What could Texas be doing if we weren’t doing re-re-redistricting?
Of course, it’s been pointed out many times that should the Legislature remain in session longer and more frequently than five months every two years, the amount of mischief accomplished would only multiply. There’s certainly much to be said for that theory (e.g., see below). But new research just published in the journal Health Affairs strongly suggests that if the state’s political leadership were more interested in the general welfare, the current special session would be devoted not to confirming gerrymandered district maps – but to expanding Medicaid.
The study, by Carter C. Price and Christine Eibner of the Rand Corporation, neatly sums up its findings in the title: “For States That Opt Out Of Medicaid Expansion: 3.6 Million Fewer Insured And $8.4 Billion Less In Federal Payments” (Health Affairs 32, No. 6, 2013). Price and Eibner considered the 14 states (including Texas) that have most strongly balked at participating in the federal Affordable Care Act (i.e., “Obamacare”) and more specifically, that aspect of the ACA which involves expanding Medicaid to cover nearly 30 more million people nationwide. Their economic analysis of the outcome concludes, “With fourteen states opting out, we estimate that 3.6 million fewer people would be insured, federal transfer payments to those states could fall by $8.4 billion, and state spending on uncompensated care could increase by $1 billion in 2016, compared to what would be expected if all states participated in the expansion.”
Reporting on the research, Ezra Klein of the Washington Post‘s Wonkblog noted drily, “So then, the math works out like this: States rejecting the expansion will spend much more, get much, much less, and leave millions of their residents uninsured. That’s a lot of self-inflicted pain to make a political point.” Klein was too polite to note that most of the pain will be endured by those 3.6 million people who will remain uninsured, unlike the politicians (such as our own Gov. Rick Perry) endlessly reiterating the argument that expanding Medicaid would be “too expensive” – when in fact, as this latest study confirms, standing pat will in fact cost states more.
Financial Folly
The Rand study doesn’t break out the figures for particular states, but over the years others have provided plenty of figures to undermine the Capitol dogma that Texas and its taxpayers save money by stoutly maintaining the state’s nation-leading rank of having more than a quarter of its residents doing without health insurance. The Center for Public Policy Priorities reiterates a few of the salient facts in its “Texas Health Care Primer”:
• “A 2003 study by Texas economist Ray Perryman estimated that for every $1 in state tax revenue that is cut from Medicaid and CHIP, local taxes go up 51 cents; local health care providers will have 53 cents of uncompensated care; state tax revenue falls by 47 cents; and $2.81 in federal funds is lost.”
• “Families USA estimates that in 2005, the cost of employer-based family coverage in Texas was $1,551 higher due to unpaid costs of health care for uninsured Texans.”
• “The state Comptroller of Public Accounts has estimated that every non-state dollar (from a federal or other out-of-state source) spent in Texas on health care generates $3.51 in overall spending. Increased Medicaid, CHIP, and Medicare coverage of Texans would therefore not only reduce the need for local government funding of indigent care programs, it would also increase the economic impact of the health care industry.”
In the CPPP’s diligent and quixotic attempts to persuade the Legislature to wake up and smell the coffee, the nonprofit recently broke out the relevant Medicaid numbers for all Texas counties. For Travis County, expanding Medicaid under the ACA would mean the percentage of uninsured residents would drop from 17.1% (175,118) to 11.7% (119,442), with a net annual gain of $224 million in Medicaid funds – enough to support more than 3,300 additional registered nurses, or more than 1,200 additional family doctors.
County voters, with their support of Prop. 1 and the new medical school and associated programs, have done what they can at the local level to address the Medicaid shortfall. We can only wish that state leaders had similar common sense.
Break Out the Magic Markers
Which brings us back to the special session, where legislators will spin their wheels for a few weeks with the puppet show of redistricting hearings designed to persuade federal judges that the continuing disenfranchisement of minority voters is not so egregious that it should be outlawed under the Voting Rights Act. That’s not a terribly productive way to spend 30 days of a Texas summer. On the other hand, few of the other bills filed thus far (should the governor decide to expand the call) are terribly reassuring.
If they ever get through the mapping festivities, there are bills proposed to allow concealed weapons on college campuses, and to defy any federal laws restricting firearms. There are bills to restrict abortion rights – under the presumed grounds that an undifferentiated fetus just might “feel pain” at 20-weeks gestation – and to constitutionally restrict state expenditures, and to drug-test the urine of welfare recipients (but not, it appears, of lobbyists). And there is Senate Bill 19, by Rodney Ellis, D-Houston, that would expand the eligibility of Texans for federal health care assistance under the federal Affordable Care Act. I wouldn’t make any bets on SB 19 making the governor’s short list.
On second thought, perhaps it’s just as well that our legislators will be spending the month of June occupied with crayons and maps.
This article appears in June 7 • 2013.
