Members Rep. Alma Allen Rep. Rafael Anchía Rep. Michelle Beckley LSG Policy Report: Medicaid Expansion- Healthcare Coverage and Rep. Diego Bernal Economic Benefits for Texans Rep. Rhetta Bowers Rep. John Bucy III Rep. Elizabeth Campos Rep. Terry Canales March 16, 2021 Rep. Sheryl Cole Rep. Garnet Coleman Rep. Nicole Collier LSG Colleagues and Supporters, Rep. Philip Cortez Rep. Jasmine Crockett Rep. Yvonne Davis This is the next in a series of LSG policy papers regarding important issues we will be Rep. Joe Deshotel considering this session. We hope you find this information regarding Medicaid expansion Rep. Alex Dominguez Rep. Harold Dutton useful for you and your staff. Rep. Art Fierro Rep. Barbara Gervin-Hawkins Rep. Jessica González Rep. Mary González Rep. Vikki Goodwin Rep. Bobby Guerra Rep. Ryan Guillen Rep. Ana Hernandez Rep. Abel Herrero Rep. Garnet F. Coleman, Chair Rep. Gina Hinojosa Rep. Donna Howard Rep. Celia Israel Rep. Ann Johnson Medicaid Expansion- Healthcare Coverage and Economic Benefits for Texans Rep. Jarvis Johnson Rep. Julie Johnson Rep. Tracy King Medicaid expansion is a centerpiece of the Affordable Care Act (ACA) which extended Rep. Oscar Longoria healthcare coverage to millions of Americans. Regrettably, the U.S. Supreme Court ruled Rep. Ray Lopez Rep. Eddie Lucio III that states could choose to refuse expansion, a ruling that led to a stark partisan divide Rep. Armando Martinez between states that expanded Medicaid and those that did not. However, many Republican- Rep. Trey Martinez Fischer Rep. Terry Meza led states have found that Medicaid expansion is undeniably good healthcare and good Rep. Ina Minjarez financial policy. In fact, voters in even predominantly Republican states, approved ballot Rep. Joseph Moody propositions that expanded Medicaid. Rep. Christina Morales Rep. Eddie Morales Rep. Penny Morales Shaw Currently, 38 states and the District of Columbia have opted into Medicaid expansion. The Rep. Sergio Muñoz Jr. ACA provides expansion states with generous federal funding that has allowed them to Rep. Victoria Neave Rep. Claudia Ordaz Perez provide affordable healthcare coverage to millions of Americans and realize related Rep. Evelina Ortega economic benefits. Rep. Leo Pacheco Rep. Mary Ann Perez Rep. Ana-Maria Ramos Regrettably, Texas state leaders have refused to expand Medicaid under the ACA, denying Rep. Richard Peña Raymond healthcare coverage to at least a million more Texans. The Texas Legislature has considered Rep. Ron Reynolds Rep. Eddie Rodriguez Medicaid expansion in every session since the implementation of the ACA in 2014, but Rep. Ramon Romero Texas remains one of only twelve states that has not adopted the Medicaid expansion. Rep. Toni Rose Rep. Jon Rosenthal Rep. Carl Sherman Additional Benefits from the American Rescue Plan Rep. James Talarico Rep. Shawn Thierry Rep. Senfronia Thompson The American Rescue Plan, the COVID-19 relief package that President Biden signed into Rep. Chris Turner law, includes provisions to improve access to affordable health insurance. Rep. John Turner Rep. Hubert Vo Rep. Armando Walle • The relief package would provide Texas an estimated $3 to $6 billion additional Rep. Gene Wu dollars over two years if the Legislature approves expansion. Rep. Erin Zwiener Sen. Sarah Eckhardt • The package would also make it easier for Texas to allow mothers to keep their Sen. Royce West Medicaid insurance for 12 months rather than just 2 months after pregnancy if the Sen. John Whitmire Sen. Judith Zaffirini The Legislative Study Group (LSG) is a bipartisan caucus in the Texas House of Representatives that is committed to developing sound public policy that benefits all Texans. Founded in 1993, the LSG has worked through thirteen regular sessions and numerous more special sessions of the Texas Legislature, becoming one of the leading policy shops in the Texas Capitol. Printed in house. P.O. BOX 12943 AUSTIN, TEXAS 78711-2943 • PHONE (512) 787-7199 • [email protected] • WWW.TEXASLSG.ORG Members Rep. Alma Allen Rep. Rafael Anchía Rep. Michelle Beckley Legislature passes such legislation, by allowing the state to implement the change Rep. Diego Bernal without requiring the long state-federal negotiation process that had been required. Rep. Rhetta Bowers with the federal government that was previously required. Rep. John Bucy III Rep. Elizabeth Campos • Without requiring state action, the package also makes insurance on Rep. Terry Canales HealthCare.Gov much more affordable by reducing monthly costs for people with Rep. Sheryl Cole Rep. Garnet Coleman low and moderate incomes and people receiving unemployment insurance benefits Rep. Nicole Collier this year. Rep. Philip Cortez • Texas would get a 5 percentage point increase in the state’s federal Medicaid match Rep. Jasmine Crockett Rep. Yvonne Davis rate for two years if the Legislature implements expansion under the ACA. Rep. Joe Deshotel Rep. Alex Dominguez Rep. Harold Dutton Texans Need Health Insurance More Than Ever Rep. Art Fierro Rep. Barbara Gervin-Hawkins Texas has both the most uninsured people and the highest rate of people without Rep. Jessica González Rep. Mary González healthcare coverage in the country. Texas’ uninsured rate pre-COVID-19 was Rep. Vikki Goodwin 18.4%, and reports indicate the uninsured rate rose from February to May of 2020, due to Rep. Bobby Guerra Rep. Ryan Guillen pandemic-related job losses. Rep. Ana Hernandez Rep. Abel Herrero Polling conducted by the Episcopal Health Foundation found that 69% of Texans support Rep. Gina Hinojosa Rep. Donna Howard Medicaid expansion – an increase from 64% last year – but state leaders have politicized Rep. Celia Israel the issue by leading a legal effort to eliminate the ACA. The United States Supreme Court Rep. Ann Johnson heard the case last year, and with a decision expected this year. Meanwhile, the number of Rep. Jarvis Johnson Rep. Julie Johnson uninsured Texans continues to climb as the COVID-19 pandemic spiked repeatedly over Rep. Tracy King the last year, making the need for Medicaid expansion more important than ever. Rep. Oscar Longoria Rep. Ray Lopez Rep. Eddie Lucio III Healthcare Coverage: A Life and Death Issue Rep. Armando Martinez Rep. Trey Martinez Fischer Rep. Terry Meza Access to affordable healthcare is a human right and huge gaps in coverage create life-or- Rep. Ina Minjarez death situations for people who need help most. Medicaid expansion is vital to helping Rep. Joseph Moody Rep. Christina Morales low-income Texans afford medical care, reducing mortality, and boosting our economy. Rep. Eddie Morales Since the ACA was enacted, studies indicate that Medicaid expansion saved the lives of at Rep. Penny Morales Shaw least 19,200 older low-income adults from 2014 to 2017 in states that adopted it. While Rep. Sergio Muñoz Jr. Rep. Victoria Neave states that did not expand Medicaid cost the lives of 15,600 people. Expansion was most Rep. Claudia Ordaz Perez consequential in preventing premature deaths from causes such as cardiovascular disease Rep. Evelina Ortega Rep. Leo Pacheco and diabetes, which are conditions responsive to medical care. Rep. Mary Ann Perez Rep. Ana-Maria Ramos During the deadly COVID-19 pandemic, essential workers have proven to be the backbone Rep. Richard Peña Raymond Rep. Ron Reynolds of our country. However, in Texas, most low-wage essential workers do not receive Rep. Eddie Rodriguez employer-sponsored insurance (ESI) and are unable to qualify for Medicaid or Medicaid Rep. Ramon Romero subsidies. More than ¾ of the uninsured adult population that would become eligible for Rep. Toni Rose Rep. Jon Rosenthal coverage under Medicaid expansion would be a part of a family where at least one adult is Rep. Carl Sherman employed full or part time. A 2020 report released by Families USA found that failing to Rep. James Talarico Rep. Shawn Thierry expand Medicaid has tangible economic costs, including a loss in revenue for hospitals, Rep. Senfronia Thompson doctor’s offices, and other medical providers resulting in job losses. Rep. Chris Turner Rep. John Turner Rep. Hubert Vo Impact on Families, Children, and Coverage Disparities Rep. Armando Walle Rep. Gene Wu Rep. Erin Zwiener Medicaid expansion would bring coverage for uninsured parents of children who are Sen. Sarah Eckhardt already receiving Medicaid benefits. In 2019, about 4 million Texans were covered by Sen. Royce West Medicaid on any given day, and about 3 million of them were children. Only about 17% of Sen. John Whitmire Sen. Judith Zaffirini The Legislative Study Group (LSG) is a bipartisan caucus in the Texas House of Representatives that is committed to developing sound public policy that benefits all Texans. Founded in 1993, the LSG has worked through thirteen regular sessions and numerous more special sessions of the Texas Legislature, becoming one of the leading policy shops in the Texas Capitol. Printed in house. P.O. BOX 12943 AUSTIN, TEXAS 78711-2943 • PHONE (512) 787-7199 • [email protected] • WWW.TEXASLSG.ORG Members Rep. Alma Allen Rep. Rafael Anchía Rep. Michelle Beckley parents with children on Medicaid are eligible. This gap between parental coverage and Rep. Diego Bernal children’s coverage can leave children vulnerable in the event a parent becomes sick and Rep. Rhetta Bowers does not seek medical attention due to the burden of medical bills. Research has shown Rep. John Bucy III Rep. Elizabeth Campos that the uninsured have longer wait times when seeking medical assistance, which often Rep. Terry Canales results in worse health outcomes and higher costs for both uninsured families and Texas Rep. Sheryl Cole Rep. Garnet Coleman taxpayers as unclaimed medical expenses increase. Rep. Nicole Collier Rep. Philip Cortez Children make up a majority of those covered by Texas Medicaid, but there are still those Rep. Jasmine Crockett Rep. Yvonne Davis who fall through the cracks. When comparing racial and ethnic demographics, all Texas Rep. Joe Deshotel children have a higher uninsured rate than the nationwide uninsured rate for children Rep.