Medicaid Expansion and Texas' Rural Hospital Crisis


In 2013, the State of Texas refused the Medicaid expansion offered as part of the Affordable Care Act for purely ideological reasons. Since the ACA was also known as "Obamacare", Rick Perry made it clear that “Texas will not be held hostage by the Obama administration’s attempt to force us into this fool’s errand of adding more than a million Texans into this broken system.”

Now that we've had a few years since Mr. Perry's statement, we can compare the results of the expansion between states that have expanded Medicaid and those that have not:

  • Medicaid expansion states experienced large reductions in uninsured rates that significantly exceed those in non-expansion states, especially for vulnerable populations.

  • Medicaid expansion states have experienced greater improvements in quality of care.

  • Medicaid expansion states have more affordable healthcare.

  • Medicaid expansion states saw no significant increases in spending from state funds as a result of Medicaid expansion and no significant reductions in state spending on education, transportation, or other state programs.

  • Medicaid expansion cut every dollar that a hospital in an expansion state spent on uncompensated care by 41 cents between 2013 and 2015, corresponding to a reduction in uncompensated care costs across all expansion states of $6.2 billion over that period.(1)

Add to that the fact that Texas now leads the nation in rural hospital closures, with fifteen rural hospitals closing between 2010 and 2018. According to this article:

". . . rural areas and small towns in non-expansion states have higher percentages of uninsured residents – and thus higher percentages of people who when they get seriously ill or injured come to the local hospital with no insurance coverage for the inevitable large bills. And the higher the percentage of uninsured people served by a rural hospital, the harder it is for that hospital to stay in business."

Despite numerous attempts by Democrats to expand Medicaid in order to save Texan lives, and to save Texas taxpayers money, Republicans continue to oppose these sensible efforts for ideological reasons. According to my former opponent, "That's some socialism right there."

I will fight hard for you in the Texas Legislature to reduce your healthcare costs by making sensible decisions without being blinkered by ideology. This one's easy!