The Affordable Care Act — a national landmark for healthcare access — turned 14 this week. The effect in Texas cannot be overstated: as of this year, 3.5 million Texans buy health insurance through the ACA. That’s nearly triple the enrollment just five years ago. Indeed, ACA coverage benefits people from all walks of life, but it is absolutely critical for people who don’t have employer-sponsored coverage. It’s the difference between being able to afford preventive care, routine checkups, as well as life-improving medications and life-saving treatments and surgeries, and… not.
Despite this success, Texas still has the highest percentage of uninsured people in the country. More than 16% of our population remains uninsured – more than double the national average.
What more can we do? Medicaid expansion of course remains the single most powerful policy option we have. We could insure around a million Texans who live in poverty. The public favors Medicaid expansion by a margin of more than 2:1. For three legislative sessions and all the time in between, I’ve pushed for Medicaid expansion through a variety of forms (most notably my Live Well Texas program). But as yet none have passed – none has even gotten a committee hearing let alone a vote.
From a fiscal standpoint as well as a moral one, the Republican refusal to expand Medicaid makes no sense at all. It’s a financial net-positive policy for the state budget, lowers employer health insurance premiums, stabilizes family finances, and makes people healthier – that’s right: it works for government, business, and people. That’s why 40 other states (and Wash. D.C.) have opted in, and 0 have opted out. Medicaid expansion under the ACA is 40-0.
But even were Texas to expand Medicaid, we would still have millions of uninsured Texans. So, what else can we do? We can get more people insured through the ACA marketplace by leveraging federal subsidies.
That’s what I did in the 87th Legislative Session, when I introduced and passed Senate Bill 1296. By restoring to the state the authority to regulate ACA premium standards (not prices), and by requiring that health insurance policies be priced relative to the value they provide, we triggered a federal funding formula that brought in billions more federal dollars to lower prices for working Texans who couldn’t afford insurance premiums otherwise.
A recent independent analysis estimated that SB 1296 resulted in around 350,000 previously uninsured Texans being able to purchase private coverage on the ACA marketplace.
We can do more. By coordinating state and private efforts, we can make it possible for hundreds of thousands of low-income Texans to afford to buy health insurance on the ACA marketplace. I’ll be leading that effort. And I’m going to keep introducing legislation to expand Medicaid, by any avenue we can.