Will Texas Expand Medicaid?

lawyerLast June the Supreme Court allowed the Individual Mandate portion of Obamacare to stand.  According to them, it is constitutional as long as it is called a tax.  President Obama swears that it is not a new tax but a penalty.

Regardless of what semantics are used, the only legitimate thing left for politicians to grand-stand over is the Medicaid Expansion.  At the same time the Supreme Court ruled that the federal government can force Americans to buy health insurance, they ruled that the federal government could not require state governments to expand Medicaid.

A handful of state insurance commissioners are on record saying that they will not use state assets to enforce a federal law that they do not agree with.  That appears to be the next major debate but it is purely political.

The governor of the state in which I live is adamant that he will not accept the federal money to expand Medicaid eligibility for people who earn less than 138% of the Federal Poverty Level (FPL.)

Several party members, from the political party that helped him get elected, are pressuring him to accept federal Medicaid money now in spite of the additional burden it will place on Texas tax-payers in the future.

The Obamacare proposed expansion of Medicaid requires the federal government to pick up the entire bill to provide health care for people who earn up to 138% of the FPL for the first 3 years of the new program.

After 3 years, the amount that is paid by the federal government starts to phase out and the individual states will need to pay the difference.  By 2020, the states are expected to pick up 10% of the cost of health care.

In this post I want to try to summarize the positions of good people who are on both sides of the argument.


The Texas legislature is currently meeting.  They are deciding on any new laws that need to be put in effect for Texas.  The proposed expansion of Medicaid is causing a great deal of hot air to come from the direction of Austin.

In the past, it has only been Democrats that have been willing to accept any part of Obamacare.  Things in the Texas legislature are starting to change.

The majority of Republican representatives are still adamantly opposed to all of Obamacare.  However, a there has been a split in the Republicans.  A handful of Republican representatives plus some normally conservative lobbies are urging Rick Perry to change his mind.  They want him to accept the money from D.C. to expand the Medicaid program.

Their idea is that since TX leads the nation in the number of uninsured people and is hurting for money, we should take the money that is being offered by D.C. now and worry about the consequences later.


Rick Perry and the Republicans are focusing on problems down the road.  Medicaid is already the largest item in the state’s budget.  They are opposed to making it even larger.

They understand that the federal government will foot the bill for 3 years, however, they are looking at what will happen starting in 4 years when Texans must start paying part of the bill for the health care of the additional enrollees in Medicaid.

The odds are that in 4 years Rick Perry and the Republicans in the Texas Legislature will no longer be in positions of power.  The stance they are taking now, in their opinion, will prevent problems for future politicians.


Heaven only knows who is right.  I understand the need to get as much money as possible now.  I also understand the concerns of people who cannot afford health insurance.

On the other hand, I appreciate the desire of Rick Perry and the other conservative politicians in Austin to prevent budget problems for future governors.

However, if there is one thing that I have learned in the past 4 years it is that politicians seldom are persuaded by what is right.  They appear to be motivated by their desire to obtain and hold onto political power.

Will Texas expand its Medicaid system?  The answer to that question is, “Nobody knows at this time.”  Whether Texas will accept or refuse the federal money to expand Medicaid will be determined like so many recent laws.

The question of what is right and what is wrong will be subordinate.  The fate of the state’s Medicaid expansion will be boiled down to which side has more political power.

There is a rumor about a potential compromise that is being considered by the Department of Health and Human Services.  The feasibility of it is being considered.

The potential compromise allows states to use federal Medicaid money to buy private Major Medical insurance for qualified applicants rather than force them to pay for health care directly.

If this compromise is adopted, it could give those who are opposed to the Medicaid expansion a way to change their minds and “save face.”  We will just have to wait and see what happens.



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