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Texas Matters: Rural Hospitals In Crisis With No Medicaid Expansion

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Rep Garnet Coleman (D) Houston
Texas Legislative Pool Feed
Rep Garnet Coleman (D) Houston

Thursday was Budget Day at the Texas Legislature with a marathon session on the house floor where nearly 240 amendments to the budget are voted on. At one point state Rep. Garnet Coleman, a Houston Democrat stepped up to the microphone and pitched his amendment that would expand state and federal health care coverage for uninsured Texans.

“Tragically Texas has the unfortunate distinction of having both the highest number in the highest percentage of uninsured residents in the nation,” said Coleman.

It was a way to basically expand Medicaid with options for Texas Republican leadership to tailor it to their needs and make it more politically acceptable to their base.

“It would direct HHSC to develop a delivery model that will promote personal responsibility, increase efficiency and accessibility of services and reduce healthcare costs to the state. Also, the control of this particular amendment would be in Governor Abbott, the health and human services commission. So that's important because it is not prescriptive to anything except the principles of Texas,” he said.

But the amendment failed by 68 to 80 – largely along partisan lines. There was one Republican, State Rep. Lyle Larson of San Antonio, voting for it.

Larson later tweeted:

All major medical groups in Texas ask the lege to increase federal healthcare dollars coming to Texas. Unfortunately we are stuck in a decade old narrative that has forced the closing of many rural hospitals and less access to physician care. Fiscal conservatism was denied today.

We’re going to hear more about how this vote, paired with the 1115 Waiver that was recently pull from Texas, is a one-two punch that is going to hurt poor and rural Texans.

But first: Even before Thursday’s vote Texans in rural communities were facing a growing crisis as their hospitals shutter — according to findings from The Texas Newsroom and American Public Media, the state has the highest rate of hospital closures in the U.S.

Texas Tech Public Media’s Jayme Lozano reports that as rural residents lose access to healthcare, one team is working to restore hospitals in the areas that need them the most.


Last week the Biden administration announced it was rescinding the 1115 Waiver for Texas. It was granted in the Trump administration to provide a health care safety net for uninsured Texans. The 1115 Waiver reimburses hospitals for the “uncompensated care” they provide to patients without health insurance and pays for innovative health care projects that serve low-income Texans, often for mental health services.

The pulling of the waiver was seen as a move by the Biden administration to push Texas towards expanding Medicaid. But that’s not happening.

John Harrison is the president and CEO of Torch – Texas Organization of Rural and Community Hospitals. He says more rural hospitals are going to close because of this decision.

Open Government

They’ve been busy at the legislature. On top of bills to overhaul elections, new restrictions on abortion, expansion of gun access, and attacks on Texans who are transgender, the Texas Legislature is moving forward on government Transparency bills.

There is bipartisan support to promote open government and also address failings in the public information arena that became evident during the COVID-19 pandemic.

Kelley Shannon is executive director of the non-profit Freedom of Information Foundation of Texas. For more information go to www.foift.org.

TPR was founded by and is supported by our community. If you value our commitment to the highest standards of responsible journalism and are able to do so, please consider making your gift of support today.

David Martin Davies can be reached at dmdavies@tpr.org and on Twitter at @DavidMartinDavi