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Time to rethink Medicaid expansion

July 28, 2018

The growing number of Texans without health care insurance, the highest in the country, is a multimillion-dollar problem that should concern all taxpayers.

When it come to personal health care, it’s pay now or pay later.

Ignoring symptoms of a health problem does not make it go away. It festers. Time serves only to make it more serious and more expensive to treat.

Often, unattended medical problems become serious, requiring emergency room visits, one of the most expensive forms of medical care available.

Sometimes, the expense to the taxpayer because of the uninsured is not even directly related to physical health.

The ripple effects are costly.

Delays in seeking medical attention, especially for mental health issues, often result in brushes with the law and incarceration for extended periods.

Among school-age children, it can lead to frequent absences, which deprive school districts of state funds based on daily headcounts.

A recently released national study found 6 in 10 Texans reported someone in their household skipped or postponed care in the past year due to cost. That included skipping dental care or checkups, postponing needed health care, skipping medical tests or treatment, cutting pills in half or skipping doses of medicine altogether.

This is not a new problem, but it’s growing.

The majority of the Texans without insurance who were surveyed had been uninsured for two years or more, according to the findings of the joint study, conducted by the Episcopal Health Foundation and the national Kaiser Family Foundation.

Texas ranks at the top of states for its uninsured rate of 21 percent among those ages 19 to 64. About 4.5 million people are without coverage in Texas, including nearly 700,000 children. The national uninsured rate among the states averages about 12 percent.

A significant factor contributing to the high Texas numbers is the fact that the state has not expanded Medicaid under the Affordable Care Act. The state also has such stringent eligibility requirement for adult Medicaid that most working adults do not qualify. Those covered under the program are primarily children, the elderly and disabled.

It is estimated a million Texans would gain health coverage if the state were to expand Medicaid. But given the current political climate in the state, that is unlikely to happen any time soon.

That doesn’t mean it doesn’t merit serious thought.

Texas has left billions of federal dollars on the table by refusing to expand Medicaid. The more than 30 states that have taken advantage of the 9-to-1 federal health care matching funds have not only kept their uninsured numbers down but have also reaped the benefit from having those dollars pumped into their state’s economy.

Before the Affordable Care Act was introduced, the uninsured rate in the country was 18 percent, but it had dropped to 11 percent by 2013. That rate is slowly inching up and will continue to as the current administration moves forward with efforts to gut the ACA.

That does not bode well for a state whose numbers already are significantly higher than the national average.

Texas state leaders need to rethink their position on this one.

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