Texas & Medicaid: Why not expanding is a moral failure - Part 1 Economics

In an upcoming series of posts, I hope to present arguments, data, and expert opinion revolving around the issue of Medicaid expansion in Texas, keeping in mind the 500 word SJR parameter. 

It was struck down by the U.S. Supreme Court in 2012. It’s a vital piece of the Patient Protection and Affordable Care Act (PP&ACA) that provides coverage to the “working poor". It was designed for individuals whom do not qualify for traditional Medicaid, and whom struggle to afford premiums for private insurance. PP&ACA (Obamacare) is one of the most polarizing, political issues in recent history. It’s come to the House floor for repeal vote more than 40 times. The Medicaid expansion legislation is as divisive. I attended a physician-led advocacy day in 2013 when I was a second year medical student. We met with representatives at our state’s capitol in Austin, Texas. Several staffers met our group at the door and declared that a Medicaid expansion conversation was a non-starter. To this point, at least 15 states have not expanded Medicaid. Commonly presented arguments against expanding are the following:

“Traditional Medicaid is a broken system.”

“Medicaid will bankrupt the state.”

“Medicaid reimbursement is so poor, physicians are reluctant to treat patients with this coverage.”

“Medicaid leads to poor medical outcomes.”

These arguments exacerbate the discrimination of the poor and those in poverty. They paint caricatures of humble citizens as social leeches, moochers, and takers. These arguments are morally and economically bankrupt. Here is why:

A few points on the economic argument:
-The federal government would contribute nearly 100 billion dollars to Texas’ program over the next 10 years. 

-Blocking medicaid expansion would NOT lower individual’s federal taxes.

-$40 billion dollars are spent each year by hospitals in uncompensated care. You’ve probably encountered this on one of your rotations. Patients without insurance seek care at emergency rooms. This is an incredibly expensive way to do health care.These costs are covered by tax-payers and local institutions. Expanding Medicaid helps mitigate much of these costs and relieve the burden on local communities, while putting an emphasis on preventative care.

-Texas' economy would add over 200,000 jobs.

-After the first three years of the expansion, Texas' contribution would not exceed 10% of the cost to run the program.

Texas loses nothing by blocking Medicaid. Unless, of course, we consider the loss of billions of federal dollars, hundreds of thousands of jobs, countless lives, and our integrity. We are withholding resources from hard working families in Texas. This money was already paid into the system through taxes. The funds sit at the federal government waiting for the elected officials in Texas to claim for their people. We’ve built a bureaucratic fortress around health, wellness, and economic freedom and deny the working class access through the gates. If our state wanted to make a deal tomorrow to bring in these federal dollars and improve the lives of Texans, they could. But they won’t. I think back to Hughes, and contemplate the sick body. 

“A hungry body exists as a potent critique of the society in which it exists. A sick body implicates no one”, said Hughes. 

These words are more true now than ever. We must implicate those enabling the sick body and be critical of our society for this social injustice. 

Considerations:
What is your state representative doing to fix the traditional Medicaid program?

Why do you think your representative is blocking Medicaid expansion?

What reservations do you have about Medicaid and the expansion?

Have you worked with physicians who are reluctant to accept Medicaid patients? What was their reasoning? What are your thoughts on this?

What is your group doing to increase access to care and embrace health care as a human right? 

How have you been successful in having access-to-care conversations at your school or program?

​Readings and sources: 
How have states handled medicaid expansion?

Obamacare repeal votes

​Sebelius on the ACA

Texas and Medicaid expansion

Alternatives to medicaid expansion

Study looking at medicaid expansion

My Medicaid Expansion "Call to Action"