Health insurance coverage may elicit yawns from other people but it gets Cossy Hough fired up. She credits her 13 years working with Texas Medicaid for her conviction that social workers should understand the social justice implications of Medicaid expansion.
What is the Affordable Care Act coverage gap?
Due to a 2012 Supreme Court decision regarding the act, Medicaid expansion became optional for states. As of March 2016, 32 states have expanded Medicaid eligibility and 19 have not. States like Texas, which chose not to expand Medicaid eligibility, have encountered a coverage gap of adults who live below the Federal Poverty Line but earn too much to qualify for Medicaid and not enough to qualify for the federal subsidies that those at higher incomes can use to purchase health insurance coverage. Most of the adults in this coverage gap remain uninsured.
How big is the coverage gap?
Almost 3 million people have fallen into this gap. One in four of them live in Texas, which is the state with the largest percentage of uninsured residents in the United States.
Who are the Texans in the coverage gap?
Some examples:
- A single mother of two children who works at a fast food restaurant and earns $18,000 per year.
- A personal care attendant who earned $9,000 in a year, after working the hours needed by the employing agency.
- The parents of two small children with one income of $10.00 per hour or $20,800 per year (the children may qualify for Medicaid).
What would have been the cost of Medicaid expansion for Texas?
The federal government would have paid 100 percent of expansion costs for the first three years, and 90 percent thereafter until 2022. Texas turned away approximately $1 billion in federal funding for Medicaid expansion, and chose not to provide health coverage to almost one million residents. Texas has the option to accept federal funds for Medicaid expansion in the future.
What does the future look like for Medicaid expansion in Texas?
The Texas Governor’s office has stated that the state should be able to address its “unique healthcare situation without federal interference,” and that it does not plan to pursue Medicaid expansion. One issue to consider, however, is payment for uncompensated care in hospitals. As we know, many people without insurance end up in emergency rooms, and in many cases the federal government provides assistance to states with the cost of this uncompensated care. Going forward, the federal government may limit uncompensated care payments for patients who would qualify for Medicaid under Medicaid expansion. This is an issue I will be watching out for here in Texas.
Cossy Hough is clinical assistant professor at the School of Social Work. Want to know more about Medicaid in Texas? Visit http://texaswellandhealthy.org