing in. 

At any time, Gov. Abbott has the power to instate Medicaid expansion or call for a special session in the Legislature to pass a constitutional amendment that would put Medicaid expansion on Texas ballots. Please join me in demanding immediate action from Gov. Abbott and your representatives to pass Medicaid expansion or send the decision to the ballot and restore the power of their constituents to make decisions about their health care.  

In a year that seems saturated in tragedy, Texas has the chance to say yes to a deal that prevents the loss of up to 9,000 Texan lives per year, while generating nearly $535 million in new tax revenue and 303,000 jobs annually. Choosing to value the health of our entire community, we can increase access to health care, fund our hospitals, and narrow the gap in racial health disparities by choosing to reap the individual, community, and statewide benefits of Medicaid expansion. 

Creean White is an LMSW, currently working at UT Health San Antonio as a housing coordinator. She is a UTSA alumni interested in public health policy, social justice, and sustainable living.