San Antonio Express-News

What is more tragic, that Texas leads the nation in the uninsured, or that state lawmakers have refused to address this by expanding Medicaid?

This compounding failure is as maddening as it is infuriating. There is simply no compelling reason for Texas to refuse to expand Medicaid, and yet here we are, stuck with the highest uninsured rate in the nation because the majority of Republican lawmakers just can’t go there. It is doubly tragic.

The numbers speak for themselves. Before the pandemic, Texas had an uninsured rate of 18.4 percent. That’s almost certainly risen with unemployment in the time of COVID. But if Texas expanded Medicaid to adults who earn 138 percent above the poverty line — roughly $17,774 for an individual or $36,570 for a family of four — then some 1.3 million people would have access to health care.

But wait, there’s more. If the state would expand Medicaid it would unlock about $5.4 billion in federal dollars, or 90 percent of the cost.

And the Perryman Group, an economics firm, recently estimated Medicaid expansion would generate $1.95 in economic benefit for every dollar Texas invests in expansion. This would translate to about $2.5 billion for Texas and another $2 billion to local governments over the next biennium.

This is what the majority of Texans want. A January poll from the University of Houston’s Hobby School of Public Affairs found 69 percent of respondents support expanding Medicaid here under the Affordable Care Act.

In other words, expanding Medicaid would provide coverage to more than 1 million Texans, reduce the state’s uninsured rate, return federal dollars to Texas, and generate state and local tax dollars while having the support of the majority of Texans — and lawmakers can’t find a way to act? They can’t boldly go where other “red” states such as Arizona, Arkansas and Oklahoma have gone before?

And on the other side of this argument is, well, nothing. Flimsy rhetoric about how having health insurance does not ensure quality health care or needing to find a “conservative” way forward on expanding Medicaid.

Nonsense. As state Rep. Lyle Larson, R-San Antonio, said last month, “If you take all the politics out of it, it’s really a bad decision not to access the federal dollars.”

Larson recently filed legislation to push for Medicaid expansion, putting the issue on the ballot as a constitutional amendment. But as the saying goes, leadership can be a lonely place. It’s unlikely such a bill could pass the Senate, and even if it did, Gov. Greg Abbott might veto it. This is Texas, after all, which has led the fight to unravel the Affordable Care Act.

Larson has argued not expanding Medicaid is bad business.

“If you are paying into a system in D.C.,” he said, “and you’re not pulling the money back in, but you’re raising taxes at the local level to offset that money you’re paying in, I think that’s fiscally irresponsible. The fiscally responsible thing to do is trying to maximize, like we do in every other revenue stream in the state budget.”

He’s right. It is fiscally irresponsible to do nothing. It’s also inhumane. About 5.2 million Texans lacked health insurance before the pandemic. That’s 5.2 million people who are likely to put off routine care only to end up in emergency rooms. Lawmakers could change this for more than 1 million Texans if they had the courage, and sense, to expand Medicaid. Why is it so hard to do the obvious right thing?

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