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Expanding Medicaid Would Insure 1M More Texans And Boost The State’s Economy. Why Are Some Lawmakers Still Against It?

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Texas has the country’s highest uninsured rate and ranks 50th for access to care. Still, Texas is one of 12 states still declining to expand Medicaid under the Affordable Care Act, effectively rejecting subsidized coverage for low-income residents who want but cannot afford health insurance.

If Texas lawmakers did vote to expand Medicaid, the federal government would provide $9 for every $1 the state put into the program, meaning $5.4 billion in new federal funds annually.

The subsidies that come with Medicaid expansion could help up to 1 million low-income Texans afford health coverage, which is critical during a pandemic that has now killed more than 40,000 residents statewide.

Republicans are historically against Medicaid expansion, but some members of the Texas GOP now say that’s just bad business, as doing so could boost the state’s overall economy and lower health care costs for all Texans.

What do we know about the economics of public health insurance and the effects of Medicaid expansions in other U.S. states? How could doing so in Texas impact the state’s budget?

Are there downsides to expanding this program? What problems exist within the Medicaid system as is, and is expansion the right or the only answer? Are there other barriers to enrollment?

Why have Texas Republicans not supported Medicaid expansion in the past? Does the political will exist now, given the pandemic’s disproportionate impact on low-income Texans, or will the state turn away federal funds again in 2021?


  • Laura Dague, health economist, associate professor at the Bush School of Government and Public Service and research fellow at the Mosbacher Institute at Texas A&M, and associate in the National Bureau of Economic Research’s Health Economics program
  • Jeremy Blackman, covers health and politics for the Houston Chronicle’s Austin bureau
  • Dr. Diana Fite, president of the Texas Medical Association and emergency room physician from Houston

"The Source" is a live call-in program airing Mondays through Thursdays from 12-1 p.m. Leave a message before the program at (210) 615-8982. During the live show, call 833-877-8255, email thesource@tpr.org or tweet @TPRSource.

*This interview was recorded on Tuesday, February 23.

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