Texas still has the largest number and percentage of citizens without any kind of health insurance coverage. That shouldn't surprise anyone, because the state also has the largest number and percentage of people making the minimum wage or less -- and workers making a poverty wage can't afford to buy health insurance. Most of these people don't qualify for a subsidy to help them buy insurance. Obamacare was designed to provide insurance for them through an expansion of the Medicaid program.
But as the chart above shows (from the Kaiser Family Foundation), Texas still refuses to expand the Medicaid program. That's because the state has a Republican governor and a Republican-dominated legislature -- and they have been far more interested in attacking Obamacare by playing political games than in helping any citizens to get health care coverage. This is causing many Texans to go without preventative care (which saves lives), and is also affecting many county hospitals in the state (who are stuck with the burden of trying to provide a minimum of care to the poor.
The crazy part of this is that expanding Medicaid would bring a huge amount of new money to the state, which would be a big boost to the state's economy. That's why many business groups have joined the effort to expand Medicaid. Now the state's largest newspaper, the Dallas Morning News (a bastion of conservatism) has joined that fight. Below is their editorial, asking the state officials to expand Medicaid:
Texas has never come to grips with the realities of providing health care to its poorest residents. It needs to now.
At the end of August, the federal Centers for Medicare and Medicaid Services plan to pull the plug on a stop-gap solution that Parkland Memorial Hospital and other county hospital districts in Texas have used to obtain federal funding matches to serve Texas' poor. Dallas Morning News Austin reporter Robert T. Garrett disclosed this threat in a recent front page story.
If those dollars go away, Parkland could lose $10 million annually, and if the feds apply the same approach to other related Medicaid programs, the financial impact could approach $24 million, Dr. Frederick Cerise, Parkland's president and chief executive officer, told us. Unless something is worked out, Parkland would have to reduce services and that could have ripple effects across North Texas.
A similar scenario could play out in other Texas counties as well.
While the loss of these funds may not seem like much in Parkland's $1.5 billion budget, the hospital is facing a $100 million budget deficit, so the threat to quality care is real. The dilemma underscores the reason the state needs to do more to live up to its responsibility to properly fund Medicaid.
To meet their responsibility to serve the poor and to help offset costs, Parkland and other county hospitals acquired the operating licenses of nursing home chains. A provision in the federal law made the hospitals and nursing homes eligible for supplemental Medicaid payments.
Now the feds want to end this arrangement and have changed the policy to discourage providers from using supplemental payments to make up the financial shortfalls created from inadequate Medicaid funding at the state and local level.
It's a sad state of affairs that Parkland and other providers have had to resort to workarounds to perform their mission. When given the opportunity to access federal dollars by expanding coverage under the Affordable Care Act, Texas refused. That setback came after years of state officials authorizing ridiculously low fees to Medicaid service providers.
Over time, state lawmakers virtually guaranteed that hospitals like Parkland would lose money every time they treated a poor person. And, by not expanding Medicaid under the Affordable Care Act, which would have provided federal matching funds, the state forced hospitals like Parkland to find creative ways to provide Medicaid services.
Short term, the Centers for Medicare and Medicaid Services would be wise to temporarily suspend action on Parkland's arrangement to allow all parties more time to unwind these complex arrangements. We don't want to see a bad situation made worse. But for the long run, the Legislature simply must step up to its funding responsibilities.
Many in the Texas business community, including the Dallas Citizens Council, the Texas Association of Business and various chambers of commerce, favor a robust Medicaid expansion program. They recognize the spiraling dangers of an underfunded health care system.
We urge lawmakers to listen to these organizations. Texas is forfeiting billions of federal dollars that could help Parkland and other hospitals cover their Medicaid costs. Now we're seeing the unfortunate consequences of the state's inaction.