As the Texas House and Senate decide which issues to consider in the 2025 legislative session, they will focus on the issues that require immediate action in Texas: expanding federal funding from Medicaid to support the health of Texans. I would like to draw your attention to the need for acceptance.
As health care professionals living in Texas, we have seen firsthand how this dire situation has left countless Texans struggling to access critical health care services. Texans pay federal taxes like all Americans. But unlike most other states, we have not accepted our fair share to support needed health services for low-income working citizens. Texas is one of 10 states that has not expanded Medicaid in the 10 years since the Affordable Care Act offered the option.
Although Texas lags behind in medical outcomes and ranks last in health indicators, it has the misfortune of having the highest proportion of uninsured adults (24.3%) and the largest population (approximately 5 million people). It has characteristics. Resistance to federal funding drives these unacceptable uninsured rates.
A vast amount of research demonstrates the overwhelming benefits of closing coverage gaps. Benefits include wide availability of preventive services. Improving the diagnosis, treatment, and health outcomes of cancer, cardiovascular disease, diabetes, and hypertension. Improving measures of self-reported healthy behaviors, including sexual and reproductive health. Reduced mortality. And treatment costs are also lower.
Contrary to popular belief, a significant proportion of adults in the coverage gap are employed, unless they are elderly or disabled. The most common jobs among adults in the coverage gap are construction workers, cashiers, cooks, waiters, house cleaners, retail salespeople, and janitors. These workers typically cannot obtain employer-based health insurance or afford plans on the federal insurance exchanges. Also, unless they are pregnant, blind, disabled, elderly, or the parent of a child and earn less than 16% of the federal poverty line for a family of three, they are generally not eligible for the Texas STAR Medicaid program. .
A related and deeply concerning issue is the continued closure of rural hospitals, which is occurring more frequently in states that do not receive federal funding under the provisions of the Affordable Care Act. Texas has the largest rural population in the nation and the highest number of rural hospital closures. Many rural areas lack essential health facilities and services, and residents have limited access to critical health services. Closing these hospitals not only impacts the health and well-being of residents, but also negatively impacts local economies. It is estimated that a local hospital closure would result in an average of 170 jobs and $22 million in annual payroll costs.
To address these urgent challenges, Texas should consider the benefits of accepting 90% matching federal funding to dramatically close the coverage gap. Through direct offsets with other state programs and increased premium revenue, this policy would generate net revenue for Texas.
An additional 1.849 million Texans would be covered if the state accepts the matching funds. As expected, if more Texans were insured, their health would improve, with clear knock-on effects on work productivity and quality of life. Research from other states shows that closing the gap can improve economic security for low-income workers. Increased employment. Disability reduction. Reducing rates of poverty, food insecurity, and housing evictions. Reducing unpaid medical bills. Improving your credit score. And delinquency has decreased. Ultimately, a healthy population creates a more productive and vibrant workforce, leading to economic growth, stability, and prosperity across the state.
Importantly, today's Medicaid is not the same program that started in the 1960s and was expanded in 2010. Over the past decade, under state guidance, Texas' Medicaid program has transitioned from a fee-for-service model to managed care, limiting growth. Public expenses. The Texas STAR program is homegrown and can be scaled responsibly.
Due to the denial of matching funds, Texas lost nearly $12 billion in federal dollars in 2023 alone.Again, as Texans, we already paid But our share of federal funds is diverted to other states, making us unintentionally philanthropists to our own detriment.
The Perryman Group estimates that if Texas had chosen to reduce the coverage gap in 2021, the state's overall economic impact over the 2022-2023 biennium would have been $45.3 billion in gross product and $45.3 billion in personal income. They estimate that the increase would have been $29.4 billion and approximately 461,700 jobs. -Years of service (which would have increased tax revenue). The total net dynamic fiscal benefits will include $2.5 billion to the state and nearly $2 billion to local governments across Texas.
Closing the coverage gap will have a significant impact on the lives of many Texans. It will boost rural and urban economies and benefit the state's revenue. This is a win-win policy change that will improve the health care and economic health of Texas. Doing anything else is not ethically or financially defensible in states that have not yet expanded.
Fabrizia Faustinella, MD, PhD, is an internist and faculty member at Baylor College of Medicine in Houston. She is also a Doctors for America A. Jean Copello Health Advocacy Fellow. Alex Gajewski is a medical student at his UT Southwestern University who will soon begin his internal medicine residency at his UT Southwestern/Parkland Hospital in Dallas. David Auerbach, MD, MBA, is an internist at the Dallas VA Medical Center and a faculty member at his UT Southwestern School of Medicine in Dallas.
