If you turned on a television in the immediate lead-up to this year’s general elections, chances are that you may have seen one of many attack ads involving Medicaid expansion.
Since the Affordable Care Act (colloquially known as Obamacare) expands eligibility for Medicaid, the federal healthcare program for low-income Americans started by former President Lyndon B. Johnson’s Great Society program, Republicans have been particularly quick to connect the popular Medicaid program with the unpopular health care reform heralded by President Barack Obama.
“[Wendy Davis] even wants to expand Obamacare in Texas by executive order,” spouted a commercial by Greg Abbott, who was decidedly elected governor over Davis last week, referencing Davis’ support for the expansion of Medicaid. It expands eligibility to families making less than 138 percent of the federal poverty line, up from 100 percent or lower now.
While many states with Republican governors, such as Arizona, Michigan, North Dakota and Pennsylvania, have chosen to expand Medicaid, thus being eligible for big federal benefits they are paying for anyway, Texas has confidently chosen to walk the other way. Gov. Rick Perry ruled out any Medicaid expansion last legislative session, and common sense would assume that Abbott will continue in such a tradition. But the evidence points that there is a chance, however minor, of a change in fortunes.
Earlier this week, Abbott — in his first major decision as governor-elect — chose Cameron County Judge Carlos Cascos as his secretary of state, a powerful position that not only carries out the governor’s foreign policy agenda with Mexico, but manage over an impressive legal and election bureaucracy. Cascos, a Republican elected in one of the most Democratic and most Hispanic counties in the state, disagrees with Abbott on Medicaid expansion. And he has strongly insinuated he will not just sit quiet about them.
“It’s contrary to what the leadership in Austin is recommending, but we thought it was important enough to take a position,” Cascos told National Public Radio regarding his position.
When the Texas Tribune pressed Cascos on how his opinion would differ from that of his boss, he calmly retorted that he was planning on “not just going to go along to get along.”
But the news for Medicaid expansion gets even better. On Wednesday, the board of the Texas Institute of Healthcare Quality and Efficiency voted to back the expansion of the program. The 15 board members, all appointees of Perry, noted to the Tribune that “we’re trying to take the politics out of it,” but admitted that Medicaid expansion would effectively maximize “available federal funds through the Medicaid program to improve health care for all Texans.”
Cascos and this state board of Republican-leaning professionals join an already diverse choir of folks from both political parties in this state in backing Medicaid expansion. Harris County Judge Ed Emmett, who represents more than 4.3 million constituents, has been a particularly vocal advocate.
Medicaid expansion is a rather straightforward idea that has been unfairly maligned by partisan one-upmanship. Contrary to common misconception, it does not involve any new government healthcare schemes. Rather, it merely expands the eligibility of an existing government program, one that is rather efficient, successful and popular.
Originally under the Affordable Care Act, the expansion of Medicaid was mandatory. If states did not participate, then all of their Medicaid funding would have been revoked. However, when the Supreme Court largely upheld the act in 2012, they ruled 6-3 against what they called the “coercion of states” implicit in the rules governing Medicaid expansion. Thus, the decision to accept 90 percent free federal funds in order to help poor sick people became voluntary.
But even though the program was only expanded through Obamacare, it should not be confused for the still uncertain results of the government subsidies and exchanges behind that program. If anything it should be called “LBJ-care.”
Abbott is in a special position with regard to the future of health care in Texas. He can continue following his party’s small-minded ideology, pathologically opposing anything with the president’s name on it despite how little they have to do with his original policies. Or he can follow mavericks in his party such as pertinent professionals and his own choice for secretary of state. On behalf of the 6.3 million Texans without health insurance, the choice is remarkably clear.
Horwitz is a government junior from Houston.