The uphill battle to expand Medicaid to more Texas adults

DALLAS – The Dallas Morning News says a few years ago, with the nation in the throes of a pandemic, Sen. Nathan Johnson’s effort to add 1 million low-income Texans to Medicaid drew support from a handful of Republicans in the GOP-dominated Texas Legislature. Most of those lawmakers are gone from the Capitol, an exodus that strips away at the Dallas Democrat’s slim hope of seeing Texas join 40 other states and Washington, D.C. in expanding Medicaid under the 2010 Affordable Care Act. Even so, Johnson filed his bill for the upcoming session — his third try — just in case the leaders of an increasingly conservative Texas Legislature change their minds. “I just want a million people to get health insurance, I want health insurance premiums to come down, and I want to do it without levying any new tax on the people,” Johnson said.

“The strategy is to present something that would allow Republican leadership to say, ‘This is a win for all of us.’ I think if there were a signal from leadership, then we would see Republicans fall in line behind this,” he said. Senate Bill 232 would create the Live Well Texas program, which would expand Medicaid while adding elements passed in other conservative states – including incentives to encourage self-sufficiency through health savings accounts, employment assistance and rewards for healthy behaviors. Additionally, the legislation seeks to increase reimbursements to health care providers who see Medicaid patients, potentially expanding access to care for Medicaid patients by bringing more hospitals, doctors and others to the program. In 2021, Johnson’s Medicaid-expansion bill had no Republican support in the Senate, but nine GOP House members joined 67 Democrats as co-authors of an identical House bill. The legislation was bottled up in a committee. Johnson tried again in 2023, but the effort gathered less bipartisan momentum during a particularly contentious session. “I was very serious about passing it when I first filed it, and we had a really good run at it, but I don’t see how the situation has improved,” Johnson said. “But I want something out there to say that if this state wants a conservative way to bring home its own tax dollars and improve the health of its population and bring down health premiums and stabilize family finances and help set people on a path to independence, there is a way to do it that has conservative bona fides.” Opponents of expanding Medicaid say the program is mismanaged, financially unstable, too expensive and fosters government reliance. They also argue that expansion does not improve health outcomes and prioritizes able-bodied adults over children and adults with disabilities who rely heavily on the program.