The Austin Chronicle

Opinion: Medicare for All Is the Timely Solution for Texas Health Care

With the recent expiration of pandemic-era health insurance requirements, millions of Texans may lose their Medicaid coverage over the coming months. It doesn’t have to be that way.

By Yosha Singh and Rohit Prasad, April 14, 2023, Columns

Nearly 1 in 10 Texans may lose their health insurance over the coming months. Women and children will be hit hardest.

It's clear, we need Texas to expand Medicaid now. In addition, we need to restructure our national health insurance system.

Doctors know firsthand the benefits of consistent health insurance. Dr. Lauren Thaxton, an OB-GYN in Austin, says, "Stable insurance coverage throughout a person's life can increase health and wellness and allow issues to be addressed before they become critical."

Texas already ranks last in the nation in health care affordability. The U.S. overall has the highest rate of women dying in childbirth among developed nations. So, as state officials decide whether 2.7 million Texans can keep their Medicaid over the coming months, these statistics may get worse. It is time for Texans to demand a solution.

At the start of the pandemic, the national government – under both Presidents Trump and Biden – saw the value of health insurance. They required states to keep people enrolled in Medicaid until the end of the pandemic. This meant millions of Texans who otherwise may have lost their insurance stayed insured.

Continued coverage had the biggest effect on Texas women. Before the pandemic, almost 90% of pregnant Texans with public insurance lost coverage in the year after birth. For the past three years, though, all these women stayed covered. They were able to keep seeing their doctors and manage their health after having a baby. Pregnancy takes a toll. Stable insurance meant that Texas women were able to manage complications and recover from their pregnancy.

Texas is now reevaluating all Medicaid recipients because the federal rule keeping people on Medicaid expired at the end of March. As the rule goes, the dependable insurance that Texans have come to know may go with it. As health care providers, we worry about what this means for our patients.

There is one solution we could start with: expanding Medicaid. The state can change its requirements, bring more people onto Medicaid, and get more federal funding in the process. This would stop the bleeding short-term and keep the gains we made in the past three years. But, this would not solve the root problem.

If the cost of the U.S. health system were its own country, it would be the third-most expensive country in the whole world, just behind the United States and China. Yet, we have the highest rates of infant, mother, and avoidable death in the developed world. Why? According to experts, the reason is simple: prices. In the U.S. we simply, and unfortunately, just pay more – without any added benefit.

More insurers leads to more spending. At the University of Toronto hospital in Canada, there are 1,272 patients beds and seven billing clerks total. At the Duke Medical Center in the U.S., there are 957 patient beds and a whopping 1,600 billing clerks. Nearly double the number of patients. These examples span the country.

A national single-payer system would keep everyone insured, reduce costs, and leave money for patient care.

Naysayers commonly cite cost as a reason not to change our system. But as it stands now, we are paying more to achieve less. The U.S. Congressional Budget Office confirmed single-payer would give everyone insurance, eliminate co-pays and deductibles, and save $450 billion annually. Our current spending helps neither patients nor doctors. It helps insurance companies. Insurance CEOs have tripled their personal profits in the past decade.

The time to act is now. In Texas, and in the short-term, we must contact our state representatives to support House Bill 204 and Senate Bill 71. We must expand Medicaid. But, if we're to be serious about improving the worst health system in the developed world in the long run, we must enact Medicare for All. The livelihood of women and children, and wallets of U.S. taxpayers, depend on it.

Yosha Singh, MPH, and Rohit Prasad are members of the national single-payer health care advocacy organization Physicians for a National Health Program (

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