Most Texas politicians balk at even discussing Medicaid expansion. They fear the wrath of state leadership and the threat of being primaried by someone further to the right.
The expansion of Medicaid to the full extent permitted by the Affordable Care Act (ACA) is both an ethical and financial imperative. From a moral standpoint, expansion would provide health care coverage to a significant number of low-income individuals who are currently unable to afford private insurance or qualify for Medicaid, thus falling into the coverage gap. Expansion would help ensure that all US citizens have access to essential health care services, regardless of their income level. Leading Texas economists estimated expansion would in-net generate savings for the state government, draw down billions in federal dollars every year, and reduce both uncompensated care costs and the need for expensive emergency services.
Fourteen years after the ACA became law, the word expansion remains politically charged. Aversion to the term is so pronounced in the Texas Legislature that it borders on the absurd, hindering open advocacy for commonsense reform. Straightforward discussions about a policy that would save lives and alleviate suffering are met with fierce resistance. The same politicians who ridicule “snowflakes,” “safe spaces,” and “political correctness” appear frightened by a single word: expansion!
While Texas politicians are busy closing their ears, their constituents continue to suffer. What about Alex? A 49-year-old without insurance who, despite having a strong family history of cancer, had no way to access lifesaving screening procedures. He died of metastatic colon cancer. And Louise? A 38-year-old mother of three who ended up in a wheelchair, her joints destroyed by untreated, excruciating rheumatoid arthritis. Ashley, 52 years old, lost her job and her health insurance. She couldn’t afford to pay for her annual mammograms and found herself ensnared by the death grips of breast cancer and mounting medical debt. Or 58-year-old Paula whose diabetes and hypertension went untreated for decades, leading to a devastating stroke that took away her speech and left her unable to walk. Paula would still be a productive and happy member of our society. Instead, she’s doomed to a life of sickness, disability, and overwhelming medical debts.
These stories are not isolated incidents but part of a broader pattern of neglect that affects thousands of Texans.
Money is not the reason Texas is holding out on Medicaid expansion. Our leaders understand that Texans are bankrolling Medicaid expansion in other states, while refusing to accept our $5 billion annual share of the pie. Texas’ refusal to expand Medicaid stems from a deep-seated and stale opposition to the ACA and an irrational scorn for the most vulnerable members of society.
Maybe if we gradually introduce the terms Medicaid and expansion opposing political leaders will build up their immunity and not react so strongly to a policy favored by 70 percent of their constituents. By normalizing the discourse around Medicaid expansion, we can create an environment responsive to the needs of our citizens.
Texas is one of only ten states that has refused Medicaid expansion. Consequently, we have the largest number of uninsured in the nation, and our residents are among the least healthy by most measures. Medicaid is good for our health and economy. Let’s talk about expansion.
David M. Auerbach is an internal medicine physician. Alex Gajewski is an internal medicine resident. Fabrizia Faustinella is an internal medicine physician.
