Texas Medicaid Is Nearly Worthless

Texas has never had a decent Medicaid program. While about one out of every six Texans lives below the poverty  line, most of those living in poverty do not qualify for Medicaid coverage. Texas, which has one of the stingiest Medicaid programs in the nation, won't give Medicaid coverage to any adult that isn't disabled, pregnant, or caregivers making less than $18,312 (for a family of three). That means any single, married without children, or other poor working adults do not qualify for coverage.

Personally, I think that is bordering on criminal behavior, because it condemns thousands of people (if not more) to die every year in this state because they have no insurance coverage and cannot afford preventive care (and by the time they are sick enough to go to an emergency room, it is too late to cure their malady). This problem could at least be partially solved by accepting the proposed federal expansion of Medicaid (which would be fully paid for by the federal government for three years, and after that the feds would pay 90%). It would mean virtually all of the state's poor would be covered by Medicare.

Sadly though, Texas is most likely to join a bunch of other states (maybe as many as 29) in refusing to expand the Medicaid program. Texas is ruled by the teabagger class of Republicanism, and it would not be the first time the state turned down huge amounts of federal money to avoid having to come up to a national standard -- with the last time being in education, when Texas wanted to continue standards below those of most other states.

But that is not the only problem. Even if Texas was to accept the federal money and cover millions more poor Texans with Medicaid, there is no guarantee that those new Medicaid recipients would be able to get the medical care they need. That is because Texas not only has a shortage of doctors and nurses (especially in rural areas), but most of the doctors practicing in Texas will no longer accept Medicaid patients. A recent survey by the Texas Medical Association showed that only about 31% of all the state's doctors will now accept new Medicaid patients (about 11% lower than in the last survey done in 2010).

Why is this? Because while Medicaid is a federally-mandated program, each state makes its own eligibility rules and payment schedules. And Texas (among some other states) is not only very stingy when it comes to eligibility for a poor person to be covered, it is even stingier in the amount it will pay a doctor to treat those with Medicaid coverage. Too many doctors have found they simply cannot afford to have many Medicaid patients on their caseload, or they wind up losing money instead of making a profit.

There is a solution for both of these problems (eligibility and poor payment schedules), but the teabagging Republicans aren't going to like it. The control of the Medicaid program must betaken away from the states. It must be administered by the federal government, much like Medicare. In fact, a better solution might be to just eliminate Medicaid altogether and allow poor Americans to sign up for Medicare (and adequate federal funding must be provided).

As long as we allow each state to administer its own Medicaid program, there will always be a number of states (like Texas) who will refuse to do the right thing (because their leadership, usually Republican, simply doesn't care about the poor).