Feet to Fire or Not, Medicaid Expansion in Texas a Near Impossibility

The Texas Tribune's Edgar Walters wrote this morning that, "The federal government is holding state leaders’ feet to the fire, hoping to get Texas to expand its Medicaid program to provide health insurance to more low-income Texans." Governor Abbott wasted little time in issuing a press release stating that "Medicaid expansion is wrong for Texas."

At issue is the reimbursement of costs hospitals incur when providing care to uninsured patients, paid for by the Centers for Medicare and Medicaid Services (CMS). In 2016, "Texas will have to ask the federal Centers for Medicare and Medicaid Services to renew a five-year waiver to pump $29 billion into state health care coffers," making this legislative session the last instance (barring a special session) in which lawmakers might do something that would directly address the likelihood of receiving another 5-year waiver.

Similar to their dealings in Florida, the CMS is using Medicaid expansion under the Affordable Care Act (ACA) as one benchmark by which to evaluate the new waiver, the expectation being that this might push some of the remaining hold-out states to expand Medicaid coverage under the ACA. The politics of Medicaid and the ACA in Texas, illustrated in public opinion, make this a near impossibility: Only 4 percent of Republicans in the February 2015 University of Texas/Texas Tribune Poll indicated that expanding Medicaid under the ACA should be a priority of this Legislature. 

In addition, but probably more importantly, when asked to rate the ACA in the February 2014 UT/TT Poll, 82 percent of Republicans, and 94 percent of Tea Party Republicans said that they held a "very unfavorable'" opinion. Needless to say, expanding an unpopular program (Medicaid) to retain money allocated through that program under the guise of another wildly unpopular program (the ACA) seems like a long-shot, and a surprisingly bullish negotiating strategy on the part of the Federal Government given Texas' political climate.